Adrenal Cortex Problems

Question 1

Adrenal cortex problems? (4)

Answer 1

• Not enough steroids
• Shock
• HYPERkalemia
• HYPOglycemia

Question 2

Addison disease–What happens?

Answer 2

Not enough steroids

Question 3

Addison disease

What would aldosterone levels be like?

Answer 3

Addison = not enough steroids

So aldosterone (mineralcorticoids) will be decreased and that would cause person to lose Na and H20 and retain K

• Fuid volume deficit
• Hyperkalemia

Question 4

Addison disease

Energy or fatigue?

Answer 4

Fatigue

Question 5

Addison disease

GI?

Answer 5

NVD

Anorexia/weight loss

Question 6

Addison disease

BP?

Answer 6

Hypotension

Question 7

Addison disease

Neuro

Answer 7

Confusion

Question 8

Addison disease

Na?
K?
Glucose?

Answer 8

Na is decreased
K is increased
Glucose is decreased

Question 9

Addison disease

Skin color?

Answer 9

Hyperpigmentation-bronzing color of skin and MM

White patchy area of depigmented skin (vitiligo)

Question 10

Addison disease

Tx?

Answer 10

Combat shock (loose H20 and Na)

Question 11

Addison disease

Increase ___

Answer 11

Na

*processed fruit and broth have a lot of Na in them

Question 12

Addison disease

I&O ___

Answer 12

Daily

Question 13

Addison disease

What is BP?
Gaining or loosing fluid?

Answer 13

Low
Loosing fluid

Both of the above = fluid volume deficit

Question 14

Addison disease

Tx?

Answer 14

Give steroids!

*Prednisolone, fludrocotisone

Question 15

Addison disease

Prednisolone dosing?

Answer 15

2x a day in split dosing

2/3 in am and 1/3 in pm (normal way hormones are secreted)

Question 16

Addison disease

What is aldosterone steroid med?

Answer 16

Fludrocortisone

Question 17

Addison disease

What must be monitored?

Answer 17

Daily weights and BP readings

Question 18

Addison disease

When on meds that need to be monitored daily, keep weight within ____ of their normal weight. Report what?

Answer 18

Within 2-3 lbs of normal weight

Report a gain of over 5 lbs

*also monitor for BP changes

Question 19

Addison disease

What is addison crisis?

Answer 19

Can occur with infections
Emotional stress
Physical exertion
Stopping steroids suddenly

Question 20

Addison crisis = ?

Answer 20

Severe HTN

Vascular collapse

Question 21

Cushings = ?

Answer 21

Too many steroids

Question 22

Cushings- Glucocorticoids

S/s?

Answer 22

• Growth arrest
• Thin extremities/skin
• Increased risk for infection
• HYPERglycemia
• Psychosis to depression
• Moon faced
• Truncal obesity
• Buffalo hump

Question 23

Cushings-Sex hormones

S/s?

Answer 23

Oily skin/acne

• Women with male trait
• Poor sex drive

Question 24

Cushings-Mineralcorticoids (aldosterone)

S/s?

Answer 24

High BP
CHF
Weight gain
Fluid volume excess

Question 25

Cushings

Too much mineralocorticoids (aldosterone) what is serum K? H20? Na?

Answer 25

Serum K is decreased

H20 and Na is increased

Question 26

Cushings

If you did 24 hour urine on this client, what are cortisol levels?

Answer 26

Increased

Question 27

Cushings

Tx?

Answer 27

Adrenalectomy (unilateral or bilateral)

*if both removed, need life time replacement

Question 28

Cushings

What kind of environment?

Answer 28

Quiet (can’t handle stress)

Question 29

Cushings

Diet pre treatment- 
K?
Na?
Ca?
Protein?

Answer 29

K: Increase
Protein: Increase
Ca: Increase

Na: Decrease

Question 30

Cushings

Why do we need to increase Ca pre-tx?

Answer 30

Steroid decrease serum Ca by excreting through GI tract. Cushing = too much steroids. Too much steroids = too much Ca being excreted. …Need to replace the Ca!

Question 31

Cushings

Avoid what ?

Answer 31

Infections!!

Steroids suppress immune system!