Unit 5 & 6 Chapter 57 Addison's and Cushing's Disease

Question 1

What is Addison’s

Answer 1

decrease steroid hormone in the adrenal cortex
(Cortisol)

Question 2

What is the purpose of Cortisol?

Answer 2

• Purpose: manages how body uses carbs, fats, proteins
• *Keeps inflammations down *Regulates blood sugar *Controls sleep/wake
• Boosts energy so you can handle stress

Question 3

What are some side effects of of Steroids?

Answer 3

-weight gain
-hyperglycemia
-fluid retention

Question 4

S/s of Addisons

Answer 4

hypoglycemia
anorexia and weight loss.
high BUN
Dry skin
Vitiligo or
Hyperpigmentation
* Anorexia
* Nausea, vomiting
* Abdominal pain
* Constipation or diarrhea
Weight loss
* Salt craving
* Anemia
Hypotension
Hyponatremia
Hyperkalemia
* Hypercalcemia
* Muscle weakness
* Fatigue
bronze pigment in skin
* Joint and/or muscle pain
Low adrenal androgen levels decrease body, axillary, and pubic hair, especially in women, because the adrenals produce most of the androgens in females

Question 5

What is the drug of choice for addison’s disease?
A. Tolvaptan
B. Bumetadine
C. Dexamethasone
D. Methadone

Answer 5

C. Dexamethasone

Question 6

Which electrolyte imbalance would cause major concern and should be reported to the health care provider immediately
A. Potassium 6.0
B. Calcium 12.0
C. Sodium 132
D. Magnesuin 1.2

Answer 6

A. Potassium 6.0

Question 7

Drug of choice to restore hormanal and electrolyte balance for addisons?
A. Fludrocortisone
B. Bumetadine
C. Hydrochloritiazide
D. Atenolol

Answer 7

A. Fludrocortisone

An additional mineralocorticoid hormone, such as fludrocortisone, may be needed to maintain or restore fluid and electrolyte balance (especially sodium and potassium).

Question 8

S/e of fludrocortisone?

Answer 8

-fluid retention

Question 9

What skin asssesment best decribed the patient with Addisons disease?
A. Pallor and pale skin
B. Damp and diaphoretic
C. Bronze skin color
D. Mottling skin

Answer 9

C. Bronze skin color

Question 10

If your patient who has undergone trauma and is diagnosed with Addison’s disease, what complication would you suspect to occur?
A. Myexadoma coma
B. Thyroid storm
C. Graves disease
D. Addisonian crisis

Answer 10

D. Addisonian crisis

Question 11

Before a surgical procedure would the provider prescribe in increase of fludrocortidone or decrease for patients with addison’s disease?
A. increase
B. decrease

Answer 11

A. increase

Question 12

What is the cause of Acute adrenal insufficiency (addisonian crisis)?

Answer 12

It often occurs in response to a stressful event (e.g., surgery, trauma, severe infection), especially when the adrenal hormone output is already reduced.

-a sudden cessation of long-term glucocorticosteroid therapy
patient’swith addison cannot wih stand stress, stress is life threateing

Question 13

What is your major-concern if your patient’s sodim levels are low?
A. seizure
B. irritability
C. risk for falls
D. fractures

Answer 13

A. seizure

Question 14

What is your major-concern if your patient’s potassium is high?
A. Cardiac Arrest
B. Myocardial infarction
C. Pulmonary Edema
D. Acute Coronary Syndrome

Answer 14

A. Cardiac Arrest

Question 15

S/s of Acute Adrenal Insufficiency
(addisonian crisis)

Answer 15

Problems are the same as those of chronic insufficiency but are more severe. However, unless intervention is initiated promptly,sodium levels fall, and potassium levels rise rapidly ( Pereira, 2016 ). Severe hypotension results from the blood volume depletion that occurs with the loss of aldosterone.
-hyponatremia
-hyperkalemia
-hypotention
-hypoglycemia

Question 16

What medications can treat hyperkalemia?
SELECT ALL THAT APPLY
A. Furosemide
B. Bumetadine
C. Lisinopril
D. Regular Insulin
E. Hydrochloriatize

Answer 16

D. Regular Insulin
B. Bumetadine
A. Furosemide
E. Hydrochloriatize

Question 17

What ECG changes are expected to see with a patient with addisons disease?
A. ST elevation
B. Depressed t waves
C . Sinus bradycardia
D. Peak T waves

Answer 17

D. Peak T waves

Question 18

Management for Acute Adreno Insuffiency
Low Hormone

Answer 18

• Start rapid infusion of normal saline or dextrose 5% in normal saline.
• Initial higher doses of hydrocortisone sodium or dexamethasone is administered as an IV bolus.
• Administer additional hydrocortisone sodium by continuous IV infusion over the next 8 hours.
• Give an additional dose of hydrocortisone IM concomitantly with hydration every 12 hours.
• Initiate an H2 histamine blocker (e.g., cimetidine) IV for ulcer prevention.

Question 19

Management for Acute Adreno Insuffiency
Hyperkalemia

Answer 19

• Administer insulin in units equal to the same number of mg of extra dextrose in normal saline intravenously to shift potassium into cells.
• Give potassium binding and excreting resin.
• Give loop or thiazide diuretics.
• Avoid potassium-sparing diuretics, as prescribed.
• Initiate potassium restriction.
• Monitor intake and output.
• Monitor heart rate, rhythm, and ECG for signs and symptoms of hyperkalemia (slow heart rate; heart block; tall, peaked T waves; fibrillation; asystole).

Question 20

Management for Acute Adreno Insuffiency
Hypoglycemia

Answer 20

• Administer IV glucose as prescribed.
• Prepare to administer glucagon as needed and prescribed.
• Maintain IV access.
• Monitor blood glucose level hourly.

Question 21

Nursing Interventions for Addisons Disease

Answer 21

-increase fluid due to hypotention
-increase glucose due to hypoglycemia
-increase salt intake due to hyponatremia(hypertonic solution)
-assess vital signs
-weight patient daily
-

Question 22

Your patient presents with a serum sodium level of 89. What order would you anticipate the provider to order?
A. Hydrochlorithiazide
B. 3% Sodium Chloride
C. Lactaded Ringers
D. 0.45% Normal Saline

Answer 22

B. 3% Sodium Chloride

Question 23

What should you restrict for a patient with addisons?
A. Sausage and potato chips
B. Banana and tomatoes

Answer 23

B. Banana and tomatoes

^THIS FOODS ARE HIGH IN POTASSIUM^

DO NOT RESTRICT FOOD HIGH IN SALT IT CAN INDUCE ADRENAL CRISIS

Dosage adjustment may be needed, especially in hot weather when more sodium is lost because of excessive perspiration. Salt restriction or diuretic therapy should not be started without considering whether it might lead to an adrenal crisis.

Question 24

57.3
Which electrolyte laboratory values indicate to the nurse monitoring a client with adrenal insufficiency undergoing IV therapy with hydrocortisone that the client is responding positively to this drug therapy?
A. Serum sodium 147 mEq/L (mmol/L); serum potassium 7.1 mEq/L (mmol/L)
B. Serum sodium 137 mEq/L (mmol/L); serum potassium 4.9 mEq/L (mmol/L)
C. Serum sodium 127 mEq/L (mmol/L); serum potassium 2.8 mEq/L (mmol/L)
D. Serum sodium 119 mEq/L (mmol/L); serum potassium 6.2 mEq/L (mmol/L)

Answer 24

B. Serum sodium 137 mEq/L (mmol/L); serum potassium 4.9 mEq/L (mmol/L)

Question 25

What is Cushings

Answer 25

increase in steroid production in the adrenal cortex
-Hypercortisolism (Cushing disease) is the excess secretion of cortisol from the adrenal cortex, causing many problems.

Question 26

What is the most common cause of hypercortisolism?

Answer 26

In addition, one of the most common causes of hypercortisolism is glucocorticoid therapy.

Question 27

S/s of Cushing’s

Answer 27

Note truncal obesity, moon face, buffalo hump,

8***HYPERGLYCEMIA

Hyperglycemia
Hypernatremia
Hypokalemia
Hypervolemia,

CARDIOVASCULAR SYMPTOMS
* Hypertension
* Frequent dependent edema
* Bruising
* Petechiae
Weight gain

history of fractures, because osteoporosis results from hypercortisolism.

GI problems include ulcer formation from increased hydrochloric acid secretion and decreased production of protective gastric mucus.

poor wound healing
SKIN SYMPTOM
* Thinning skin
* Increased facial and body hair
* Striae(stretch marks) and increased pigmentation

Immune System Symptoms
* Increased risk for infection
* Reduced immunity
* Decreased inflammatory responses
* Signs and symptoms of infection and inflammation possibly masked

Question 28

You suspect your patient has Cushins syndrome. What question is most accurate in uncovering your suspicion?
A. What is your daily medication regimen like?
B Have you sustained a head injury?
C. Have you been rubbing your throat recently?
D. Are you eating a diet low in salt and sugar?

Answer 28

A. What is your daily medication regimen like?

Ask about the patient’s other health problems and drug therapies because glucocorticoid drug therapy is common.

if the patient exhibits signs of cushings look over medication list

Question 29

Drug therapy for Cushings disease

Answer 29

Drug therapy involves the use of drugs that interfere with adrenocorticotropic hormone (ACTH) production or adrenal hormone synthesis for temporary relief and are categorized as steroidogenesis inhibitors. Metyrapone, aminoglutethimide, ketoconazole, mitotane, and etomidate use different pathways to decrease cortisol production

Question 30

Nutrition Interventions for Cushings

Answer 30

• sodium restriction of 2-4g a day
  -no processed foods
  -no fried foods
  -no fast foods
  -low sodium diet
  -increase potassium intake
  BAKED OR GRILLED OPTIONS

Question 31

If all nursing interventions for Cushings disease do not work , what is the next action?

Answer 31

Hypopsectomy