Adrenal disorders (405) Flashcards
what are the two adrenal disorders
1) Cushing’s disease/syndrome
2) Addison’s disease
what is the most common cause of Cushing’s syndrome
oral systemic steroids
Cushing’s syndrome CM
-glucose intol & hypergly
-HTN, capillary friability, bruising, fluid retention
-muscle wasting & weakness, thinning skin
-osteoporosis
-moon face, buffalo hump, skinny extremities
-impaired wound healing & immune response
-risk for infection
-mood swings & insomnia
Cushing’s clinical presentation (upper body)
thin body hair, upper body obesity, moon face, buffalo hump, hirsutism, thinning arms & legs
Cushing’s clinical presentaiton (lower body)
skin, fragile & thin, bruising, poor healing, purplish stretch marks
pts w/ Cushing’s are at risk for what electrolyte imbalance
hypokalemia
inc alderstone, inc Na+, dec K+
what type of BP are people w/ Cushing’s at risk for
hypertension secondary to salt retaining activity of cortisol & increased blood volume
Cushing’s definition
too much cortisol
Cushing’s primary goal
normalize hormone secretion
Cushing’s treatment
treat underlying cause
-adrenalectomy
-removal of tumor
-drug therapy
-reduce steroid use
Cushing’s related nursing care
-I&Os + daily wts
-glucose metabolism
-monitor VS
-prevent & monitor infection
-offer emotional support
Cushing’s diet teaching
-increased protein & potassium
-decreased kcals & Na
Addison’s disease is caused by
sudden insufficiency of serum corticosteroids
what hormones are involved in Addison’s disease
decreased secretion of
-cortisol (primary stress hormone)
-aldosterone (steroid hormone)
-androgens (male hormones)
Addison’s disease CM: early
-anorexia
-weakness, malaise, apathy
-hyperK
-skin hyperpigmentation
Addison’s disease CM
hypoaldosteronism
-hypotension
-dec CO
-salt craving / low serum Na
-dehy
hypocortisolism
-hypoglym
-weakness & fatigue
-unsuppressed ACTH production
-hyperpigmentation
Addison’s disease primary nursing problems
-FVD
-malnut
-activity intol
-addisonian crisis
Addison’s disease treatment
-daily hydrocortisone
-daily fludrocortisone (exogenous aldosterone)
-salt additives for heat & humidity
increase dosages in times of stress
cortisol replacement therapy for Addison’s disease teaching points
-closely follow prescription
-never abruptly stop
-lifelong
-3X3 rule when stressed
-always have emergency supply
-wear med alert bracelet
3X3 rule
3 times the normal dose for 3 days when stressed
sx of Addisonian crisis
-sudden penetrating pain in the lower back, abdomen or legs
-severe vomiting & diarrhea
-dehy
-low blood pressure
-loss of consciousness
Addisonian crisis treatment
IV: hydrocortisone, saline & dextrose
PO: once tolerated
Addison’s disease emergency kit
-hydrocortisone 100mg IM
-syringes
-instructions
Addison’s disease nursing care
-frequent vital signs
-stress free environment
-low lights & volume
pheochromocytoma is found where
on the adrenal medulla
pheochromocytoma triad of symptoms
based on high BP
-palpitations
-headache
-episodic sweating
how to treat pheochromocytoma
remove the tumor
function of cortisol
-inc glucose availability
-maintain vascular system
-protein breakdown
-fat breakdown
-suppression of immune & inflammatory responses
-CNS excitability
