KEY TERMS DX TESTS RISK FACTORS CANCER PATHOPHYS HODGE- PODGE

Abnormalities caused by excess corticosteroids

Cushing’s syndrome

Glucocorticoids, mineralcorticoids, androgens

Corticosteroids

Adrenocortical insufficiency

Addison’s disease

Most common cause of Addison’s disease

Autoimmune response

Disease of excess secretion of catecholamines causing severe hypertension

Pheochromocytoma

Moon face, buffalo hump, wt. gain, muscle wasting of arms and legs, hypokalemia, hyperglycemia, proteinuria, calcium in the urine, renal calculi, osteoporosis, susceptibility to infections

Symptoms of Cushing’s syndrome

Electrolyte and fluid imbalance, dehydration, water loss, hypovolemia

Results of Addison’s disease

Nursing interventions for major abd surgery, Administer large amounts of hydrocortisone, monitor for fluctuations in BP, avoid stress, allow rest, give sedatives, careful I and O, administer IV solutions, Vasopressors may be given, avoid stimulants such as coffee, tea, sodas

Nursing Interventions for pheochromocytoma surgery

Loss of ability to concentrate, irritability, anxiety, euphoria, insomnia, irrationality, psychosis, suicidal, depression, loss of libido, bachache, increased appetite

Subjective nursing assessment of cushing’s syndrome

Weakness, fatigue, craving for salt, postural hypotension, vertigo, syncope, headache, disorientation, abd or low back pain, anxiety, apprehension, tolerating stress poorly

Subjective assessment for Addison’s disease

Ecchymosis, petechiae, thin skin, delayed wound healing, abd wt gain with striae, edema, hypertension, hyperglycemia, hirsutism, menstrual irregularities, deepening voice, undetected infection

Objective nursing assessment data for Cushing’s syndrome

Abnormally low or high body temp, orthostatic hypotension, hyponatremia, hyperkalemia, nausea, vomiting, sudden severe drop in BP, cyanosis

Adrenal crisis

Monitor circulatory status, I and O, daily wt. check skin turgor, frequent fluids, monitor temp and BP, monitor response to steroid drugs, keep environment free from stress, screen and exclude visitors with infectious disease. Teach patient to carry and inject 100mg IM hydrocortisone and may have to take extra medications during times of stress

Nursing interventions for Addison’s

Elevated plasma cortisol, Plasma ACTH elevated or decreased, skull radiograph, adrenal angiography, 24 hr urine showing increased17- ketosteroids and 17-hydroxysteroids, hyperglycemia, glycosuria, Abd US and CT

Diagnostic factors in Cushing’s syndrome

Adrenal toxic agent

Mitotane

Stress producing situations, infections, surgery, trauma hemorrhage, psychological stress etc.

Precipitation factors for adrenal crisis

Pt may expect to have major life style changes, possibly many complications and shortened life expectancy depending on whether cause is benign or malignant

Prognosis for Cushing’s disease

Low in sodium to reduce edema, reduced calories and carbohydrates to help control hyperglycemia, high in potassium to help correct hypokalemia

Diet for Cushing’s disease

Gentle handling to prevent skin impairment, frequent turning and ambulation if possible, elbow and heel protectors, eggcrate mattress to prevent decubs, ADLs with rest periods, encourage verbilazition of concerns, monitor for depression and suicidal ideations

Nursing interventions for Cushing’s disease

24 hr 17-hydroxysteroids, 17- ketosteroids

Diagnostic tests for Cushing’s and Addison’s diseases

Hyponatremia, hyperkalemia, hypoglycemia, 24 hr urine showing decreased 17-ketosteroids and 17- hydroxysteroids, ACTH stimulation test showing low plasma cortisol and aldosterone levels

Diagnostics for Addison’s disease

Plasma cortisol levels increased,

Cushing’s syndrome

Hydrocortisone and fludrocortisone, fluid and electrolyte replacement

Tx for Addison’s disease

A life threatening Addisonian crisis

Adrenal Crisis

Sudden severe drop in blood pressure, nausea, vomiting, extremely high temperature, cyanosis

Adrenal Crisis