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Chapter 81
Unit 12: Nursing care of clients with endocrine disorders
| Question | Answer |
|---|---|
| Cushing's disease & Cushing syndrome's cause? (Pg. 892) | Over secretion of the adrenal cortex |
| What is pituitary disease caused by? | Over secretion of ACTH by the anterior pituitary |
| What causes cushing's syndrome to differ from cushing's disease? | Syndrome; caused by long term use of glucocorticoids to treat other conditions (Ex. asthma, COPD) Disease: over secretion of adrenal cortex |
| What does the adrenal cortex produce? | Mineralcorticoids (aldosterone), glucocorticoids (cortisol) & sex hormones (androgens & estrogens) |
| Client should eat foods high in? & avoid which drinks? | Calcium & vitamin D -Alcohol & caffeine |
| Client should monitor for what kind of bleeding? | Gastric -coffee-ground emesis, black tarry stools |
| Risk factors; endogenous (disease) | Adrenal hyperplasia, carcinoma; dif locations (Pg. 892) that can secrete ATCH |
| Risk factors; exogenous (syndrome) | Organ transplant, chemo, autoimmune, asthma, allergies, inflx disorders |
| S/s: (pg. 893) sleep? where is the pain? emotions? | Weak/fatigue/sleep disturbances Back/joint pain Irritable/depressed/etc. |
| S/s con't What happens to inflammation & immune response? | Decreased response, ex. getting sick more often, infections but w no redness/swelling etc. |
| S/s Skin effects, HR/BP | Thin/fragile skin, bruising & petechiae (Fragile blood vessels) Htn & tachy |
| S/s ulcers where?, wt, period, edema? | Gastric ulcers d/t ^ hydrochloric acid Wt gain Irregular menses Dependent edema |
| Where is the dependent edema/wt gain seen? | Moon face, truncal obesity, buffalo hump (fat in back of neck) |
| S/s Bones & muscles Glucose | Bone pain/ fxs (osteoporosis) w increased risk for falls Muscle wasting in extremities (thin) Impaired glucose tolerance |
| S/s looks, color, scars | Hirsutism (lack of hair), acne, red cheeks striae; abdomen & thighs |
| Lab tests: | ^ plasma cortisol in abscense of illness/stress urine cortisol levels 24 hr urine= ^ cortisol |
| ACTH levels lab test: | Hypersecretion by AP Disorder of adrenal cortex or med therapy |
| Lab's con't -Salivary cortisol Serum…. K+ & calcium glucose & sodiium lymphocytes | Salivary cortisol; ^ = disease K+ & calcium = decreased sodium & glucose ^ lymphocytes decrease |
| Dethamethasone suppression test | 24 hr urine collected -no suppression of cortisol = disease -meds with held/ stress avoided prior to & during test |
| Dx procedures: (noninvasive/not painful) 1. To identify lessions 2. To find adrenal insufficiency | X-ray, MRI, CT scans radiological imaging |
| Dietary alterations: Sodium, K+, protein & calcium | decrease sodium Increase the rest |
| Nursing actions: wt, volume issues, env't, immune, skin | -Daily wt, I&O -Watch for hypervolemia; edema, jvd, SOB, crackles, htn, tachy -Safe env't to minimize risk of fx/skin trauma -prevent infection; wash hands -meticulous skin care, protect against skin breakdown & infection |
| Medications (Pg. 895) 1. Aminoglutheimide (Cytadren) what is it? what does it do? long or short relief? Used for? Monitor? Etc. see page | Adrenal corticosteroid inhibitor -decreases synthesis -short term relief for syndrome used temporarily for surgery, no more than 3 months monitor bp for hypotension monitor fluid & electrolytes |
| 2. Ketoconazole (Nizoral) what is it? Can be used in addition to monitor.. | Adrenal corticosteroid inhibitor -Antifungal agent; w high doses inhibits synthesis -addition to radiation/surgery -Monitor liver enzymes for liver toxicity (yellow sclera, dark urine) -Fluids and lytes |
| 3. Mitotane (Lysodren) What does it do? Used to tx what? Monitor for? | Suppress action of adrenal cortex -Treats inoperable adrenal carcinoma (reduces size of tumor) -Shock & hepatotoxicity |
| 4. Spironolactone (Aldactone) what is it? when used? monitor? | Aldosterone antagonist -potassium sparing diuretic Used when bilateral adrenal hyperplasia is the cause -monitor lytes, vs, wt |
| Therapeutic procedures -Chemotherapy w cytotoxic agents for cushing's disease caused by a tumor Adverse effects? | Thrombocytopenia/nausea/vomit (Antiemetic) WBC + dif, H&H Assess for bruising/bleeding avoid crowds alopecia bleeding; black tarry stools/coffee ground emesis |
| -Radiation therapy Provide care.. | Skin care & assess avoid lotions & removing marks avoid sun altered taste & fatigue expected |
| Surgical interventions: 1. Hypophysectomy: | Surgical removal of the pituitary gland (depending on cause of cushings) |
| Hypophysectomy nursing actions 6 key things (Pg. 897) | Lytes, infection, bleeding, neuro checks q1hr first 24 hr, then q4hr administer glucocorticoids to prevent sudden drop in cortisol stool softners to prevent straining (high fiber) |
| How is a hypophysectomy done? | Transphenoidal… through nasal cavity avoid sneezing, coughing, laughing, straining, blowing nose -Breathe through mouth |
| What might be experienced 3-4 months after surgery? (physectomy) | Numbness @ surgical site & diminished sense of smell |
| Client should avoid what to prevent increased ICP? | Bending at waist & straining bend at knees! |
| Should the client brush teeth? | No avoid for 2 weeks floss & rinse mouth instead |
| What type of drainage from the nose might indicate a CSF leak? | Sweet-tasting, halo (yellow edge clear center), clear drainage Headache, excessive bleeding, confusion (notfiy provider) |
| 2. Adrenalectomy (Pg. 898) | Surgical removal of the adrenal gland |
| Nursing actions: Provide what kind of replacement? S/s of adrenal crisis | Glucocorticoid & hormone as needed hypotension, tachycardia, nausea, tachypnea, headache |
| Nursing actions con't for adrenalectomy | VS, hemodynamic levels (q15min) fluids/lytes bleeding, BS, pain meds, stool softners slowly introduce foods assess for distention & tenderness monitor site |
| Complications of Cushings: 1. Perforated viscera/ulcerations see pg. 899 for the rest | low production of protective mucus -monitor for GI bleeding, administer antiulcer meds |
Created by:
mary.scott260!
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