Adrenal Disorders (Exam 3)

Question 1

Adrenal Cortex Secretes

Answer 1

Glucocorticoid (Cortisol) Stress

Mineralocorticoids (Aldosterone) Salt

Sex steroids (Testosterone) Sex

Question 2

Adrenal Medulla Secretes

Answer 2

Catecholamines

Epi and NorEpi

Question 3

Cushing Disease / Syndrome

Answer 3

Too much cortisol

Disease = Rare

Syndrome = Collection of S/S

Question 4

What Causes Cushing Syndrome?

Answer 4

Patient is on long term oral systemic steroids

Question 6

Cushing Syndrome: Manifestations

Function of Cortisol and Clinical Manifestation with Increase Cortisol

Answer 6

Increase glucose availability

Glucose intolerance + hyperglycemia

HTN - Capillary friability (ecchymosis) (Bruising)

Muscle wasting, weakness, thinning of skin and bones

Redistribution of fat to abdomen, shoulder, and face

Impaired wound healing and immune response / risk of infection

Mood swings / insomnia

Question 7

Cushing Syndrome Manifestation

Answer 7

Personality changes

Hyperglycemia

Moon face

Trunk fat

Skinny arm

Gynecomastia (male)

Hirsutism (women)

Purply Striae (stretch mark

Question 8

Cushing other manifestations

Answer 8

Mental depression and lability

Glucose intolerance

Hypertension
-2 to salt retaining

Hypokalemia
-High levels of cortisol stimulate the mineralocorticoid (aldosterone) receptor activity
-Increase aldosterone = increase sodium + decrease potassium

Bone demineralization
-Spontaneous fractures possible

Question 9

With Cushing high levels of cortisol stimulate

Answer 9

Aldosterone

Aldosterone increase sodium retention and decrease potassium (hypokalemia)

Question 10

Cushing Priority Nursing Problems

Answer 10

-Risk for infection

-Weight gain

-Risk for impaired skin integrity

-Risk for injury (bone demineralization)

-Ineffective coping (labile moods)

-Body image concern

-Risk for unstable blood glucose

-HYPOKALEMIA

Question 11

Cushing’s: Nursing Primary Goal

Answer 11

Normalize hormone secretion

Question 12

Cushing’s: Treatment depends on underlying cause

Answer 12

Adrenalectomy (if adrenal tumor)

Removal of tumor (if ectopic ACTH secreting tumor)

Question 13

How do we treat cushing’s if patient goes into cushing SYNDROME because of prolong steroid use

Answer 13

-Gradual d/c of drugs

-Reduction of dose

-Conversion of alternate-day regimen

Question 14

Cushing’s: Monitor for

Answer 14

Fluid balance
(-I&O / Daily weight)

Glucose metabolism
(-FSBS)

Hypertension
(-VS)

Infection
(-Skin, urinary tract, temp, WBC)

Mood swings

Question 15

Cushing Syndrome Diet

Answer 15

Increase Protein

Increase Potassium

Decrease Calories

Decrease Sodium

Question 16

Addisons Disease

Answer 16

Not enough adrenal cortex activity

Insufficiency in corticosteroids and glucosteroids

Question 17

Addison’s Disease: Clinical Manifestations

Answer 17

Bronze pigmentation

Hypoglycemia (low cortisol)

Changes in body hair

Postural Hypotension (low aldosterone)

Weakness

Weight loss (not eating / fluid volume

Question 18

Adrenal Crisis

Answer 18

Profound fatigue

Dehydration

Vascular Collapse (decrease BP)

Renal Shutdown

Decrease NA

Increase K

Question 19

Addisons Disease Is the decrease secretion of

Answer 19

Cortisol
-Stress
-Sugar

Aldosterone
-Na and water retention
-BP

Androgens
-male hormone

Question 20

Addison’s Disease: Clinical Manifestation are r/t

Answer 20

Low levels of circulating cortisol and aldosterone

Question 21

Addisons Disease: Rate of onset and severity of symptoms

Answer 21

Slow degenerative destruction
-Subtle onset of symptoms

Rapid
-Very severe and life threatening

Question 22

Addison’s Disease: Clinical Manifestations

Answer 22

WEAKNESS r/t fluid and electrolyte imbalance

Anorexia / weight loss

HYPERKALEMIA (low aldosterone)

Hyperpigmentation

Question 23

Addison’s Disease: Hypoaldosteronism

Answer 23

Hypotension

Salt Craving
-Low serum Na levels

Dehydration

Question 24

Addison’s Disease: Hypocortisolism

Answer 24

-Lack of stress hormones

-Hypoglycemia

-Weakness and fatigue

Question 25

Addisons Disease Priority Problems

Answer 25

Deficient fluid volume Malnourishment r/t nausea Activity intolerance r/t muscle weakness Potential complication = Addisonian Crisis

Question 26

Mainstay of Treatment For Addison's

Answer 26

Hormone Replacement Therapy 1. Daily hydrocortisone; 2/3 on awakening / 1/3 later afternoon 2. Daily fludrocortisone in AM 3. Salt additives for heat/humidity 4. Increased doses when stressed

Question 27

Addisons: Cortisol Replacement Therapy Teaching

Answer 27

Closely follow dosing Never abruptly stop therapy Replacement therapy is lifelong 3 times the dose for 3 days when sick or stressed or surgery Keep supply on hand Medical Alert Bracelet

Question 28

Addisonian Crisis: What is it?

Answer 28

Medical Emergency (acute adrenal insufficiency)

Question 29

Addisonian Crisis: Cause

Answer 29

Suggen insufficient of serum corticosteroids -sudden loss of gland -sudden increase in stress in chronic condition -sudden cessation of drug therapy

Question 30

Addisonian Crisis: Symptoms

Answer 30

Sudden penetrating pain in lower back - abdomen - legs Severe vomiting and diarrhea Dehydration Low blood pressure Loss of consciousness FATAL if Untreated

Question 31

Treating Addisonian Crisis

Answer 31

Intravenous hydrocortisone, saline, and dextrose Hydrocortisone dose is decreased when patient can take PO If aldosterone decreases maintenance therapy includes fludrocortisone acetate

Question 32

ADDISONS DISEASE EMERGENCY KIT

Answer 32

100 mg IM injection of hydrocortisone

Question 33

Nursing care Addison's Disease

Answer 33

Frequent VS (VERY unstable) Stress free environment (do not have cortisol to response to stress)

Question 34

Pheochromocytome: How is it diagnosed?

Answer 34

Elevated (24 hr) urine catecholamines and plasma serum catecholamines

Question 35

Pheochromocytome: Clinical Manifestations

Answer 35

Intractable high BP and Triad of symptoms -Palpitations -Headache -Episodic sweating

Question 36

Pheochromocytoma: Triad of Symptoms

Answer 36

Palpitations Headache Episodic Sweating