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13 Cards in this Set
- Front
- Back
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Cushing's syndrome |
-overactive adrenal cortex, releases too much cortisol |
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Pathophysiology (adrenal glands) -biggest cause |
-located on top of the kidneys release corticosteroids (cortex releases this, they are essential to life) medulla releases norephedrine and epi -overuse of steroids, tumors is next biggest, can be located anywhere (lungs secreting ATCH) |
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Manifestations (adrenal glands) -carbohydrate metabolism |
-increased glucogenesis -polydipsia -polyuria -diabetes type 2 |
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Manifestations (adrenal) -increased protein catabolism |
-muscle weakness -easily bruised skin -osteoporotic bones -poor wound healing |
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Manifestations (adrenal) Increased redistribution of body fat (5) |
-reduced inflammatory response -increased stomach acid production -mineralocorticoid effects
-central obesity -moon face -buffalo hump -lemon on a stick -high risk sodium and water retention, CHF, watching blood glucose levels |
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Diagnosis (adrenal) (4) |
-cortisol level - elevated -24 hour urinary free cortisol - elevated -ACTH suppression (48 hour dexamethasone test)-body should respond, will fail to suppress cortisol levels -circadian rhythm- will be abnormally high evening cortisol levels |
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Treatment Medications for treatment |
-needs to be treated as it can be fatal due to hypertension, MI, heart failure, infection
-mitotane: lower cortisol production -aminogluthemide: lower cortisol production -somatostatin: decreases ATCH production |
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Adrenalectomy -reasons for it -risk for -monitor what levels? -patient will need (2) |
-indicated if Cushing's caused by adrenal cortex tumor -infection -cortisol levels -lifelong hormone replacement is both adrenal glands are removed, dietary consultation |
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Addison's disease -what is it? -what causes it? |
-a disorder resulting from destruction or dysfunction of adrenal cortex. Result is chronic deficiency of cortisol, aldosterone, and adrenal androgens
-autoimmune -TB -surgical removal -hemorrhage/infarction -tumor (2) -drugs -HIV |
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Symptoms (adrenal) -cortisol insufficiency (8) -aldosterone insufficiency (10) |
-liver function decreases -stomach digestive enzymes decrease -hypoglycemia -lethargy -weakness -nausea -vomiting -diarrhea -hyper pigmentation of skin
-water and sodium loss -dehydration -sodium loss (hyponatremia) -postural hypotension -syncope -hypovolemic shock -confusion -neuromuscular irritability -hyperkalemia -arrhythmia |
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Diagnosis -blood (6) |
-cortisol - low -ACTH- high = pituitary -glucose-low -sodium-low -potassium-high -BUN/Cr-increased with Addison's disease |
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Treatment -Long-term -monitor for: -acute |
-replacement glucocorticoid and mineralcorticoid -symptoms -cortisol levels -electrolytes -VS -patients need a medical alert bracelet
-IM hydrocortisone/IV hydrocortisone in ER -fluid replacement -dextrose IV for severe hypoglycemia -fludrocortisone is needed in latter stages to provide mineralcorticoid replacement |
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Nursing diagnosis |
-deficient fluid volume -risk for ineffective therapeutic regimen |
