– Use of corticosteroid medications (prednisone) Cushing Syndrome • Excessive adrenocortical activity. Manifestations:
Cushing’s Syndrome • Diagnostics – Cortisol levels-elevation in plasma cortisol – 24 hr urine cortisol-elevation in free cortisol – ACTH-hypersecretion by pituitary – Dexamethasone suppression test • Oral dexamethasone given in eve/bedtime • plasma cortisol levels obtained around 8am next day. • If your cortisol level remain high=Cushings.
• Taking dexamethasone should reduce ACTH level and lead to a decreased cortisol level. Nursing Process: The Care of the Patient With Cushing Syndrome—Assessment • Activity level and ability to carry out self-care • Skin assessment • Changes in physical appearance and patient responses to these changes • Mental function • Emotional status • Medications Nursing Process: The Care of the Patient With Cushing Syndrome—Diagnosis • Risk for injury r/t weakness • Risk for infection r/t altered inflammatory process • Self-care deficit r/t weakness/fatigue/muscle weakness • Impaired skin integrity • Disturbed body image • Disturbed thought processes Nursing Process: The Care of the Patient With Cushing Syndrome—Planning and Interventions • Goals may include: • decreased risk of injury, • decreased risk of infection, • increased ability to carry out self-care activities, • improved skin integrity, • improved body image, • improved mental function, • absence of complications
Pheochromocytoma • Benign Tumor of adrenal medulla • ↑ catecholamines • Men & women equally • 40-50 yrs • Family tendency • Diagnostic – Cortisol levels – 24 hr urine for catecholamines • VMA & MN (metanephrine-catecholamine metabolite) – Serum catecholamines – MRI, CT 5 H’s • Hypertension • Headache • Hyperhidrosis • Hypermetabolism • Hyperglycemia Management • Episodic – Manage HTN, tachycardia, anxiety – Bed rest
– Head of bed elevated-promotes orthostatic decrease in b/p • Medications – Goal: control HTN • Antihypertensive • Surgical – Surgical removal of tumor – adrenalectomy – Laproscopic/open • Quiet environment • Vital Signs, EKG • Fluid & electrolyte • Glucose monitoring • Corticosteroids pre & post -op Corticosteroid Therapy • Suppress inflammation and autoimmune response, control allergic reactions, and reduce transplant rejection • Patient education: refer to Table 52-5 – Timing of doses – Need to take as prescribed, tapering required to discontinue or reduce therapy – Potential side effects and measures to reduce side effects
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- Spring '18
- Endocrine System, Cortisol, thyroid gland