Serious complications and maintaining a positive self

serious complications, and maintaining a positive self-image, and actively
participate in the therapy plan
o Health promotion
 Teach at risk related to using medications and monitoring side effects is an
important preventative measure
o Acute Care
 Therapy has many side effects, so assessment focuses on S&S of hormone
and drug toxicity and complicating conditions
 Cardiovascular disease, diabetes mellitus, infection
 Vitals, daily weight, surgical site assessment, S&S of
thromboembolic events such as a PE
 Provide comfort due to body image changes and provide emotional
support. Reassure patient that physical changes and much of the emotional
lability will resolve when hormones levels return to normal.
o Preoperative Care
 Before surgery patient should be brought to optimal physical condition.
Hypertension and hyperglycemia must be controlled. Hypokalemia must
be corrected. High protein to correct protein depletion. Teaching depends
on approach and information regarding postop care.
o Postoperative Care
 Surgery on adrenal glands poses great risks. Glands are very vascular, and
the risk of hemorrhage is increased. Regardless of approach patients will
have a NG, Foley, IV, and central venous pressure monitor, and SCDs.
 Manipulation of gland may cause flood of hormones into circulation
producing marked fluctuations in metabolic processes. BP, F&E balance
may be unstable. Sudden changes in these or RR should be reported
immediately.
 High dose corticosteroids are given in the days following to ensure
adequate stress responses from the procedure.
 Urine analysis each morning to determine effectiveness of surgery

 If corticosteroid dosage is tapered too rapidly after surgery acute adrenal
insufficiency may develop
 Vomiting, increased weakness, dehydration, and hypotension are signs of
hypocortisolism. Painful joints, pruritus, peeling skin, emotional
disturbances should be reported, and dosages should be adjusted.
 Bedrest until BP stabilizes
 S&S of infection due to inflammatory response suppression.