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26 Cards in this Set
- Front
- Back
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Cushing's Disease/Syndrome General cause |
Excess cortisol |
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Moon face, buffalo hump (fat deposits), thin skin, fine hair on face & body, unhealed wounds, aabdominal striae |
Cushing's Syndrome clinical presentation |
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Cushing's Clinical Impact |
Cardiac - High PB, bounding pulse Hypervolemia & Edema Na & H2O retention Muscle Atrophy (extremities) Osteoporosis Elevated glucose suppressed Immune emotional instability |
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Cushing's Diagonstic |
High cortisol (blood, urine, saliva) Low K and Ca High Na & Glucose (possible) Adrenal or Pituitary lesions (xray, ct, mri) |
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Cushing's treatment surgery |
remove pituitary (hypophysectomy) remove adrenal, partial or complete (adrenalectomy) |
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Cushing's treatment pharmacologic |
Aminogluthethimide (Cytadren) Spironolactone (Aldactone) |
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Spironolactone pharmocology |
aldosterone antagonist blocks reabsorption of Na & water treats adrenal hyperplasia |
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Cushing's Priority Problems |
Fluid Overload Infection risk Injury risk Body image Knowledge deficite |
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Cushing's Fluid Overload tx |
daily weight i/o vitals breath sounds assess for edema fluid restrictions |
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Cushing's Infection Risk tx |
vitals and labs aseptic technique protein & vitamin increase |
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Cushing's Knowledge deficite tx |
medication regimen Diet restrictions (low Na & fluid) Daily weight infection signs |
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Cushing's Injury risk tx |
safe environment skin assessment |
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Addison's Disease basic cause |
low cortisol - insufficient production |
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Primary Addison's Disease Causes |
Autoimmune HIV / TB infection Tumors Adrenalectomy |
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Secondary Addison's Disease Causes |
sudden withdrawal of long term, high dose steroid therapy |
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Addison's Clinical Manifestations |
Salt craving - diet change weakness & fatigue dehydration Nausea Vomiting & Anorexia Hyperpigmentation - 90% bronze-like color Orthostatic Hypotension Mood Changes |
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Addison's Diagnostic Test |
ACTH Stimulation Test IV ATCH (stimulates cortisol production) monitor serum cortisol at 30 & 60 min Cortisol should rise CT/MRI of pituitary/adrenal glands |
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Addison's Lab Indicators |
Low cortisol low Na hypoglycemia high K & Ca Elevated BUN (possible) |
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Addison Treatment |
Florinef - mineralocorticoid take with food weight, bp, electrolytes report weight gain 5 lb Prednisone - glucocorticoid weight, electrolytes, bp (high) take with food excess may cause Cushing's |
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Addison's Crisis |
Severe Adrenal Insufficiency sudden or over several days due to sudden d/c of steroids |
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Addison's Crisis - symptoms and progression |
difficult to diagnosis - dehydration & nausea Severe Hypotension -> Circulatory Collapse -> Shock (kidney failure) -> Coma |
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Addison's Crisis Treatment |
5 S's Salt Replacement (normal saline) Sugar Replacement (D5w) Steroid Replacement (IV) Support physiological functioning (gi, resp, heart) Search for and treat cause |
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Addison's Disease Primary Problems |
Fluid Volume Deficite Injury Risk Nutrition Deficit Knowledge Deficit Body Image |
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Addison's Fluid Volume Deficite tx |
symptoms - low bp fast heart, dry membranes monitor vitals labs - bun & creatinine monitor weights sit and stand slowly (ortho hypo) increase fluid intake |
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Addison's Risk for Injury tx |
Sensory Sensitivity - quiet environment Hypoglycemia hypotension tachycardia dehydration |
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Addison's Knowledge Deficite tx |
Carry Emergency Kit & medic alert band Med regimen signs of Adrenal Insufficiency - early dizzy, fatigue, nausea, salt craving, muscle pain late confusion, headache, bp drop no alcohol caffeine hypoglycemia- shaky sweaty GI bleeds - black tarry stool, coffee ground emesis |
