A rehabilitation client with a history of Cushing's syndrome (hypercortisolism) and COPD is being cared for post-stroke. Which nursing diagnosis is most consistent with Cushing's syndrome?

A rehabilitation client with a history of Cushing's syndrome (hypercortisolism) and COPD is being cared for post-stroke. Which nursing diagnosis is most consistent with Cushing's syndrome?

• A. Risk for imbalanced fluid volume related to excessive sodium loss.
• B. Risk for impaired skin integrity related to tissue catabolism secondary to cortisol hypersecretion.
• C. Ineffective health maintenance related to frequent hypoglycemic episodes secondary to Cushing's syndrome.
• D. Decreased cardiac output related to hypotension secondary to Cushing's syndrome.

Answer: (B)

In Cushing's syndrome, excess cortisol drives protein breakdown (tissue catabolism) and reduces collagen synthesis. This weakens skin and connective tissue, making the skin thin, fragile, and slow to heal, with a higher risk of breakdown from friction or pressure. In a rehabilitation patient who is recovering from a stroke and has COPD, maintaining skin integrity is a key nursing focus because immobility and frequent turning are common, so the risk for impaired skin integrity is elevated when cortisol is high. That’s why a nursing diagnosis focusing on impaired skin integrity related to tissue catabolism from cortisol hypersecretion best fits this condition. The other options don’t align with how cortisol excess typically affects physiology. Cortisol tends to promote sodium and water retention rather than excessive sodium loss, so a risk for fluid volume deficit is not consistent. Cortisol also raises blood glucose (causing hyperglycemia or glucose intolerance), not frequent hypoglycemia. And while cortisol can influence blood pressure, it more commonly contributes to hypertension rather than hypotension, so decreased cardiac output due to hypotension isn’t typical in this scenario.

In Cushing's syndrome, excess cortisol drives protein breakdown (tissue catabolism) and reduces collagen synthesis. This weakens skin and connective tissue, making the skin thin, fragile, and slow to heal, with a higher risk of breakdown from friction or pressure. In a rehabilitation patient who is recovering from a stroke and has COPD, maintaining skin integrity is a key nursing focus because immobility and frequent turning are common, so the risk for impaired skin integrity is elevated when cortisol is high. That’s why a nursing diagnosis focusing on impaired skin integrity related to tissue catabolism from cortisol hypersecretion best fits this condition.

The other options don’t align with how cortisol excess typically affects physiology. Cortisol tends to promote sodium and water retention rather than excessive sodium loss, so a risk for fluid volume deficit is not consistent. Cortisol also raises blood glucose (causing hyperglycemia or glucose intolerance), not frequent hypoglycemia. And while cortisol can influence blood pressure, it more commonly contributes to hypertension rather than hypotension, so decreased cardiac output due to hypotension isn’t typical in this scenario.