disturbances of the adrenal gland semester v rn fall 2002
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Disturbances of the Adrenal Gland Semester V RN Fall 2002. Ann MacLeod, RN, BScN, MPH. Agenda. Test Take Up Understand Disturbances of the Adrenal Gland Assessment of Nursing diagnoses Nursing care. Disturbance in Adrenal Hormones. - PowerPoint PPT PresentationTRANSCRIPT
A. MacLeod, Fall 2002 1
Disturbances of the Adrenal GlandSemester V RN Fall 2002
Ann MacLeod, RN, BScN, MPH
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Agenda
Test Take Up Understand Disturbances of the Adrenal
Gland Assessment of Nursing diagnoses Nursing care
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Disturbance in Adrenal Hormones Over view: A&P: adrenal glands- 2 small
structures which cap the top of the kidneys each composed of 2 structures with its own
function inner core: adrenal medulla outer shell: adrenal cortex
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Functions of Adrenal Medulla:
Adrenal medulla: releases epinephrine and norepinepherine which convert glycogen to glucose to increase cardiac output
Fight or flight response nor-epinephrine produces vascular
constriction which increases BP
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Hyposecretion of the adrenal medulla Assessment
plasma and urine catacholamines, epinephrine and norepinephrine
• low BP, little fight or flight response• uncommon
management• supplement with catacholamines
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Adrenal Medulla (hypertrophy) epinephrine & norepinephrine
Pheochromocytoma: tumor of the adrenal gland Assessment• can be life-threatening• headache, vertigo, blurred visiontinnitus• dyspnea, palpitations, tachycardia• hyperglycemia, glucosuria• hypertension very high (and postural hypotension)• nervousness, anxiety, tremors• indigestion, nausea, vomiting, abdominal pain• fatigue, exhaustion
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Pheochromocytoma: tumor of the adrenal gland Assessment cont’d plasma & urine epinephrine and
norepinephrine (catecholamines) clonidine ( Catapres) suppression test
blocks sympathetic stimulation & will not suppress if the gland is over producing epinephrine
CT Scan, MRI, MIBG tagged x-ray, ultrasound
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Pheochromocytoma: tumor of the adrenal gland: Management
Pharmacologic tx to treat symptoms• alpha adrenergic blockers (phentolamine)• beta adrenergic blockers (propranolol)• catacholamine synthesis inhibitors (metyrosine)
Surgical removal: adrenalectomy• then supplement catacholamines andn
corticosteroids• monitor BP, BS, ECGs
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Adrenal Cortex Hypothalamus Corticotropin Releasing
Hormone Post. Pituitary releases Adrenocorticotropin hormone ( ACTH) stimulate adrenal cortex to release hormones:• Glucocorticoids ( cortisol): stimulates blood glucose,
anti- inflammation• Mineralocorticoids (aldosterone) : regulates electrolyte
balances• Sex hormones (s/a estrogen, androgens) : sexual dev’p
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Glucocorticoids- cortisol
Regulate blood sugar by conserving body glucose and promoting gluconeogenesis
regulates protein, fat and CHO metabolism stress response anti- inflammatory and immune response
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Mineralocorticoids-Aldosterone
promotes Na+ retention and K+ excretion targets kidney tubules only responsible for increases in blood volume of
5-10 % offset by increased Glomerular Filtration Rate
(ADH is more responsible) low K+ muscle weakness, lowered membrane
potential, therefore more easily excited cramping and become weak
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Sex Hormones Androgens
small amount of estrogens sexual development
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Hyposecretion of the Adrenal Cortex - Addison’s Disease may be primary or secondary Primary: as a result of atrophy or
autoimmune destruction, tumors or suppressed pit. Function
secondary: insufficient ACTH from pituitary gland
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Glucocorticoid hyposecretion cortisol Wide spread metabolic imbalances decreased gluconeogenesis blood sugar
(pt. Weak, exhausted, wt, loss, nausea, vomiting)
decreased resistance to stress, infection and inflammation
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Decreased aldosterone:
Na+ channels in Kidney tubule do NOT open Na+ and H20 stay in the urine
Dehydration, hypotension, decreased Cardiac output, circulatory collapse
K+ cannot get into urine hyperkalemia K+ decreased muscle contractility arrthymias death
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Assessment:
Blood K+, WBC Blood Glucose, Na+, aldosterone Muscular weakness, anorexia, GI upset fatigue, wt. Loss decreased BP chronic dehydration ACTH fails to cortisol
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Addisonian Crisis
When subject to stress, infection, trauma and surgery. (could be fatal)
headache, nausea, vomiting,fever, abd. Pain, severe hypotension
vascular collapse>>>SHOCK
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Management:
Immed. Tx. To combat shock and administer fluids
IV solucortef, vasopressin to increase BP antibiotics to combat infection if present Increase NA+, Decrease K+ diet life long admin. Of corticosteroids and
mineralocortoids
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Pharmacotherapy
Florinef: mineralocorticoid cortisone, cortisol, prednisone,
betamethesone} glucococorticoids corticosteroids may cause S/E: moonface,
wt. Gain, edema., K+ loss, Increased urination, nocturia, masking of s/s infection
Steroids must be tapered!
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Nursing Diagnoses/ Process
Fluid vol. deficit Daily wt. I+O, assessment of mucous membranes
monitor BP freq. Diet:
carb,protein,Na+, increased fluids
pharmcotherapy monitor excessive
sweating
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Nursing Process
Activity intolerance
Knowledge Deficit
Avoid stressful activity, quiet environ. Complete bedrest, help with bathing, turning
rationale for steroid replacements, medic alert, diet, wt,injectable hormones
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Hypersecretion of Adrenal Cortex: Cushing’s Syndrome Usually secondary to hypersecretion of the
of ACTH by the pituitary due to tumours Hypercorticism: steroid hormone
replacement
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Cushings syndrome
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Glucocorticoid Excess Gluconeogenesis- Breakdown of fats and
proteins to increase blood sugar distrubution of adipose tissue in the abd. and
behind shoulders (buffalo hump) protein loss thin skin, weak blood vessels,
osteoporosis, decreased immunity ( IGg) hyperglycemia diabetes vasoconstrictor (anti-inflammatory)
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Aldosterone Excess
Kidney tubules opens Na+ channels Na+ and water retention in blood edema, elevated BP
K+ is excreted in urine blood depletion hypokalemia K+muscle excitability cramps, fatigue
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Androgen Excess
Women more masculin hair on head thins abnormal facial hair
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Assessment for Cushing’s Disease 24 hr. urine: free cortisol increased DST Dexamethesone Suppression Test: 1
mg. Of dexamethesone is given po the night before. This should suppress plasma cortisol levels at 0800 the next day to 50% of baseline
Blood tests: Glucose, K+, Na+ CT or MRI : adrenal mass or pit. tumor
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Management:
Surgical removal of the tumor of the pituitary gland is Rx. Of choice
adrenalectomy may have radiation often causes hyposecretion so must assess
for this and monitor supplements of hormones
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Nursing Diagnoses
Risk for injury due to weakness Self Care Deficit imp. Skin integrity high risk for infection body image disturbance fluid vol. Excess pt. Teaching and followup
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Adrenalectomy Nursing Care:
Post-op: vital signs q 1-4hrs especially BP
I+O observe for
hemorrhage (area is highly vascular)
monitor serum electrolytes (may cause insufficiency
Be alert for s/s adrenal insufficency
IV corticosteroids dressing change prn observe for s/s
infection and delayed wound healing
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Corticosteroid treatment
Either for Addisons, or post op adrenalectomy actions: gluconeogenesis ( breakdown, fat & proteins) inhibits prostoglandin formation inflammatory process
complement system, and permeability, cytokines blocked &B lymphocytes not activatedimmune
response vasoconstriction & Na +retention BP bone absorption into blood stabilize mast cells therefore less broncho- constriction
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Cortisone-nursing considerations Has both cortisol and mineralocorticoid hormones
15-30 mg PO daily Taper Doses, give with or after meals monitor blood counts and glucose, Na+ K+ monitor mood changes, skin for lesions or acne,
stretch marks, menstrual changes monitor signs of infection many drug contraindications monitor weight loss, skin hyperpigmentation
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Cushings Syndrome Non-surgical maintenance Monitor emotions & support systems skin care & hygiene Diet hi K+, low Na+ and calories
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