compression fractures; peptic ulcer, pancreatitis; myopathy, muscle weakness; acne, ecchymoses (bruises), petechiae, striae, thinning of skin; mood alterations (depression, b. distress); psychoses. Females: Hitruism, amenorrhea; decreased sex drive.
(Hinkle, 10/2017, p. 1537): Woman with moon face, buffalo hump, facial hair . 30. What is treatment of Cushing’s Nurses- Treatment: A. Assessment: Hx & Physical Exam— A. Activity level & ability to carry out self-care activities B. Skin Assessment: observe for trauma, infection, breakdown, bruising, edema. C. Physical appearance D. Mental function: mood, responses to questions, awareness of environment, level of depression. E. Emotional status F. Medications Hx B. Interventions: A. Decrease risk of injury: B. Safe environment— prevent falls, fractures, other bone and soft tissue injuries. C. Assist with ambulation (if patient is very weak)— to avoid falling, bumping into sharp corners. D. Foods high in protein, calcium, Vitamin D— to minimize muscle wasting and osteoporosis E. Refer to dietitian — for help in selecting appropriate foods low in sodium and calories. C. Decrease risk for Infection: A. Avoid contact with others who have an infection B. Assess for subtle signs of infection— anti- inflammatory effects of corticosteroids mask common signs of inflammation and infection. D. Prep for Surgery: (Adrenalectomy (if indicated by pituitary tumor causing Cushing’s): A. Insulin therapy and medication to prevent or treat peptic ulcers B. Monitor BGL before, during and after C. Assess stools for blood D. Breathing exercise (education provided pre-op) E. Encourage Rest & Activity F. Encourage moderate activity to prevent complications of immobility G. Promote increased self-esteem H. Help patient plan and space rest periods I. Promote relaxed, quiet environment for rest and sleep. E. Promote Skin Integrity A. Avoid adhesive tape B. Frequently assess skin and bony prominences C. Encourage and assist with repositioning to prevent skin break down.
F. Improve Body Image A. Low carb, low sodium, high protein diet for weight gain G. Improve Coping A. Encourage patient and family to verbalize feelings and concerns H. Monitor and Manage Possible Complications: A. Addisonian Crisis: Treat for circulatory collapse and shock B. Adverse Effects of Adrenocortical Activity: C. Assess fluid and electrolyte status— by monitoring lab values & daily weights D. Monitor BGL E. If BGL high— nurse contacts PCP I. Promote Home, Community-Based, & Transitional Care A. Self-Care Education: B. Don’t abruptly stop drug C. Dietary modifications to ensure adequate calcium intake D. How to monitor BP, BGL, & weight E. Advise patient to wear medical alert bracelet & notify other healthcare providers about their condition. A. Medical Management: a. Surgery: a. If caused by Pituitary tumors— surgically removed (transsphenoidal hypophysectomy) ; 80% success b. Radiation of pituitary gland— successful but takes longer c. Adrenalectomy — for unilateral primary adrenal hypertrophy d. Post-Op Symptoms: i. May appear 12-48 hours after due to the reduction of high levels circulating adrenal hormones.
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- Fall '16
- Denise Cauble