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410 Patho exam 6 > Addison & Cushing disease > Flashcards

Addison & Cushing disease Flashcards

1
Q

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

A
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2
Q

What is primary Addison disease?

A

reduction of glucocorticoids, mineralocorticoids and androgens

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3
Q

what is secondary Addison disease?

A

lack of pituitary acth
lack of glucocorticoids and androgens

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4
Q

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

A

an autoimmune response

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5
Q

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

A

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

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6
Q

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

A
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7
Q

notes
etiology and patho

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

A
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8
Q

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

A

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

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9
Q

the biggest complication from having Addison disease is what?

A

addisonian crisis

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10
Q

what is addisonian crisis?

A

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

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11
Q

is addisonian crisis a life-threatening emergency?

A

yes

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12
Q

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

A

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

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13
Q

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

A

decrease sodium
increase potassium
increase glucose

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14
Q

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

A

because of circulatory collapse

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15
Q

how do we diagnose Addison disease ? (3)

A

ACTH stimulation test
CRH stimulation test
lab work

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16
Q

how does the ACTH stimulation test work ?

A

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

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17
Q

how do we do the CRH stimulation test?

A

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

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18
Q

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

A

high potassium
low sodium
low glucose

anemia
increase BUN
ECG changes
CT scan
MRI

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19
Q

what is the treatment for Addison disease?
2 medication names

A

life long hormone therapy
- hydrocortisone & fludrocortisone ( flornief )

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20
Q

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

A

take it with food
increase dosage during periods of stress

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21
Q

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

A

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

22
Q

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

A

salt intake
- remember they have that salt Craving

23
Q

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

A

2 large bore ivs

fluids fluids

then vasopressors

iv glucose

high dose- hydrocortisone

24
Q

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?

A

steroid usage

25
Q

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

electrolyte ?
weight?

A

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

26
Q

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

A

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

27
Q

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

A

administer IM hydrocortisone

28
Q

to re-emphasize how are we going to tell patients to take hydrocortisone ?

and why do we tell them this ?

A

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

29
Q

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

A

when swelling is presented

  • remember this is a sign of fluid overload or more so fluid retention
30
Q

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

A

decrease potassium & calcium

increased glucose and bp

delayed healing

infection

PPI

Cushing syndrome side effects

31
Q

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

A

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

32
Q

what are some patient teaching regarding corticoertoid therapy ?

what about swelling?
what about glucose?
what about healing?
what about bones?

A

sodium restriction if edema occurs

monitor for hyperglycemia

prevent injury/infection

treatment to reduce osteroporosis

dietary, rest and exercise

33
Q

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.

A

A. The patient is alert and oriented.

34
Q

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.”

A

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

35
Q

The following flashcards are going to be on Cushing syndrome

A
36
Q

something I want to mention before I begin on Cushing syndrome

  • remember they are opposite

Addison = low cortisol
Cushing = high cortisol

A
37
Q

what is Cushing disease?

A

excess of corticosteroids

38
Q

what are common causes for Cushing disease?

A

ACTH secreting pituitary adenoma

adrenal tumors

iatrogenic administration of exogenous corticosteroids

39
Q

what are clinical manifestation for Cushing disease? (12)

A

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

40
Q

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

A

hypokalemia

41
Q

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

A

severe acne for both

women = men characterizes

men = women characterizes

42
Q

how do we diagnoses Cushing syndrome ?

A

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

43
Q

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?

A

high or normal with Cushing disease ( acth )

44
Q

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

A

surgical removal or irradiation

adrenalectomy for adrenal tumors

45
Q

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

A

gradually taper off and discontinue therapy

convert to an alternate day dosing if needed

46
Q

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

A

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

47
Q

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

A
48
Q

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

A

control hypertension and hyperglycemia

correct the hypokalemia

high protein diet to correct protein depletion ( remember the lack of healing )

49
Q

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

A
50
Q

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

A
51
Q

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

A

410 Patho exam 6 (5 decks)

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