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17 Cards in this Set
- Front
- Back
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Adrenal cortex location
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outer adrenals - surrounding medulla
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Disorders - hyperfunction (3)
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1. Cushings syndrome - glucocorticoid or maybe androgen excess
2. Primary aldosteronism - mineralcorticoid excess 3. Adrenogenital syndrome - androgen excess |
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Cushings: causes (3)
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1. cortisol secreting tumor of cortex
2. excess ACTH from tumor elsewhere in body (lungs, pancreas) 3. Excess admin of glucocorticoids |
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S&S Cushings (3)
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1. hyperglycemia - (may DM w polyuria, polydipsia, huger)
2. Protein tissue wasting - stunts grouth, fatique, weakness, skin thin, fragile, ecchymosis, osteoporosis, backache, kyphosis, fx r/t bone wasting 3. Na, h2 retention - puffy, edema, wt gain, hi bp (CHF, stroke) |
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Cushing's syndrome
S&S cont' (w edema) |
Abnorm fat distrib:
- moon face, -trunk fat w thin limbs from protein wasting, -big belly -stretch marks |
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Cushing's syndrome
S&S cont' (K ) |
Hypokalemia:
-muscle weak -arryhtmias -renal probs (met alk - dec ca and tetany) |
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Cushing's syndrome
S&S cont' (4 more ) |
-Incr suscept to infex, slower healing (r/t to inflamm response)
-Mood changes, swings, dec libido -May excess androgens - hirsutism (excess hair), brst atrophy, no menses - May gastric ulcers |
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Cushings dx (6)
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-Incr BS, Na, decr K
-Incr cortisol (may androg) 24 hr urine -Plasma cortisol level - HIgher in am, grad decrease eve => incr levesl am and pm (vs decr w eve - norm) -Radioimmunoassay of ACTH -to ID cause Dexamathasone suppression test - give med 11 pm, draow bld 8 hrs - no suppress of cortisol w Cush CT scan, MRI - tumors |
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RX Cushings - If cause is adrenal tumor
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adrenalectomy - 1 or 2
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RX Cushings - cause is pituitary hyperplasia
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bilateral adrenalectomy (if remove pit - must replace ALL horm)
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RX Cushings - cause secreting tumor of pit
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remove/radiatepit
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RX Cushings - cause ectopic secretion
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remove tumor
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RX Cushings - cause excessive admin
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decr dose or give alternative day therapy
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Nursing care regardless of Rx
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-Monitor BS
-Rest -Skin care - fragile skin -Safety - remove hazards, bed lo -Diet - decr cal, CHO, Na, (wt loss, edema) hi protein, hi K, CA, vit D, DM needs special diet -Monitor edema, vs, s&s, Na, K, cortisol -prevent, ck s&s infex -emot support -wear medic aleert bracelet |
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Adrenalectomy- Pre-op care
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correct F&E imbalances
-teach t&p, C&db -im glucocort am of surg, IV during surg (norm gland ~atrophied - takes 6-12 mo to produce enuf) |
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Adrenalectomy- Post-op care
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often ICU
-monitor adrenocortical insuff -*MOST IMPORT - ck BP - 1 gland removed - cortisol & mineralgcort 6-12 mo, if both - life -rest, pain meds, teach -prevent shock - ck s&s - may give IV rapid =>ck jug vn disten, orthopnea -prev infex, skin care - no tape |
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Bilateral adrenalectomy done if:
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Pt has malignancy of br or prostate. Adrenal horm incr chance of recurrence.
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