Test 3 Nursing Process 2Nd Semester

Front 1

dysfuction of adrenal glands

Back 1

pheochromocytoma-
Addisons disease
Cushing's syndrom

Front 2

phyochromocytoma-paraphysiology

Back 2

Hypersecretion of the adrenal medulla

Front 3

Addison's disease

Back 3

Adrenocortical insufficiency-from the adrenal cortex

Front 4

Cushing's syndrome

Back 4

Adrenocortical excess

Front 5

pheochromocytoma-what is it?

Back 5

Rare Catecholamine secreting tumor-90% are in the adrenal gland 10% are in either the sympathetic nerve chain along the spinal cord, overlying the distal aorta, within the ureter, or the urinary blader

Front 6

pheochromocytoma facts

Back 6

90% are benign, 10% are malignant, occurs at any age. 10% have a family member with same type of turmor asociated with Multiple Endrocrine Neoplasia-MEN. Over production causes a sever elevation in BP

Front 7

pheochromocytoma signs and symptoms

Back 7

Paroxysmal hypertension, Episodic headaches, sweating, tachycardia, Nervousness, anxiety, irritability-tremors, nausea, vomiting, heat intolerance, weight loss

Front 8

pheochromocytoma if high bp is left untreated:

Back 8

heart failure, stroke, kidney failure, acute respiratory distress, confusion, psychosis, seizures, visual impairment, premature death

Front 9

diagnositc tests of pheochromocytoma

Back 9

urine levels of free catecholamines, 24 hour urine for catecholamines and metanephrines,
Plasma metanephrine levels, VMA (vanillylmandelic acid) serum catecholamines,
Imaging studies: CT SCAN, MRI, ULTRASOUND
high 5's

Front 10

high 5's

Back 10

hypertension, headache, hyperhydrosis (excessive sweating), hypermetabolism, hyperglycemia-highly predictive of pheochromocytoma

Front 11

factors that can increase catecholamine decongestatns and should be restricted before tests.

Back 11

coffee, tea, tobacco, emotional and physical stress, drug: amphetamines, nose drops or sprays, decongestants agent, bronchodialators

Front 12

pheochromocytoma: medical management

Back 12

admission to icu for close monitoring of ecg changes and careful administration of alpha-adrenergic blocking agents or smooth muscle relaxants to lower the bp quickly. (control bp!!)
surgical removal of tumor with adrenalectomy

Front 13

pharmacological therapy for pheocromocytoma

Back 13

decrease bp-
Nipride
Ca Channel blockers (cardizem, procardia)
Beta-adrenergic blocking agents (inderal)
IV Corticosteroid replacement (solu-medrol)
oral corticosteroids (prednison)

Front 14

Pheorocmocytoma-removing tumor causes

Back 14

catecholamines release in patient

Front 15

Pheochromocytoma: nursing management
Patient teaching

Back 15

medic alert bracelet, avoid temperature extremes, avoid infections, and emotional disturbances, teach life long replacement, adjust corticoid steroid replacement in response to therapy, maintain fluid and electrolyte balance

Front 16

pheochromocytoma: Nursing management

Back 16

do not do abdominal palpations, maintain bed rest until bp is stable, monitor for hypoglycemia (with steroid use), monitor for hypotension due to meds, monitor for pain, nausea and vomiting. Monitor fluid and electrolyte imbalance, usually post op and preop teaching and care

Front 17

Nursing diagnosis for pheochromocytoma

Back 17

Anxiety r/t symptoms from increased catelcholamines, headache,palpitations, sweating, nervousness, N/V, syncope

Front 18

where does addison's disease occur

Back 18

in the adrenal cortex occurs when the functionis inadequate to meed the patient's need for cortical hormones

Front 19

what causes addison's disease

Back 19

inadequate development of the adrenal gland, inability for adrenal gland to produce cortisol. Adrenal destruction

Front 20

Clinical manifestations of Addison's disease

Back 20

Muscle weaknes, anorexia/emaciation, GI symptoms (nausea,abdominal pain, diarrhea) fatigue, dark pigmentation on the knuckles,knees, and elbow, mucous membranes, low blood glucose, low serum sodium, high serum potassium, mental status changes such as depression, emotional instability, apathy, and confusion are present in 60-80% of patients. hypotesion,

Front 21

diagnositc testing

Back 21

low levels of adrenocortical hormones in the blood or urine, decreased serum cortisol levels, low glucose, low chlorine, high bun, low sodium, high potassium, high wbc's, anemia,acth admin fails to cause rise in plasma cortisol, CRH stimulation test, x rays of the abdomen, ct of pituitary gland, ekg changes, tall peaked t wave in the absence of hyperkalemia

Front 22

Medical Management

Back 22

restoration of circulatory shock, restore blood circulating,admin. fluids-large volumes of NS/D5W, REplace cortisol, monitor vs, place in recumbent position with legs elevated. vasopressors for hypotension.

Front 23

Addison's disease Nursing Mgt. activity intolerance

Back 23

activity intolerace due to fatigue r/t fatigue
monitor vs around activity
organize activities to provide frequent rest periods, assist with ADL's, provide supplemental o2 therapy if needed.
implement corticosteroid therapy as ordered to prevent addison's crises,

Front 24

addison's disease nursing magt. risk for infection

Back 24

aseptic technique-ggod handwashing,

Front 25

addison inffective coping

Back 25

monitor for mood change

Front 26

addison's risk for injury r/t weakness

Back 26

assist with activity

Front 27

addison's patient teaching medications

Back 27

names and dosages, action, signs/symptoms of over/underdosing, dosing time-minerocorticoid-one daily in morning, steroids 2/3 daily in am, 1/2 daily in pm, condition requiring increase in medicine, prevent infection, understand life long replacement, need for medication follow up, fluid and electorlyte replacement with vomiting and diarrhea, drug interaction with other medicaitons