Unit 12: Nursing care of clients with endocrine disorders
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| Cushing's disease & Cushing syndrome's cause? (Pg. 892) | Over secretion of the adrenal cortex
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| What is pituitary disease caused by? | Over secretion of ACTH by the anterior pituitary
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| 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
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| What does the adrenal cortex produce? | Mineralcorticoids (aldosterone), glucocorticoids (cortisol) & sex hormones (androgens & estrogens)
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| Client should eat foods high in? & avoid which drinks? | Calcium & vitamin D
-Alcohol & caffeine
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| Client should monitor for what kind of bleeding? | Gastric
-coffee-ground emesis, black tarry stools
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| Risk factors; endogenous (disease) | Adrenal hyperplasia, carcinoma; dif locations (Pg. 892) that can secrete ATCH
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| Risk factors; exogenous (syndrome) | Organ transplant, chemo, autoimmune, asthma, allergies, inflx disorders
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| S/s: (pg. 893) sleep? where is the pain? emotions? | Weak/fatigue/sleep disturbances
Back/joint pain
Irritable/depressed/etc.
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| S/s con't What happens to inflammation & immune response? | Decreased response, ex. getting sick more often, infections but w no redness/swelling etc.
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| S/s Skin effects, HR/BP | Thin/fragile skin, bruising & petechiae (Fragile blood vessels)
Htn & tachy
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| S/s ulcers where?, wt, period, edema? | Gastric ulcers d/t ^ hydrochloric acid
Wt gain
Irregular menses
Dependent edema
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| Where is the dependent edema/wt gain seen? | Moon face, truncal obesity, buffalo hump (fat in back of neck)
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| S/s Bones & muscles Glucose | Bone pain/ fxs (osteoporosis) w increased risk for falls
Muscle wasting in extremities (thin)
Impaired glucose tolerance
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| S/s looks, color, scars | Hirsutism (lack of hair), acne, red cheeks
striae; abdomen & thighs
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| Lab tests: | ^ plasma cortisol in abscense of illness/stress
urine cortisol levels 24 hr urine= ^ cortisol
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| ACTH levels lab test: | Hypersecretion by AP
Disorder of adrenal cortex or med therapy
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| Lab's con't -Salivary cortisol Serum…. K+ & calcium glucose & sodiium lymphocytes | Salivary cortisol; ^ = disease
K+ & calcium = decreased
sodium & glucose ^
lymphocytes decrease
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| Dethamethasone suppression test | 24 hr urine collected
-no suppression of cortisol = disease
-meds with held/ stress avoided prior to & during test
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| Dx procedures: (noninvasive/not painful) 1. To identify lessions 2. To find adrenal insufficiency | X-ray, MRI, CT scans
radiological imaging
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| Dietary alterations: Sodium, K+, protein & calcium | decrease sodium
Increase the rest
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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
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| -Radiation therapy Provide care.. | Skin care & assess
avoid lotions & removing marks
avoid sun
altered taste & fatigue expected
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| Surgical interventions: 1. Hypophysectomy: | Surgical removal of the pituitary gland (depending on cause of cushings)
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| 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)
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| How is a hypophysectomy done? | Transphenoidal… through nasal cavity
avoid sneezing, coughing, laughing, straining, blowing nose
-Breathe through mouth
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| What might be experienced 3-4 months after surgery? (physectomy) | Numbness @ surgical site & diminished sense of smell
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| Client should avoid what to prevent increased ICP? | Bending at waist & straining
bend at knees!
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| Should the client brush teeth? | No avoid for 2 weeks
floss & rinse mouth instead
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| 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)
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| 2. Adrenalectomy (Pg. 898) | Surgical removal of the adrenal gland
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| Nursing actions: Provide what kind of replacement? S/s of adrenal crisis | Glucocorticoid & hormone as needed
hypotension, tachycardia, nausea, tachypnea, headache
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| 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
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| 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
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