J.S. is a 58-year-old woman brought to the emergency department (ED) at 7:00 am by her husband because when she got up this morning, she was light-headed, confused, and so weak that she could not dress herself. J.S.’s husband immediately drove her to the ED in her pajamas. She has a history of rheumatoid arthritis and had been taking prednisone 10 mg daily.
Husband states that J.S. has not been feeling good, has been tired, and has had very little appetite. Husband states he lost his job a couple of months ago, and J.S. stopped taking her medication a couple of weeks ago because they could not afford it because they no longer had health insurance. J.S. denies a headache or blurred vision J.S. has been feeling ill, tired, and has had little appetite, according to his husband. Husband claims he lost his job a few months ago, and J.S. claims she stopped taking her medication a few weeks ago because they couldn’t afford it because they didn’t have health insurance. J.S. denies having a headache or having blurred vision.
Temperature 98.7°F, pulse 94, respirations 20, blood pressure 100/60
No difficulty speaking
Oriented to name only
Poor skin turgor
Dry mucous membranes
Weakness in bilateral upper and lower extremities
Glucose 66 mg/dL
Calcium 9.2 mg/dL
Sodium 130.0 mEq/L
Potassium 5.5 mEq/L
HCO3 25.4 mEq/L
Chloride 93.5 mEq/L
Cortisol 4 mcg/dL (normal 8:00 am level is 5-23 mcg/dL)
Answer each of the questions below. Each short-answer case study will be a minimum of 250 words. Include any references used to research your answer in APA format, with proper citations and references. Please number your answers.
Interpret J.S.’s laboratory results and describe their significance.
What other assessment findings could confirm a diagnosis of adrenal insufficiency?
What is the likely cause of J.S.’s adrenal insufficiency and why?
Would J.S.’s adrenal insufficiency be considered to be from a primary or secondary cause?
Why? How would this be confirmed?
What is the treatment and nursing care for J.S.’s adrenal insufficiency?
What teaching should J.S. receive regarding taking her prednisone?
What else can you do to assist J.S. in being compliant with taking her medication?