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Module 4 > UNIT 4- ADRENAL DISORDERS > Flashcards

UNIT 4- ADRENAL DISORDERS Flashcards

1
Q

What adrenal disorders can arise from problems within the adrenal cortex?

A
  1. Addison’s disease
  2. Cushing’s syndrome
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2
Q

What adrenal disorders can arise from the medulla?

A
  1. Pheochromocytoma
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3
Q

What is the function of the adrenal glands?
(general)

A

Adrenal glands secrete hormones which help regulate chemical balance, regulate metabolism and supplement other glands

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4
Q

What type of steroid hormones does the adrenal cortex secrete?

A
  1. Secretes mineralocorticoids
    • aldosterone- fluid balance
  2. Secretes glucocorticoids
    • Cortisol aids metabolism; when under stress;
    • aids in decreasing the immune response
  3. Secretes androgens & estrogens
    • androgens- male traits
    • estrogens- female traits
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5
Q

What is Cushing’s disease

A
  1. Disease that increases cortisol due to increased ACTH from pituitary (FYI only)
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6
Q

What causes Cushing’s syndrome?

A
  1. Use of corticosteroids
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7
Q

What are the types of Cushing’s syndrome?

A
  1. Iatrogenic: Extended use of glucocorticoid
  2. Primary: Adrenal cortex
  3. Secondary:
    • ACTH produced by CA of lung or pancreas leading to hyperplasia of a. cortex
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8
Q

What would lab work look like for a patient with Cushing’s syndrome?

A
  1. Decrease K+
  2. Increased NA & Glucose
  3. Increase cortisol (Serum & Urine)
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9
Q

What might our assessment of a patient with Cushing’s syndrome look like? (CV, MS, Psych, integument)

A

CV: HTN
MS: Osteoporosis, muscle wasting, & Weakness
Psych: Mood & Mental activity changes, psychosis
Integument: Abnormal fat deposits, fragile skin, bruising, striae, poor wound healing

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10
Q

What are examples of abnormal fat deposits?

A
  1. buffalo hump
  2. Moon face
  3. Truncal obesity w/ thin extremities
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11
Q

What are s/s of Cushing’s?

A
  1. Personality changes
  2. Moon face
  3. Increased susceptibility to infection
    • high levels of cortisol can weaken the immune system.
  4. Males: Gynecomastia
  5. Fat deposits on back
  6. Hyperglycemia
  7. CNS irritability
  8. NA & fluid retention
  9. Thin extremities
  10. Gi distress- Increased acid
  11. Females: Amenorrhea/hirsutism
  12. Thin Skin
  13. Purple striae
  14. Bruises & Petechiae
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12
Q

How is Cushing’s diagnosed?

A
  1. Confirmation of increased plasma cortisol levels
    • midnight or late night salivary cortisol
    • low-dose dexamethasone suppression test
    • 24- hour urine cortisol
      • levels >80-120mcg/24 hours
  2. Plasma ACTH levels
    • low or undetectable with Cushing syndrome
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13
Q

How do we manage Cushing’s syndrome?

A

Iatrogenic
1. Decrease corticosteroid dose
2. Change to every other day schedule
3. Taper off gradually

Medication- suppress ACTH or cortisol

Chemo and/or surgery for adrenal tumors or pituitary tumors

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14
Q

What are some nursing problems to keep in mind with a patient that has Cushing’s syndrome?

A
  1. knowledge deficit
  2. Fluid overload
  3. impaired skin integrity
  4. Altered body image
  5. Risk- for injury or infection
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15
Q

What should the nurse evaluate with a patient that has Cushing’s syndrome

A
  1. Cortisol & glucose level
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16
Q

What is Addison’s disease?

A

Hypofunction of A. Cortex

  1. A. Cortex: adrenocortical insufficiency
    • decreased glucocorticoid, mineralocorticoid, androgens
  2. Decrease aldosterone and cortison leading to increased k+, decreased NA and glucose
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17
Q

What causes Addison’s disease?

A
  1. sudden d/c of high dose steroids
  2. Destruction of the adrenal cotex
    • Autoimmune
    • sepsis
    • trauma
    • Surgery
    • kidney injury
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18
Q

What might labs look like for a patient with Addison’s disease?

A
  1. Decreased aldosterone & Cortisol
  2. Decreased Na and glucose
  3. Increased K+
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19
Q

What might our assessment of a patient with Addison’s disease look like?
(CV, GI, Skin, MS, Mental status)

A

CV: Dysrhythmia, tachycardia, hypotension
GI: N/V, anorexia, diarrhea
SKIN: Hyper-pigmentation, poor healing
MS: Muscle & Joint pain, muscle weakness & Tremor
Mental Status: Depression, emotional liability, confusion

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20
Q

What are the s/s of Addison’s disease?

A
  1. Bronze pigmentation of skin
  2. Tachycardia
  3. GI disturbances
  4. weakness & Fatigue
  5. Depression
  6. Hypoglycemia
  7. Postural hypotension
  8. Weight loss, anorexia

Adrenal crisis:
1. Profound fatigue
2. Dehydration
3. Vascular collapse (decreased bp)
4. Decreased serum NA
5. Increased K+

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21
Q

What are the diagnostic testing for Addison’s disease?

A
  1. Adrenocortical hormone level
  2. ACTH levels
  3. ACTH/CTH stimulation test.
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22
Q

What is the therapeutic management of addison’s disease?

A

Administer: Glucocorticoid & Mineralocorticoid

Nutrition: Increased ca and vit. D, Na normal to mod. increase

Observe: Addisonian crisis

Monitor: VS, I&O, daily weight, WBC’s glucose, na, k, & CA

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23
Q

What should we educate Addison’s patients on?

A
  1. Medication- prescribed and OTC
  2. Stress/ sick day regime
  3. Symptoms to report
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24
Q

Addisonian crisis is precipitated by?

A
  1. Stress
  2. Trauma
  3. Abrupt d/c of corticosteroid use
  4. Infection
  5. Surgery
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25
Q

What are the s/s of Addisonian crisis?

A
  1. decreased Na and glucose
  2. H/A
  3. Weakness
  4. abd, leg & low back pain
  5. increased k+
  6. severe decreased bp
  7. irritable/confusion
  8. shock
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26
Q

Addisonian crisis care includes?

A
  1. shock management
  2. High-dose hydrocortisone replacement
    • monitor for Cushing
  3. D5NS
  4. Frequent VS & Neuro assessment
  5. I&O, daily wt
  6. Protect from extremes- light, noise, temperature
  7. Protect from infection
27
Q

What should the nurse monitor during an Addison’s crisis?

A
  1. Vs
  2. Neuro status
  3. NA
  4. K
  5. Glucose
28
Q

How is Addison’s crisis managed?

A
  1. Glucocorticoids
  2. F&E balance
  3. Rest
29
Q

Glucocorticoids influence what?

A
  1. carbohydrate metabolism
30
Q

Mineralocorticoids regulate what?

A
  1. Regulate salt & Water balance
31
Q

Androgens contribute to what in our body?

A
  1. Contribute to expression of sexual characteristics
32
Q

Which glucocorticoid is most important?

33
Q

What is the physiologic effects of glucocorticoids?

A

Carbohydrate metabolism
1. Stimulate gluconeogenesis
2. Reduce peripheral glucose utilization
3. Inhibit glucose uptake
4. Promote glucose uptake

Protein matabolism
Fat metabolism
Cardiovascular function

34
Q

What are the pharmacologic effects of glucocorticoids?

A
  1. High dose admin
35
Q

What are the negative physiologic effects of glucocorticoids?

A

Large doses of cortisol can cause
1. Osteoporosis
2. Muscle weakness & atrophy
3. Stress adaptation interference
4. Inhibit action of growth hormone

36
Q

Hydrocortisone (Cortef) Glucocorticoid adrenal insufficiency tx MOA is?

A

Produces multiple glucocorticoid & Mineralocorticoid effects.

37
Q

What are adverse effects of Hydrocortisone (Cortef) glucocorticoid adrenal insufficiency tx?

A
  1. Adrenal suppression
  2. Production of Cushing’s syndrome
38
Q

What are the contraindications of using hydrocortisone (cortef) – glucocorticoid adrenal insufficiency tx?

A
  1. Systemic fungal infection
  2. Hypersensitivity
39
Q

What is the dosage for hydrocortisone (Cortef)?

A

25-30mg BID by mouth
1. divided into 3rds- give 2/3 in morning and 1/3 in afternoon. Take between 8-9 when normal levels of cortisol are at peak
2. Night shift adjust accordingly.

40
Q

Nursing interventions for hydrocortisone (cortef)– glucocorticoid for adrenal insufficiency tx?

A
  1. Assess vital signs, weight, respirations, & signs of dependent edema
  2. Monitor for depression, insomnia, anorexia
  3. Assess skin for bruising, color changes, acne, changes in hair growth
  4. Advise regular eye exams
  5. reposition immobilized patients every 2 hours.
  6. Monitor stool for occult blood
41
Q

What should we teach a patient taking hydrocortisone (cortef) for adrenal insufficiency?

A
  1. Take oral doses with meals & avoid alcohol
  2. Take any missed dose as soon as remembered
  3. Limit sodium intake
  4. Monitor blood sugar, esp. if diabetic
  5. Report any bloody or black tary stools, mood changes or insomnia
  6. Avoid immunizations during therapy
  7. Avoid immunization for 3m. following completion of therapy
  8. Report fever, cough, sore throat, malaise, unhealed injuries
  9. Do not share drugs w/ other
  10. Do not stop abruptly
  11. Medical alert ID
  12. Emergency KIT
42
Q

Mineralocorticoids: Adrenal insufficiency tx affect renal processing of what?

A
  1. NA
  2. K
  3. Hydrogen
43
Q

What hormone is most important with mineralocorticoids?

A

Aldosterone

44
Q

Mineralocorticoids Aldosterone does what

A
  1. Promotes sodium & potassium hemostasis
  2. Helps maintain intravascular volume
  3. Harmful cardiovascular effects when high
45
Q

Fludrocortisone is a type of what?

A

Mineralcorticoids

46
Q

What is the MOA of fludrocortisone (mineralocorticoid) for the tx of adrenal insufficiency

A

produces multiple glucocorticoid & mineralocorticoid effects

47
Q

What are adverse effects of fludrocortisone (mineralocorticoid) for the tx of adrenal insufficiency?

A
  1. HTN
  2. Edema
  3. Cardiac enlargement
  4. Hypokalemia
48
Q

What are contraindications of fludrocortisone (mineralocorticoid) for the tx of adrenal insufficiency?

A
  1. Systemic fungal infections
  2. Hypersensitivity
49
Q

What is the dose for fludrocortisone (mineralocorticoid) for the tx of adrenal insufficiency?

A
  1. 0.1-0.2 mg/PO every day in AM
50
Q

What are nursing interventions to consider with fludrocortisone (mineralocorticoid) for the treatment of adrenal insufficiency?

A
  1. Monitor for wt. gain, elevated blood pressure
  2. Monitor electrolytes, esp. sodium & potassium
  3. Signs of overdose: psychosis, excess wt gain, edema, CHF, increased appetite, severe insomnia, hypertension
  4. give daily doses before 0900 to mimic peak corticosteroid blood levels
51
Q

What should we teach a patient taking fludrocortisone (mineralocorticoid) for the tx of adrenal insufficiency?

A
  1. Report muscle weakness, fatigue, delirium, paresthesia’s, numbness of the mouth, anorexia, nausea, depression, diminished reflexes, polyuria, irregular heart rate
  2. Eat foods high in potassium
  3. Weigh daily
  4. Report any edema
  5. Report infection, trauma, or unexpected stress
52
Q

Adrenal medulla hormones functions as part of the ____

A

Autonomic NS

53
Q

What are the adrenal medulla hormones?

A
  1. Catecholamines
    • Epinephrine
    • norepinephrine
54
Q

What is pheochromocytoma?

A

Hyperfunction of the A. medulla

55
Q

What causes pheochromocytoma?

A

Catecholamine producing tumor in adrenal medulla
1. Increased epinephrine & norepinephrine
2. severe life- threatening hypertension

56
Q

What would our assessment of a patient with pheochromocytoma show

(HTN, LAB, Triad)

A

HTN- Severe
Lab: increased catecholamine (blood & urine)
Triad- HA, diaphoresis, palpitations w/HTN

57
Q

What are the 5h’s of pheochromocytoma?

A
  1. HTN
  2. HA
  3. Heat
  4. Hypermetabolism
  5. Hyperhidrosis
58
Q

What are the complications of pheochromocytoma?

A
  1. HTN crisis leads to renal & retina damage
  2. AMI
  3. CVA
  4. CHF
  5. Dysrhythmia
59
Q

How do we test pheochromocytoma?

A
  1. 24 hour urine for VMA
    • Vanillylmandelic acid
  2. Plasma- catecholamine
  3. Clonidine suppression
  4. CT/MRI
60
Q

What is the management of pheochromocytoma?

A
  1. Medication
  2. Monitor
    • BP, fluid & electrolytes, EKG
  3. Manage
    • Rest & Activity, stress
  4. Surgery: Adrenalectomy
  5. Educate: medications/diet
61
Q

What is an adrenalectomy?

A
  1. Surgical removal of one or both adrenal glands
  2. Open incision or laparoscopic technique
  3. Bilateral adrenalectomy- post op steroid supplementation cortisone & hydrocortisone
62
Q

What does pre-op management of an adrenalectomy look like?

A
  1. Diet- vitamins & proteins
  2. Increased risk of infection
  3. Monitor electrolytes and glucose
  4. IS, TCDB, pain scale
63
Q

What does post-op care for adrenalectomy look like?

A
  1. VS, I&O, electrolytes
  2. Pain med, cortisol, & IVF
  3. Risk- Addisonian crisis, & hypovolemic shock, delayed wound healing & infection, difficult control
  4. Return to work 1-3 wks
64
Q

What is our discharge teaching for an adrenalectomy?

A
  1. Home health
  2. MedicAlert bracelet
  3. Avoid: Extremes of temp, infection & stress
  4. Teach: Adjust meds & when to call HCP
  5. Lifetime replacement therapy

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