Q1. In relation to your chosen patient, discuss the pathophysiology of presenting condition, and using evidence based literature explore current surgical treatment options for your patient.
The Pathophysiology of Cushing’s Syndrome
Cushing’s Syndrome is a condition that occurs as a result of an excess of cortisol production or by extreme utilization of cortisol or other comparable steroid hormones. After the adrenal gland stimulation by ACTH, it secretes cortisol hormone as well as other steroid hormones. The pituitary gland produces ACTH and releases it to the PVS (petrosal venous sinuses) after the hypothalamus CRH (corticotropin-releasing hormone) stimulation (Feelders & Hofland, 2013). ACTH is discharged in a diurnal pattern, which is autonomous in the circulation of cortisol hormone levels: immediately before awakening, there is peak release and decline all through the day. ACTH and CRH release is controlled via cortisol negative feedback at the pituitary and hypothalamic levels. The hypothalamic neuronal input level can as well stimulate the release of CRH hormone (Pivonello et al., 2015).
Although the Cushing’s disease’s adenomas produce excessive ACTH, in general, they preserve some negative feedback receptiveness to elevated glucocorticoids doses. Ectopic ACTH sources, more often than not, in extracranial neoplasms form remain irresponsive to the negative glucocorticoids high doses’ feedback. Nevertheless, a number of overlap exists in return to the negative reaction between excessive ectopic sources of ACTH and the pituitary (Sheth et al., 2012).
Cushing’s syndrome remains classified as ACTH-dependent and ACTH-independent. Ideally, these types remain expedient for the organization of the improvement of patients with supposed hypercortisolism (Pivonello et al., 2010). Alcoholism, eating disorders, depression, drugs, along with other conditions is capable of leading to mild clinical as well as lab findings, like those in Cushing’s syndrome, which is referred to as pseudo-CS. The hypercortisolism’ lab and clinical features of go in case the main process is fruitfully managed (Feelders, Hofland & De Herder, 2010).
Literature explores current surgical treatment options (surgery for a laparoscopic right adrenalectomy) for Susan Jones.
Laparoscopic adrenalectomy is a procedure that was introduced about three decades ago and has quickly turned out to be the favored approach for the management of most adrenal neoplasms. The method has developed to incorporate a retroperitoneal and a lateral transperitoneal approach. The benefits of this procedure over open adrenalectomy comprise of reduced blood loss, fewer morbidity, reduced hospitalization, a more quick return to standard activity, as well as better patient satisfaction (Adair et al., 2010). Laparoscopic adrenalectomy emerges to have reputed itself as the typical of most adrenal neoplasms care. The approach still has a place for extremely big growth and apparent malignancy, although the open posterior process has basically been replaced. The transperitoneal option against retroperitoneal remains right now resolute mainly by surgeon favorite except for in bigger cancers where the transperitoneal process is evidently superior (Zou et al., 2011).
Q2. Critically discuss the assessment of ventilation, circulation and consciousness prior to the patient’s discharge from PARU. Discussion must relate to the effects of anaesthesia and surgery on these three physiological functions, and be directly related to your chosen patient.
Postoperative care entails evaluation, planning, diagnosis, intervention, and result assessment. The postoperative care degree required relies on the person’s pre-surgical health position, surgical type, as well as whether the surgery was done in a day’s surgery background or the healthcare institution (Youngblood & Duffy, 2013). Ideally, patients with procedures performed in a day surgery facility more often than not need merely a small number of times of care by healthcare expertise prior to their discharge from the hospital . In case postoperative or postanesthesia complications take place in these times, the patient has to be admitted to the healthcare institutions. Patients admitted may need weeks or days of postoperative healthcare by hospital staff prior to their discharge (Godoy, 2013).
The Effects of Anaesthesia
The anesthesia side effects can take place at the time a procedure or surgery, or later when individuals are recuperating as well as the anesthesia remains wearing off. Ideally, the likely side effects differ with regard to what type of anesthesia is used: General (sedation given through intravenous or inhalational medications), regional (numbing just the area of the body, more often than not below the waist) or local (numbing a diminutive region) (Nicholson & Hall, 2011). At the same time as a number of side effects, which take place following surgery may perhaps be uncomfortable or exasperating, most do not last long. These side effects incorporates nausea and vomiting, sore throat, confusion, muscle, itching, and chills and shivering (hypothermia). Rarely, postoperative delirium or cognitive dysfunction, delirium, cognitive dysfunction, malignant hyperthermia (Hodkinson et al., 2012).
Q3. Develop a discharge plan to support your chosen patient on discharge home. Include any education you deem relevant, any referrals to allied health professional/s required, and discuss your rationale.