Friday, December 6, 2019

Polycystic Ovarian and Metabolic Syndromes †

Question: Diascuss about the Polycystic Ovarian and Metabolic Syndromes. Answer: Introduction: Researchers are of the opinion that there are two causes of Cushing syndrome in patients. The first one is the exogenous source where intake of oral corticosteroid medications in extremely high doses for a large period may result in occurrence of the diseases (Lowitz Klein, 2015). Oral corticosteroids like Prednisone are one of the medications that are provided to individuals when they suffer from rheumatoid arthritis as well as lupus or asthma. In such conditions, body requires more cortisol than it can actually possess to handle the disorders (Martinez et al., 2016). In such situations, such medications produce side effects resulting in the occurrence of Cushing syndrome. In the case study also, Maureen had been suffering from rheumatoid arthritis from the age 15 and are prescribed to take prednisone for a long period. This might have caused the disorder in the patient. Besides, in other cases, the body itself may result in higher secretion of the hormone of cortisol like a noncan cerous tumor in the pituitary gland that results in secretion of high level of adrenocorticotrophic or ACTH hormone (Barber, 2017). This stimulates the adrenal gland to produce more and more cortisol from the adrenal gland. Moreover, in other cases tumors develop can develop on the adrenal gland those results in the higher production of the cortisol in the body. This tumor is called the adrenal adenoma and occurs on the adrenal cortex. Researchers are of the opinion that the females who are between the age group of 25 to 40 are most prone to development of the disorder (Maletkovic, 2018). Moreover, obesity, type 2 diabetes as well as poorly controlled glucose levels as well as hypertensions are the main risk factors that make individuals highly vulnerable to the development of the disease (Lowitz Klein, 2015). Moreover, taking of corticosteroid medication is yet another risk factor that associates with the disease. Primary adrenal gland disorders, nodular enlargements of the adrenal glands, pituitary gland tumors and others are highly responsible for the occurrence of the disorders. Studies suggest that Cushing syndrome is not treated properly or remains untreated, it may result in bone loss, muscle loss or weakness, high blood pressure, fracture in bones, infections, enlargement of the pituitary tumors as well as kidney stones (Yedinac, 2016). All these will lead to poor quality life of the individuals making them suffer physically as well as mentally. Such suffering of the patients result their caregivers to face emotional turmoil and they get depressed to see their suffering and pain. It results in financial flow on the healthcare expenses that may affect the lives of the family members along with the patients (Maletkovic, 2018). Weight gains as well as fatty tissue deposits mainly in the midsection, upper back, in the face like a moon face and between the shoulders like a buffalo hump are seen in individuals who are affected by the disorders. Researchers are of the opinion that cortisol helps the body to handle stress. When stress level is high in blood, cortisol level rises up. In such situation, cortisol helps in the stimulation of the fat as well as carbohydrate metabolism in the stressful situations. This in turn leads to increased blood sugar level that the body requires for fast energy. Therefore, this result in stimulation of more insulin releases which increases appetite and results in more calories intake takes place in terms of food intake (Yedinac, 2016). Even after over of the stress situation, cortisols linger in the body and try to bring the body in balance. The hormone does this by increasing appetite for properly replacing the fact and carbohydrate that had been already usedfor the flight and fight response. Consuming more food results in fat accumulation in the body. This causes obesity. Overproduction of the cortisol also results in the liberation of the amount of amino acids from muscle tissue that accompanies resultant weakening of the protein structures specifically the elastic and muscle tissue. This results in development of protuberant abdomen that accompanies the purple striae, poor wound healing, marked osteoporosis and others. High level of cortisol is also responsible for the distribution of fat to specific regions of the body like that of the chest, face, stomach and many other regions (Kine et al., 2017). A buffalo hump like symptom mainly occurs as the accumulation of fat takes place on the neck as well as shoulders giving the patients a typical symptom of Cushing syndrome. The fourth symptom is the occurrence of edema as well as water retention that takes place under the skin. Mineralocorticoid activity of the cortisol results in sodium as well as water retention. This in turn leads to increase in the hydrostatic capillary pressure. This in turn results in increased leakage of the fluid through the capillaries all over the body. There is also increased weakness of the muscles that mainly takes place due to increase in the catabolism of the proteins for single amino acids for the process of gluconeogenesis as well as decreased transport of the amino acids into the different skeletal muscle tissues that occur under the effect of cortisol (Tating et al., 2016). One of the FDA approved drug is the class of pasireotide. This drug is mainly seen to activate a broad spectrum of the different receptors of somatostatin. This class of drug is seen to have a higher binding affinity for somatostatin receptors like those of the receptors 1,3 and 5. It also provides a comparable binding affinity for somatostatin receptors like receptor 2. This binding as well as activation may result in inhibiting of the ACTH secretion in the patients who are suffering from Cushing syndrome (Papaoin et al., 2015). Researchers have also stated that this class of drug is also more powerful for the inhibition of the releases of the human growth hormone, glucagon and insulin. Thereby this drug is seen to promote reduced levels of cortisol secretion in the patients suffering from Cushing syndrome. However, the professionals have to be aware of the side effect like that, it causes an increase in the blood sugar level and may cause diabetes. Another FDA approved medication is called the mifepristone. This medication is helpful as it blocks the effect of excessive cortisol in comparison to other drugs that mainly take part in decreasing the levels of cortisol in the blood. It mainly does so by following the procedure of antagonizing the cortisol receptors in the body of the patient. Researchers have found that such medications helps in binding with the glucocorticoid receptor blocker and thereby helps in the blocking if the action of the cortisol (Langton et al., 2018) Thereby it helps to decrease the symptoms of the disorder and help in improving the metabolic derangements that remains intricately associated by the excess amount of cortisol on blood. One of the best advantages of using this medication is the improvement of blood sugar and development of the physical features in the patients. However, nausea, low potassium level as well as headaches are common side effects of the disorder. In the case of Maureen, it can b e seen that se as high level of cortisol and high level of blood glucose levels. Therefore, this medication would prove to be suitable for her. Gastrointestinal bleeding may be of various reasons out of which use of corticosteroids so one of the factor. Various randomize control trail had assured of the fact and hence in the case of Maureen, the excessive use of corticosteroids can be considered as the main factor for the development of gastrointestinal bleeding. Attending to this acute situation would be the first priority of the healthcare professionals. For assessing the signs of GI bleed, the healthcare professionals should first confirm the color of the stool and the vomit to ensure the presence of blood signs in them. The professional should also assess the blood pressure of the patient, her urine output and ere art rate for understanding the extent of the blood loss. If the patients shows drop in blood pressure, time output as well as increased heart rate, then the professional can be sure that extensive blood loss had taken place. This is the assessment phase (Abraham et al., 2015). This will be followed by the diagn ostic procedures. Here, the physician would need to determine the exact site of the GI bleeding. These procedures would mainly be including the endoscopy, sigmoidoscopy, colonoscopy and barium studies. Nursing professionals should ensure that they are assisting the physicians properly and helping them with every procedure. The third step would be mainly administering fluids and other treatments. The nurse should be mainly providing importance to the administration of the blood, blood products, fluids, electrolytes, vitamins and well as other medications. The nurse would mainly provide importance to the replacements of the blood loss, prevent any further loss of blood hereby preventing anemia. In case of very severe situations, the doctors may need to resuscitate the patient with fluids and blood transfusion (Brown et al., 2017). In some cases, the patient may need surgery. In other cases, the patients may be needed to give IV proton pump inhibitors (PPIs) such asomeprazole(Prilosec) for suppressing acid. The nurse may also give prokinetics such as erythromycin and metoclopramide. This helps in clearing the stomach from blood clots or any food reside before endoscopy. The nurse should also be careful that she does not give any medication to the patient that may cause further bleeding. The last step in the emergency ward that should be conducted before transferring her to the general ward is proper evaluation. The nurse had to make sure that the interventions that they have taken are successful or not. Reassessment would mainly include checking of the vital signs, inspecting the patients stool as well as vomit. If the patients blood pressure, urine output and heart rate are normal, then the interventions taken can be evaluated to be correct. (Jairath et al., 2015). References: Abraham, N. S., Singh, S., Alexander, G. C., Heien, H., Haas, L. 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