Week 1 - Adrenal Disorders Flashcards
what are the 3 main classifications of adrenal cortex hormones (corticosteroids)
- glucocorticoids (cortisol)
- androgens
- mineralocorticoids (aldo)
what is the main fnxn of glucocorticoids (3)
- regulate metabolism
- increase glucose
- critical in stress response
what is the main fnxn of mineralocorticoids (aldo) (2)
- retains Na
- releases K
- helps regulate BP
what is the main fnxn of androgens
- contribute to growth and development in both genders
- sexual desire & satisfaction in women
what are the two main disorders associated with the adrenal cortex
- cushing’s
- addison’s
what is cushing’s syndrome
- conditions caused by too excess lvls of corticosteroids (especially glucocorticoids)
what can cause cushing’s syndrome (4)
- iatrogenic admin of prednisone
- tumour of the adrenal cortex
- other malignant growth that causes excess ACTH production (ex. lungs)
- tumour of the pituitary gland
what is cushing’s DISEASE
- when you have excess cortisol due to a tumour of the pituitary gland which then causes too much ACTH
what effect does cushing’s have on body composition (5)
causes:
- weight gain
- “moon face”
- “buffalo hump”
- trunkal obesity
- thin extremities & muscle wasting
what effect does cushing’s have on the skin and hair (5)
causes:
- thin and fragile skin
- purple striae
- bruises and petchiae
- acne
- excessive body and facial hair
what effect does cushing’s have on fluids & electrolytes and glucose (4)
- low K+
- high Na+
- water retention = increased BP
- hyperglycemia
what effect does cushing’s have on sexual characteristics (3)
in women:
- amennorhea
- hirsutism (start to have male characteristics)
in men:
- gynecomastia (development of breasts)
what effect does cushing’s have on bone’s
- can cause osteoporosis
how does cushing’s impact the immune system (2)
- causes increased suscpetibility to infection
- delayed wound healing
what effect does cushing’s have on personality and mood (3)
- causes personality changes
- depression
- CNS irritability
how can cushing’s syndrome be diagnosed (3)
- 24-hour cortisol urine sample
- blood & urine for cortisol lvls
- CT or MRI for tumours
what is the treatment goal for cushings
- normalize hormone secretion
how is treatment of cushings chosen
- based off cause
if the underlying cause of cushings is a pituiatry tumour or adrenal gland, what is the treatment (3)
- surgery
- radiation
- drug therapy to remove tumour or inhibit adrenal function
if the underlying cause of cushings is prolonged corticosteroid use, what is the treatment (3)
- tapered discontinuation of corticosteroid therapy
- reduction of dosage
- conversion to alternate day therapy
why is it important to never dc corticosteroids abruptly?
- may cause life-threatening adrenal insufficiency
why is it important to offer emotional support to a pt with cushings? how can we offer this?
- changes in appearance/emtional behavior are distressing
- reassure that once cortisol levels are restored they will look and feel normal again
what should you monitor for post-op (after tumour removal) for a pt with cushings (3)
- electrolyte balance
- hemorrhage
- corticosteroid lvl
- S&S of addison’s
why is it important to monitor electrolytes post-op for a pt with cushings
- surgery can cause fluctuating hormones = unstable electrolytes
why is it important to monitor for hemorrhage post-op for a pt with cushings
- bc the glands are very vascular = increased risk of hemorrhage
why is it important to monitor corticosteroid lvls post-op for a pt with cushings?
- corticosteroids may now be too low and require replacement
what should you teach a pt with cushings post-op
- to monitor for signs of addison’s disease
what is addison’s disease
- a condition caused by too little corticosteroid
what can cause addison’s disease (3)
conditions that interefer w production of cortisol:
- adrenal tissue autoimmune disease (destroys adrenal tissue)
- pituitary disease
- abruptly stopping prednisone
describe the onset of addison’s disease
- slow, insidious bc manifestations do not tend to become evident until 90% of the adrenal cortex is destroyed
what effect does addison’s have on the skin and haor
- hyperpigmentation
- changes in distribution of body hair
what effect does addison’s have on BP
- can cause postural hypotension
what effect does addison’s have on body composition
- weight loss
what effect does addison’s have on an individual’s emotional characteristics (5)
can cause:
- depression
- irritability
- fatigue
- weakness
- trouble coping w stressors (cortisol is imp for stress response)
what effect does addison’s have on the GI tract (4)
- nausea
- vomitting
- diarrhea
- anorexia
r/t electrolyte imbalances
what effect does addison’s have on electrolytes and blood glucose (3)
- hyperkalemia
- hyponatremia
- hypoglycemia
describe how addison’s can be diagnosed (4)
- S&S
- blood and urine for cortisol lvls
- CT or MRI for tumours
- electrolyte lvls
what is the treatment goal for addison’s
- normalize hormone secretion
- maintain fluid & electrolyte balance
what is the treatment for addison’s (5)
- replacement therapy –> hydrocortisone
- NS replacement
- 5% dextrose
- electrolyte replacement
- diet changes
what is hydrocortisone
- med that has both glucocorticoid and mineralocorticoid properties
why is NS and dextrose used as treatment for someone w addison’s disease
- reverse hypotension and electrolyte imbalances
what should you monitor in a pt with addison’s (5)
- fluid and electrolyte status
- hyperkalemia
- hyponatremia
- hypoglycemia
- dehydration
what type of diet should someone w addison’s have (3)
- high protein
- high carb
- make sure getting enough salt
what is a complication of addison’s disease
- addisonian crisis
what is addisonian crisis
- occurs when the pt has extremely low cortisol lvls
what can trigger an addisonian crisis (4)
- infection
- surgery
- trauma
- physical activity
what does addisonian crisis cause (4)
- hypotension
- tachycardia
- severe dehydration
- shock
what is the treatment for addisonian crisis (2)
- high-dose hydrocortisone treatment
- shock management
what 4 things should the nurse discuss during discharge teaching for a pt with addison’s
- self dose adjustments for corticosteroids
- medical alert bracelet
- emergency kit
- S&S of cortisol excess and deficiency
when might glucocorticoid dosages need to be adjusted? why?
- during times of physiological stress to avoid addisonian crisis
ex. surgery, running a marathon
when are glucocorticoids taken in a pt with addisons
2/3 of dose in morning
1/3 in evening
when are mineralocorticoids taken in a pt with addisons
in morning
describe the teaching for a pt with addison’s regarding the emergency kit
- carry at all times
- teach pt and family how to use
what does the emergency kit for addison’s contain
- IM injection of glucocorticoid - solucortef
in cushing’s syndrome, the pt has an increasded risk for infection. list nursing interventions for this (10)
- monitor for systemic and local signs of infection
- provide private room
- maintain asepsis for pt at risk
- screen all visitors for communicable diseases
- monitor WBC, absolute granulocyte count, and differential
- obtain culture samples as indicated
- inspect skin & mucous membranes for redness, warmth, drainage
- teach pt and family how to avoid infections
- teach pt and family about signs and symptoms
- teach pt and family about signs and symptoms of infection and when to report them
weight gain is associated with cushing’s. what nursing interventions can be used to allow the pt to maintain low-calorie diet that meets nutritional needs & attain a weight appropriate for their height (4)
- determine, w dietician, number of cals and types of nutrients needed to help correct effects of excess cortisol
- instruct pt about nutritional needs
- monitor caloric and dietary intake
- monitor trends in weight gain & loss
what type of diet would a pt with cushing’s have (6)
- high protein
- low fat
- low carbs
- low sodium
- high K
- high calcium
what nutritional counseling can be given to a pt with cushing’s (4)
- discuss pt’s knowledge of food groups
- discuss pt’s perception of the needed diet modication
- evaluate progress of dietary modification goals at regular intervals
- provide referral/comsultation with other members of the health care time
pts with cushing’s may experience situational low self-esteem due to alteration in body image.
what are some nursing interventions to help the pt report increased acceptance of appearance and use self-care methods to improve appearance (5)
- encourage pt to identify strengths
- reinforce personal strengths the pt identifies
- make positive statements about the pt
- encourage increased responsibility for self
- provide reassurance about the pt’s condition (that changes will resolve with hormonal balance)
pts with cushing’s have an increased risk of altered skin integrity.
what are some nursing interventions to help the pt experience no skin impairment & maintain intact skin? (5)
- observe extremities for color, warmth, swelling, pulses, texture, edema, ulcertaions
- monitor for sources of pressure and friction
- monitor skin for rashes & abrasions
- monitor skin & mucous membranes for discoloration, bruising, breakdown
- document skin or mucous membrane changes
what are some topical treatments to maintain intact skin in a pt with cushing’s
- provide support to edematous areas to promote circulation
- use devices on bed that protect the pt
