Cushing Syndrome Flashcards
Collaborative Care
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
Collaborative Care: Mitotane
Suppresses cortisol production
Alters peripheral metabolism of cortisol
Decreases plasma and urine corticosteroid levels
Metyrapone, ketoconazole, and aminoglutethimide inhibit cortisol synthesis
Collaborative Care
If developed during use of corticosteroids
- Gradual discontinuance
- Reduction of dose
- Conversion to alternate-day regimen
Avoids potentially life-threatening adrenal insufficiency
Nursing Assessment: PMH
PMH
- Pituitary tumour
- Adrenal, pancreatic, or pulmonary neoplasms
- Frequent infections
Nursing Assessment
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
Nursing Assessment
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
Nursing Diagnoses
Risk for infection
Imbalanced nutrition: more than body requirements
Disturbed self-esteem
Impaired skin integrity
Nursing Planning
Client will:
- Experience relief of symptoms
- Have no serious complications
- Maintain positive self-image
- Actively participate in therapeutic plan
Nursing Implementation
Identify risk’s for Cushing’s syndrome
- Long-term exogenous cortisol
- Teaching r/t medications
Nursing Implementation
Assessment of S/S of hormone and drug toxicity, complicating conditions
- Cardiovascular disease
- Diabetes
- Infection
- Pathological fractures
Nursing Implementation
Monitor
- VS
- Daily weight
- Glucose
- S/S of infection
- Redness, fever may be minimal or absent
- S/S of thromboembolic phenomena
Nursing Implementation
Emotional Support
- May feel unattractive or unwanted
- Physical symptoms will resolve when hormone levels return to normal
Nursing Implentation
Pre-Op Care
- Hypertension and hyperglycaemia must be controlled
- Hypokalemia is corrected with supplements
- High-protein meals prevent depletion
Nursing Implentation
Teaching depends on surgical approach (include information on post-op care)
- NG tube
- Urinary catheter
- IV therapy
- Central venous pressure monitoring
- Leg compression devices
Nursing Implementation
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
Nursing Implentation
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
Nursing Implementation
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
Nursing Implementation
Adrenal insufficiency may develop if corticosteroid dosage is tapered to rapidly
Vomiting, increased weakness, dehydration, and hypotension may indicate hypocortisolism
Nursing Implementation
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
Nursing Implementation
Meticulous care when assessing areas under skin, circulation, or body cavities to prevent infection
- Inflammatory responses suppressed
Nursing Implementation
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
Nursing Evaluation
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
Collaborative Care: Addison’s Disease
Hydrocortisone most commonly used as replacement therapy
Glucocorticoid dosage must be increased during times of stress to prevent Addisonian crisis
Diagnostic Studies: Addison’s Disease
Treatment directed at shock management and high-dose hydrocortisone replacement
Large volumes of NS and D5 are administered to reverse hypotension and electrolyte imbalances
Nursing Implementation: Addison’s Disease
Frequent assessment
VS and signs of F&E imbalances every 30 minutes to 4 hours for first 24 hours
Daily weights
Diligent corticosteroid administration
Nursing Implementation: Addison’s Disease
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
Nursing Implementation: Addison’s Disease
Glucocorticoids usually given in divided doses
Mineralocorticosteroids usually given once in the morning
- Reflects normal circadian rhythm
Nursing Implementation: Addison’s Disease
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
Nursing Implementation: Addison’s Disease
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
Nursing Implementation: Addison’s Disease
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
