Medical Surgical Nursing: Adrenal Disorders

Adrenal Glands

a pair of endocrine glands that sit just above the kidneys and secrete hormones that help arouse the body in times of stress.

Steroids Helpful hint

Sugar, Salt and Sex

Cortisol

stress hormone released by the adrenal cortex

ACTH

Stimulates adrenal cortex to release cortisol.

What is Addison's disease?

A condition where the body does not produce enough cortisol or aldosterone.

How does the body compensate in Addison's disease?

The body releases increased ACTH, but aldosterone does not increase.

What is the pathophysiology of primary Addison's disease?

Decreased secretion of glucocorticoids and mineralocorticoids from the adrenal cortex.

What can cause Addison's disease?

Autoimmune or Disease

What causes secondary adrenal insufficiency?

Long-term use of corticosteroids that are abruptly stopped.

What are common manifestations of Addison's disease?

Hyperpigmentation, weakness, weight loss, fatigue, nausea, abdominal pain, and emotional lability.

What will a patient with Addison's disease crave?

Salt

What causes hyperpigmentation in Addison's disease?

Increased ACTH levels.

What is the medical management for Addison's disease?

Cortisol replacement with glucocorticoids.

What are key lab findings in Addison's disease?

Hypovolemia, hypotension, hypoglycemia, hyponatremia, and hyperkalemia.

What are the goals of care for a patient with Addison's disease?

Maintain normal blood pressure and normal sodium and potassium levels.

What are common nursing diagnoses for Addison's disease?

Fluid volume deficit, electrolyte imbalance, and disturbed body image.

Why is cardiac monitoring needed in Addison's disease?

Due to hyperkalemia, which can cause arrhythmias.

What is a risk of addisonian crisis

Physical or Physiological Stressors

Priority Tx for addisonian crisis

- First Hydrocortisone IV

- Followed by: 5% Dextrose in NS

Once PT is alert and oriented from addisonian crisis, what medication is next?

- Oral Hydrocortisone to prevent abruptly discontinuing steroids

Why are seizure precautions needed in Addison's disease?

Due to hyponatremia.

What is an Addisonian crisis?

A life-threatening condition that can lead to shock.

How is an Addisonian crisis treated?

IV fluid resuscitation and IV hydrocortisone.

Biggest Risk of Addison's Disease

Shock

What hormone levels are elevated in Cushing's disease?

High ACTH and high cortisol.

What are common causes of Cushing's disorder?

Excess glucocorticoids, ACTH-secreting tumors, or excessive steroid use.

Causes of Cushing's

- Excess corticosteroids

- Tumor on pituitary or adrenal

- Small Cell Lung Cancer

How is Cushing's disease treated if caused by a tumor?

Surgical removal of the tumor.

What medications are used if the tumor is inoperable?

Drugs that inhibit glucocorticoid or ACTH synthesis.

How should steroid-induced Cushing's be managed?

Gradual tapering of steroids.

What are common physical findings in Cushing's disease?

Fluid retention, moon face, truncal obesity, decreased muscle mass, facial hair, purple striae, and poor wound healing.

Why does poor wound healing occur in Cushing's disease?

Due to hyperglycemia and impaired immune response.

What are common lab findings in Cushing's disease?

Hyperglycemia, hypokalemia, and normal or slightly elevated sodium.

What are the goals of care for Cushing's disease?

Maintain stable weight and normal electrolyte levels.

What are common nursing diagnoses for Cushing's disease?

Fluid volume excess, disturbed body image, risk for infection, deficient knowledge, and risk for decreased cardiac output.

What are priority nursing interventions for Cushing's disease?

Monitor blood pressure and assess for osteoporosis.

Biggest Risk for Cushing's Disease

Cardiovascular complications and infection

Precautions for Steroids

- Swelling

- Sepsis

- Increased Sugar

- Skinny

- Impaired Sight

- Increase dose if stressed

- Slowly taper