Endocrine Case Study
Patient Profile
J.S. is a 58-year-old female 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.
Subjective Data
• Husband states that J.S. hasn’t 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
Objective Data
Physical Examination
• 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
Diagnostic Studies
• Lab values
o Glucose 68 mg/dL
o Calcium 9.2 mg/dL
o Sodium 130.0 mEq/L
o Potassium 5.5 mEq/L
o HCO3 25.4 mEq/L
o Chloride 93.5 mEq/L
o Cortisol 4 mcg/dL (normal 8:00 am level is 5-23 mcg/dL)

Discussion Questions
Answer the following questions.

1. Interpret J.S.’s laboratory results and describe their significance.
2. Based on the assessment what is the most likely problem (think medical diagnosis)? List other assessment findings to confirm this diagnosis.
3. Analyze the likely cause of J.S.’s diagnosis, would this be considered a primary or secondary cause? Explain.
4. Outline the treatment and nursing care for J.S.
5. Devise a teaching plan to include patient teaching regarding prednisone administration and ways to assist with increased medication compliance.