Labs/vitals of hypo/hyper pituitism, cushings, addisons, DI and SIADH

addisons na, k, ca

Hyponatremia

Hyperkalemia

hypercalcemia

As the loss of sodium and water continues, the patient may develop dehydration and hypotension and hyperkalemia.

s/s of addisons diseases ( remember directly related to actions of the adrenal cortex hormones)

darkened bronzed pigmentation

weakness

wt loss

fatigue

nausea

abd pain

gastroenteritis

emotional lability

when do you check cortisol levels for addisons disease

early morning

what meds may be given for addisons disease

hydrocortison sodium succinate

dexamethasone

kayexalate for hyperkalemia

Adrenal crisis

hypovolemia

hypotension

hyponatremia

hypoglycemia

hyperkalemia

possible vascular collapse

what medication is given in an addisonian crisis

solu-cortef

risk factors for an adrenal crisis are

trauma

surgery

infections

insulin tolerance test

uses hypoglycemic stress to induce cortisol production. The peak serum cortisol response is measured after an insulin challenge of 0.1–0.15 units/kg. The test requires close monitoring of the patient and is contraindicated in patients with a history of seizures or cardiovascular disease.

cushings has excess

cortisol

patho for cushings

excessive circulating cortisol or aldosteron

excessive secretion of ACTH form ant pituitary gland

adrenal cortex hyperfunction cushings s/s

hyperglycemia

fluid retention

hypokalemia

abnormal fat

decreased muscle

deepenign voice

breast atrophy

vocal changes

amenorrhea

edema

thin skin

loss of bone dencity

decreased inflammatory process

increased risk of infection

moon face

buffalo hump

what is a specific test we do for adrenal cortex hyperfunction

urine free cortisol 24-hr urine

how can cushings (adrenal cortiex hyperfunction damage heart, vascular, kidneys and eyes

from HTN

hypercortisolism s/s

Hypertension

Hyperglycemia

Dependent edema

Thin, friable skin

Fat maldistribution (truncal obesity, “moon face,” and “buffalo hump”) (Fig. 42.2)

Loss of bone density

Decreased inflammatory process l Increased risk of infection

hyperaldosteronism

HTN

hypernatremia

hypokalemia

headache

what kind of s/s would a catecholamine secreting tumor as in pheochromocytoma produce

vasoconstriction, tachycardia, increased stroke volume, rise in BP, widened pulse pressure, hyperglycemia

triad of pheochromocytoma

diaphorosis, headache, palpiations

sudden elevation in bP think what

pheochromocytoma

tx for pheochromocytoma

require bedrest with the head of the bed elevated, usually in a critical care setting. The patient is placed on a cardiac monitor to assess for cardiac dysrhythmias.

Bedrest with head of bed elevated

Bedrest decreases secretion of catecholamines and elevating the head of the bed facilitates orthostatic hypotension.

what bp meds may be used for pheochromocytoma

alpha-adreneric blocking agents/BB/CBB

if a patient recieves a bilateral adrenalectomy they are at risk for what

adrenal insufficiency, for the remainder of their lives

adrenalectomy monitor for

s/s of hypovolemiaand shock secondary to hemmorrhage

which med may be used for pheochromacytoma

nitroprusside

why does the nurse maintain a calm quiet enviroment for pheochromocytoma

to reduce the risk of triggering release of epi and norepi

when is a patient especiallyat risk for adrenal insufficiency?

during times of physiological or emotional stress and lifelong cortisol replacement is required

a patietn with an adrenalectomy should

monitor body temperature as well as surgical site infection