General Info
Where is the pituitary gland located?
What is "Base of the brain directly below the hypothalamus".
Physical assessment findings include
Moon face, buffalo hump, thin extremities, central obesity, easy bruising and petechiae, slow wound healing (increased risk of infx), increased risk of bone fractures (brittle bones/osteoporosis from increased steroid levels)
Treatment of Cushing's syndrome/Disease depends on the
What is "Cause"
Cushing's syndrome/Disease risk factors include
What is "Females between the ages of 20 and 40 years, history of long-term glucocorticoid use (from asthma or RA)"
High levels of cortisol lead to a decreased production of protective mucus in the lining of the stomach. What complication can this lead to?
Perforated viscera/ulcerations. Monitor for GI bleeding, and avoid NSADIS, alcohol, and caffeine.
A condition with a HYPERsecretion of adrenal cortex hormone?
What is "Cushing's syndrome"
Expected findings include
What is
-- weakness, fatigue, sleep disturbances -- back and joint pain -- altered emotional state -- decreased libido
In Cushing's Disease, the #1 treatment is
What is "Hypophysectomy" (the surgical removal of the pituitary gland or part of it).
Dietary alterations should include:
Decreased: sodium intake
Increased: K+, Protein, Ca, and Vit D intake
Hypocalcemia can lead to what complication?
The excessive ACTH secreted from the pituitary gland overstimulates what gland?
What is "Adrenal Glands"
Women with Cushing's may show
hirsutism and amenorrhea
An adrenalectemy is the surgical removal of the adrenal gland (unilateral or bilateral). This procedure requires that a patient
be on immediate glucocorticoid and hormone replacement. May be life long if both are removed.
What are "blood sugar and BP". (Increased cortisol directly increases blood glucose, and indirectly increases BP as cortisol mimics aldosterone, causing your kidneys to retain sodium and water, which increases blood volume and raises blood pressure)
Immunosuppression and reduced inflammatory response occur due to elevated glucocorticoid levels. What complication can be expected?
Infection. Monitor WBC, and signs of infx.
In Cushing's, the adrenal glands excessively secrete
What is "cortisol"
Men with Cushing's may demonstrate
For Cushing's syndrome, what medications are you using?
Ketoconazole: adrenal corticosteroid inhibitor
Mitotane: produces selective destruction of adrenocortical cells
Hydrocortisone: for replacement for clients who have adrenocortical insufficiency resulting from treatment of the disease
A client who is 6hr post operative following a transsphenoidal hypophysectemoy should have their nasal drainage tested for what?
Glucose
The sudden drop in cortisol (from tumor removal, stress of illness, trauma, surgery, dehydration, or abrupt withdrawal of steroid medication) can lead to what complication
Adrenal crisis/Acute adrenal insufficiency. Medical emergency.
What differentiates Cushing's Disease from Cushing's syndrome is the presence of a
What is "pituitary tumor".
Using "High" and "Low" measures, what would the patients: -- BP -- blood sugar -- sodium -- weight -- potassium
look like?
High: BP, blood sugar, sodium, weight
Low: potassium
What should be monitored to prevent glucocorticoid toxicity?
Liver damage (liver toxicity shows yellow sclera, dark colored urine); Fluids and electrolytes for clients who have gastric effects (bleeding); Renal damage (UO changes, edema, muscle cramps), shock
Nursing care for Cushing's syndrome includes
Monitor I&O, indications of hypervolemia (edema, distended neck veins, SOB, adventitious breath sounds, hypertension, tachycardia), maintain safe environment (prevent falls/injury), HH (prevent infx), meticulous skin care, monitor WBC
Indications of Adrenal Crisis/Acute Adrenal Insufficiency include
Hypotension, Hypoglycemia, Hyperkalemia, Abdominal pain, weakness, and weight loss.