Adrenal Gland Flashcards
Adrenal Disorders in the cortex
Addison’s
Cushing’s
Adrenal Disorders in the medulla
Pheochromocytoma
Adrenal glands work with
chem balance
metabolism
Sugar, salt/K, sex
Adrenal glands secrete
mineralocorticoids, glucocorticoids, androgens and estrogens
mineralocorticoid
aldosterone - fluid balance
glucocorticoid
cortisol - aids in metabolism under stress
low immune system help
androgens and estrogens
male and female traits
Cushing’s disease cause
high cortisol due to high ACTH from the pituitary
metabolic disorder
Cushing’s syndrome caused
large or prolonged corticosteroid use
from adrenal cortex
Types of Cushing’s
Iatrogenic
primary
secondary
Iatrogenic Cushing’s
extended use of glucocorticoids
Primary cushing’s
adrenal cortex tumor
Secondary cushing’s
ACTH produced by CA of lung or pancreas leads to hyperplasia of a. cortex
Cushing’s labs
low K
hig NA, glucose, and cortsol
Cushing’s assessments
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
Dx Cushing’s syndrome
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
Iatrogenic Cushings Management
Decrease corticosteroid dose
Change to every other day schedule
Taper off gradually
Txsuppress ACTH or cortisol
chemo or surgery for tumors
Cushing’s syndrome mgmt
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
Seven Dwarves of Cushing’s
forgetful
chubby
bruisy
sleepy
hairy
angry
psycho
Addison’s disease is the
hypofunction of A cortex
low glucocorticoid, mineral and adreogens
Addison’s causes
Sudden d/c of high dose steroids
Destruction of the adrenal cortex
Autoimmune
Trauma
Sepsis
Surgery
Low ACTH and aldosterone and cortisol
High K
low Na and glucose
Addison’s labs
low aldosterone and cortisol
low Na glucose
high K
Addison’s s/s
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
Adrenal Crisis
profound fatigue
dehydration
low BP vascular collapse
low Na
High K
Dx of Addison’s
Adrenocortical hormone levels
ACTH levels – pituitary problem
ACTH / CTH stimulation test
Dark skin pigment in areas
gums dark purple
Addison’s Administer
Glucocorticoid & Mineralocorticoid
Addison’s nutriton
High Ca & Vit. D, Na normal to mod
Addison’s observe for
Addisonian crisis
Addison’s monitor
VS
I&O
WT
WBC
Glucose
Na
K
Ca
Addison’s education
take sick day regimen
go to ER if N/V
proteins and carbs
Addisonian Crisis is caused by
Stress Infection
Trauma Surgery
Abrupt d/c of corticosteroid use
Addisonian Crisis s/s
low Na, Glucose
high Potassium
H/A
Severe low BP
Weakness
Irritable/confusion
Abd, leg & low back pain
Shock
Addisonian Crisis Care
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
Glucocorticoids
Influence carbohydrate metabolism
cortisol
- carb metabolism (genesis, lower utilization peri,inhibit uptake, and promote storage)
- protein metabolism
- fat metabolism
- CV function
Mineralocorticoids
Regulate salt & water balance
Androgens
Contribute to expression of sexual characteristics
Large doses of Cortisol can cause
Osteoporosis
Muscle weakness & atrophy
Stress adaptation interference
Inhibit action of Growth Hormone if younger (need to put some breaks)
hydrocortisone (Cortef)** goal
produces multiple glucocorticoid & mineralcorticoid effects
hydrocortisone (Cortef)**
adverse effects
adrenal suppression, production of Cushing’s syndrome
hydrocortisone (Cortef)**
used for
Addison’s and crisis
hydrocortisone (Cortef)**
contraindications
systemic fungal infection, hypersensitivity
hydrocortisone (Cortef)**
dosage
Largest dose 2-3 in morning 8-9am
1/3 IN AFTERNOON NO LATER THAN 6
flip if night shift
hydrocortisone (Cortef)**
monitor for
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
hydrocortisone (Cortef)**
teachings
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
hydrocortisone (Cortef)**
avoid
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
Mineralocorticoids
RAAS = Aldosterone
Promotes sodium & potassium hemostasis**
Helps maintain intravascular volume
BP = Harmful cardiovascular effects when high
fludrocortisone**
GOAL
produces multiple glucocorticoid & mineralcorticoid effects
fludrocortisone**
adverse effects
HTN, edema, cardiac enlargement, hypokalemia
fludrocortisone**
contraindications
systemic fungal infection, hypersensitivity
fludrocortisone**
med given when
morning at 0900
fludrocortisone**
monitor
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
fludrocortisone**
teachings
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
Adrenal medulla functions with
autonomic NS
epinephrine and norepinephrine
Pheochromocytoma is the
hyperfucntion of the A medulla
Pheochromocytoma Causes
Catecholamine-producing tumor in adrenal medulla
high epinephrine & norepinephrine**
Severe life-threatening hypertension**
Pheochromocytoma s/s
HTN – severe
Lab: high catecholamine (blood & urine)
Triad – HA, Diaphoresis, Palpitations w/ HTN
5 “H’s”- HTN, HA, Heat, Hypermetabolism, Hyperhidrosis
Pheochromocytoma complications
HTN crisis leads to renal & retina damage
AMI CHF
CVA Dysrhythmia
Pheochromocytoma Dx
24 hr urine for VMA
= high vanillylmandelic acid
Plasma – catecholamine
Clonidine Suppression
CT/MRI - tumor
Pheochromocytoma need to avoid
stimulants
Pheochromocytoma medications
none, ADRENALECTOMY is best options due to chemo not working
Pheochromocytoma monitor
BP
fluid and electro
EKG
Pheochromocytoma NUTRITION
HIGH CAL
Pheochromocytoma education
Knowledge deficit
Health maintenance
Risk – injury
Risk – thought process
Risk – sleep pattern
decrease anxiety and agitation
Adrenalectomy
Surgical removal of one or both adrenal glands
Open incision or laparoscopic technique
Bilateral Adrenalectomy
postop steroid supplementation cortisone & hydrocortisone
Adrenalectomy Pre-op
Diet - vitamins & proteins
high risk of infection.
Monitor electrolytes & glucose
IS, TCDB, pain scale
Adrenalectomy Post-op
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
D/C teaching for adrenalectomy
Home health
MedicAlert bracelet
Avoid: extremes of temperature, infection, & stress
Teach: adjust medication & when to call HCP
Lifetime replacement therapy
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
Wisdom teeth extraction
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
Perform weight-bearing exercise regularly
Glucocorticoid pts need to do what with the steroid when experiencing stressful situations
raise
