Mr. Alvarez has taken oral prednisone for three years for rheumatoid arthritis. He presents to clinic with a rounded, reddened face, purple striae across his abdomen, and new truncal weight gain. He mentions that a cut on his forearm from two weeks ago still hasn't closed, and that he bruises "if I just bump into a doorway."
Before you move on, notice:
Which action should the nurse take first?
Bone protection matters in long-term steroid use, but it isn't an acute threat today. It belongs in his teaching plan, not the first action in this visit.
Cortisol excess suppresses the immune response and thins the skin, so a wound that hasn't closed in two weeks is exactly where infection can take hold silently. This is the finding that needs eyes on it first.
Stopping prednisone abruptly after three years shuts down a hypothalamic-pituitary-adrenal axis that has been suppressed the whole time, which can trigger an adrenal crisis. Steroids in Cushing's are tapered under medical supervision, never stopped because the symptoms are visible.
His hypertension in Cushing's is driven by cortisol's mineralocorticoid-like effects, not straightforward volume overload, and there's no order or indication for fluid restriction here. It doesn't address the most urgent finding.