disturbances of the adrenal gland semester v rn fall 2002

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A. MacLeod, Fall 2002 1 Disturbances of the Adrenal Gland Semester V RN Fall 2002 Ann MacLeod, RN, BScN, MPH

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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 Presentation

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Page 1: Disturbances of the Adrenal Gland Semester V RN Fall 2002

A. MacLeod, Fall 2002 1

Disturbances of the Adrenal GlandSemester V RN Fall 2002

Ann MacLeod, RN, BScN, MPH

Page 2: Disturbances of the Adrenal Gland Semester V RN Fall 2002

A. MacLeod, Fall 2002 2

Agenda

Test Take Up Understand Disturbances of the Adrenal

Gland Assessment of Nursing diagnoses Nursing care

Page 3: Disturbances of the Adrenal Gland Semester V RN Fall 2002

A. MacLeod, Fall 2002 3

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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A. MacLeod, Fall 2002 4

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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A. MacLeod, Fall 2002 5

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A. MacLeod, Fall 2002 6

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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A. MacLeod, Fall 2002 7

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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A. MacLeod, Fall 2002 8

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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A. MacLeod, Fall 2002 9

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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A. MacLeod, Fall 2002 10

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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A. MacLeod, Fall 2002 11

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A. MacLeod, Fall 2002 12

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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A. MacLeod, Fall 2002 13

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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A. MacLeod, Fall 2002 14

Sex Hormones Androgens

small amount of estrogens sexual development

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A. MacLeod, Fall 2002 15

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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A. MacLeod, Fall 2002 17

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

Page 18: Disturbances of the Adrenal Gland Semester V RN Fall 2002

A. MacLeod, Fall 2002 18

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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A. MacLeod, Fall 2002 20

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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A. MacLeod, Fall 2002 21

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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A. MacLeod, Fall 2002 22

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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A. MacLeod, Fall 2002 23

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

Page 24: Disturbances of the Adrenal Gland Semester V RN Fall 2002

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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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A. MacLeod, Fall 2002 27

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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A. MacLeod, Fall 2002 28

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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A. MacLeod, Fall 2002 31

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

Page 33: Disturbances of the Adrenal Gland Semester V RN Fall 2002

A. MacLeod, Fall 2002 33

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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