Exam 2

Question 1

Adrenal medulla releases

Answer 1

Epi and norepi

Question 2

Sympathomimetic

Answer 2

Mimic SNS
Epi and norepi released from adrenal medulla
Catecholamines

Question 3

Epi and norepi act on which receptors?

Answer 3

Alpha 1 beta 1&2 adrenergic receptors

Question 4

Released from adrenal cortex

Answer 4

Mineralcorticoids (aldosterone)
Glucocorticoids (cortisol)
Gonadocorticoids (androgens, estrogen)

Question 5

Primary disorder

Answer 5

Something wrong with the gland itself

Question 6

Secondary disorder

Answer 6

Something wrong with a different gland or organ that affects the endocrine gland

Question 7

Cortisol

Answer 7

Regulates metabolism
Increases blood glucose
Stress response

Question 8

Cushing syndrome

Answer 8

High levels of cortisol in the blood

Can also affect aldosterone and androgens

Question 9

Cushing syndrome causes

Answer 9

Chronic exposure to excess corticosteroids particularly glucocorticoids
Exogenous corticosteroid administration like prednisone

Question 10

Cushing disease

Answer 10

More serious
Pituitary Cushing disease or adrenal Cushing disease
High levels of cortisol all the time

Question 11

Pituitary Cushing disease

Answer 11

Over secretion of act in pituitary usually from pituitary adenoma
Causes adrenals to over secrete cortisol

Question 12

Adrenal Cushing disease

Answer 12

Excess glucocorticoids caused by a problem in the adrenal cortex such as an adrenal adenoma which is usually benign

Usually only occurs in one adrenal gland

Question 13

Cushing’s syndrome manifestations

Answer 13

Weight gain with trunkle obesity and thin arms and legs due to muscle wasting and weakness
Moon face and buffalo hump
Hyperglycemia
Osteoporosis due to cortisol interfering with osteoblast formation
Loss of collagen leading to stretch marks also known as striae
Immunosuppression and increased risk for infection
psychosocial changes such as irritability anxiety euphoria and psychosis

Question 14

Mineral corticoid excess in Cushing’s syndrome

Answer 14

Salt and water retention, hypertension, and bounding pulse

Question 15

Adrenal androgen excess in Cushing’s syndrome

Answer 15

Acne, amenorrhea, virilization in women (developing male characteristics) and hirsutism

Question 16

Care of Cushing syndrome patients

Answer 16

Vital signs, watching for fluid overload
Mental status
Laboratory tests: glucose, cortisol, acth, potassium

Question 17

Cushing syndrome priority nursing diagnoses

Answer 17

1. fluid overload
2. Risk for injury related to skin thinning poor wound healing and bone density loss
3. Risk for infection

Question 18

Addison’s disease

Answer 18

Primary cause of adrenocortical insufficiency

lack of glucocorticoids and or mineral corticoids and or androgens

Question 19

Addison’s disease primary causes

Answer 19

Autoimmune (aids, tb)

Bilateral adrenalectomy

Question 20

Addison’s disease secondary causes

Answer 20

Pituitary or hypothalamus problem

Abrupt discontinuance of long-term steroids

Question 21

Addison’s disease clinical manifestations

Answer 21

Hypotension due to insufficient aldosterone
Dizziness due to hypotension
Progressive weakness
Fatigue and confusion
Weight loss and anorexia
Hyperpigmentation of skin
Hypovolemia
Hypoglycemia
Hyponatremia
Hyperkalemia
Irritability and depression

Question 22

Addison’s disease treatment

Answer 22

Hormone therapy
Hydrocortisone has glucocorticoid and mineralo corticoid properties
Prednisone
Possible sex hormone replacement
Given in divided doses at the same time each day to mimic the way the body releases hormones throughout the day
during times of illness or stress they may need to increase dosage temporarily

Question 23

Addison’s disease nursing interventions

Answer 23

Correct fluid and electrolyte imbalance and monitor weight daily
Administer corticosteroids
Cardiac monitoring necessary due to hyperkalemia
assess for manifestations of addisonian crisis or Cushing syndrome
Educate patient to manage stress, high sodium low potassium diet, be careful of heat because sweating can lead to sodium loss, take medications at the same time everyday

Question 24

Addisonian crisis AKA acute adrenal insufficiency

Answer 24

Life-threatening condition emergency! Coma and death can result!

need for cortisol and aldosterone is greater than available supply

occurs in response to a stressful event or sudden sharp decrease in these hormones (adrenalectomy)

Question 25

Addisonian crisis signs and symptoms

Answer 25

Fluid volume deficit, hypoglycemia, hyponatremia, hyperkalemia
Shock (bp, HR)
Lethargy which can lead to coma and death

Question 26

Addisonian crisis treatment

Answer 26

Manage symptoms of shock
Give high dose of hydrocortisone replacement
IV fluids with dextrose
Electrolyte replacement
High doses of IV glucocorticoids example solu- cortef

Question 27

Long-term corticosteroid therapy risks

Answer 27

Increased risk for infection, osteoporosis, GI ulceration, fluid and electrolyte imbalances
Risk of Cushing’s syndrome

Abrupt discontinuation may lead to adrenal insufficiency

Question 28

Hyperaldosteronism (Conn’s syndrome)

Answer 28

Excessive secretion of aldosterone

Can be caused by tumor on adrenal glands

Question 29

Hyperaldosteronism (Conn’s syndrome) can cause

Answer 29

Hypernatremia
Hypokalemia
Metabolic alkalosis

Question 30

Hyperaldosteronism (Conn’s syndrome) interventions

Answer 30

Adrenalectomy
Spironolactone (aldosterone antagonist) therapy if unable to perform surgery

Question 31

Pheochromocytoma

Answer 31

Tumor in adrenal medulla

Causes excess production of catecholamines, epinephrine and norepinephrine

Question 32

Pheochromocytoma symptoms

Answer 32

Severe episodic hypertension with classic triad of associated symptoms:
Severe pounding headache, tachycardia with palpitations and profuse sweating, unexplained abdominal or chest pain

Question 33

Pheochromocytoma diagnostic tests

Answer 33

24 hour urine for metanephrines and vanillymandelic (VMA)

CT or MRI

Question 34

Pheochromocytoma treatment

Answer 34

Primary treatment is surgery to remove tumor

Post-op care similar to adrenalectomy
May be put on CCB, BB, alpha blockers
HRT

If surgery is not an option medication can be given to decrease catecholamine production by tumor