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Module 4 (MedSurg 2) > Adrenal Gland > Flashcards

Adrenal Gland Flashcards

1
Q

Adrenal Disorders in the cortex

A

Addison’s
Cushing’s

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2
Q

Adrenal Disorders in the medulla

A

Pheochromocytoma

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3
Q

Adrenal glands work with

A

chem balance
metabolism
Sugar, salt/K, sex

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4
Q

Adrenal glands secrete

A

mineralocorticoids, glucocorticoids, androgens and estrogens

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5
Q

mineralocorticoid

A

aldosterone - fluid balance

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6
Q

glucocorticoid

A

cortisol - aids in metabolism under stress
low immune system help

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7
Q

androgens and estrogens

A

male and female traits

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8
Q

Cushing’s disease cause

A

high cortisol due to high ACTH from the pituitary
metabolic disorder

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9
Q

Cushing’s syndrome caused

A

large or prolonged corticosteroid use
from adrenal cortex

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10
Q

Types of Cushing’s

A

Iatrogenic
primary
secondary

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11
Q

Iatrogenic Cushing’s

A

extended use of glucocorticoids

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12
Q

Primary cushing’s

A

adrenal cortex tumor

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13
Q

Secondary cushing’s

A

ACTH produced by CA of lung or pancreas leads to hyperplasia of a. cortex

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14
Q

Cushing’s labs

A

low K
hig NA, glucose, and cortsol

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15
Q

Cushing’s assessments

A

HTN
osteoporosis
muscle wasting - hand and arm bruising and thinning(SIADH but with fat)
weakness
LOC and mood change moonface
psychosis
Buffalo hump - fat glob on back
straie - tiger strips
poor wound healing

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16
Q

Dx Cushing’s syndrome

A

Midnight or late-night salivary cortisol
Low-dose dexamethasone suppressiontest
24-hour urine cortisol
Levels >80-120 mcg/24 hours
ran at 2300 WITH labs at 0800
-Plasma ACTH for pituitary or steroid

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17
Q

Iatrogenic Cushings Management

A

Decrease corticosteroid dose
Change to every other day schedule
Taper off gradually
Txsuppress ACTH or cortisol
chemo or surgery for tumors

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18
Q

Cushing’s syndrome mgmt

A

Due to moods, reteaching and family member involvement
Increase use of steroid use attracts water
Daily wt with body measurements journal
Monitor BP
Body is fat consumed
Risk for fractures and infections
Skin tear easy

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19
Q

Seven Dwarves of Cushing’s

A

forgetful
chubby
bruisy
sleepy
hairy
angry
psycho

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20
Q

Addison’s disease is the

A

hypofunction of A cortex
low glucocorticoid, mineral and adreogens

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21
Q

Addison’s causes

A

Sudden d/c of high dose steroids
Destruction of the adrenal cortex
Autoimmune
Trauma
Sepsis
Surgery

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22
Q

Low ACTH and aldosterone and cortisol

A

High K
low Na and glucose

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23
Q

Addison’s labs

A

low aldosterone and cortisol
low Na glucose
high K

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24
Q

Addison’s s/s

A

CV: dysrhythmia, tachycardia, hypovolemia, POSTURAL HYPOTENSION
GI: N/V/D , anorexia
Skin: hyper-pigmentation, poor healing
MS: muscle & joint pain, muscle weakness & tremor
Mental status: depression, emotional lability, confusion

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25
Q

Adrenal Crisis

A

profound fatigue
dehydration
low BP vascular collapse
low Na
High K

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26
Q

Dx of Addison’s

A

Adrenocortical hormone levels
ACTH levels – pituitary problem
ACTH / CTH stimulation test
Dark skin pigment in areas
gums dark purple

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27
Q

Addison’s Administer

A

Glucocorticoid & Mineralocorticoid

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28
Q

Addison’s nutriton

A

High Ca & Vit. D, Na normal to mod

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29
Q

Addison’s observe for

A

Addisonian crisis

30
Q

Addison’s monitor

A

VS
I&O
WT
WBC
Glucose
Na
K
Ca

31
Q

Addison’s education

A

take sick day regimen
go to ER if N/V
proteins and carbs

32
Q

Addisonian Crisis is caused by

A

Stress Infection
Trauma Surgery
Abrupt d/c of corticosteroid use

33
Q

Addisonian Crisis s/s

A

low Na, Glucose
high Potassium
H/A
Severe low BP
Weakness
Irritable/confusion
Abd, leg & low back pain
Shock

34
Q

Addisonian Crisis Care

A

Shock management
High-dose IV hydrocortisone replacement (glucocorticoid)
Monitor for Cushing
D5NS
Frequent VS & neuro assessment
I&O, daily wt.
QUIET WITH REST Protect from extremes- light, noise, temperature
Protect from infection

35
Q

Glucocorticoids

A

Influence carbohydrate metabolism
cortisol
- carb metabolism (genesis, lower utilization peri,inhibit uptake, and promote storage)
- protein metabolism
- fat metabolism
- CV function

36
Q

Mineralocorticoids

A

Regulate salt & water balance

37
Q

Androgens

A

Contribute to expression of sexual characteristics

38
Q

Large doses of Cortisol can cause

A

Osteoporosis
Muscle weakness & atrophy
Stress adaptation interference
Inhibit action of Growth Hormone if younger (need to put some breaks)

39
Q

hydrocortisone (Cortef)** goal

A

produces multiple glucocorticoid & mineralcorticoid effects

40
Q

hydrocortisone (Cortef)**
adverse effects

A

adrenal suppression, production of Cushing’s syndrome

41
Q

hydrocortisone (Cortef)**
used for

A

Addison’s and crisis

42
Q

hydrocortisone (Cortef)**
contraindications

A

systemic fungal infection, hypersensitivity

43
Q

hydrocortisone (Cortef)**
dosage

A

Largest dose 2-3 in morning 8-9am
1/3 IN AFTERNOON NO LATER THAN 6
flip if night shift

44
Q

hydrocortisone (Cortef)**
monitor for

A

Assess vital signs, weight, respirations, & signs of dependent edema overdose s/s
Monitor for depression, insomnia, anorexia
Assess skin for bruising, color changes, acne, changes in hair growth
Advise regular eye exams bc glucose
Reposition immobilized patients every 2 hours
Skin care for pressure injuries
Monitor stool for occult blood

45
Q

hydrocortisone (Cortef)**
teachings

A

Take oral doses with meals & avoid alcohol
Take any missed dose as soon as remembered
with juice or coke bc of bad taste from overdose
Limit sodium intake
Monitor blood sugar, esp. if diabetic
Report any bloody or black tarry stools, mood changes, or insomnia

46
Q

hydrocortisone (Cortef)**
avoid

A

Avoid immunizations during therapy**
Avoid immunizations for 3 months following completion of therapy**
Report fever, cough, sore throat, malaise, unhealed injuries
Do not share drug with others
Do not stop abruptly**
Medical Alert ID
Emergency kit

47
Q

Mineralocorticoids

A

RAAS = Aldosterone
Promotes sodium & potassium hemostasis**
Helps maintain intravascular volume
BP = Harmful cardiovascular effects when high

48
Q

fludrocortisone**
GOAL

A

produces multiple glucocorticoid & mineralcorticoid effects

49
Q

fludrocortisone**
adverse effects

A

HTN, edema, cardiac enlargement, hypokalemia

50
Q

fludrocortisone**
contraindications

A

systemic fungal infection, hypersensitivity

51
Q

fludrocortisone**
med given when

A

morning at 0900

52
Q

fludrocortisone**
monitor

A

Monitor for weight gain, elevated blood pressure
Monitor electrolytes, especially sodium & potassium
Signs of overdose: psychosis, excess weight gain, edema, CHF, increased appetite, severe insomnia, hypertension

53
Q

fludrocortisone**
teachings

A

Report muscle weakness, fatigue, delirium, paresthesias, numbness of the mouth, anorexia, nausea, depression, diminished reflexes, polyuria, irregular heart rate
Eat foods high in potassium supplements too
Weigh daily
Report any edema**
Report infection, trauma or unexpected stress

54
Q

Adrenal medulla functions with

A

autonomic NS
epinephrine and norepinephrine

55
Q

Pheochromocytoma is the

A

hyperfucntion of the A medulla

56
Q

Pheochromocytoma Causes

A

Catecholamine-producing tumor in adrenal medulla
high epinephrine & norepinephrine**
Severe life-threatening hypertension**

57
Q

Pheochromocytoma s/s

A

HTN – severe
Lab: high catecholamine (blood & urine)
Triad – HA, Diaphoresis, Palpitations w/ HTN
5 “H’s”- HTN, HA, Heat, Hypermetabolism, Hyperhidrosis

58
Q

Pheochromocytoma complications

A

HTN crisis leads to renal & retina damage
AMI CHF
CVA Dysrhythmia

59
Q

Pheochromocytoma Dx

A

24 hr urine for VMA
= high vanillylmandelic acid
Plasma – catecholamine
Clonidine Suppression
CT/MRI - tumor

60
Q

Pheochromocytoma need to avoid

A

stimulants

61
Q

Pheochromocytoma medications

A

none, ADRENALECTOMY is best options due to chemo not working

62
Q

Pheochromocytoma monitor

A

BP
fluid and electro
EKG

63
Q

Pheochromocytoma NUTRITION

A

HIGH CAL

64
Q

Pheochromocytoma education

A

Knowledge deficit
Health maintenance
Risk – injury
Risk – thought process
Risk – sleep pattern
decrease anxiety and agitation

65
Q

Adrenalectomy

A

Surgical removal of one or both adrenal glands
Open incision or laparoscopic technique

66
Q

Bilateral Adrenalectomy

A

postop steroid supplementation cortisone & hydrocortisone

67
Q

Adrenalectomy Pre-op

A

Diet - vitamins & proteins
high risk of infection.
Monitor electrolytes & glucose
IS, TCDB, pain scale

68
Q

Adrenalectomy Post-op

A

VS, I&O, electrolytes
Pain med, cortisol, & IVF
Risk - Addisonian crisis & hypovolemic shock
Risk - delayed wound healing & infection
Risk – difficult glycemic control
Return to work 1- 3 wks

69
Q

D/C teaching for adrenalectomy

A

Home health
MedicAlert bracelet
Avoid: extremes of temperature, infection, & stress
Teach: adjust medication & when to call HCP
Lifetime replacement therapy

70
Q

The nurse is instructing a college student with Addison’s disease how to adjust the dose of glucocorticoids. The nurse should explain the patient needs to increase the dosage in which situation?
Completing final exams
Gaining 5 pounds
Seasonal allergies
Wisdom teeth extraction

A

Wisdom teeth extraction

71
Q

Bone reabsorption is a possible complication of Cushing’s Syndrome. To help prevent this complication, the nurse would recommend that the patient:
Increase potassium in their diet
Perform weight-bearing exercise regularly
Limit dietary intact of Vit. D
Perform isometric exercises

A

Perform weight-bearing exercise regularly

72
Q

Glucocorticoid pts need to do what with the steroid when experiencing stressful situations

A

raise

Module 4 (MedSurg 2) (36 decks)

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