NURSING FOR ADULTS TEST 3 - THE ADRENAL GLANDS

The adrenal glands

Help to regulate metabolism, immune system, BP, stress response and more

Hormones released by the adrenal gland

Cortisol

Aldosterone

DHEA

Androgen / Estrogen

Adrenaline (Nori and EPI)

Too little from the adrenal glands

Addison

Too much from the adrenal glands

Cushing's disease

Addison's disease cause

Autoimmune disorders

Infections (fungal and other)

Cancer

Genetic factors

Addison's disease what is happening

Hypofunction of the adrenal glands aka adrenal insuffiency

Failure to produce cortisol and aldosterone

Body keeps producing ACTH to stimulate adrenals unresponsive

Addison's disease : How will the client present

Fatigue

Weight loss / decreased appetite

Darker skin

Hypotensive / syncope

Salt cravings

Hypoglycemia

N/V/D (GI issues)

Muscle / joint pain

Irritability

Depression / behavioral symptoms

Body hair loss and sexual dysfunction

Addison's disease labs

BMP

Cortisol

ACTH

Antibodies (Autoimmune)

Addison's diagnostics

ACTH stimulation test (measure cortisol levels pre and post)

Insulin Induced hypoglycemia test (assessing for pituitary disease)

CT (abdomen)

MRI (Pituitary)

Addison's medication

Hydrocortisone / Prednisone / Methylprednisolone

Replace cortisol

Fludrocortisone acetate (aldosterone)

Salt

Increase Meds / Stress (operation / infection / minor illness)

Addison's crisis

Physical stress (injury / infection / illness)

Adrenals unable to response with appropriate cortisol

Sometimes appears as just "flu-like" symptoms

Life-Threatening; body begins to shut down in > 30 minutes

Hypotension, Hypoglycemia, hyperkalemia

Addison's crisis emergent care

IV corticosteroids (prednisone / methylprednisolone)

Normal saline (contains Na)

Sugar (dextrose)

Addison's crisis symptoms

severe / weak / fatigue / hypotension / severe dehydration / abdominal pain NVD / Confusion / disorientation / LOC / Hypoglycemia / hyponatremia / hyperkalemia / fever

Addison disease : Emergent high dose corticosteroids

IV corticosteroids

Normal saline (normal or dextrose)

Electrolyte management (correct hyperkalemia --> dextrose / insulin / calcium gluconate)

Underlying cause (Infection = antibiotics)

Addison disease : Nursing considerations

Monitor closely for shock (low bp / weak pulse / cold / clammy skin)

Recognize early signs (fatigue / dizzy / nausea)

Administer meds / fluids promptly

Addison disease : Patient education

Stress dosing if you know that you are going somewhere stressful

Emergency hydrocortisone injection

Medical alert indentification

Addison's nursing care

Monitor labs closely

Provide meds on time daily

Considerations monitor I&O / Daily weights

Watch VS trends closely

Addison disease : Patient education

Discuss the important of taking meds

Discuss need for salt in diet

Cushing's Syndrome : Causes

Ling term corticosteroid (prednisone) Use

Tumors

High stress levels / panic disorders

Alcoholism

Cushing's Syndrome :What is happening

Adrenals making too much cortisol

High levels of cortisol for long time (hypercortisolism)

Cushing's Syndrome : How will the client present

Weight gain

Fatty tissue deposits (midsection / upper back / moon face / between shoulders)

Pink / purple striae

Thin / fragile skin / easy to bruise

Slow healing

difficult sleeping

acne

Women : body hair irregular periods

Men : Decreased libido and fertility, erectile dysfunction

Muscle weakness

Depression / anxiety / irritability / cognitive difficulties

New / worse HTN

HA

Increased pigmentation of skin

Bone loss / pathologic

Impaired growth in children

TYPE II DM

Cushing's Syndrome : Lab / Diagnostic

24 hour urinary free cortisol test

Salivary cortisol measurement

Low dose dexamethasone suppression test

Blood ACTH test

CRH stimulation test

CT / MRI (look for tumor)

Cushing's Syndrome : Medications that decrease cortisol from adrenals

Ketoconazole

Mitotane

Metyrapone

Isurisa

Cushing's Syndrome : Decrease ACTH from pituitary

Pasireotide

Medications that block effects of cortisol on tissue

Mifepristone (type II dm, glucose intolerance)

Cushing's syndrome complications

Osteoporosis

Muscle atrophy / weakness

HTN

Type II DM

Frequent infections

MI / CVA

Depression / anxiety

Cognitive Difficulties

Tumors enlargement

Cushing syndrome nursing care

Falls risk

monitor electrolytes

Monitor skin closely

Mood changes

Risk for infection

VS and daily weights

Adrenalectomy

Get enough Ca and vitamin D

Monitor caloric intake / avoid alcohol / low sodium diet

Monitor blood sugar

Reduce NA intake

Pheochromocytoma

Tumor of an adrenal gland

Develops in chromaffin cells

Chromaffin = epinephrine / norepinephrine

Pheochromocytoma symptoms

HTN

HA

Diaphoresis

Panic attack

Tachycardia

SOB

Hyperglycemia

Pheochromocytoma symptomatic spells

Physical exertion, stress, changes in body position LD, surgery / anesthesia

Foods high in tyramine

Certain meds MAO inhibitors and stimulants

Pheochromocytoma complications

CVA

MI

CHF

AKI -- renal failure

Pheochromocytoma medications

Alpha blockers

Beta blockers

Pheochromocytoma labs and diagnostics

24 hour urine / blood test (epi/nori)

CT / MRI / PET

Pheochromocytoma surgery

Remove tumor

Block epi during surgery to prevent a hypertensive crisis