T2: Cushings & Hyperaldosteronism

Question 1

Cushing syndrome

Answer 1

a clinical condition that results from chronic exposure to excess corticosteroids (hyper function on adrenal), particularly glucocorticoids, mineral corticoids, androgens
“SUGAR SALT SEX”

Question 2

common causes of cushing syndrome

Answer 2

-Iatrogenic administration of exogenous corticosteroids
-ACTH-secreting pituitary adenoma-85%
-Adrenal tumors
-Ectopic ACTH production by tumors-lung-pancreas

Question 3

manifestations of cushing syndrome

Answer 3

-Moon-face,
-Buffalo Hump
-Truncal/Android Obesity
-Purplish Striae
-Thin, Fragile Skin
Florid Cheeks, Acne
- muscle wasting, osteoporosis, back pain
-Poor Wound Healing
-LE Edema
-Hyperglycemia

Question 4

excess glucocorticoids cause

Answer 4

-Hyperglycemia related to glucose intolerance and ↑ gluconeogenesis
-Muscle wasting → weakness
-Loss of bone matrix → osteoporosis and back pain
-Loss of collagen → thin skin, easily bruises
-Delay in wound healing

Question 5

excess mineralcorticoids cause

Answer 5

-Hypokalemia
-Hypertension

Question 6

excess androgen cause

Answer 6

-Severe acne
-Virilization in women
-Feminization in men

Question 7

diagnostic studies for cushing syndrome

Answer 7

• blood draw of ACTH
  -MRI or CAT scan on pituitary

Question 8

what ACTH levels indicate cushing DISEASE

Answer 8

high or normal

Question 9

what ACTH levels indicate cushing SYNDROME

Answer 9

low

Question 10

treatment for cushing syndrome

Answer 10

-Surgical removal or irradiation of pituitary adenoma
-Adrenalectomy for adrenal tumors or hyperplasia
-Removal of ACTH-secreting tumors
(pituitary problem: surgery, radiation, chemo)

Question 11

treatment for cushing syndrome if the cause of iatrogenic

Answer 11

-Gradually discontinue therapy
-Decrease dose
-Convert to an alternate-day regimen
-Dose must be tapered gradually!!

Question 12

alternate-day regimen

Answer 12

used to treat iatrogenic cushings: daily dosage of a shorter-acting corticosteroid is given every other morning to minimize hypothalamic-pituitary-adrenal suppression, growth suppression, and altered appearance.

Question 13

labs for cushings

Answer 13

-↓ Potassium level
-↑ Glucose level
-↑ Serum cortisol level
-Abnormal ACTH levels

Question 14

health promotion for cushings

Answer 14

-Identify patients at risk for Cushing syndrome
-Long-term exogenous cortisol therapy is major risk factor
-Teach patients about medication use and to monitor for side effects

Question 15

nursing implementation: acute care

Answer 15

monitor VS, daily weight, glucose

Question 16

nursing implementation: assess for s/s of

Answer 16

Inflammation/infection
-Thromboembolism (sudden chest pain, dyspnea, tachypnea)

Question 17

nursing implementation: emotional support

Answer 17

-Patient may feel unattractive or unwanted
-Remain sensitive to patient’s feelings and be respectful
-Reassure patient that physical changes and emotional lability will resolve when hormone levels return to normal

Question 18

nursing implementation: preop care

Answer 18

-Optimize physical condition
-Control hypertension and hyperglycemia
-Correct hypokalemia
-High-protein diet to correct protein depletion
-Depends on planned surgical approach

Question 19

nursing implementation: postop care

Answer 19

-HIGH DOSES OF CORTICOSTROIDS ARE GIVEN IV DIRNG AND SEVERAL DAYS AFTER SURGERY
-bed rest until BP is stabilized
-↑ Risk of hemorrhage
-Large release of hormones into circulation → instabilities in BP, fluid balance, and electrolyte levels
-obtain morning urine samples for cortisol measurement

Question 20

why are corticosteroid dosages tapered after surgery

Answer 20

*If corticosteroid dosage is tapered too rapidly after surgery, acute adrenal insufficiency may develop.

Question 21

s/s of acute adrenal insufficiency

Answer 21

-Vomiting, increased weakness
-Dehydration, hypotension
-Painful joints
-Pruritus
-Peeling skin
-Severe emotional disturbances

Question 22

ambulatory care

Answer 22

-Home health nurse
-Wear MedicAlert bracelet at all times
-Avoid exposure to extremes of temperature, infection, and stress
-Teach how to adjust medication and when to call health care provider
-Lifetime replacement therapy