Assessment
J.A. has no disability that prevents her in any way to learn; therefore any form of teaching can be employed. Because the client’s health status is dynamic, the assessment is an ongoing activity. She has to be educated of her medical condition as client education is considered one of the most important things to do in any health care setting.
The patient showed that she has a high level of understanding and that her current health status has not affected her level of understanding in any way. The client’s behavior showed that she has a rather long attention span, has sharp memory, and has the ability to concentrate during a teaching session. J.A. is strongly motivated to learn about her medical condition.
Nursing Diagnosis
After assessing information related to J.A.’s ability and need to learn, the data gathered is interpreted and the defining characteristics clustered to form diagnoses that reflect the client’s specific learning needs.
Plasma cortisol is normally 10 to 25 μg/100 ml in early morning hours (6 to 8 am) and declines gradually to < 10 in the evening (6 pm and later). Patients with Cushing’s syndrome usually have elevated morning cortisol levels but lack the normal diurnal decline in cortisol production, so that evening plasma cortisol levels are above normal and total 24-h cortisol production is elevated (Robbins, 1998). J.A. showed high levels of cortisol in her ACTH test. Free urinary cortisol is elevated and less subject to variation in obese patients.
The administration of 1 mg of dexamethasone orally at 11 to 12 pm with measurement of plasma cortisol at 7 to 8 am the following morning is a good screening test for Cushing’s syndrome. Most normal patients will suppress their morning plasma cortisol to 5 μg or less following this procedure, whereas most patients with Cushing’s syndrome will continue to secrete undiminished quantities of cortisol.
Giving oral dexamethasone 0.5 mg q 6 hours for 2 days to normal subjects leads to inhibition of ACTH secretion. Consequently, urinary 17-OHCS will usually decrease to < 3 mg/24 hours on the second day.
Therapy is directed at correcting the hyperfunction of the pituitary gland or the adrenal cortex; the precise approach depends on the underlying physiologic abnormality.
Planning
Goals and Expected Outcomes
J.A. has to lower her plasma cortisol levels. But aside from these, various problems are also to be solved like her obesity. J.A. has to lose weight.
If clinical manifestations are severe and definitive correction is immediately required, either suppression of excess cortisol production, with aminoglutethimide followed by bilateral adrenalectomy, or removal of a pituitary adenoma will be the treatment of choice.
Most importantly, J.A. has to learn about Cushing’s syndrome, what it is and other important things that she needs to know in order to be able to live normally after having Cushing’s syndrome.
Learning Experiences
The availability of nursing resources will be taken into account in the client’s learning experience. Educational methods that will be used will include (1) one-on-one discussion with J.A., (2) lecture which will include the aid of pictures and other audiovisual materials, and (3) printed material such as pamphlets, booklets, and brochures.
The table below lists the description of the teaching tools for instruction to be used and its learning implication:
Description
Learning Implication
Pamphlets, booklets and brochures
Photographs or drawings
Photographs accurately portray the details of the real item or in the case of Cushing’s syndrome, it will accurately portray the disease and its manifestations.
Audiovisual materials (slides, audiotapes, television and videotapes used with printed material or discussion)
These are useful since J.A., at her age could possibly have problems with her eyesight or reading comprehension problems.
One-on-one discussion is perhaps the most common method of teaching the clients (Potter & Perry, 2004). The teaching aids mentioned in the table above could be used during the discussion. Information is usually given in an informal manner and this allows J.A. to ask questions or share her concerns.
Evaluation
J.A.’s education is not complete until the nurse will evaluate outcomes not only of the teaching-learning process but her health status as well. If there are significant improvements in client’s health, then the nurse can evaluate that J.A. have learned the material. One measure would be to check J.A.’s cortisol levels and assess if she is still obese.
Evaluation reinforces correct behavior in the client. The nurse can evaluate success by observing the client’s performance of each of the expected behavior or goals set (Potter & Perry, 2004). The success of the teaching plan depends on J.A.’s ability to meet the established outcomes and goals.
References:
Potter, P. and Perry, A. (2004). Fundamentals of Nursing. Mosby.
Robbins, S.L. (1998). Pathologic Basis of Disease, W.B.Saunders Company.
Credit:ivythesis.typepad.com
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