Question | Answer |
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 |