S&S
ADDISON'S
What skin findings would you expect to see in someone with Addison's?
hyper-Pigmentation! TAN!
especially in mucus membranes
Addison's disease is the HYPO-secretion of these two adrenal cortex hormones.
Cortisol and Aldosterone
ADDISON'S
Glucocorticoid commonly prescribed to replace cortisol in Addison's disease?
Hydrocortisone!
CUSHING'S DAILY DOUBLE!
The primary cause is?
Prolonged steroid usage
What are the other causes?
ADDISON'S
What is the most important education the nurse needs to make sure the PT understands about medication regimens?
That it is LIFELONG.
CUSHING'S
Name some PHYSICAL S&S
Thin extremities
Buffalo hump
Bruising
Petechiae (rash)
Moon face
Stretch marks
Hirsutism (hair)
Trucial obesity! (belly fat)
CUSHING'S
caused by the HYPER-secretion of this adrenal cortex hormone
Cortisol
Why is long tern prednisone use tapered off rather than stopped suddenly?
Prevent adrenal insufficiency due to HPA axis suppression!
(hypothalamic-pituitary-adrenal axis)
TRUE or FALSE
The stress of surgery or dehydration resulting from preparation for diagnostic tests or surgery may precipitate an Addisonian or hypotensive crisis because of the inhibited feedback loop?
TRUE- why? explain
ADDISON'S
What must a person carry with them at all times in case of emergency?
Emergency hydrocortisone injection kit
MEDICAL ID
ADDISON'S
a life-threatening complication in which severe hypotension, cyanosis, fever, nausea, vomiting, and signs of shock develop
Addisonian Crisis
ADDISON'S
This electrolyte abnormality is found in both Addison's disease and adrenal crisis.
Hyperkalemia
ADDISON'S DAILY DOUBLE
LIFE-LONG medications taken to treat Addison's.
STEROIDS- Sones
EX: Prednisone/ hydrocortisone
What can taking too much (too high of a dose) of these cause?
ADDISON'S
Top causes of Addisons.
Cancer
Trauma
Infection of the adrenals
ADDISON'S
Corticosteroids can cause this and Pt's should be closely monitored for S&S of infections due to it.
Immuno-suppression
ADDISON'S
Name some PHYSICAL S&S
alopecia
weight loss (usually thin)
BRONZE SKIN
CUSHING'S
A PT with cushings has a 24hr urine cortisol screening. results are >100mcg in 24 hrs. is this normal?
no, its elevated. should be around or <50mcg.
If a person with Cushing's disease is NOT a surgical candidate, this antifungal is given off-label to block steroid production?
Ketoconazole
CUSHING'S True or False
Is more likely to affect women than men?
TRUE!
CUSHING'S
Due to high steroid levels, the pts bones are at risk for what?
Osteoporosis/brittle bones
Risk of fractures if the pt falls!
ADDISON'S
Salt craving is due to what?
Hyponatremia due to aldosterone deficiency
CUSHING'S
When undergoing a low-dose Dexamethasone suppression test, what confirms Cushing's?
No suppression of morning cortisol level.
Should be <5mg/dL
ADDISON'S
Treatment for Addisonian crisis includes?
IV glucocorticoids- severe hypotension
Fluids- Elevated potassium!
Dextrose- hypoglycemia
CUSHING'S DAILY DOUBLE
if the cause is a pituitary tumor. what will the PT require? What if it is from the adrenal cortex?
Hypophysectomy for tumor
Adrenalectomy- what will the PT require after this procedure!!!!!! +200
CUSHING'S
3 nursing interventions to prevent injury on a PT with Cushing's
Assistive devices, fall precautions, skin care