Med Surge - Test 3 P. 29-38

Front 1

Adrenal Disorders

Hypofunction: Production of adrenocortical steroids may decrease as a result

Back 1

of inadequate secretion of adrenocorticotropin hormone (ACTH).

Front 2

Adrenal Disorders

Hypofunction
Insufficiency of adrenocortical steroids causes problems through the loss of _______ & ________ action.

Back 2

aldosterone and cortisol

Front 3

Adrenal Disorders
-Hypofunction:

Impaired secretion of cortisol results in???

Back 3

hypoglycemia.

Front 4

Adrenal Disorders
-Hypofunction

Reduced aldosterone secretion causes (3)

Back 4

hyperkalemia,
hyponatremia,
hypovolemia

Front 5

Adrenal Disorders
-Hypofunction


K+ retention also promotes reabsorption of hydrogen ions, which can lead to .

Back 5

acidosis

Front 6

4 Adrenal Disorders

Back 6

Pheochromocytoma

Addison’s disease

Cushings Syndrome


Hyperaldosteronism

Front 7

Adrenal Disorders

Pheochromocytoma – is what?





hypofuncton or hyperfunction of the adrenal gland?

Back 7

secreting tumor that grows off adrenal gland




(adrenal gland hyperfunction)

Front 8

Adrenal Disorders


-Addison’s disease –you have to “add” back what you don’t have



hypofuncton or hyperfunction of the adrenal gland?

Back 8

(adrenal gland Hypofunction)

Front 9

Adrenal Disorders


Cushings Syndrome
hypofuncton or hyperfunction of the adrenal gland?

Back 9

hyperfunction of the adrenal gland

you have more than enough couchin - too much

Front 10

Adrenal Disorders

Hyperaldosteronism:
-secretion of what?




hypofuncton or hyperfunction of the adrenal gland?

Back 10

excessive mineralocorticoid production or excessive androgen production





(adrenal gland hyperfunction)

Front 11

Addison’s Disease

deficiency of what 3 hormone?

Back 11

-A deficiency of adrenocorticotropic hormone.



-Hyposecretion of glucocorticoids (Cortisol) and mineralocorticoids (aldosterone)

Front 12

Addison’s Disease


-most often occurs in response to?

Back 12

-often occurs in response to a stressful event (surgery, trauma, severe infection)

Front 13

Addison’s Disease

Condition is FATAL if not treated
-what happens?

Back 13

(sodium levels fall and potassium levels rise rapidly..severe hypotension results from the blood volume depletion that occurs with the loss of aldosterone)

Front 14

Addison’s Disease

Caused by:

Back 14

autoimmune,
adrenal hemorrhage,
adrenalectomy,
tumor,
fungal infection,
TB

Front 15

Addison’s Disease - Assessment

Back 15

*Lethargy, fatigue & muscle weakness
*GI disturbances (diarrhea, n/v, abdominal pain, anorexia)
*Weight Loss
-Menstrual Changes, Impotence in men

Front 16

Addison’s Disease - Assessment


glucose level
potassium levels
sodium levels
calcium levels

hypertensive or hypotensive?

Back 16

-Hypoglycemia
-Hyperkalemia
-Dehydration
-Emotional disturbances after awhile
-Hyponatremia
-hypercalcemia
-hypotension

Front 17

Interventions for Addison’s Disease

-Monitor VS, weight, I & O, electrolyte balance


-Monitor levels of what (2)

Back 17

blood glucose & potassium levels

Front 18

Interventions for Addison’s Disease

Glucocorticoid deficiencies are treated with _________

Back 18

hydrocortisone

Front 19

Interventions for Addison’s Disease

Mineralocorticoid deficiencies can be treated with __________if needed

Back 19

Florinef

(maintains electrolyte balance –Na and K)

Front 20

Interventions for Addison’s Disease


aim to promote what?

monitor for fluid ____




prevent what?

Back 20

-aim to promote fluid balance,

monitor for fluid deficit,

prevent hypoglycemia

Front 21

“Addisonian Crisis”


A life-threatening event caused by ACUTE adrenal insufficiency secondary to a stressful event (surgery, trauma, infection)

so what hormones are there a need for?

Back 21

–the need for cortisol and aldosterone is greater than the available supply.

Front 22

“Addisonian Crisis”

sodium level
potassium level

hypertension or hypotension



hypoglycemia or hyperglycemic

Back 22

Can cause hyponatremia which can cause seizure,

hyperkalemia,

severe hypotension from the blood volume depletion that occurs with the loss of aldosterone,


hypoglycemia, and shock,



need to wear medical bracelet

Front 23

Pathophysiology of Acute Adrenal Crisis / Adrenal Insufficiency

usually related to what?

Back 23

Usually related to bilateral adrenal hemorrhage!

Front 24

Pathophysiology of Acute Adrenal Crisis / Adrenal Insufficiency


sodium levels


potassium levels

Back 24

Unless treatment is initiated promptly, sodium levels fall and potassium levels rise rapidly.

Front 25

Assessment in “Addisonian Crisis”


4

Back 25

-Severe headache
-Severe abdominal, leg and low back pain
-Generalized weakness
-Irritability

Front 26

Assessment in “Addisonian Crisis”


3

Back 26

-Severe headache
-Severe abdominal, leg and low back pain
-Generalized weakness
-Irritability

Front 27

“Addisonian Crisis” – Interventions


-Administer IV Glucocorticoids as ordered
-Following resolution of crisis, administer (3)

Back 27

oral gluccorticoids & mineralocorticoids


-insulin product (usually sq or ivp)

Front 28

“Addisonian Crisis” – Interventions

-Monitor VS, neuro status, noting irritability and confusion
-Monitor I and O, blood glucose, Na & K+
-Administer fluids prn (NS)
-Protect patient from infection

Back 28

yes!

Front 29

Cushing’s Syndrome

Condition resulting from

Back 29

the hypersecretion of glucocorticoids (cortisol) from the adrenal cortex

Front 30

Cushing’s Syndrome(Hypercortisolism)



3 causes

Back 30

Increased pituitary secretion of adrenocorticotropic hormone (ACTH) which causes hyperplasia of the adrenal cortex in both adrenal glands and an excess of most hormones secreted by the adrenal cortex


Pituitary Adenoma





Adrenal Adenoma

Front 31

Cushing’s Syndrome(Hypercortisolism)


The excess glucoroticoids affect metabolism and all body systems.

Back 31

Nitrogen, carbohydrate, and mineral metabolism are altered. An increase in total body fat results. The fat is redistributed to produce the typical body pattern of truncal obesity “buffalo hump” and “moon face”

Front 32

Cushing’s Syndrome - Assessment


-Truncal Obesity with thin extremities
-Moon face
-Buffalo hump
-Generalized muscle wasting & weakness
-Fragile skin that bruises easily
-immunosuppression and increased risk for infection result from excess cortisol
-Reddish/purplish striae on abdomen & upper thighs

Back 32

yes

Front 33

Cushing’s Syndrome - Assessment

-Hirsutism-caused by an increase in __________production (also causes acne) hirsutism is increased hair growth.


_______ hormone alteration.

Doesn’t affect men but it affects woman and the woman become mascularized. Hair distribution will increase (mustache, side burns) ---thick and coarse.. Hair up abdomen.



Alteration in ovulation (fertility problems and getting pregnant)
-Hypertension

Back 33

androgen



sex hormone

Front 34

Cushing’s Syndrome - Assessment

-both sodium and water are reabsorbed and retained, leading to hypovolemia and edema formation

-increased androgen production decreases what?

-sodium?
-glucose?
-potassium?
-WBC?

-

Back 34

-the production of estrogens and progesterone and oligomenorrhea occurs as a result (scant or infrequent menses)


-increased sodium level
-increased blood glucose
-decreased potassium

-high levels of corticosteriods kill lymphocytes and shrink organs containing lymphocytes such as the liver, spleen, and lymph nodes. Protection from the inflammatory and immune responses is reduced

Front 35

Cushing’s Syndrome - Interventions

monitor what?

what is the best indicator for fluid retention and overload?

Back 35

-Monitor VS, I & O, electrolytes (we monitor these for anything with the anterior pituitary)




weight (best indicator for fluid retention and overload)

Front 36

Cushing’s Syndrome - Interventions


tell me about skin care

Back 36

-Good skin care b/c because the pt with fluid overload and dependent edema is at risk for skin breakdown.

Front 37

Cushing’s Syndrome - Interventions

-restriction of ??????






-Allow patients to express feelings related to body image

Back 37

both fluid and sodium intake to control fluid volume

Front 38

Cushing’s Syndrome - Interventions

-Drug therapy involves the use of drugs that interfere with

Back 38

adrenocorticotropic hormone (ACTH) production or adrenal hormone synthesis for temporary relief.

Administer adrenal enzyme inhibitors, i.e., Lysodren, Cytadren, Modrastane to decrease cortisol production “adrenal inhibitors” look at back of word

Front 39

Cushing’s Syndrome - Interventions

Diagnosis


normal level

Back 39

salivary cortisol levels are used to detect hypercortisolism in a patient’s saliva.





(normal salivary cortisol is lower than 2.0 ng/mL. higher levels indicate hypercortisolism.

Front 40

Cushings Syndrome

Additional laboratory findings that accompany hypercortisolism include:



glucose?
WBC?
sodium?
calcium?
potassium?

Back 40

-increased blood glucose
-decreased lymphocyte found
-increased sodium level
-decreased serum calcium level
-decreased serum potassium level

Front 41

Cushing’s Syndrome – Interventions


-Prepare patient for possible radiation treatment if caused by

Back 41

pituitary adenomas)

Front 42

Cushing’s Syndrome – Interventions

-Prepare for possible hypophysectomy if condition is caused by

Back 42

increased pituitary secretion of ACTH is causing adrenal hyperfunction

Front 43

Cushing’s Syndrome – Interventions

-Prepare for adrenalectomy if condition is from what?

Back 43

from adrenal adenoma (tumors) causing hypercorticolism

Front 44

Pheochromcytoma

-what is it?

Back 44

a catecholamine-producing tumor that arises from the adrenal gland which produces excess adrenaline.

Front 45

Pheochromcytoma

-what do the tumors store, produce, and release?

Back 45

excessive epinephrine and norepinephrine, which stimulates adrenergic receptors which mimic the action of the sympathetic nervous system

Front 46

Pheochromcytoma


-tumors that arise from where?

Back 46

Arise from the central portion of the adrenal gland which is called the adrenal medulla.




The adrenal medulla is responsible for the normal production of adrenaline which our body requires to help maintain blood pressure and to help cope with stressful situations.
A tumor which arises from the adrenal medulla and overproduces adrenaline can be a deadly tumor because of the severe elevation in blood pressure it causes

Front 47

Pheochromcytoma

S/S

Back 47

S/S
Headaches (severe)
Excess sweating (generalized)
Racing heart (tachycardia and palpitations)
Anxiety / nervousness (feelings of impending death)

Front 48

Pheochromcytoma

S/S

Back 48

Nervous shaking (tremors)
Pain in the lower chest or upper abdomen
Nausea (with or without nausea)
Weight loss
Heat intolerance -very hot

Front 49

Pheochromcytoma


what is the main treatment?

Back 49

Surgery is the main treatment for a pheochromocytoma. One or both adrenal glands are removed.

Front 50

Who Should be Examined for a Pheochromocytoma

Back 50

-Patients with very difficult to control hypertension
-Patients requiring more than 4 blood pressure medications
-Patients with onset of hypertension before the age of 35
-Patients with onset of hypertension after the age of 60
-Patients with signs or symptoms of pheochromocytoma
-foods or beverages high in tyramine (aged cheese, red wine) also induce hypertension

Front 51

Diagnosing Pheochromocytomas

24 hour urine collection that shows elevated levels of (2)

Back 51

catacholamines and metanephrines (metabolite of epinephrine)

Front 52

Diagnosing Pheochromocytomas


24 hour urine collection that shows elevated levels of catacholamines and metanephrines


This study is designed to measure production of the different types of what?

Back 52

adrenaline compounds that the adrenal makes.




-This test measures different types of adrenaline (epinephrine, norepinephrine, dopamine) as well as the break-down products of these compounds which the liver and kidney have degraded.

Front 53

Surgical Treatment of Pheochromocytomas


All pheochromocytomas should be removed how?

Back 53

by surgery, one ore more of the adrenal glands are removed.

Front 54

Surgical Treatment of Pheochromocytomas

-tumors may be inoperable because of the patient’s other medical conditions. Treatment then is medical with

Back 54

alpha adrenergic and beta adrenergic blocking agents, because the tumors do not respond well to chemotherapy or radiation therapy (Calcium channel blockers, sodium channel blockers, beta, we have to block)

Front 55

Surgical Treatment of Pheochromocytomas


what is the hallmark of this disease and the most common complication after surgery?

Back 55

hypertension


Monitor BP closely.

Front 56

Surgical Treatment of Pheochromocytomas


-palpation when doing a head to toe asessment

Back 56

Do not palpate the abdomen because this action could cause a sudden release of Catecholamines and severe hypertension.

Front 57

Surgical Treatment of Pheochromocytomas

what is now the preferred method for removing pheochromocytomas and is available in most hospitals in the U.S.

Back 57

-The vast majority of patients can be treated with the new technique of minimally invasive Laparoscopic Adrenalectomy.