Addison & Cushing disease

Question 1

The following flashcards are going to be on Addison and Cushing syndrome from the powerpoint

Question 2

What is primary Addison disease?

Answer 2

reduction of glucocorticoids, mineralocorticoids and androgens

Question 3

what is secondary Addison disease?

Answer 3

lack of pituitary acth
lack of glucocorticoids and androgens

Question 4

80% of cases of Addison disease is mainly caused by what?

Answer 4

an autoimmune response

Question 5

explain to me the patho on how patients end up getting Addison disease?

Answer 5

the autoimmune response sends antibodies to destroy the adrenal cortex, resulting in the loss of glucocorticoid, mineralocorticoid, and Adrenal androgen hormones

Question 6

notes about the etiology and pathophysiology behind Addison disease

autoimmune polyglandular syndrome
- just a syndrome where your autoimmune attacks various of your endocrine properties

co-occuring endocrine conditions
- type 1 diabetes
- autoimmune thyroid disease
- pernicious anemia
- celiac disease

most common in white females

Question 7

notes
etiology and patho

can be triggered by
- tb
- amyloidosis
- fungal infections
- aids
- metastatic cancer

Question 8

what are the signs and symptoms of Addison disease ?(4 big ones)

Answer 8

weight loss!!
nausea/vomiting
hypotension !!
salt craving!!
loss of appetite
diarrhea
bronzed skin !!

Question 9

the biggest complication from having Addison disease is what?

Answer 9

addisonian crisis

Question 10

what is addisonian crisis?

Answer 10

acute adrenal insufficiency or
insufficient or sudden, sharp decrease in hormones

Question 11

is addisonian crisis a life-threatening emergency?

Answer 11

yes

Question 12

what are the clinical manifestation of addisonian crisis ? (4) BIG ONES

Answer 12

hypotension !!
tachycardia!!
dehydration !!
decrease sodium & increase potassium & glucose !!
fever
shock

Question 13

what is the electrolytes looking like for when a patient has Addison disease?(3)

Answer 13

decrease sodium
increase potassium
increase glucose

Question 14

why does shock occur in a patient who is having an addisonian crisis ?

Answer 14

because of circulatory collapse

Question 15

how do we diagnose Addison disease ? (3)

Answer 15

ACTH stimulation test
CRH stimulation test
lab work

Question 16

how does the ACTH stimulation test work ?

Answer 16

first collect a baseline level of cortisol and acth

IV injection a synthetic acth given

RECEHCK levels after 30-60minutes
- if its elevated its normal
- little or no increase is addison

Question 17

how do we do the CRH stimulation test?

Answer 17

we only do this if there was an abnormal ACTH test response

we inject synthetic CRH

do a blood drawn 30-60 minutes after

high ACTH levels with no cortisol indicates addison disease

absence of ACTH or delayed response is common in secondary adrenal insufficicneyc

Question 18

how are the electrolytes or labs going to look like when we are diagnosing someone with Addison disease?
( mainly 3 )

Answer 18

high potassium
low sodium
low glucose

anemia
increase BUN
ECG changes
CT scan
MRI

Question 19

what is the treatment for Addison disease?
2 medication names

Answer 19

life long hormone therapy
- hydrocortisone & fludrocortisone ( flornief )

Question 20

when giving a patient hydrocortisone, what do we have to tell them ? (2)

Answer 20

take it with food
increase dosage during periods of stress

Question 21

how do we tell patients to administer hydrocortisone for Addison disease?

Answer 21

2/3 dosage in the morning
1/3 dosage in the afternoon

Question 22

typically this is the only time in a disease where we tell patients to increase their what needs?

Answer 22

salt intake
- remember they have that salt Craving

Question 23

how do we treat a patient who is going into addisonian crisis ? (5)

Answer 23

2 large bore ivs

fluids fluids

then vasopressors

iv glucose

high dose- hydrocortisone

Question 24

something I forgot to mention in the diagnosis, we are going to perform a ACTH stimulation test, then a CRH stimulation test and as well look at lab work, but ontop of that, we also want to ask patients about what?

Answer 24

steroid usage

Question 25

what are some nursing implementations we are going to do for patients who have been diagnosed with Addison disease? electrolyte ? weight?

Answer 25

correct fluid and electrolyte imbalance ( increase sodium ) ( decrease potassium ) assessment of daily weight because they are going to be losing a lot of weight due to the lack of appetite

Question 26

why do we want to watch signs for Cushing syndrome for a patient who has Addison disease?

Answer 26

because remember we are going to be treating a patient who no steroids, with steroids, and eventually when they go back to normal limits, they can end up with extra and develop Cushing

Question 27

in an emergency, like addisonisn crisis, we want patients to understand how to what?

Answer 27

administer IM hydrocortisone

Question 28

to re-emphasize how are we going to tell patients to take hydrocortisone ? and why do we tell them this ?

Answer 28

2/3 dosage in the morning 1 dosage in the evening ( additional to increase the dosage in times of stress ) because it reflects normal circadian rhythm and decease side effect of corticosteroids

Question 29

when do we tell patients to restrict their sodium and why ?

Answer 29

when swelling is presented - remember this is a sign of fluid overload or more so fluid retention

Question 30

what are some side effects that come along with corticosteroids therapy ?

Answer 30

decrease potassium & calcium increased glucose and bp delayed healing infection PPI Cushing syndrome side effects

Question 31

why do we tell pateitns who are on corticoetoids treatment for Addison disease to not stopped abruptly their medications ?

Answer 31

because it puts them at risk for developing an acute adrenal crisis

Question 32

what are some patient teaching regarding corticoertoid therapy ? what about swelling? what about glucose? what about healing? what about bones?

Answer 32

sodium restriction if edema occurs monitor for hyperglycemia prevent injury/infection treatment to reduce osteroporosis dietary, rest and exercise

Question 33

Practice question The nurse gives corticosteroids to a patient with acute adrenal insufficiency. The nurse determines that treatment is effective if what is observed? A. The patient is alert and oriented. B. The patient’s lung sounds are clear. C.The patient’s urinary output decreases. D. The patient’s potassium level is 5.7 mEq/L.

Answer 33

A. The patient is alert and oriented.

Question 34

An IV hydrocortisone infusion is started before a patient is taken to surgery for a bilateral adrenalectomy. Which explanation, if given by the nurse, is most appropriate? A. “The medication prevents sodium and water retention after surgery.” B. “This drug stimulates your immune system and promotes wound healing.” C.“The drug prevent clots from forming in the legs during your recovery from surgery.” D. “This medicine is given to help your body respond to stress after removal of the adrenal glands.”

Answer 34

D. “This medicine is given to help your body respond to stress after removal of the adrenal glands.”

Question 35

The following flashcards are going to be on Cushing syndrome

Question 36

something I want to mention before I begin on Cushing syndrome - remember they are opposite Addison = low cortisol Cushing = high cortisol

Question 37

what is Cushing disease?

Answer 37

excess of corticosteroids

Question 38

what are common causes for Cushing disease?

Answer 38

ACTH secreting pituitary adenoma adrenal tumors iatrogenic administration of exogenous corticosteroids

Question 39

what are clinical manifestation for Cushing disease? (12)

Answer 39

hyperglycemia !! thin skin weight gain osteoporosis moon face!! hypokalemia Buffalo hump !! skinny extremities hypertension stretch marks

Question 40

what are the electrolytes looking like for patient with Cushing syndrome ?

Answer 40

hypokalemia

Question 41

adrenal androgen excess may cause what in males and in females?

Answer 41

severe acne for both women = men characterizes men = women characterizes

Question 42

how do we diagnoses Cushing syndrome ?

Answer 42

confirmation of increased plasma cortisol levels 24 hour urine cortisol - levels greater than 100 mcg/24 hours urine levels of 17-ketosteroids may be high CT/MRI for tumor

Question 43

we can also do something called the plasma acth levels for a diagnostic study for a patient with Cushing syndrome, what are the results if positive?

Answer 43

high or normal with Cushing disease ( acth )

Question 44

how do we treat a patient with Cushing disease if its a tumor ?

Answer 44

surgical removal or irradiation adrenalectomy for adrenal tumors

Question 45

if the cause of a patient who has Cushing disease if from the prolonged use of corticosteroids, what do we tell them?

Answer 45

gradually taper off and discontinue therapy convert to an alternate day dosing if needed

Question 46

if we are going to remove the entire gland or potentially removal partial of it, what do we have to monitor (2) things?

Answer 46

the creation of Addison disease cause remember we are going to take away a lot of cortisol and bleeding cause they have delayed wound healing

Question 47

notes Cushing syndrome Acute care Monitor Vital signs Daily weight Glucose Assess for signs and symptoms of Inflammation/infection VTE Emotional support Patient may feel unattractive or unwanted Be sensitive to patient’s feelings and offer respectful Reassure patient that physical changes and emotional lability will resolve when hormone levels return to normal

Question 48

before we go to surgery for Cushing syndrome, what do we have to ?

Answer 48

control hypertension and hyperglycemia correct the hypokalemia high protein diet to correct protein depletion ( remember the lack of healing )

Question 49

Postoperative care Monitor for acute adrenal insufficiency Vomiting, increased weakness Dehydration, hypotension Painful joints Pruritus Peeling skin Severe emotional problems Postoperative care Bed rest until BP is stabilized after surgery Monitoring for subtle signs of infection Meticulous care to prevent infection

Question 50

Expected outcomes Have no signs or symptoms of infection Maintain weight appropriate for height State acceptance of appearance and treatment regimen Show healing of skin and maintaining intact skin

Question 51

additionally I want to include that we need to to give calcium and vitamin d more than often because of how low the calcium becomes from all the cortisol usage or just he body producing it. we want to prevent bone destruction as much as we can