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Chapter 81

Unit 12: Nursing care of clients with endocrine disorders

Cushing's disease & Cushing syndrome's cause? (Pg. 892) Over secretion of the adrenal cortex
What is pituitary disease caused by? Over secretion of ACTH by the anterior pituitary
What causes cushing's syndrome to differ from cushing's disease? Syndrome; caused by long term use of glucocorticoids to treat other conditions (Ex. asthma, COPD) Disease: over secretion of adrenal cortex
What does the adrenal cortex produce? Mineralcorticoids (aldosterone), glucocorticoids (cortisol) & sex hormones (androgens & estrogens)
Client should eat foods high in? & avoid which drinks? Calcium & vitamin D -Alcohol & caffeine
Client should monitor for what kind of bleeding? Gastric -coffee-ground emesis, black tarry stools
Risk factors; endogenous (disease) Adrenal hyperplasia, carcinoma; dif locations (Pg. 892) that can secrete ATCH
Risk factors; exogenous (syndrome) Organ transplant, chemo, autoimmune, asthma, allergies, inflx disorders
S/s: (pg. 893) sleep? where is the pain? emotions? Weak/fatigue/sleep disturbances Back/joint pain Irritable/depressed/etc.
S/s con't What happens to inflammation & immune response? Decreased response, ex. getting sick more often, infections but w no redness/swelling etc.
S/s Skin effects, HR/BP Thin/fragile skin, bruising & petechiae (Fragile blood vessels) Htn & tachy
S/s ulcers where?, wt, period, edema? Gastric ulcers d/t ^ hydrochloric acid Wt gain Irregular menses Dependent edema
Where is the dependent edema/wt gain seen? Moon face, truncal obesity, buffalo hump (fat in back of neck)
S/s Bones & muscles Glucose Bone pain/ fxs (osteoporosis) w increased risk for falls Muscle wasting in extremities (thin) Impaired glucose tolerance
S/s looks, color, scars Hirsutism (lack of hair), acne, red cheeks striae; abdomen & thighs
Lab tests: ^ plasma cortisol in abscense of illness/stress urine cortisol levels 24 hr urine= ^ cortisol
ACTH levels lab test: Hypersecretion by AP Disorder of adrenal cortex or med therapy
Lab's con't -Salivary cortisol Serum…. K+ & calcium glucose & sodiium lymphocytes Salivary cortisol; ^ = disease K+ & calcium = decreased sodium & glucose ^ lymphocytes decrease
Dethamethasone suppression test 24 hr urine collected -no suppression of cortisol = disease -meds with held/ stress avoided prior to & during test
Dx procedures: (noninvasive/not painful) 1. To identify lessions 2. To find adrenal insufficiency X-ray, MRI, CT scans radiological imaging
Dietary alterations: Sodium, K+, protein & calcium decrease sodium Increase the rest
Nursing actions: wt, volume issues, env't, immune, skin -Daily wt, I&O -Watch for hypervolemia; edema, jvd, SOB, crackles, htn, tachy -Safe env't to minimize risk of fx/skin trauma -prevent infection; wash hands -meticulous skin care, protect against skin breakdown & infection
Medications (Pg. 895) 1. Aminoglutheimide (Cytadren) what is it? what does it do? long or short relief? Used for? Monitor? Etc. see page Adrenal corticosteroid inhibitor -decreases synthesis -short term relief for syndrome used temporarily for surgery, no more than 3 months monitor bp for hypotension monitor fluid & electrolytes
2. Ketoconazole (Nizoral) what is it? Can be used in addition to monitor.. Adrenal corticosteroid inhibitor -Antifungal agent; w high doses inhibits synthesis -addition to radiation/surgery -Monitor liver enzymes for liver toxicity (yellow sclera, dark urine) -Fluids and lytes
3. Mitotane (Lysodren) What does it do? Used to tx what? Monitor for? Suppress action of adrenal cortex -Treats inoperable adrenal carcinoma (reduces size of tumor) -Shock & hepatotoxicity
4. Spironolactone (Aldactone) what is it? when used? monitor? Aldosterone antagonist -potassium sparing diuretic Used when bilateral adrenal hyperplasia is the cause -monitor lytes, vs, wt
Therapeutic procedures -Chemotherapy w cytotoxic agents for cushing's disease caused by a tumor Adverse effects? Thrombocytopenia/nausea/vomit (Antiemetic) WBC + dif, H&H Assess for bruising/bleeding avoid crowds alopecia bleeding; black tarry stools/coffee ground emesis
-Radiation therapy Provide care.. Skin care & assess avoid lotions & removing marks avoid sun altered taste & fatigue expected
Surgical interventions: 1. Hypophysectomy: Surgical removal of the pituitary gland (depending on cause of cushings)
Hypophysectomy nursing actions 6 key things (Pg. 897) Lytes, infection, bleeding, neuro checks q1hr first 24 hr, then q4hr administer glucocorticoids to prevent sudden drop in cortisol stool softners to prevent straining (high fiber)
How is a hypophysectomy done? Transphenoidal… through nasal cavity avoid sneezing, coughing, laughing, straining, blowing nose -Breathe through mouth
What might be experienced 3-4 months after surgery? (physectomy) Numbness @ surgical site & diminished sense of smell
Client should avoid what to prevent increased ICP? Bending at waist & straining bend at knees!
Should the client brush teeth? No avoid for 2 weeks floss & rinse mouth instead
What type of drainage from the nose might indicate a CSF leak? Sweet-tasting, halo (yellow edge clear center), clear drainage Headache, excessive bleeding, confusion (notfiy provider)
2. Adrenalectomy (Pg. 898) Surgical removal of the adrenal gland
Nursing actions: Provide what kind of replacement? S/s of adrenal crisis Glucocorticoid & hormone as needed hypotension, tachycardia, nausea, tachypnea, headache
Nursing actions con't for adrenalectomy VS, hemodynamic levels (q15min) fluids/lytes bleeding, BS, pain meds, stool softners slowly introduce foods assess for distention & tenderness monitor site
Complications of Cushings: 1. Perforated viscera/ulcerations see pg. 899 for the rest low production of protective mucus -monitor for GI bleeding, administer antiulcer meds
Created by: mary.scott260!