Question

Samara P. is a 30 year old African American nurse who works in the public health clinic with you. She was diagnosed with systemic lupus erythamtosus 10 years ago and is being treated with methotrexate, prednisone, calcium supplements, and ibuprofen. She often jokes in the cafeteria that she would "rather have another baby" than come visit the dental clinic. Her new physician has read the studies linking oral and systemic health and insists that she make an appointment for a prophylaxis and a complete dental checkup. When you take her back to your treatment area and assess her vital signs, her blood pressure is 160/100 mm Hg and her pulse rate is 100 bpm, which, she states, are her usual readings. After taking her radiographs and performing a thorough assessment, you formulate a dental hygiene diagnosis of moderate bone loss and moderate periodontitis, although her oral hygiene is excellent. You have just started cling the upper right quadrant when she complains of severe stomach pain and then lapses into unconsciousness. You reassess her blood pressure, and it has dropped to 80/60 mm Hg. You immediately dial 911.

Which is the probable cause of Samara's drop in BP, stomach pain, and loss on consciousness?
A. Adrenal crisis
B. Hypotensive crisis
C. Hypertensive crisis
D. Psychogenic shock

Answer 1

The most likely cause of the patient's symptoms is an Adrenal crisis option (A), which may occur in individuals who have been on long-term corticosteroids like prednisone and who are under stress.

Step-by-step explanation:

The probable cause of Samara's drop in blood pressure, stomach pain, and loss of consciousness is most likely an Adrenal crisis option (A). This condition occurs when there is insufficient production of the hormone cortisol, which can be triggered by stress or illness in people with an underlying adrenal insufficiency. Given that Samara has been treated with long-term corticosteroids (prednisone) for her systemic lupus erythematosus, her adrenal glands may not be able to produce enough cortisol in response to the stress of the dental procedure. The sudden severe stomach pain and the rapid drop in blood pressure leading to unconsciousness are classical signs of an adrenal crisis. Immediate medical intervention with intravenous fluids and steroids is crucial to treat the crisis.