A nurse is caring for a client who has Cushing’s syndrome. The nurse should recognize that which of the following are manifestations of Cushing’s syndrome? (Select all that apply)

Choice A: Observe for clear drainage.

Reason: Observing for clear drainage is important as it can indicate cerebrospinal fluid (CSF) leakage, especially after nasal or sinus surgery. CSF leakage is a serious complication that requires immediate medical attention. Clear drainage from the nose should be tested for the presence of glucose, which can confirm if it is CSF.

Choice B: Assess for signs of bleeding.

Reason: Assessing for signs of bleeding is crucial in the immediate postoperative period. Nasal packing can sometimes mask ongoing bleeding, so it is important to monitor for any signs of excessive blood loss. This includes checking for blood-soaked dressings, frequent swallowing (which can indicate blood trickling down the throat), and changes in vital signs such as increased heart rate and decreased blood pressure.

Choice C: Watch the client for frequent swallowing.

Reason: Watching the client for frequent swallowing is important because it can be a sign of posterior nasal bleeding. Blood can trickle down the back of the throat, causing the client to swallow frequently. This is a subtle but significant sign that should prompt further investigation and possible intervention.

Choice D: Change the nasal packing.

Reason: This choice is incorrect. Nasal packing should not be changed by the nurse without specific orders from the physician. Changing the packing prematurely can disrupt the surgical site, cause bleeding, and increase the risk of infection. The packing is usually removed by the surgeon or under their direct supervision.

Choice E: Administer a nasal steroid to decrease edema.

Reason: Administering a nasal steroid can help reduce inflammation and edema in the nasal passages. However, this should only be done if prescribed by the physician. Nasal steroids can help improve breathing and reduce discomfort, but they must be used according to medical guidance to avoid potential side effects.

Choice A: You May Bring Some Music to Listen to for Distraction

Bringing music for distraction is generally not a standard instruction given before an EEG. While listening to music might help some patients relax, it is not a critical part of the preparation for the test. The primary focus of EEG preparation is to ensure accurate readings of brain activity, which can be influenced by various factors such as medication and sleep.

Choice B: Do Not Take Any Sedatives 12 to 24 Hours Before the Test

Avoiding sedatives before an EEG is crucial because these medications can alter brain activity and affect the test results. Sedatives can suppress the electrical activity in the brain, leading to inaccurate readings. Therefore, it is essential for patients to avoid taking any sedatives 12 to 24 hours before the test to ensure the EEG captures the brain’s natural activity.

Choice C: You Will Need to Have Someone to Drive You Home

This instruction is typically given if the patient is expected to be sedated or if the test involves procedures that might impair their ability to drive. However, for a standard EEG, patients are usually not sedated, and there is no need for someone to drive them home. This instruction is more relevant for other types of medical procedures that involve sedation.

Choice D: Please Do Not Have Anything to Eat or Drink After Midnight

Fasting is not a standard requirement for an EEG. Patients are generally allowed to eat and drink before the test. However, they are often advised to avoid caffeine as it can affect brain activity. The instruction to avoid food and drink after midnight is more commonly associated with procedures that require anesthesia or sedation, not an EEG.