A nurse is monitoring a middle-aged male client in the intensive care unit.

Exhibits

Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.

Rationale for Correct Choices

• Cushing's Syndrome: The client exhibits hallmark features of Cushing’s syndrome, including central obesity, facial swelling, fragile skin with bruising, and hypertension. Laboratory findings of elevated cortisol with normal ACTH suggest an ACTH-independent hypercortisolism, consistent with this condition.
• Administer antihypertensive medication: Blood pressure remains elevated despite prior medication, increasing the risk of cardiovascular complications. Administering antihypertensives helps manage hypertension and reduce end-organ damage while treating the underlying condition.
• Provide nutritional counselling: Clients with Cushing’s syndrome are at risk for obesity, hyperglycemia, and dyslipidemia. Nutritional counselling helps address weight management and reduces cardiovascular and metabolic complications.
• Blood pressure: Continuous monitoring of blood pressure is essential to evaluate the effectiveness of antihypertensive therapy and to prevent complications related to sustained hypertension.
• Cortisol levels: Monitoring cortisol levels assesses disease activity and response to therapy, including medications or surgical interventions aimed at reducing hypercortisolism.

Rationale for Incorrect Choices

•  Hypothyroidism: Symptoms of hypothyroidism usually include fatigue, weight gain, cold intolerance, and bradycardia. This client has hypertension, central obesity, and elevated cortisol, which are not consistent with hypothyroidism.
• Diabetes Mellitus: While the client has mildly elevated blood glucose, hyperglycemia is secondary to cortisol excess rather than primary diabetes mellitus. The overall clinical picture points to Cushing’s syndrome.
• Addison’s Disease: Addison’s disease typically presents with hypotension, weight loss, hyperpigmentation, and low cortisol, which contrasts with this client’s elevated cortisol and hypertension.
• Encourage regular physical activity: While generally beneficial, the client’s acute presentation of hypertension and fatigue may limit the safety and feasibility of exercise as an immediate intervention.
• Restrict fluid intake: There is no evidence of fluid overload or edema severe enough to require fluid restriction at this stage. Fluid restriction is not a primary treatment for Cushing’s syndrome.

• Monitor blood glucose levels: Although hyperglycemia can occur secondary to cortisol excess in Cushing’s syndrome, the client’s current blood glucose levels are only mildly elevated and not the primary indicator of disease progression.
• Respiratory rate: The client’s respiratory rate is slightly elevated but not clinically significant in this context. Respiratory rate does not directly reflect Cushing’s syndrome progression or response to treatment, making it a lower-priority parameter for monitoring.

• Heart rate: The client’s heart rate is within normal limits and not immediately indicative of disease progression or treatment efficacy, making it a lower-priority parameter compared with blood pressure and cortisol levels.
• Oxygen saturation: The client maintains adequate oxygen saturation, so this is not a priority parameter for monitoring in the context of Cushing’s syndrome.