Adrenal Disorders (Exam 3) Flashcards
Adrenal Cortex Secretes
Glucocorticoid (Cortisol) Stress
Mineralocorticoids (Aldosterone) Salt
Sex steroids (Testosterone) Sex
Adrenal Medulla Secretes
Catecholamines
Epi and NorEpi
Cushing Disease / Syndrome
Too much cortisol
Disease = Rare
Syndrome = Collection of S/S
What Causes Cushing Syndrome?
Patient is on long term oral systemic steroids
Cushing Syndrome: Manifestations
Function of Cortisol and Clinical Manifestation with Increase Cortisol
Increase glucose availability
Glucose intolerance + hyperglycemia
HTN - Capillary friability (ecchymosis) (Bruising)
Muscle wasting, weakness, thinning of skin and bones
Redistribution of fat to abdomen, shoulder, and face
Impaired wound healing and immune response / risk of infection
Mood swings / insomnia
Cushing Syndrome Manifestation
Personality changes
Hyperglycemia
Moon face
Trunk fat
Skinny arm
Gynecomastia (male)
Hirsutism (women)
Purply Striae (stretch mark
Cushing other manifestations
Mental depression and lability
Glucose intolerance
Hypertension
-2 to salt retaining
Hypokalemia
-High levels of cortisol stimulate the mineralocorticoid (aldosterone) receptor activity
-Increase aldosterone = increase sodium + decrease potassium
Bone demineralization
-Spontaneous fractures possible
With Cushing high levels of cortisol stimulate
Aldosterone
Aldosterone increase sodium retention and decrease potassium (hypokalemia)
Cushing Priority Nursing Problems
-Risk for infection
-Weight gain
-Risk for impaired skin integrity
-Risk for injury (bone demineralization)
-Ineffective coping (labile moods)
-Body image concern
-Risk for unstable blood glucose
-HYPOKALEMIA
Cushing’s: Nursing Primary Goal
Normalize hormone secretion
Cushing’s: Treatment depends on underlying cause
Adrenalectomy (if adrenal tumor)
Removal of tumor (if ectopic ACTH secreting tumor)
How do we treat cushing’s if patient goes into cushing SYNDROME because of prolong steroid use
-Gradual d/c of drugs
-Reduction of dose
-Conversion of alternate-day regimen
Cushing’s: Monitor for
Fluid balance
(-I&O / Daily weight)
Glucose metabolism
(-FSBS)
Hypertension
(-VS)
Infection
(-Skin, urinary tract, temp, WBC)
Mood swings
Cushing Syndrome Diet
Increase Protein
Increase Potassium
Decrease Calories
Decrease Sodium
Addisons Disease
Not enough adrenal cortex activity
Insufficiency in corticosteroids and glucosteroids
Addison’s Disease: Clinical Manifestations
Bronze pigmentation
Hypoglycemia (low cortisol)
Changes in body hair
Postural Hypotension (low aldosterone)
Weakness
Weight loss (not eating / fluid volume
Adrenal Crisis
Profound fatigue
Dehydration
Vascular Collapse (decrease BP)
Renal Shutdown
Decrease NA
Increase K
Addisons Disease: Decrease Secretion of
Cortisol
-Stress
-Sugar
Aldosterone
-Na and water retention
-BP
Androgens
-male hormone
Addison’s Disease: Clinical Manifestation are r/t
Low levels of circulating cortisol and aldosterone
Addisons Disease: Rate of onset and severity of symptoms
Slow degenerative destruction
-Subtle onset of symptoms
Rapid
-Very severe and life threatening
Addison’s Disease: Clinical Manifestations
WEAKNESS r/t fluid and electrolyte imbalance
Anorexia / weight loss
HYPERKALEMIA (low aldosterone)
Hyperpigmentation
Addison’s Disease: Hypoaldosteronism
Hypotension
Salt Craving
-Low serum Na levels
Dehydration
Addison’s Disease: Hypocortisolism
-Lack of stress hormones
-Hypoglycemia
-Weakness and fatigue
Addisons Disease Priority Problems
Deficient fluid volume
Malnourishment r/t nausea
Activity intolerance r/t muscle weakness
Potential complication = Addisonian Crisis
Mainstay of Treatment For Addison’s
Hormone Replacement Therapy
- Daily hydrocortisone; 2/3 on awakening / 1/3 later afternoon
- Daily fludrocortisone in AM
- Salt additives for heat/humidity
- Increased doses when stressed
Addisons: Cortisol Replacement Therapy Teaching
Closely follow dosing
Never abruptly stop therapy
Replacement therapy is lifelong
3 times the dose for 3 days when sick or stressed or surgery
Keep supply on hand
Medical Alert Bracelet
Addisonian Crisis: What is it?
Medical Emergency (acute adrenal insufficiency)
Addisonian Crisis: Cause
Suggen insufficient of serum corticosteroids
-sudden loss of gland
-sudden increase in stress in chronic condition
-sudden cessation of drug therapy
Addisonian Crisis: Symptoms
Sudden penetrating pain in lower back - abdomen - legs
Severe vomiting and diarrhea
Dehydration
Low blood pressure
Loss of consciousness
FATAL if Untreated
Treating Addisonian Crisis
Intravenous hydrocortisone, saline, and dextrose
Hydrocortisone dose is decreased when patient can take PO
If aldosterone decreases maintenance therapy includes fludrocortisone acetate
ADDISONS DISEASE EMERGENCY KIT
100 mg IM injection of hydrocortisone
Nursing care Addison’s Disease
Frequent VS (VERY unstable)
Stress free environment (do not have cortisol to response to stress)
Pheochromocytome: How is it diagnosed?
Elevated (24 hr) urine catecholamines and plasma serum catecholamines
Pheochromocytome: Nursing Implication
Monitor for intractable high BP and Triad of symptoms
-Palpitations
-Headache
-Episodic sweating
Pheochromocytoma: Triad of Symptoms
Palpitations
Headache
Episodic Sweating
