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Nursing 272: Final Semester > Unit 2: Pheochromocytoma > Flashcards

Unit 2: Pheochromocytoma Flashcards

1
Q

Pheochromocytoma

A

rare catecholamine-secreting tumors of the adrenal medulla; tumor that secretes excess catecholamines

  • 50% of cases are diagnosed upon autopsy
  • b/c of excessive catecholamine (epinephrine and norepinephrine) secretion, pheochromocytoma may precipitate life-threatening hypertension or cardiac arrhythmias leading to sudden death
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2
Q

Catecholamines

A

ex: adrenaline, epinephrine, norepinephrine, cortisol

“stimulant’s on steroids”; drives everything up

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3
Q

Pathophysiology of Pheochromocytoma

A

pheochromocytomas are catecholamine-secreting tumors of the adrenal medulla and are usually unilateral

  • release of epinephrine and norepinephrine is paradoxical, rather than continuous, and leads to vasoconstriction, increased HR, increased stroke volume leading to a rise in systolic BP and a widening pulse pressure
  • catecholamine release also stimulates gluconeogenesis = hyperglycemia
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4
Q

Clinical Manifestations of Pheochromocytomas

A

associated w/ the systemic actions of epinephrine and norepinephrine
-tachycardia (High HR)
-hypertension (high BP)
-severe headache
-palpitations
-tremors
-hyperhidrosis (excessive sweating)
-hypermetabolism
-hyperglycemia
>severity of attacks correlates to the amount of catecholamine release
>paroxysmal (sudden-onset) hypertension may be seen with elevations up to 250/140 mmHg; life threatening

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5
Q

The classic presentation of Pheochromocytoma

A

-sudden elevation of blood pressure accompanied by other clinical manifestations of catecholamine excess

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6
Q

Diagnosing Pheochromocytoma

A
  • recognition of signs and symptoms
  • measurements of catecholamines in urine and serum (catecholamine release 2 times a day; early in morning, late afternoon)
  • imaging (CT or MRI) to visualize tumor
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7
Q

Patient Preparation for Direct Measurements of Plasma Catecholamines: to prevent elevations of circulating catecholamines

A
  • urine + blood samples
  • supine and rests for 30 minutes prior to test
  • small IV catheters are placed 30 minutes prior to the actual collection of the blood samples
  • catecholamine metabolites (metanephrine and vanillylmandelic acid) and free catecholamines are also measured in urine; 24-hour urine collection test
  • avoid bananas, chocolate, vanilla, and tea or coffee (including decaffeinated)
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8
Q

CT or MRI Scans

A

to determine whether tumor is unilateral or bilateral

-also helps guide the surgeon performing a adrenalectomy

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9
Q

Medical Management for Pheochromocytoma

A

patient presenting w/ signs of hypertension, tachycardia and other clinical manifestations of pheochromocytoma require:

  • Bed rest with HOB elevated
  • Cardiac monitor to assess for cardiac dysrhythmias
  • Pharmacological: focuses on quickly lowering BP; includes alpha-adrenergic blocking agents or smooth muscle relaxants, and beta blockers and calcium channel blockers to low HR and BP
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10
Q

Pharmacological Management

A

focuses on quickly lowering the BP

  • alpha-adrenergic blocking agents
  • smooth muscle relaxants
  • beta blockers and calcium channel blockers to lower HR and BP
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11
Q

Adrenalectomy

A
  • definitive treatment
  • goal: complete tumor resection, minimal tumor manipulation, and adequate exposure of the adrenal gland to avoid injury to other organs
  • different approaches; standard approach is open transabdominal anterior approach through a bilateral subcostal incision; or a laparoscopic approach
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12
Q

Patient Preparation for Adrenalectomy (preop)

A

focuses on control of blood pressure and heart rate

  • treatment w/ alpha-adrenergic blockers is started 7 to 10 days prior to scheduled procedure w/ a goal of 120/80 mmHg or lower in a seated position
  • a beta blocker may be used to control HR but only AFTER blood pressure is lowered
  • fluid management preoperatively b/c of vasodilation secondary to alpha-adrenergic blockers
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13
Q

During an Adrenalectomy what is the patient at risk for?

A
  • a hypertensive crisis b/c the vascular pheochromocytoma is manipulated and removed
  • sodium nitroprusside (Nipride) or alpha-adrenergic blockers cautiously administered
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14
Q

Postoperative management of Adrenalectomy

A

focuses on monitoring blood pressure, heart rate, and blood glucose

  • b/c of sudden decrease in circulating catecholamines as a result of tumor removal, patient may develop hypotension and or hypoglycemia
  • monitor for blood loss d/t the vascular nature of the adrenal gland
  • several days post-op, plasma and urine samples are collected for measurement of catecholamine levels and catecholamine metabolites
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15
Q

What if a Patient Requires Bilateral Adrenalectomy

A

-necessitates life-long adrenal cortex hormone replacements
-required to take cortisol daily and may acquire additional doses during physiological or emotional stress
-are at risk for adrenal insufficiency for the remainder of their lives
>catecholamines from the adrenal medulla do not require replacement b/c they are also produced in the sympathetic nervous system)

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16
Q

Nursing Management: Assessment and Analysis

A 
clinical presentation of pheochromocytoma is r/t the effects of increased levels of circulating epinephrine and norepinephrine
>Hypertension
>Tachycardia
>Hyperglycemia
>Pounding Headaches
17
Q

Nursing Diagnoses

A
  • Risk for injury: Cerebrovascular Hemorrhage r/t severe hypertension
  • Acute pain: Headache r/t increased levels of circulating catecholamines secondary to the hypersecreting tumor
  • Risk for injury: Postoperative hemorrhage rt/t adrenalectomy
18
Q

Nursing Interventions: Assessments

A
  • Vital Signs
  • Cardiac Monitoring
  • Headache (from hypertension)
  • Plasma and catecholamine metabolite measurements (VMA)
19
Q

Assessments: Vital Signs

A
  • hypertension and tachycardia develop secondary to excessive circulating catecholamines
  • pt who undergo adrenalectomy, may develop signs of hypovolemia and chock secondary to hemorrhage
20
Q

Assessments: Cardiac monitoring

A

patient is at risk for tachydysrhythmias secondary to elevated catecholamines

21
Q

Assessments: Plasma and Catecholamine metabolite measurements (VMA)

A

elevated levels of catecholamines result in increased levels of catecholamine metabolites

22
Q

Nursing Actions

A
  • Administer sodium nitroprusside (Nipride)
  • Administer alpha-adrenergic blocking agents
  • Administer beta-adrenergic blocking agents
  • Best rest w/ HOB elevated
  • Maintain calm, quiet environment
  • Administer Glucocorticoid the morning of surgery for adrenalectomy
23
Q

Sodium Nitroprusside (Nipride)

A

quickly decreases BP through direct action on blood vessels, leading to peripheral vasodilation

24
Q

Alpha-adrenergic Blocking Agents

A

decreases blood pressure by blocking the alpha-adrenergic effects of blood vessels that lead to vasoconstriction
-blocking action results in vasodilation

25
Q

Beta-adrenergic Blocking Agents

A

leads to increased chronotropic (rate) and inotropic (force) effects of the heart
-decreases HR and force of contraction

26
Q

Why should you administer glucocorticoid the morning of surgery for Adrenalectomy?

A

minimizes risk of adrenal insufficiency post-op caused by the surgical manipulation of the adrenal glands, particularly pts undergoing bilateral adrenalectomy

27
Q

Nursing Teachings

A

> Clinical manifestations of adrenal insufficiency

  • in bilateral adrenalectomy, lifelong cortisol replacement is required
  • patient is at risk for adrenal insufficiency, especially at times of stress

> Postoperative teaching r/t adrenalectomy

  • monitor body temp
  • monitor surgical site
28
Q

Evaluating Care Outcomes

A
  • definitive treatment w/ adrenalectomy results in compete resolution of the disease process
  • b/c there is possibility of incomplete resection of the pheochromocytoma or recurrence in patients w/ a family hx of this disorder, need to have periodic checks of their blood pressure
  • patients w/ bilateral adrenalectomy require lifelong cortisol replacement
29
Q

Connection Check: Which assessment maneuver is contraindicated in the patient suspected of having a pheochromocytoma?
A. having the patient attempt to touch the chin to the chest
B. Inflating the BP cuff above 200 mmHg
C. Attempting to dorsiflex the feet
D. Palpating the abdomen

A

D. Palpating the abdomen

adrenal gland on kidneys

Nursing 272: Final Semester (79 decks)

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