Use of corticosteroid medications prednisone cushing

– 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