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Nursing 4 Exam 1

Adrenal Gland Dysfunction

adrenal glands? small paired highly vascular glands that act independently of one another
how many parts does the adrenal gland have? two
what are teh two parts of the adrenal gland? adrenal medulla(center) and the adrenal cortex(outer)
which gland makes up 90% of the the adrenal gland? adrenal cortex(outer)
what is the purpose of the adrenal gland? maintain salt levels in the blood, maintain BP, help control kidney function, control overall fluid concentrations in the body
adrenal medulla? produces 2 hormones(catecholamines)
what two hormones does the adrenal medulla produce? epinephrine and norepinephrine
epinephrine(adrenaline) function? increases blood glucose by stimulating the release of ACTH from pituitary-stimulated the adrenal cortex to release glucocorticoides; increases rate and force of cardiac contractions
epinephrine function on blood vessels? constricts in skin, mucous membranes & kidneys; dilates in skeletal muscles, coronarry & pulmonary arteries
norepinephrine(noradrenaline) function? increases heart rate and force of contractions, constricts blood vessels throughout body
levofed synthetic norephinephrine
what hormones are produced by the adreanl cortex? mineralcorticoids and glucocorticoids
mineralcorticoids aldosterone
aldosterone? retains sodium and water to increase blood volume and pressure; decreases potassium b/c promotes urinary excretion of dietary potassium;holds on to water and sodium and gets rid of potassium
glucocorticoids? cortisol
function of cortisol? stress hormone; carb metabolism by regulating glucose use in body tissue, mobilizing fat, shifting energy sourcefor muscle cells from glucose to fat; responds to stress
chronic adrenocortical insufficiency? Addison's disease
Addison's disease? dysfunction of adrenal cortex, chronic deficiency of cortison, aldosterone adrenal androgens; more common in women and those adults under 60
causes of addison's disease? autoimmune destruction of adrenal tissue, accounts for 80% of spontaneous cases; occurs alone or with polyendocrine deficiency syndrome
causes of addison's disease? trauma in clients on an anticoagulant resulting in b/l adrenal hemorrhage
causes of addison's disease? pituitary dysfunction from tumors, surgery, radiation
causes of addison's disease? abrupt withdrawal of from long-term, high dose corticosteroids(mineralcorticoids & gloucocorticoids)
clincial manifestations of addison's disease? slow onset, r/t decreased levles of cortisol and aldosterone, lack of functions of adrenal cortex or decrease in "sugar, salt and sex", hyponatremia, hyperkalemia, low circulating bv, postural hypotension, syncope & possibly hypovolemic shock
clinical manifestations of addison's disease? dizziness, confusion, cardiac dysrhthmias, hypoglycemia, n/v, weakness, lethargy, diarrhea, irritability, depression, hyperpigmentatino due to increased ACTH levels(bronzed appearance in caucasions)
clinical manifestations of addison's disease? salt craving, body hair may decrease, chronic, worsening fatigue, loss of appetite, wt loss
potassium functions maintains ICF, promotes neuromuscular functions and regulates cardiac impulses
sodium functions maintains serum osmolality, regulates water balance(ECF volume), transmits nerve impulses, contracts muscles
diagnostic tests for addison's disease serum cortisol decreased, urine 17-ketosteroids and 17 hydroxycorticosteroids are decreased, electrolytes show hyponatremia,hyperkalemia, serum glucose is decreased, hematocrit and BUN are elevated
diagnostic tests for addison's disease ct scan head may be done to determine if intracranial lesion affecting pituitary gland
normal BUN levels 7-18
normal Hct levels 36-47%
ACTH stimulation test is the... most specific test for diagnosing addison's disease
how is ACTH stimulation test done? blood cortisol is measured vefore and after a synthetic form of ACTH is given by injection, measurement is repeated 30-60 mins after an IV ACTH injection
what is the normal response after an injection of ACTH? a rise in blood and urine cortisol
what kind of response does a pt have with adrenal insufficiency? poorly or not at all
addisonian crises is... a life threatening response to acute adrenal insufficiency
addisonian crises occurs in clients with... addison's disease in response to major stressors
major symptoms of addisonian crises include? high fever, weakness, abd pain, severe hypotension, circulatory collapse, shock, and coma
treatment for addisonian crises is... rapid IV replacement of fluids and glucocorticoids(cortisol
nursing care for acute addisonia crises? rapid IVF infusion(0.9%), replacement therapy, get labs first, hydrocortisone IV(Solu-cortef) bolus then infusion over 8 hrs, hydrocortisone IM q 12 hrs, after crises-adjust dosages
caution: salt restriction or diuretics may cause... adrenal crises
medication management of addison's crises hydrocortisone(glucocorticoid replacement), fludrocorticsone(Florinef)-mineral corticoid replacement
what s/s shoudl be reported indicating excessive drug therapy? rapid wt gain, round face, fluid retention
what illness' should be reported during medication management? severe vomitting, diarrhea or fever
Diet during addison's crises? increased salt, at least 1 1/2 liters of water daily
nursing care goal during addison's crises promoting fluid and electrolyte balance & monitoring fluid defecit
nursing care during addison's crises weigh daily and I&O, VS q 1-4 hrs, monitor lab values, glucocorticoid therapy & mineral corticoids for electrolyte balance, education
nursing care addison's dx pt must continue under medical care and should wear medical id bracelet
nursing care addison's dx pt and family must be aware of need to continue meds and s/s of insufficient hormone levels
nursing care addison's dx care must be taken whenever pt will face stressor such as sx, serious illness
nursing diagnoses for addison's dx defecient fluid volume
nursing diagnoses for addison's dx decreased c/o r/t decreased vascular volume
nursing diagnoses for addison's dx risk for ineffective therapeutic regimen management
nursing diagnoses for addison's dx fatigue r/t disease state
adrenal hypersecretion adrenal cortex-cushings syndrome(increased corticosteroids), adrenal medulla-pheochromocytoma-increased catecholamines
cushing's syndrome chronic disorder hyperfunction of adrenal cortex producing excessive amounts of ACTH or cortisol
hypercortisolism cushing's syndrome
cushing syndrome is more common in... females between the ages of 30 and 50
cushing syndrome occurs in persons on... high dose steroids for long periods of time
patients who are at high risk for cushing syndrome are... asthma pt's, auto immune dx pt's, transplant pt's, COPD pt's
causes of cushing syndrome (endogenous)adrenal hyperplasia, pituitary tumor, Ca of lung, GI or pancreas, adrenal tumors; (exogenous)therapeutic use of glucocorticoids
cushing syndrome affect functions of... adrenal cortex "sugar, salt and sex" (glucose metabolism, secondary sex characteristics and mineralcorticoid levels)
characteristics of someone with cushing's syndrome? obesity and redistribution of body fat: central obesity, fat pads under clavicles & upper back (buffalo hump), rounded face
Glucose and electrolyte imbalance in cushing's syndrome include... hyperglycemia, hypernatremia, hypokalemia
signs of cushing syndrome HTN, thinning of skin, bruises easily, abdominal striae, altered immunity, delayed healing, prone to infection, altered calcium absorption increasing osteoporosis and risk for fractures
A pt with cushing syndrome has an increased... gastric acid secretion increasing risk for ulcer
what kind of emotional chages does a pt with cushing syndrome have? from depression to psychosis
what kind of changes in secondary sexual characteristics occur in cushing's syndrome? hirsuitism(hair in irregular places) in females, gynecomastia in males
Menstrual irregularities is what occurs in cushing's syndrome? (T or F) True
cushing's assessment will include truncal obesity, buffalo hump, moon face, thin skin, bone density loss, decreased muscle mass, abnormal sleep patterns, HTN
diagnosing cushing syndrome will include... measurement of plasma cortisol(alterations in normal diurnal alteration: higher in mornings, lower in afternoons and evenings)
diagnosing cushing syndrome will include... 24 hour urine collections for measurements of hormones: 17 ketosteroids and 17 hydroxycorticosteroids which are elevated
diagnosing cushing syndrome will include... electrolytes and glucose levels (elevated Na, glucose; decreased K)
Treament for cushing syndrome tumors may be treated with surgery, radiation, medications, or a combination
medications for cushing syndrome with inoperable pituitary or adrenal tumors mitotane, metyrapone, ketoconazole-which suppress adrenal cortex, decrease cortisol synthesis
surgery for cushing syndrome include... adreanlectomy and hypophysectomy
adrenalectomy? removal of adrenal gland if tumor is in the adrenal gland; if both glands are removed, client will need to be on lifelong hormone replacement
hypophysectomy? removal of pituitary gland through transphenoidal route or craniotomy
nursing care post op? clients being treated for adrenal or pituitary sx need intensive care; pt's who have undergone tx often need to be on life long hormone replacement & wear id bracelet; must not abruptly stop hormone or could develop addisonian crisis
nursing diagnoses for cushing's syndrome excess fluid volume r/t excess water & Na reabsorption; risk for infection r/t immunosuppression & inadequate primary defenses; fattigue r/t sleep deprivation; disturbed body image r/t illness
pheochromocytoma definition... tumor of the adrenal medulla that produces excessive levles of catecholamines(epinephrine and norepinephrine)
symptoms of pheochromocytoma severe h/a, generalized excessive sweating, tachycardia & palpitations, HTN, anxiety/nervousness, tremors, pain in lower chest or upper abd, nausea with or w/out vomitting, wt loss, heat intolerance
assessment of pt's with pheochromcytoma hx may include intermittent hypertensive episodes, 24 hr urine for vanillylmandelic acid(VMA)- a product of epinephrine & norepinephrine(catecholamines)
VMA testing restrict foods for 2-3 days(coffee tea, bananas, chocolate, cocoa, citrus, fruits, and vanilla), meds to hold, collect 24 hr urine, decrease stress, starvation, and physical activity
interventions during VMA testing DO NOT PALPATE ABDOMEN, avoid smoking and caffeine, MONITOR BP, hydration
post op adrenalectomy monitor hypovolemia, monitor VS, I&O, monitor for hemorrhage and shock
Created by: jbittner