Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
TL Adrenal Gland
Cushing's, Addison's, Pheochromocytoma
| Question | Answer |
|---|---|
| Define Cushing’s syndrome. | hyperfunction of the adrenal gland cortex resulting in elevated serum cortisol or ACTH levels |
| What effect does excessive cortisol have on the body? | causes life-threatening changes in physiologic and metabolic functioning |
| Who is most at risk for Cushing’s Syndrome? | Women 30-40 years old |
| What is the cause of primary Cushing’s syndrome? | tumor of the adrenal cortex |
| What is the cause of secondary Cushing’s syndrome? | disorder of the pituitary or hypothalamus = too much ACTH or ectopic tissue like ACTH-producing cancer of the lung, bronchus, or pancreas; in either case the result would be hyperplasia/secretion of the Adrenal cortex, or just too much steroid use |
| What are the clinical manifestations of Cushing’s syndrome? | weakness, muscle wasting, thin skin, bruising, emotional lability, skin infections, poor wound healing, striae, hirutism, HTN, fluid overload, weight gain, osteoporosis, truncal obesity, moon facies, fat pad-neck, amenorrhea, impotence, decreased libido |
| What lab findings are typical of Cushing’s syndrome? | INCREASED: cortisol, sodium, glucose, calcium, and potassium; elevated urine 17 Ketosteroids; ACTH up or down; Positive ACTH suppression test; normal BUN |
| Briefly explain how the ACTH suppression test works. | Dexamethasone is given. Dexamethasone is a synthetic cortisol. If the hypothalamus/pituitary gland works it should respond by decreasing ACTH levels. |
| Give 5 nursing diagnoses applicable to the client with Cushing’s syndrome. | Fluid volume excess; risk for injury; risk for infection; disturbed body image; deficient knowledge |
| What are the postoperative interventions for client who has had adrenalectomy? | encourage deep breathing (no coughing for transphenoidal surgery), mouth breathing -nasal packing, turning q2 hr, ankle dorsiflexion q hr, minimize stress on incision by log roll from lying to seated and vice versa, watch for CSF leaks, HOB 30% |
| What post-adrenalectomy interventions are purposed toward preventing Addisonian crisis? | Give IV NS infusion bolus and cortisol as prescribed |
| What symptoms alert the nurse to possible Addisonian crisis post adrenalectomy? | dry, tenting skin; decreased BP; increased pulse; decreased level of consciousness; anorexia; weakness |
| What medications would the nurse expect for the patient with Cushing ’s syndrome? | Meturapone, Octreotide (Sandostatin), mitotane (Lsodren) |
| What does meturapone do? | directly inhibits cortisol production and secretion by the adrenal cortex |
| What does octreotide (Sandostatin) do? | Sandostatin is a somatostatin analog that suppresses ACTH secretion |
| What does mitotane (Lysodren) do? | Suppresses the function of the adrenal cortex and decreases the metabolism of corticosteroids, thus decreasing serum cortisol |
| What symptoms should the client with Cushing’s disease report to their provider? | signs of hyperglycemia, hypoglycemia, and signs of infection |
| What does the client with Cushing’s syndrome need to know about self- care? | about the disorder, wear medica alert bracelet, how to take medication, diet should be high protein, vitamin B and C to support immune system, supplemental potassium and calcium, how to care for postoperative wound and postoperative cortisol replacement |
| What kind of diet is appropriate for the client with Cushing’s syndrome? | High protein, high in vitamin B and C to support immune system, Supplemental potassium and calcium |
| Define Addison’s disease. | insufficient level of cortisol |
| What are some potential causes of Addison’s? | destruction of the adrenal cortex, caused by autoimmune disorder, tuberculosis, septicemia, AIDS, bilateral adrenalectomy, or sudden cessation of long term steroid medication |
| Who is most at risk for Addison’s disease? | Women <60years of age |
| What is the function of cortisol? | to increase rate of glucose sysnthesis, glycogen formation, release of fatty acids, and breakdown of fatty acids, and to exert anti-inflammatory effects to suppress the immune system |
| What happens when aldosterone and cortisol are decreased? | leads to hyponatremia, hyperkalemia, decreased extracellular fluid, decreased intravascular volume, decreased glucneogenesis, hypoglycemia, and stress intolerance |
| What causes the “eternal tan” of Addison’s disease? | High ACTH levels lead to hyperpigmentation from increased stimulation of malanocytes |
| What are the clinical manifestations of Addison’s disease? | hyperpigmentation, delayed wound healing, tachycardia, dysrhythmias, hypotension; dehydration, hypovolemia; weight loss; anorexia, nausea, vomiting; diarrhea; depression; lethargy; emotional lability; confusion; muscle weakness; tremors; muscle/joint pain |
| Define Addison’s crisis. | life threatening response to sudden withdrawal of steroids or increased stress manifested by severe hypotension, circulatory collapse, shock, and coma |
| What labs are common to the patient with Addison’s disease? | decreased serum cortisol, glucose, sodium; increased potassium, BUN, and ACTH levels; decreased urine 17 ketosteroids; no increase in cortisol with ACTH stimulation test; CT scan positive |
| What is the treatment for Addison’s disease? | replace corticosteroids and mineralosteroids |
| What are some applicable nursing diagnoses for Addison’s disease? | Deficient fluid volume; Risk for ineffective therapeutic regimen management; deficient knowledge; risk for electrolyte imbalance |
| What do we need to do for the client admitted with Addison’s? | maintain fluid/lyte balance – lab values, I&O, daily weight; encourage 3000mL fluid/day & increased sodium in diet; protect from falls; administer hydrocortisone (Cortef) replaces cortisol; Fludrocortisone (Florinef) for mineralcorticosteroids replacement |
| What does the client with Addison’s need to know about self care? | about Addison’s, symptoms to report; need for life long medication and disease management, no OTC w/o HCP okay; how to administer medication; how to adjust dose to stress; medic alert bracelet; IM cortisol; diet- immune system, up sodium, potassium down |
| Define pheochromcytoma (malignant HTN). | increased level of catecholamine secretion from chromaffin tissue in the adrenal medulla leading to increase sympathetic stimulation; rapid acute HTN; life-threatening requires treatment within first hour |
| Explain the pathophysiology of pheochromocytoma. | tumors in the adrenal medulla cause mega secretion of epinephrine and norepinephrine leading to rapid increased vasoconstriction causing acute HTN |
| What are the clinical manifestations of Pheochromocytoma? | Rapid rise in BP- systolic 200-300 and diastolic 150-175, visual changes, HA, LOC changes/confusion |
| What will lab and diagnostic tests show for the patient with pheochromocytoma? | increase urine and serum catecholamines, Renal CAT scan shows tumor of adrenal glands |
| How is pheochromocytoma treated? | adrenalectomy (usually just one), medication therapy, management of stress |
| What are some applicable nursing diagnoses for the client with pheochromocytoma? | risk for injury; frisk for interrupted thought processes, deficient knowledge |
| What do we do for the client admitted with pheochromocytoma? | pre/post-adrenalectomy care, monitor BP; monitor for changes in LOC or confusion, Administer Alpha and beta blockers as prescribed, administer drugs to suppress catecholamine secretion like metyrosine (Demser) |
| What does the client with pheochromocytoma need to know about self care? | Report changes in vision or LOC, facial edema, headaches, take antihypertensives on time, avoid physical and emotional stress |
Created by:
Perseverandovercome
Popular Nursing sets