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Nursing Theory III > Cushing Syndrome > Flashcards

Cushing Syndrome Flashcards

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1
Q

Collaborative Care

A

Goal of normalizing hormone secretion
Treatment dependent on cause
Surgical removal or radiation for pituitary adenoma
Adrenalectomy for adrenal tumours or hyperplasia
Ectopic ACTH- secreting tumours managed by treating primary neoplasm
Drug therapy indicated when surgery is contraindicated
Goal is inhibition of adrenal function

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2
Q

Collaborative Care: Mitotane

A

Suppresses cortisol production
Alters peripheral metabolism of cortisol
Decreases plasma and urine corticosteroid levels

Metyrapone, ketoconazole, and aminoglutethimide inhibit cortisol synthesis

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3
Q

Collaborative Care

A

If developed during use of corticosteroids
- Gradual discontinuance
- Reduction of dose
- Conversion to alternate-day regimen
Avoids potentially life-threatening adrenal insufficiency

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4
Q

Nursing Assessment: PMH

A

PMH

  • Pituitary tumour
  • Adrenal, pancreatic, or pulmonary neoplasms
  • Frequent infections
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5
Q

Nursing Assessment

A 
Use of corticosteroids
Weight gain
Anorexia
Polyuria
Prolonged wound healing
Easy bruising
Insomnia
Back, joint, bone, and rib pain
Amenorrhea
Impotence
Mood disturbances, anxiety, psychosis
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6
Q

Nursing Assessment

A 
Truncal obesity
 Buffalo hump
Moon faces
Hirsutism of body and face
Thinning of hair
Thin, friable skin
Acne
Petechiae
Purpura
Hyperpigmentation
Striae
Hypertension
Muscle wasting
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7
Q

Nursing Diagnoses

A

Risk for infection
Imbalanced nutrition: more than body requirements
Disturbed self-esteem
Impaired skin integrity

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8
Q

Nursing Planning

A

Client will:

  • Experience relief of symptoms
  • Have no serious complications
  • Maintain positive self-image
  • Actively participate in therapeutic plan
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9
Q

Nursing Implementation

A

Identify risk’s for Cushing’s syndrome

  • Long-term exogenous cortisol
  • Teaching r/t medications
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10
Q

Nursing Implementation

A

Assessment of S/S of hormone and drug toxicity, complicating conditions

  • Cardiovascular disease
  • Diabetes
  • Infection
  • Pathological fractures
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11
Q

Nursing Implementation

A

Monitor

  • VS
  • Daily weight
  • Glucose
  • S/S of infection
    • Redness, fever may be minimal or absent
  • S/S of thromboembolic phenomena
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12
Q

Nursing Implementation

A

Emotional Support

  • May feel unattractive or unwanted
  • Physical symptoms will resolve when hormone levels return to normal
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13
Q

Nursing Implentation

A

Pre-Op Care

  • Hypertension and hyperglycaemia must be controlled
  • Hypokalemia is corrected with supplements
  • High-protein meals prevent depletion
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14
Q

Nursing Implentation

A

Teaching depends on surgical approach (include information on post-op care)

  • NG tube
  • Urinary catheter
  • IV therapy
  • Central venous pressure monitoring
  • Leg compression devices
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15
Q

Nursing Implementation

A

Post-op

  • Risk of hemorrhage is increased
  • Manipulation of glandular tissue may release hormones into circulation
  • BP, F&E tend to be unstable due to hormone fluctuations
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16
Q

Nursing Implentation

A

High doses of corticosteroids are administered IV during and several days after surgery to ensure adequate response to surgery
Report any significant changes to BP, F&E, RR, and HR

17
Q

Nursing Implementation

A

Monitor I&O
Critical period for circulatory instability ranges from 24-48 hours post-op
Morning urine levels of cortisol are measured to evaluate effectiveness of surgery

18
Q

Nursing Implementation

A

Adrenal insufficiency may develop if corticosteroid dosage is tapered to rapidly
Vomiting, increased weakness, dehydration, and hypotension may indicate hypocortisolism

19
Q

Nursing Implementation

A 
S/S of painful joints
Pruritus
Peeling skin
Severe emotional disturbances should be reported so doses can be adjusted
Maintain bed rest until BP stabilizes
20
Q

Nursing Implementation

A

Meticulous care when assessing areas under skin, circulation, or body cavities to prevent infection
- Inflammatory responses suppressed

21
Q

Nursing Implementation

A

Discharge instructions based on lack of endogenous corticosteroids
Wear medic-alert bracelet at all times
Avoid exposure to stress, extremes of temperature, and infection
Lifetime replacement therapy for many

22
Q

Nursing Evaluation

A

No infection/ early detection of infectious process
Maintenance of body weight or no more than 0.5-1 kg loss per week
Verbalization of acceptance of and self-care of appearance
Intact skin

23
Q

Collaborative Care: Addison’s Disease

A

Hydrocortisone most commonly used as replacement therapy

Glucocorticoid dosage must be increased during times of stress to prevent Addisonian crisis

24
Q

Diagnostic Studies: Addison’s Disease

A

Treatment directed at shock management and high-dose hydrocortisone replacement
Large volumes of NS and D5 are administered to reverse hypotension and electrolyte imbalances

25
Q

Nursing Implementation: Addison’s Disease

A

Frequent assessment
VS and signs of F&E imbalances every 30 minutes to 4 hours for first 24 hours
Daily weights
Diligent corticosteroid administration

26
Q

Nursing Implementation: Addison’s Disease

A

Protect against infection
Hygiene
Protect from light, noise, and temperature extreme
As discharge usually occurs before maintenance dose reached, instruct on importance of follow-up appointments

27
Q

Nursing Implementation: Addison’s Disease

A

Glucocorticoids usually given in divided doses
Mineralocorticosteroids usually given once in the morning
- Reflects normal circadian rhythm

28
Q

Nursing Implementation: Addison’s Disease

A

Long term care revolves around recognizing the need for extra medication and techniques for stress management
For vomiting and diarrhea, notify the health care provider because electrolyte replacement may be necessary and may indicate crisis

29
Q

Nursing Implementation: Addison’s Disease

A

Teach S&S of corticosteroid deficiency and excess and to report findings
Instruct to wear medic-alert bracelet at all times
Provide handouts on medications causing increased need for glucocorticoids

30
Q

Nursing Implementation: Addison’s Disease

A

Instruct on how to take BP and to report findings
Instruct to carry emergency kit with IM hydrocortisone, syringes, and instruction for use
- Teach how to give IM injection

Nursing Theory III (17 decks)

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