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Module 4 (MedSurg 2) > Adrenal Gland > Flashcards

Adrenal Gland Flashcards

(72 cards)

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1
Q

Adrenal Disorders in the cortex

A

Addison’s
Cushing’s

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2
Q

Adrenal Disorders in the medulla

A

Pheochromocytoma

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3
Q

Adrenal glands work with

A

chem balance
metabolism
Sugar, salt/K, sex

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4
Q

Adrenal glands secrete

A

mineralocorticoids, glucocorticoids, androgens and estrogens

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5
Q

mineralocorticoid

A

aldosterone - fluid balance

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6
Q

glucocorticoid

A

cortisol - aids in metabolism under stress
low immune system help

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7
Q

androgens and estrogens

A

male and female traits

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8
Q

Cushing’s disease cause

A

high cortisol due to high ACTH from the pituitary
metabolic disorder

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9
Q

Cushing’s syndrome caused

A

large or prolonged corticosteroid use
from adrenal cortex

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10
Q

Types of Cushing’s

A

Iatrogenic
primary
secondary

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11
Q

Iatrogenic Cushing’s

A

extended use of glucocorticoids

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12
Q

Primary cushing’s

A

adrenal cortex tumor

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13
Q

Secondary cushing’s

A

ACTH produced by CA of lung or pancreas leads to hyperplasia of a. cortex

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14
Q

Cushing’s labs

A

low K
hig NA, glucose, and cortsol

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15
Q

Cushing’s assessments

A

HTN
osteoporosis
muscle wasting - hand and arm bruising and thinning(SIADH but with fat)
weakness
LOC and mood change moonface
psychosis
Buffalo hump - fat glob on back
straie - tiger strips
poor wound healing

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16
Q

Dx Cushing’s syndrome

A

Midnight or late-night salivary cortisol
Low-dose dexamethasone suppressiontest
24-hour urine cortisol
Levels >80-120 mcg/24 hours
ran at 2300 WITH labs at 0800
-Plasma ACTH for pituitary or steroid

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17
Q

Iatrogenic Cushings Management

A

Decrease corticosteroid dose
Change to every other day schedule
Taper off gradually
Txsuppress ACTH or cortisol
chemo or surgery for tumors

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18
Q

Cushing’s syndrome mgmt

A

Due to moods, reteaching and family member involvement
Increase use of steroid use attracts water
Daily wt with body measurements journal
Monitor BP
Body is fat consumed
Risk for fractures and infections
Skin tear easy

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19
Q

Seven Dwarves of Cushing’s

A

forgetful
chubby
bruisy
sleepy
hairy
angry
psycho

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20
Q

Addison’s disease is the

A

hypofunction of A cortex
low glucocorticoid, mineral and adreogens

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21
Q

Addison’s causes

A

Sudden d/c of high dose steroids
Destruction of the adrenal cortex
Autoimmune
Trauma
Sepsis
Surgery

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22
Q

Low ACTH and aldosterone and cortisol

A

High K
low Na and glucose

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23
Q

Addison’s labs

A

low aldosterone and cortisol
low Na glucose
high K

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24
Q

Addison’s s/s

A

CV: dysrhythmia, tachycardia, hypovolemia, POSTURAL HYPOTENSION
GI: N/V/D , anorexia
Skin: hyper-pigmentation, poor healing
MS: muscle & joint pain, muscle weakness & tremor
Mental status: depression, emotional lability, confusion

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25
Adrenal Crisis
profound fatigue dehydration low BP vascular collapse low Na High K
26
Dx of Addison's
Adrenocortical hormone levels ACTH levels – pituitary problem ACTH / CTH stimulation test Dark skin pigment in areas gums dark purple
27
Addison's Administer
Glucocorticoid & Mineralocorticoid
28
Addison's nutriton
High Ca & Vit. D, Na normal to mod
29
Addison's observe for
Addisonian crisis
30
Addison's monitor
VS I&O WT WBC Glucose Na K Ca
31
Addison's education
take sick day regimen go to ER if N/V proteins and carbs
32
Addisonian Crisis is caused by
Stress Infection Trauma Surgery Abrupt d/c of corticosteroid use
33
Addisonian Crisis s/s
low Na, Glucose high Potassium H/A Severe low BP Weakness Irritable/confusion Abd, leg & low back pain Shock
34
Addisonian Crisis Care
Shock management High-dose IV hydrocortisone replacement (glucocorticoid) Monitor for Cushing D5NS Frequent VS & neuro assessment I&O, daily wt. QUIET WITH REST Protect from extremes- light, noise, temperature Protect from infection
35
Glucocorticoids
Influence carbohydrate metabolism cortisol - carb metabolism (genesis, lower utilization peri,**inhibit uptake, and promote storage)** - protein metabolism - fat metabolism - CV function
36
Mineralocorticoids
Regulate salt & water balance
37
Androgens
Contribute to expression of sexual characteristics
38
**Large doses of Cortisol** can cause
Osteoporosis Muscle weakness & atrophy Stress adaptation interference Inhibit action of Growth Hormone if younger (need to put some breaks)
39
hydrocortisone (Cortef)** goal
produces multiple glucocorticoid & mineralcorticoid effects
40
hydrocortisone (Cortef)** adverse effects
adrenal suppression, production of Cushing’s syndrome
41
hydrocortisone (Cortef)** used for
Addison's and crisis
42
hydrocortisone (Cortef)** contraindications
systemic fungal infection, hypersensitivity
43
hydrocortisone (Cortef)** dosage
Largest dose 2-3 in morning 8-9am 1/3 IN AFTERNOON NO LATER THAN 6 flip if night shift
44
hydrocortisone (Cortef)** monitor for
Assess vital signs, weight, respirations, & signs of dependent edema overdose s/s Monitor for depression, insomnia, anorexia Assess skin for bruising, color changes, acne, changes in hair growth Advise regular eye exams bc glucose Reposition immobilized patients every 2 hours Skin care for pressure injuries Monitor stool for occult blood
45
hydrocortisone (Cortef)** teachings
Take oral doses with meals & avoid alcohol Take any missed dose as soon as remembered with juice or coke bc of bad taste from overdose Limit sodium intake Monitor blood sugar, esp. if diabetic Report any bloody or black tarry stools, mood changes, or insomnia
46
hydrocortisone (Cortef)** avoid
Avoid immunizations during therapy** Avoid immunizations for 3 months following completion of therapy** Report fever, cough, sore throat, malaise, unhealed injuries Do not share drug with others Do not stop abruptly** **Medical Alert ID** **Emergency kit**
47
Mineralocorticoids
RAAS = Aldosterone Promotes sodium & potassium hemostasis** Helps maintain intravascular volume **BP = Harmful cardiovascular effects when high**
48
fludrocortisone** GOAL
produces multiple glucocorticoid & mineralcorticoid effects
49
fludrocortisone** adverse effects
HTN, edema, cardiac enlargement, hypokalemia
50
fludrocortisone** contraindications
systemic fungal infection, hypersensitivity
51
fludrocortisone** med given when
morning at 0900
52
fludrocortisone** monitor
Monitor for weight gain, elevated blood pressure Monitor electrolytes, especially sodium & potassium Signs of overdose: psychosis, excess weight gain, edema, CHF, increased appetite, severe insomnia, hypertension
53
fludrocortisone** teachings
Report muscle weakness, fatigue, delirium, paresthesias, numbness of the mouth, anorexia, nausea, depression, diminished reflexes, polyuria, irregular heart rate **Eat foods high in potassium supplements too** Weigh daily Report any edema** Report infection, trauma or unexpected stress
54
Adrenal medulla functions with
autonomic NS epinephrine and norepinephrine
55
Pheochromocytoma is the
hyperfucntion of the A medulla
56
Pheochromocytoma Causes
Catecholamine-producing **tumor** in adrenal medulla high epinephrine & norepinephrine** Severe life-threatening hypertension**
57
Pheochromocytoma s/s
HTN – severe Lab: high catecholamine (blood & urine) Triad – HA, Diaphoresis, Palpitations w/ HTN **5 “H’s”- HTN, HA, Heat, Hypermetabolism, Hyperhidrosis**
58
Pheochromocytoma complications
HTN crisis leads to renal & retina damage AMI CHF CVA Dysrhythmia
59
Pheochromocytoma Dx
24 hr urine for VMA = high vanillylmandelic acid Plasma – catecholamine Clonidine Suppression CT/MRI - tumor
60
Pheochromocytoma need to avoid
stimulants
61
Pheochromocytoma medications
none, ADRENALECTOMY is best options due to chemo not working
62
Pheochromocytoma monitor
BP fluid and electro EKG
63
Pheochromocytoma NUTRITION
HIGH CAL
64
Pheochromocytoma education
Knowledge deficit Health maintenance Risk – injury Risk – thought process Risk – sleep pattern decrease anxiety and agitation
65
Adrenalectomy
Surgical removal of one or both adrenal glands Open incision or laparoscopic technique
66
Bilateral Adrenalectomy
postop steroid supplementation cortisone & hydrocortisone 
67
Adrenalectomy Pre-op
Diet - vitamins & proteins high risk of infection. Monitor electrolytes & glucose IS, TCDB, pain scale
68
Adrenalectomy Post-op
VS, I&O, electrolytes Pain med, cortisol, & IVF Risk - Addisonian crisis & hypovolemic shock Risk - delayed wound healing & infection Risk – difficult glycemic control Return to work 1- 3 wks
69
D/C teaching for adrenalectomy
Home health MedicAlert bracelet Avoid: extremes of temperature, infection, & stress Teach: adjust medication & when to call HCP Lifetime replacement therapy
70
The nurse is instructing a college student with Addison’s disease how to adjust the dose of glucocorticoids. The nurse should explain the patient needs to increase the dosage in which situation? Completing final exams Gaining 5 pounds Seasonal allergies Wisdom teeth extraction
Wisdom teeth extraction
71
Bone reabsorption is a possible complication of Cushing’s Syndrome. To help prevent this complication, the nurse would recommend that the patient: Increase potassium in their diet Perform weight-bearing exercise regularly Limit dietary intact of Vit. D Perform isometric exercises
Perform weight-bearing exercise regularly
72
Glucocorticoid pts need to do what with the steroid when experiencing stressful situations
raise

Module 4 (MedSurg 2) (36 decks)

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