Adrenal Cortex Problems Flashcards
Adrenal cortex problems? (4)
- Not enough steroids
- Shock
- HYPERkalemia
- HYPOglycemia
Addison disease–What happens?
Not enough steroids
Addison disease
What would aldosterone levels be like?
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
Addison disease
Energy or fatigue?
Fatigue
Addison disease
GI?
NVD
Anorexia/weight loss
Addison disease
BP?
Hypotension
Addison disease
Neuro
Confusion
Addison disease
Na?
K?
Glucose?
Na is decreased
K is increased
Glucose is decreased
Addison disease
Skin color?
Hyperpigmentation-bronzing color of skin and MM
White patchy area of depigmented skin (vitiligo)
Addison disease
Tx?
Combat shock (loose H20 and Na)
Addison disease
Increase ___
Na
*processed fruit and broth have a lot of Na in them
Addison disease
I&O ___
Daily
Addison disease
What is BP?
Gaining or loosing fluid?
Low
Loosing fluid
Both of the above = fluid volume deficit
Addison disease
Tx?
Give steroids!
*Prednisolone, fludrocotisone
Addison disease
Prednisolone dosing?
2x a day in split dosing
2/3 in am and 1/3 in pm (normal way hormones are secreted)
Addison disease
What is aldosterone steroid med?
Fludrocortisone
Addison disease
What must be monitored?
Daily weights and BP readings
Addison disease
When on meds that need to be monitored daily, keep weight within ____ of their normal weight. Report what?
Within 2-3 lbs of normal weight
Report a gain of over 5 lbs
*also monitor for BP changes
Addison disease
What is addison crisis?
Can occur with infections
Emotional stress
Physical exertion
Stopping steroids suddenly
Addison crisis = ?
Severe HTN
Vascular collapse
Cushings = ?
Too many steroids
Cushings- Glucocorticoids
S/s?
- Growth arrest
- Thin extremities/skin
- Increased risk for infection
- HYPERglycemia
- Psychosis to depression
- Moon faced
- Truncal obesity
- Buffalo hump
Cushings-Sex hormones
S/s?
Oily skin/acne
- Women with male trait
- Poor sex drive
Cushings-Mineralcorticoids (aldosterone)
S/s?
High BP
CHF
Weight gain
Fluid volume excess
Cushings
Too much mineralocorticoids (aldosterone) what is serum K? H20? Na?
Serum K is decreased
H20 and Na is increased
Cushings
If you did 24 hour urine on this client, what are cortisol levels?
Increased
Cushings
Tx?
Adrenalectomy (unilateral or bilateral)
*if both removed, need life time replacement
Cushings
What kind of environment?
Quiet (can’t handle stress)
Cushings
Diet pre treatment- K? Na? Ca? Protein?
K: Increase
Protein: Increase
Ca: Increase
Na: Decrease
Cushings
Why do we need to increase Ca pre-tx?
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!
Cushings
Avoid what ?
Infections!!
Steroids suppress immune system!
