Scenario You graduated 3 months ago and are working with a home care agency. Included in your caseload is J.S., a 60-year-old man suffering from chronic obstructive pulmonary disease (COPD) related to (R/T) cigarette smoking. He has been on home oxygen, 2 L oxygen by nasal cannula (O2/NC), for several years. Approximately 10 months ago, he was started on chronic oral steroid therapy. Medications include ipratropium-albuterol (Combivent) inhaler, formoterol (Foradil) inhaler, dexamethasone (Decadron), digoxin, and furosemide (Lasix). On the way to J.S.’s home, you make a mental note to check him for signs and symptoms (S/S) of Cushing’s syndrome. Clinical Presentation • Centripedal (truncal) obesity or Difference between Glucocorticoid receptors and Mineralocorticoid receptors? Glucocorticoid have a high affinity for cortisol and Mineralocorticoid have a high affinity for Aldosterone AND cortisol.
9. How would your assessment change if J.S. were taking a glucocorticoid that also has significant mineralocorticoid activity? I would look at potassium levels because he is taking furosemide and this mineralocorticoid. I would also look into hypertension symptoms or hypotension symptoms.
10. Review J.S.’s list of medications. Based on what you know about the side effects of loop diuretics and steroids, discuss the potential problem of administering these in combination with digoxin. Loop diuretics loose potassium and can alter sodium/water balance. Steroids cause increased cortisol, which is anti-inflammatory, and it also increases levels of glucose in blood while raising BP. It makes the patient at risk for infection. Diuretics lower BP while steroids can increase BP along with digoxin. Taking loop diuretics and digoxin can lead to digoxin toxicity, cardiac arrytymia’s and electrolyte imbalances. All three of those: diuretics, steroids, and digoxin lower potassium levels in body. Hypokalemia. They also enhance the levels of digoxin in the body so toxicity can occur easier.
11. Realizing that patients like J.S. are susceptible to all types of infections, you write guidelines
