Test 4: Neuro, Onc and Endocrine Flashcards
What type of meningitis is more severe, and what causes it?
Bacterial-Neisseria meningitidis which causes meningococcal meningitis
What are the causes of viral meningitis?
Mumps
Measles
Herpes
Arboviruses
How is viral meningitis prevented?
MMR Vaccine
What is the vaccine schedule for MMR vaccination?
1st vaccine at 12-15 months and 2nd at 4-6 years of age
How can bacterial meningitis be prevented?
Hib vaccine given at 2 months, 4 months, (6 months) and 12 to 15 months of age
What is the hallmark symptom of bacterial meningitis?
Excruciating constant headache
What are the subjective signs of bacterial meningitis?
Excruciating, constant headache (HALLMARK)
Nuchal Rigidity (stiff neck)
Photophobia
Altered mental status (patient is deteriorating)
What are the objective symptoms of bacterial meningitis?
Pallor, cold extremities with high fever, signs of shock (early s/s)
Fever, Chills
N/V
Stomach/joint/muscle pain
LOC (confusion, disorientation, lethargy, difficulty swallowing, coma)
+ Kernig’s Sign
+ Brudzinski’s Sign
May not be very obvious due to nucal rigidity
Hyperactive deep tendon reflexes
Tachycardia
Tachypnea
Seizures
Red Macular Rash
Restlessness, irritability
What are Kernigs and Brudzinki’s signs?
Kernig’s: Knee cannot fully extend when patient is supine and hip is flexed 90 degrees
Brudzinki’s Neck sign: passive flexion of the neck causes flexion of both legs and thighs
What is the ‘glass test’ in regards to meningitis?
Macular red rash from meningitis will not blanche when glass is pressed against it
Meningitis, when exhibited in older adults, immunocompromised patients, or patients on antibiotics may not exhibit what symptom?
A fever
What labs should you collect on a patient with meningitis?
Urine
Throat
Nose
Blood Culture and Sensitivity
**Basically you are trying to identify the possible infectious bacteria asap to be able to administer antibiotic
What is the most definitive diagnostics for meningitis?
A lumber puncture for CSF analysis
What is the alternative diagnostic measure if there is a delay in a lumbar puncture?
Blood Culture and Sensitivity
What is a lumbar puncture for CSF analyzed for?
Cell Count
Differential Cell Count
Glucose concentrations
Culture/sensitivity/gram stain
How many tubes of CSF will be collected during the lumbar puncture?
3-5
If the meningitis is bacterial, what results will we see on a CSF?
Cloudy
Increased protein, WBC, CSF Pressure
Decreased glucose
If the meningitis is viral, what results will we see on a CSF?
Clear
Increased protein, CSF Pressure
Normal Glucose
Inability to move the eyes to the left (6th cranial nerve defect) can indicate?
The development of hydrocephalus
In older patients with meningitis, what should you also monitor for?
Pneumonia
Meningitis Medications:
Antibiotic:
Ceftriaxone or Cefotaxime
Meningitis Medications:
Anticonvulsant:
Phenytoin
Meningitis Medications:
Antipyretic:
Acetaminophen
Meningitis Medications:
Analgesic:
Non-opioid because you do not want to alter mental status
What is a normal ICP pressure?
5-15mmHg
A hallmark of a transient ischemic attack is that if there are any deficits/symptoms, they typically resolve within?
24 hours
What are the causes of a hemorrhagic stroke?
HTN
Aneurysm
AV malformation
head injury
subarachnoid hemorrhage
What are the three causes of ischemic strokes?
Thrombotic
Embolic
Infarct and pneumbra
What is the difference between an embolic cause and a thrombotic cause of an ischemic stroke?
Thrombotic: atherosclerotic plaque in cerebral artery
Embolic: Embolus travels from a distant location to the cerebral artery
The most common reason for an embolic cause of ischemic stroke is?
A-Fib
What is the goal of stroke management?
To save the ischemic penumbra before it becomes an infarction
What are the risk factors for ischemic stroke?
A-Fib
Smoking
Oral Contraceptives
HTN
Sleep Apnea
Carotid Stenosis
Hyperlipidemia
Substance/cocaine use
Obesity
A Snake Originally Had Super Creepy Old Slimy Hands
What is the most common cause of a hemorrhagic stroke?
HTN/cocaine use
Cranial Nerves:
1
2
3
4
5
6
7
8
9
10
11
12
1) Olfactory (Smell)
2) Optic
3) Oculomotor (Ability to move or blink)
4) Trochlear (ability to move eyes up/down and back and forth
5) Trigeminal (sensation in face/cheeks, taste)
6) Abducens (ability to move your eyes)
7) Facial Nerve (facial expressions and taste)
8) Auditory/vestibular (Sense of hearing/balance)
9) Glossopharyngeal nerve (Ability to taste and swallow)
10) Vagus nerve (Digestion and heart rate)
11) Accessory nerve (or spinal accessory nerve (
Shoulder and neck muscle movement)
12) Hypoglossal nerve: Ability to move your tongue.
Only Owls Often Taste Tacos And Fresh Guacamole Very Aloofly, Huh?
What is the treatment for ischemic stroke?
Initiate ASA or antiplatelet to prevent stroke
-DAT (dual antiplatelet therapy-aspirin and clopidogrel)
Txt Between 3 and 4.5 hours from onset of symptoms
Control of blood glucose
Decrease HTN (MAP goals)
Control of lipids
In cerebral autoregulation, hypoxia and hypercapnia cause?
Vasodilation
In cerebral autoregulation, hypocapnia causes?
Vasoconstriction
What is the formula for cerebral perfusion pressure?
CPP=MAP-ICP
What is a normal cerebral perfusion pressure?
Normal CPP: 60-80 mmHg
What MAP do we want to see to insure cerebral perfusion?
MAP > 60 mmHg to maintain perfusion
Normal is between 70 and 110
What are the common s/sx of a stroke?
Common s/s include:
Facial weakness, droop, or numbness
Arm/leg weakness, drift, or numbness
Slurred speech confusion , or trouble
understanding others
Sudden change in vision
Dizziness, trouble walking, loss or balance or coordination
Sudden severe HA with no known cause (hemorrhagic; worst headache ever)
How is the NIH Stroke scale scored?
Range of 0 (no deficits) to 42 (significant deficits)
Lower the number the better the outcome
< 4 = highly likely to have good clinical outcomes (minor stroke)
21-42 = severe stroke
A rapid bedside assessment for a stroke includes?
Cognitive changes (LOC and commands)
Drift of eyes in direction of stroke
Motor Changes (facial palsy, arm and leg drift, ataxia via heel-shin)
Sensory changes (Numbness, tingling)
Language/aphasia/Dysarthria
Neglect (Innattention)
Cats Literally Don’t Make Sense Normally
What is Dysarthria?
Tongue, mouth and lips no longer functional to produce speech
Impaired articulation, slurred speech
What is hemianopia?
Hemianopia– loss of vision in either R or L sides of both eyes
Ensure to ask patient’s to read or ask what they see
What is agnosia?
Agnosia– loss of ability to recognize objects, persons, sounds, shapes
What is apraxia?
Apraxia– unable to perform tasks or movements when asked (command understood)
What is hemiparesis?
Hemiparesis– weakness on one side of body
What is hemiplegia?
Hemiplegia– total paralysis of one side of body (arm, trunk, leg)
What is Broca’s aphasia?
Expressive (Broca’s)– comprehension, but unable to express thoughts coherently
They know it’s cup but they can’t say its a cup
What is Wenicke’s aphasia?
Receptive (Wernicke’s)– inability to understand spoke or written language
Right-sided or frontal lobe strokes may exhibit what types of symptoms?
Impulsivity, impaired judgment, impaired attention span
(Might get out of bed when told not to, or drink out of the urinal)
What labs should you run for a stroke patient?
CBC
BMP
Platelets
PT/INR, aPTT
Glucose (to rule out hypoglycemia)
What are the different types of diagnostics for strokes?
CT without contrast***
MRI (Superior to CT for ischemic lesions within first 24 hours)
Carotid Duplex/Vascular Study
Cerebral angiogram
Lumbar Puncture
Myelogram
*You need to determine whether the suspected stroke is not hemorrhagic in nature, Add contrast AFTER without
If a stroke patient suddenly has an increase in blood pressure, what is the nursing priority?
Notify the provider
If BP>185mmHg call Rapid Response
To what O2 saturation should you keep a stroke patient above?
94%
If one side of a stroke patient is affected, what are the nursing actions?
Dress affected side first
Do not use affected arm for BP readings, to move up in bed, etc.
What are the preventative medications for strokes?
Ischemic:
Hemorrhagic:
Ischemic: antiplatelets (ASA, clopidogrel)
Hemorrhagic: HTN management
What are the medications for acute ischemic stroke treatment?
Fibrinolytic therapy: tPA (tissue plasminogen activator)
Newer: Tenecteplase TNK (recombinant fibrinolytic agent)
Anticoagulants: Heparin, warfarin
Anticonvulsants: Phenytoin
Meds to ↓ ICP: Mannitol, loop diuretics
How is tPA (tissue plasminogen activator) administered?
What about TNK?
tPA: given within 3-4.5 hours of onset of symptoms
Bolused and given over 60 minutes; weight-based
TNK: Given as a one-time bolus; weight-based
What type of stroke should tPA NOT be used?
Hemorrhagic
What levels do we want to see prealbumin at for stroke patients?
Prealbumin 16-30 mg/dL
What does FAST stand for?
Rapid recognition and response to early warning signs (FAST)
Facial droop, Arm weakness, Speech difficulty, Time is critical
What is the negative feedback loop for thyroid hormones?
Hypothalamus signals anterior pituitary to release TSH (thyroid stimulating hormone) which then stimulates the thyroid to produce T3 and T4. T4 is then converted to T3 in the peripheral tissue. If too much T3, the hypothalamus is signaled to stop sending messages to the anterior pituitary.
What is Thyrocalcitonin?
Inhibits calcium reabsorption from bone
What are the normal levels of thyroid stimulating hormone?
~4 (0.5 to 5.0 mIU/L)
What is the difference between a primary and secondary alterations in the thyroid hormone system?
Primary Alterations: Disease of thyroid
Secondary: Disease of Pituitary
What types of medication can cause hypothyroidism?
Lithium
Amiodarone
Sulfonylureas
What are the laboratory trends for hypothyroidism?
↑ TSH (primary)
↓ or normal TSH (secondary)
↓ T3- Triiodothyronine
↓ T4- Thyroxine
What would be the results of a thyroid scan– radioisotope uptake?
Determines whether or not the thyroid is working
Uptake will be low in hypo and high in hyperthyroid
Serum Cholesterol levels will be high in what type of thyroid disorder?
Hypothyroidism because they are not able to use fatty acids properly
Patients with hypothyroidism will have to do what for the rest of their lives?
Lifelong thyroid hormone replacement– T4
Normally in form of Levothyroxine
What is the hallmark disease for hypothyroidism?
Hashimotos
How long will it take levothyroxine to reach therapeutic levels?
Will take approx. 4 weeks to achieve steady state blood level of medication
What is the hallmark disease for hyperthyroidism?
Grave’s disease
Besides Graves Disease, what other disorders could cause hyperthyroidism?
Goiter
Hyperfunctioning Thyroid Nodules
Thyroiditis
Postpartum (inflammation)
Excessive Exogenous Thyroid Hormone Replacement
Excessive Intake of Dietary Iodine
What are the laboratory trends for someone with hyperthyroidism?
↓ TSH
↑ T3 levels
↑ T4 levels
What would you see on an ECG of a patient with hyperthyroidism?
ECG– tachycardia, atrial fibrillation, dysrhythmias
What is the nursing priority when caring for a patient with hyperthyroidism?
Report temperature ↑ of ≥ 1° F (possible impending thyroid crisis)
What are some of the nursing actions for a patient with hyperthoidism?
Pace activity with rest periods
↓ stimulation (avoid palpation)
Monitor ECG for dysrhythmias-There should be a telemetry order for these patients. If there is not, you as the nurse need to ask for one
↑ HOB to ↓ eye pressure
Keep environment cool
What are the risks for a Thyroidectomy surgery?
Normally used as a treatment for hyperthyroidism, it presents a risk for laryngeal nerve damage and parathyroid damage.
What is a complication of damage to the parathyroid gland?
The parathyroid gland is responsible for calcium balance
Besides a Thyroidectomy, what other treatment options are there for hyperthyroidism?
Radioactive Iodine (RAI) treatment
Anti-thyroid medications
Ablation surgery
Before a patient can have any type of thyroid surgery, what needs to occur?
euthyroid state required before
What is the nutritional guidelines for patients with hyperthyroidism?
↑ Calories (high protein)
↑ Vitamin supplements
Calcium supplements to combat bone demineralization
Small, frequent meals
Avoid excessive iodine intake
What is the nursing guidance for patients undergoing Radioactive Iodine therapy for hyperthyroidism?
Avoid pregnant women and children for approx. 7 days s/p tx
Keep > 3 ft away from others
Avoid use of same bathroom for 2 weeks; flush toilet twice
Rinse washing machine before washing other family members’ clothes
Sleep alone for up to 7 days
Avoid public transportation for 7 days
Can trigger radiation monitors at airports for up to 3 mos s/p tx
↑ fluid intake and urinate frequently
What medication is the synthetic T4 replacement?
Levothyroxine (Synthroid)
What is the nursing guidance for patients taking levothyroxine?
Small difference between generic and brand name
Maintain the same Rx inpatient/discharge
Start with small dose (112mcg) and increase slowly
Take 1 hr before meals or 3 hours after meals
Do not take within 4 hours of antacids, iron, calcium, PPIs
What two drugs can Levothyroxine affect?
Can increase the effects of Warfarin, and digoxin
What are the two thioamide drugs used to treat hyperthyroidism?
Methimazole (Tapazole)
Propylthiouracil (PTU)
What does Methimazole do?
For hyperthyroidism– inhibits production of thyroid hormone, and is often given before radioactive iodine treatment
What are the nursing considerations for methimazole?
Fewer side effects than PTU
Taken 1x/day (Better adherence)
Itching, rash, hives, joint pain, change in taste
Agranulocytosis– Report fever, sore throat, jaundice, bruising
Pancreatitis
Avoid during early pregnancy
What does Propylthiouracil do?
For hyperthyroidism– inhibits production of thyroid hormone AND blocks conversion of T4 to T3 in periphery
Often drug of choice for thyrotoxicosis
What are the nursing considerations for Propylthiouracil?
Taken 3-4x/day
Itching, rash, hives, joint pain, change in taste
Agranulocytosis– Report fever, sore throat, jaundice, bruising
Liver damage, vasculitis
Okay in pregnancy
How can propanol help to treat hyperthyroidism?
Control symptoms of adrenergic activation (HR, BP, tremors)
May help prevent peripheral conversion of T4 to T3
What is Thyrotoxicosis (Thyroid Storm)?
Increased release of thyroid hormones
Precipitated by sudden worsening of hyperthyroid symptoms like surgery or severe illness or caused by digoxin toxicity, DKA, trauma, infection
What are the symptoms of thyrotoxicosis?
Profound hyperthermia (40.5°C, 105°F)
Severe tachycardia, dysrhythmias, HTN → hypotension & ↓ CO, HF
Restlessness, agitation, tremors, unconsciousness, coma
What are the priority nursing interventions for thyrotoxicosis?
place on monitor, O2, fluids, high doses of iodine and propylthiouracil, propranolol
Immediate endocrine consult
What is a Myxedema Coma?
Severe deficiency in thyroid hormone
Precipitated by abrupt cessation in exogenous hormone, severe illness
What are the symptoms of a Myxedema Coma?
Profound hypotension, bradycardia, ↓ CO, hypothermia, hypoglycemia
What are the nursing priority interventions for myxedema coma?
IV thyroid hormone (T4)
O2
Temp control
Cardiac monitoring
Fluids
What do these symptoms indicate??
Hypocalcemia, Chvostek’s Sign, Trousseau’s Sign, tingling of fingers, toes, or mouth, tetany, seizures
Damage to the parathyroid gland
What are the nursing priority interventions for a damaged parathyroid gland?
Institute seizure precautions, prepare for calcium replacement, constipation prevention, fall & injury risk precautions
What are the symptoms of Hypoparathyroidism?
hypocalcemia
hyperphosphatemia
paresthesia, muscle cramps, fatigue
What can cause hypoparathyroidism?
neck surgery radiation, autoimmune, hereditary, hypomagnesemia
What are the nursing interventions for hypoparathyroidism?
calcium replacement, Vit D replacement, magnesium replacement, stool softeners
Why are calcium supplements and stool softeners often given together?
Calcium supplements can often cause constipation, hence the stool softeners
What are the symptoms of Hyperparathyroidism?
hypercalcemia
hypophosphatemia
osteoporosis
renal calculi
bone pain
nausea
anorexia
abdominal pain
“Disease of bones, groans and moans”
What can cause hyperparathyroidism?
parathyroid hyperplasia, CKD, calcium and vit D deficiency
What are the nursing interventions for hyperparathyroidism?
hydration
diuretics (to help with fluid volume retention)
parathyroidectomy
fall & injury precautions
What is one of the main functions of the posterior pituitary gland?
secretion of Antidiuretic Hormone (ADH)/Vasopressin
Controls serum osmolarity & water balance via effecting water reabsorption in distal renal tubules
What is diabetes insipidus?
ADH deficiency or inability of kidneys to respond to ADH
Excretion of large amounts of dilute urine
What are the two different origins of diabetes insipidus?
Neurogenic: Head injury/TBI, Tumor, Surgery or irradiation near pituitary, meningitis
Nephrogenic: Lithium, Renal Damage
What are some of the signs and symptoms of diabetes insipidus?
Hypovolemia
Excessive water excretion & dehydration
Dilute urine
Polyuria (5-30 L/day)
Nocturia
Polydipsia (2-20 L/day)
Acute weight loss
S/s of dehydration
S/s of hypernatremia
S/s of hyperkalemia
What are these symptoms a sign of?
Hypotension, tachycardia, weak pulses, thirst, dry mucous membranes, decreased skin turgor
Dehydration
What are these symptoms of?
Muscle irritability and twitching, ↑ DTRs, restlessness progressing to confusion
Hypernatremia
What are these symptoms of?
Peaked T waves, dysrhythmias, diarrhea, metabolic acidosis
Hyperkalemia
What trends would you see in the serum chemistry for diabetes insipidus?
↑ Sodium (> 145 mEq/L)
↑ Potassium (> 5.0 mEq/L)
↑ Osmolality (> 295 mOsm/kg)
↓ ADH
What trends would you see in the urine chemistry for diabetes insipidus?
↓ Sodium
↓ Potassium
↓ Osmolality (↓ specific gravity, < 1.005)
What is the Water Deprivation Test?
+ for DI if polyuria persists in presence of dehydration (kidneys cannot concentrate urine)
If DI is present, there will be no concentration of urine
What are the two diagnostic tests for diabetes insipidus?
Water Deprivation Test
Vasopressin Challenge Test
What is the Vasopressin Challenge Test?
+ for DI if urine specific gravity ↑ after administration of vasopressin
Diabetes Insipidus is also known as ________ insufficiency.
ADH insufficiency
What are signs of water intoxication?
Headache
Confusion
Why should someone with DI avoid caffeine?
Because caffeine exhibits a diuretic effect
What is Desmopressin?
A synthetic ADH that can be given to patients with DI
Which form of desmopressin is stronger? IV or PO
The IV (parental) form of desmopressin is 10x stronger than the oral form and the dosage must be reduced
What medications would be expected on the MAR for a patient with diabetes insipidous?
Desmopressin
Thiazide Diuretic
Insulin/Kayexelate
Why would you administer a thiazide diuretic to a patient with DI?
To facilitate ADH action and potassium wasting
What are the complications from DI?
Dehydration
Circulatory Collapse
Seizures
What is a disorder of ADH excess?
SIADH
Syndrome of Inappropriate Antidiuretic Hormone
What normally inhibits ADH production and secretion?
Decreases in plasma osmolarity
What things can cause SIADH?
Tumors
Increased intrathoracic pressure (mechanical ventilation)
Head injury
Stroke
Medications
What are the types of medications that can cause SIADH?
Chemotherapeutic Agents
TCAs
SSRIs
Opioids
Fluoroquinolone antibiotics
What are the early SSAs for SIADH?
Hypervolemia
Fluid Retention
Concentrated urine
Oliguria
Anorexia
Headache
Muscle cramps
Acute weight gain
S/S of fluid volume overload
S/S of hyponatermia
S/S of hypokalemia
What are the late SSAs for SIADH?
Decreased deep tendon reflexes
N/V
Seizures
Diarrhea
Change in personality
What are the signs/symptoms of hyponatremia?
Muscle weakness
Decreased DTR
Confusion
Lethargy
Seizures
What are the signs/symptoms of hypokalemia?
Flat or inverted T-waves
Dysrythmias
Irregular Pulse
Paresthesia
Constipation
Metabolic Acidosis
What trends would you see in the serum chemistry for SIADH?
↓ Sodium (< 135 mEq/L)
↓ Potassium (< 3.5 mEq/L)
↓ Osmolality (< 275 mOsm/kg)
↑ ADH
What trends would you see in the urine chemistry for SIADH?
↑ Sodium
↑ Potassium
↑ Osmolality (↑ specific gravity)
What are the first-do priorities for SIADH?
Fluid restriction <1 L a day
Daily weights
s/s of heart failure from fluid volume overload
s/s of pulmonary edema
Monitor for altered mental status
Cardiac Dysrythmias
Flush enteral tubes w/NS instead of water
What medications are used to treat SIADH?
Loop Diuretics (furosemide)
Vasopressin Antagonists
Hypertonic 3% NaCL administered through a central line
What are the complications of SIADH?
Water intoxication
Cerebral edema
Cheyne-Stokes Ventilation Pattern
Pulmonary edema
Severe Hyponatremia
Seizures
Coma
Central pontine myelinolysis
What is a glucocorticoid?
Known more as Cortisol, it diverts amino acids from the metabolism from building into supplying energy to deal with stress
Increased glucocorticoid ______ gluconeogenesis and __________ peripheral glucose utilization.
Increased glucocorticoid increases gluconeogenesis and decreases peripheral glucose utilization.
What occurs to protein breakdown when the levels of glucocorticoids are increased?
Protein synthesis is suppressed which can lead to a loss in muscle mass from the extremities
In patients with increased glucocorticoids, why do we see a pot belly, moon face, and buffalo hump?
Glucocorticoids stimulated lipolysis and fat redistribution
What effect do glucocorticoids have on bone?
It increases osteoclast activity and decreases osteoblast activity
What does mineralocorticoid do?
Also known as Aldosterone, it regulated Na+ and K+ balance by promoting reabsorption of sodium and renal excretion of potassium
What effect does mineralocorticoid Aldosterone have on blood volume and pressure?
It increases blood volume and increases blood pressure by decreasing urine output
Why is Addison’s disease also known as ‘double d’?
Decreased cortisol
Decreased aldosterone
The disease of ‘not enough’
What causes Addison’s disease?
Hypofunction of the adrenal gland normally autoimmune in origin
What are the endogenous risk factors for Addison’s Disease?
Auto-Immune mediated destruction of the adrenal glands
Deficiency in ACTH secretion
Adrenal Infarction
Infection
Metastatic Cancer
Bilateral adrenalectomy
Adrenal Hemorrhage
What are the exogenous risk factors for Addison’s Disease?
Abrupt discontinuation of chronic pharmacological steroids that can cause adrenal shock
What are some of the stand out SSAs of Addison’s disease?
Hyperpigmentation
Thinning of public and axillary hair
Hypoglycemia
Hypotension
Hyperkalemia
Hyponatremia
What trend will you see in the lab values for sodium, potassium, calcium and glucose in a patient with Addison’s Disease?
Decreased sodium and glucose
Increased potassium and calcium
What are the diagnostic tests for Addison’s Disease?
Adernocorticotropic hormone test
Stimulation test
ECG
CT
MRI
What are the nutritional needs of a patient with Addison’s Disease?
Increased calories, carbohydrates, and sodium
Decreased potassium
What will you administer to a patient with Addison’s disease at the lowest level first?
Exogenous glucocorticoid
You administer it slowly so that the pendulum does not swing in the other direction
What is an “Addisonian Crisis” or adrenal crisis?
A life-threatening event in which the need for cortisol and aldosterone is greater than the body’s supply and normally results from an abrupt discontinuation of pharmacological steroids
What are the signs and symptoms of an Addisonian Crisis?
Severe hypotension
Hyponatremia
Hyperkalemia
Dehydration->circulatory shock
Hypoglycemia
What is the treatment of an Addisonian Crisis?
Fast-Acting IV glucocorticoid replacement
(May require a mineralocorticoid as well)
Dextrose IV
Loop Durietics/kayexalate/dextrose+insulin (Potassium wasting drugs)
Seizure precautions
What is Cushing’s Syndrome?
Hyperfunction of the adrenal gland that causes adrenocortical excess resulting in increased glucocorticoids and mineralocorticoids
What are the endogenous risk factors for Cushing’s syndrome?
ACTH-secreting pituitary tumor
Adrenal Tumors
ACTH-secreting tumors of lungs or pancreas
What are the exogenous risk factors for Cushing’s syndrome?
High-dose, chronic administration of pharmacological steroids (for autoimmune diseases, asthma, cancer tx, etc) for more than 2 weeks
What are some of the physical SSAs of Cushings syndrome?
Changes in fat distribution:
Moon face
Buffalo hump
Abdominal adiposity
Muscle wasting
Ecchymosis
Petechiae
Weight gain
Hirsutism
What are some of the metabolic SSAs of Cushing’s syndrome?
Hyperglycemia
Glucosuria
Increased appetite
Peptic ulcers
What are some of the physiological symptoms of Cushing’s syndrome?
Osteoporosis
Irritability
HTN
Arrythmias
Cardiac Hypertrophy
Infection from excess glucose
What trend in the lab values for sodium, potassium, calcium and glucose would you see in Cushing’s Syndrome?
Increased sodium and glucose
Decreased potassium and calcium
What are some of the diagnostics to test for Cushing’s Syndrome?
Blood and Salivary cortisol levels
24hr urine for free cortisol level
Dexamethasone suppression test
ECG
CT
MRI
What is the dexamethasone suppression test for Cushing’s syndrome?
Administration of dexamethasone in the evening at bedtime, then collect a 24 hr urine.
If the patient does not have Cushing’s, then the cortisol levels will not go up.
If cortisol excretion continues despite administration of dexamethasone, Cushing’s is present
What should you be monitoring in a patient with Cushing’s syndrome?
VS
Neuro
S/S of infection
GI Bleed (Dark, tary stools)
Blood glucose
S/S of fluid overload
Because GI bleeds can be common due to peptic ulcer formation in Cushing’s syndrome, what medication should you administer?
H2 receptor Blocker
What are the nutritional recommendations for Cushing’s Syndrome>
Low sodium
Low Fat
High potassium
High Calcium
ADA diet if hyperglycemic
What are the potential complications of Cushing’s syndrome?
Severe:
Hypernatremia
Hypokalemia
Hypocalcemia
Seizures (secondary to hypokalemia)
Why are patient’s with Cushing’s sydrome at an increased risk for peptic ulcer development?
Increased cortisol=loss of gastric mucosal protection
Addison’s Patients will require lifelong?
Lifelong physiological glucocorticoid replacement
Both Addison’s and Cushing’s patient should wear?
A medical alert bracelet
What is a pheochromocytoma?
A tumor in the adrenal medulla that produces excess catecholamines (epi, norepi)
What are the signs and symptoms of a pheochromocytoma?
Tachycardia
HTN
HA
Angina/palpitations/dysrythmias
Increased temperature, diaphoresis, heat intolerance
N/V
If a patient has uncontrolled hypertension, even after the administration of anti-hypertensive medication, what could be suspected?
A pheochromocytoma
What should you monitor for a patient with pheochromocytoma?
VS
Neuro
Development of HTN crisis
What can you expect to administer to a patient with a pheochromocytoma?
Antihypertensives
Alpha Adreneric Blockers
Beta Blockers
What is the treatment for a pheochromocytoma?
Adrenalectomy
What are the adverse effects of chemotherapy?
NAUSEA*
N: Non-productive cough/fever/tachypnea/pneumonia
A: Anemia
U: Uricemia
S: Stomatitis
E: Elimination problems (anorexia, nausea, vomiting, constipation)
A: Alopecia
Can a patient undergoing internal radiation have visitors?
Yes for under 30 minutes and they must stay 6 feet away
What is Superior Vena Cava Syndrome?
MEDICAL EMERGENCY
Compression of the superior vena cava results in swelling from the shoulders up, and the patient turns bright red and cannot breathe
How is superior vena cava syndrome treated?
Radiation, Steroids and Chemo
