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Addison's and Cushings
Terms in this set (61)
Where are your adrenal glands located?
On your kidney, they produce cortisol
What is ACTH?
Adrenal corticosteroid stimulating hormone
It is produced next to the pituitary the hypothalmus stimulates it the ACTH stimulates adrenal glands to make cortisol
Adrenal cortex secretes hormones that are _______ for life
Essential: Maintain a healthy environment when stress happens, life threatening if hyper or hypo function
Medulla is not ______ for life
We need to add hormone
We don't need to add hormone
What is Cushings syndrome?
A chronic disorder that is caused by excessive secretion of cortisol and ACTH
Who are at risk for developing Cushings?
People who are immunosuppressed
Long term steroid use
What causes Cushings?
Iatrogenic- people who take chronic steroids
Pituitary form- benign pituitary tumor- benign secretion of ACTH
Excessive adrenal secretion by adrenal tumor: Caused by tumors- commonly lung tumors
What are signs and symptoms of Cushing disease?
Skin becomes stretched with purple stria
Poor wound healing
Fluid volume overload
Polyuria and Polydipsia
Hyperglycemia and hypernatremia and hypokalemia and hypocalcemia
Palpitations and leg cramps
Hiruism- males grow breasts
Muscle wasted legs- impaired carbohydrate metabolism
Increased risk of infection
How do we diagnose Cushings?
Cortisol blood levels
Salivary Cortisol test start at midnight take saliva sample from patient. Then patient is given demethasone then at 8 am they do a spit test. If ACTH is supressed after demethasone then it is thought there is some abnormality. Then if ACTH is not depressed after it is suspected adrenal tumor
How do we treat Cushings?
If it is a tumor we remove it with and adrenalectomy we need to give her cortisol before and after so she does not develop addisons
We restrict their fluids as they can have high blood pressures, jugular vein distention
What do you do with nursing care for adrenalectomy?
IV cortisol before and after
What kind of diet should the person with Cushings be on?
One a day multivitamin
Why is skin care important?
They have increased risk for infection and poor nutrition
What is Addison's disease?
from the destruction or dysfunction of adrenal cortisol levels: Deficienty or cortisol glucocorticoids, aldosterone mineralcorticoids, adrenal adrogens
If it is not treated it is fatal.
What are causes of addisons disease?
Insulin dependent diabete
Primary Ovarian or testicular disorders
ACTH deficit- pituitary tumors, surgery or use of STEROIDS
ABRUPT STOP OF CORTICOSTEROIDS > send yourself into addisonial crisis
Anticoagulation can cause bleeding in adrenal glands
How is addisons disease work?
Takes until you only have 10 percent function left to show symptoms
Increased ACTH and DECREASED CORTISOL
Often occurs with withdraw of corticosteroid care
What are signs and symptoms of addisons?
Delayed wound healing
Orthostatic hypertension, tachycardia due to aldosterone deficiency
Volume depleted- Sodium is low, Potassium is high
Arrhythmia because potassium is high or hypovolemia
Lethargy- Anorexia, Nausea and vomiting, diarrhea
What should the labs for addisons be like?
hemoglobin and hematocrit high
BUN and creatinine elevated
Glucose low due to cortisol
Sodium is low
Potassium is high
What kind of diet should someone with addison's be on?
High calorie diet
What is a diagnostic test for Addisons?
ACTH stimulation test
Looking for cortisol deficiency they give cortisol and do lab draws to watch cortisol levels.
If they shoot up we look at pituitary
If they do nothing
What are nursing cares for Addisons?
Sodium, Potassium and calcium watch closely
Monitor blood sugar closely- hypoglycemic
Hormone replacement - forever
At risk for infection review s/s of infections
TEACH TO WASH HANDS
Take steroids at same time every day
Might want to take them at the beginning of the day
Combination therapy- glucocorticoid or mineralcorticoid
Prednisone, flucracortisone give IV
What is addison Crisis?
is caused by untreated cortisol deficiency
They then have developed a chronic condition
Caused by abrupt withdraw, poorly controlled addisons disease, trauma, surgery, acute infection, hemorrhage in adrenal glands
What are signs and symptoms of ADD crisis?
Hypoglycemia- unable to maintain blood glucose
Back leg pain
Decreased level of consciousness
Nausea, vomiting, diarrhea
At risk for hypovolemic shock
At risk for kidney failure due to hypovolemia
At risk for cardiac failure due to hyperkalemia- P wave changes supportive care
How do we treat?
Hydrocortisone given IV 50 mg every 6-8 hours
Vasopressors for supportive treatment
They will be on steroids for life at risk for developing cushings
How do we know the patient is responding to hydrocortisone?
Blood pressure returns to normal
Sodium returns to normal and potassium level goes down
What is phenochytoma?
high blood pressures systolic 200
Caused by tumor secreting noepinipherine and epinephrine leading to increased secretion of catecholimine
Unilateral and billateral
How do we diagnose phenochytoma?
Surgical exploration at risk for stroke
How do we treat phenochytoma?
Surgical removal though there is a risk it could return
Give blood pressure medication
What is happening if you lose vision in one eye?
Likely a pituitary tumor
What can hypersecretion of growth hormone before puberty and growth plate closure lead to?
What is acromegaly?
Long extremities with enlarged hands and feet
Occurs due to excess production of growth hormone as a adult.
Face becomes longer
How do we treat acromegaly?
Medications to suppress growth hormone have intense GI effects for the first 4 to 6 weeks of treatment when used after surgery. A year later these medications can cause gallstones
How does hypersecretion of prolactin affect men and women?
Inability to lactate
What is the most common anterior pituitary disorder?
What are common posterior pituitary disorder hormone?
Antidiuretic hormone- secreted due to low circulatory volume- people that are hypovolemic
What is a normal serum osmolality?
What does it mean if we are less than 240 serum osmolaity?
What does it mean with serum osmolality over 300?
Fluid volume overload
What happens if the body secretes too much ADH?
Fluid volume excess
What is SIADH?
Syndrome of inappropriate antidiuretic hormone secretion
High levels of ADH
with normal osmolality levels in the beginning.
What are causes for SIADH?
Caused by malignancies
Caused by trauma and cancer
Diuretics, barbiturates, anesthesia increase risk of getting
HIV and AIDS
Senile dementia due to atrophy are at risk
Pain and fear
With SIADH the normal feedback that tells you when to regulate ADH is failing.
Increased ADH but decreased osmolality of the blood.
Causes kidney to reabsorb more water
ADH continues to be given out retaining fluids
What are signs and symptoms of SIADH?
Do not often have edema
Two systems most affected by SIADH are Neuro and GI
Decreased Level of consciousness
Hyponatremia and water intoxication
Nausea vomiting diarrhea
What are labs?
Serum osmolality low
Urine specific gravity- concentrated
What are nursing interventions for SIADH?
Fluid restriction- water intake should not exceed output until sodium is normal
Monitor Intake and output
3% hypertonic saline give slowly over 6 hours
DECLOMYCIN causes excessive urination
DILANTIN blocks the effects fo ADH
SEIZURE PRECAUTIONS due to hyponatremia
What happens if sodium is less than 125?
S/S are headaches, restlessness, seizures
What are the three goals for SIADH?
Treat the cause
Get rid of excess water retention
manage low sodium
What is diabetes insipidus?
Caused by insufficient secretion of ADH
The kidney's lose their ability to reabsorb water
Large diuresis 20 liters of output
Leads to hypovolemia
Can be central or neurogenic
What are s/s of diabetes insipidus?
Peeing 20 L
Serum osmolarity elevated
Urine is dilute
Elevated body temperature- body working hard
What are complications of diabetes insipidus?
How do we treat diabetes insipidus?
Desmopressin given nasally DDAVP
Slows down diuresis
Fluid replacement hypotonic- D5W mimics regular water intake
Fix the cause: Surgery,
Nursing interventions for Diabetes insipidus
Make you stop peeing with desmopressin
What is DKA?
Blood sugars in 250's
Ketones in urine due to protein breakdown
High potassium and low sodium
Fruity breath, alcohol breath
Elderly are at increased risk for seizures
Polydipsia, polyuria, nausea, vomiting, kusmaul respiration- fast, hypertensive, respiratory acidosis
Significantly elevated white blood cell count can
Ketones mean there is no sepsis
What is HHNS?
Occurs in people with type 2 diabetes
Have many other co-morbidities: HTN, Smoker,
Slow progress due to presence of insulin in blood
Blood sugar is 600-2000 present with higher blood sugar due to continued insulin production
No ketones due to insulin production
Profoundly dehydrated by the time they are diagnosed
Relatively normal Ph but are in lactic acidosis because they are hypotensive.
What causes DKA?
Inadequate admin of insulin
Infections: Pneumonia and UTI
Intentionally not taking insulin
Unintentionally giving too many carbs
How do you treat?
give large amounts of normal saline once their blood sugar goes to 250 switch to something that has glucose.
When blood sugars get to 150 give insulin subcu
Reverse ketoacidosis by giving insulin and fluid
Lower potassium raise sodium
Clients with Cushings should have what kind of diet?
Decreased sodium in their diet
What vitamin is directly related to the parathyroid hormone?
What is an immediate concern with DKA?
Irritability as it indicates cerebral edema
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