Chapter 50: Caring for Clients with Disorders of the Endocrine System

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

A client diagnosed with parathormone deficiency is admitted to the hospital. As the nurse initiates the care plan, which body system should be the focus of care 1)Skeletal 2)Urinary 3)Respiratory 4)Integumentary

Skeletal See p. 750, Parathyroid Glands

The nurse takes the vitals for a client scheduled for open heart surgery in the next few minutes and notes that the clients pulse, respirations, and blood pressure are elevcate. The nurse explains to the client that the elevations are normal response to stress and anxiety and are due to the release of which hormone. 1) Insuin 2) Epinephrine 3) Thyroxine 4) Aldosterone

Epinephrine See p. 752, Adrenal Glands

The nurse gently palpates the neck of a client diagnose with a thyroid disorder. The client asks shy the nurses touch is so gentle. Which response is most appropriate. Forceful palpation can result in excessive release of thyroid hormone. This type of palpation is the way my instructor in nursing school taught me to do it This type of palpation prevents closing off the trachea, which would cause you to gasp for air Forceful palpation causes pain in an area that is already enlarged and tender to touch.

1) 2) 3) 4)

Forceful palpation can result in excessive release of thyroid hormone. See p. 754, under Physical Examination

A client is to undergo radioimmunoassay tests. Which of the following is a prerequisite before the test?

1)Venous Blood Samples 2) A Radioactive substance injected intravenously 3) A CT scan 4) Radiographs of the chest

1)Venous Blood Samples See p. 754

A nurse is explaining the rationale for a nuclear scan test to a client with a thyroid disorder. Which of the following would be the best explanation

1)The test determines the concentration of a substance in the plasma 2)The test visualizes certain endocrine organs and their activities 3) The test detects tumors of the parathyroid 4)The test evaluates for suspected pituitary tumors.

2)The test visualizes certain endocrine organs and their activities See p. 755

Pituitary disorders usually result from excessive or deficient production and secretion of a specific hormone. When the over secretion of growth hormone (GH)occurs before puberty GIGANTISM results. When secretion of GH during childhood is insufficient, dwarfism occurs Over secretion of GH during adulthood results in acromegaly. An absence of pituitary hormonal activity cause panhypopituitarism or Simmonds disease

Pathophysiology and Etiology: Oversecretion of GH due to hyperplasia

GH is overproduced when the pituitary gland is insensitive to feedback inhibiting hormones such as somatostatin, a hypothalmic hormone and insulin-like growth factor 1 (IGF-1) IGF-1: A hormone released by the liver, stimulates the growth of bones and tissues

Assessment Findings: Signs and Symptoms Coarse features; Huge lower jaw, thick lips, thickened tongue, bulging forehead Bulbous nose, large hands and feet Enlarged organs; Muscle weakness Partial blindness may result from pressure on the optic nerve Muscle weakness is common and hypertrophied joints become painful and stiff Osteoporosis of the spine and joint pain may develop Men:ED Women: amenorrhea, increased facial hair, deepened voice (from compression of areas of the pituitary) Some people develop DM

Is the following statement true or false?

Acromegaly is caused by oversecretion of GH before puberty.

False.
Acromegaly is caused by oversecretion of GH during adulthood. Gigantism is caused by oversecretion of GH before puberty.

Assessment Findings: Diagnostic Findings

GH level; Glucose tolerance test most reliable

method of confirming Acromegaly

Skull radiography, MRI, and CT reveal pituitary enlargement Bone radiograph show thickened long bones and skull bones Increased blood levels of IGF-1, can also indicate acromegaly in nonpregnant women; usually 2-3x higher than normal in pregnant women

Ingestion of a bolus of glucose should lower GH levels, but GH remains elevated in persons with acromegaly

Medical and Surgical Management

Surgery: Removal of pituitary gland through a nasal approach Radiation for 4-6 wks, for pts who are a surgical risk; to remove tumor fragments that remain after surgery Frequent monitoring for evidence of tumor recurrence. If surgery or radiation therapy removes or destroys normal pituitary tissue, replacement therapy with thyroid hormone, corticosteroids, ADH and sex hormones is necessary. Medical treatment includes oral administration of Parlodel (inhibits release of GH in clients with acromegaly) or Dostinex; or parental injections of octreotide, lanreotide or pegvisomant. One form of octreotide is injected subcutaneously every 8 hrs; a longer acting form, Sandostatin LAR Depot, is injected IM every month
Both forms may cause GI side effects, gallstones, and diabetes

Pegvisomant newest and most effective drug for treating acromegaly, injected sub q daily, normalizes IGF-1 level. Clients must be monitored for liver damage

Nursing Management Psychological support Pacing activities to accommodate fatigue Pain relief from headaches, abdominal distention(organ enlargement), and skeletal pain Self-care when endurance permits Postoperative care

Frequent neuro assessments to detect signs of ICP and meningitis If nasal packing: Monitor for drainage for presence of csf Promote Cleanliness Remind client to Avoid drinking from a straw, sneezing, coughing, and bending over to prevent dislodging the graft that seals the operative area between the cranium and nose

Pathophysiology and Etiology

GH)

Anterior pituitary hormone activity stops, all hormones of the anterior pituitary (TSH, LH, FSH, Caused by events such as postpartum emboli, or hemorrhage, surgery, tumor, and tb

Assessment Findings: Signs and Symptoms

s/s of Hypothyroidism, hypoglycemia, adrenal insufficiency Gonads and genitalia atrophy; Premature aging Cachexia (Wasting syndrome), fatigue, loss of weight, muscle atrophy etc. Decreased hormone levels (thyroid, corticosteroid, reproductive hormones)

Medical Management
Substitute hormones Untreated Dz is fatal GH replacement only necessary for children Deficiency of TSH requires lifetime replacement with synthroid or Cytomel Males receive testoterone Females receive estrogen Both receive LH and FSH

Nursing Management Monitor all hormone replacements as prescribed. Adhere to medication and never omit a dose Monitor blood hormone levels Assess mental status, emotional state, energy level, and appetite. Alert to alterations in nutrition Clients tolerate 4-6 small meals a day vs. 3 large meals

Is the following statement true or false? A sign of panhypopituitarism is premature aging.

True.
A sign of panhypopituitarism is premature aging. Also included in the signs and symptoms are hypothyroidism, hypoglycemia, adrenal insufficiency, gonads and genitalia atrophy, and cachexia.

Pathophysiology and Etiology

Characterized by extremely large volumes of urine Neurogenic or central diabetes insipidus develops when there is insufficient ADH A second type is nephrogenic diabetes insipidus *similar symptoms; nephrogenic diabetes insipidus, the secretion of ADH is normal, but receptors in renal tubules completely fail to respond to the hormone. The lack of ADH secretion or an ineffective response to it causes the client to produce large volumes of dilute urine. Neurogenic causes: head trauma, brain tumors, congenital defects, or surgical removal of the pituitary
Nephrogenic causes: *less common, as a side effect from drugs (lithium, declomycin, Amphocin) and elevate prostaglandin E2)
If inadequate intake dehydration with concentrated levels of electrolytes occurs.

Assessment Findings: Signs and Symptoms Polyuria (urine output as high as 20 L/24 hours, urine is dilute) *Limiting fluid intake does not control urine excretion Weight loss Thirst Weakness Dehydration

Diagnostic Findings:

Fluid deprivation test can diagnose DI and

differentiate neurogenic and nephrogenic
Fluids withheld for 5-6 hrs, measuring urine volume, urine specific gravity, and serum osmolality Desmopressin acetate administered after fasting stage If urine continues to be dilute, with low specific gravity nephrogenic DI If urine is more concentrated = nuerogenic DI

Medical Management Drug therapy: DDAVP and Diapid nasal spray (reduce urine output) you 2-3 L/day IV fluids Restrict amount of sodium excreted, Restrict dietary

sodium

Thiazide diuretic (HCTZ), excretes water but less than in an untreated state Sometimes Aldactone or Midamor prescribed to prevent hypokalemia Sometimes Indocin prescribed- acts a prostaglandin inbibitor Restricts intake of protein to reduce work of the kidney to excrete protein nitrogenous wastes

Nursing Management

Correcting fluid volume deficit Monitoring IV, Is and Os If client acutely ill or extremely dehydrated, fails to take oral fluids or is beginning to receive medical treatment, urine output measured q 30 min. Daily weights Notify MD of sudden or steady wt. gain or loss Educate client on sufficient fluid intake Methods to decrease fluid loss such as remaining in air conditioning, avoidance of strenuous activity Compliance on drug therapy (and diet)

Hold container upright Place nozzle in nostril while in sitting position Spray prescribed number of times in each nostril Avoid exceeding the number of sprays per self-administration Do Not inhale medication Report nasal irritation to the MD Monitor urine output and level of thirst

Pathophysiology and Etiology: Causes of SIADH:lung tumors, central nervous system disorders, brain tumors, CVA, head trauma, drugs such as vassopressin, general anesthics, oral hypoglycemics, tricyclic antidepressants Continued release of ADHHyponatremia Assessment Findings

Water retention; Headaches; Muscle cramps; Anorexia , N/D, Changes in LOC Diagnosis bases on symptoms and history of a disorder associated with SIADH Serum sodium levels and serum osmolality are

decreased, urine sodium level and osmolality are high

Medical Management:

Nursing Management

Eliminate underlying cause Osmotic diuretics (Mannitol) and Loop diuretics (Lasix) help correct water retention IV administration: 3% hypertonic sodium chloride solution for severe hyponatremia

IS and Os and vitals LOC report changes Fluid overload (distention, confusion, dyspnea, pulmonary congestion, htn) and hyponatremia (weakness, muscle cramps, anorexia, nausea, diarrhea, irritability headache, wt. gain w/o edema) Education on medication and adhereance

Pathophysiology and Etiology:

Hypersecretion of thyroid hormones (T3 and T4) Autoimmune or inherited Hypersecretion accompanies thyroid tumors, pituitary tumors, and hypothalmic malignancies, stress or infection More common in women Restless; Agitated; Hand tremors; Diarrhea Increased appetite; Weight loss; Visual changes

Assessment Findings: Signs and Symptoms

(blurred or double vision); Exophthalmos in severe cases; Neck swelling

Diagnostic findings: Serum T3, T4 are elevated, TSH is decreaed; Thyroid scan (increased uptake of RAI) and ultrasonography

Medical and Surgical Management: Antithyroid drugs-PTU and Tapazole are given to block production of thyroid hormone

Radiation Thyroidectomy (subtotal thyroidectomy, partial thyroidectomy, total thyroidectomy)

Can reactivate if do not comply with therapy

Complications: accidental removal of or alteration in the blood supply to the parathyroid glands, hemorrage, thyrotoxicosis (excessive secretion of thyroid hormones), damage to the recurrent laryngeal nerve)

Nursing Management

Monitor heart rate and bp Sleep patterns and daily weights Promotes rest and avoidance of excess physical stimulation Increased caloric intake can compensate for increased metabolism Antithyroid therapy may take several weeks or more. Inform that RAI does not affect other tissue, transient effect are n/v, malaise, fever and gland tenderness

Nutrition
Calorie needs increase between 10% and 50%; a high protein intake helps replenish losses from muscle catabolism Encourage frequent meals and intake of nutritionally dense good (fortified milkshakes, food fortified from skim milk powder, eggs, cheese, butter or milk. After treatment restores metabolism, calories are adjusted downward to avoid excess weight gain

Is the following statement true or false? The etiology of Graves Disease is the hyposecretion of thyroid hormones.

False. The etiology of Graves Disease is the hypersecretion of thyroid hormones.

Pathophysiology and Etiology: Triggering factors extreme stress, infection, DKA, trauma, toxemia during pregnany or manipulation of a hyperactive thyroid during surgery T3, T4 oversecretionEpinephrine release Metabolism increased Assessment Findings
High temperature (up to 106 F), Rapid pulse; chest pain, Dyspnea Cardiac dysrhythmias; Vomiting; Delirium Diagnosis: Hyperthyroidism history; Laboratory tests (T3 and T4) markedly elevated Immediate treatment Antithyroid drugs IV treatment- Corticosteroid to replace depletion that results from over stiumulation IV sodium iodide prevent thyroid from releasing thyroid hormone Inderal reduces effect of thyroid hormone on cardiovascular system Supportive therapy: IV fluids, antipyretic measures, and oxygen therapy

Medical Management

Nursing Management
Cleint Acutely Ill Monitors vitals, esp temp frequently Failure to respond to antipyretics requires other measures (cooling blanket or ice) Cool Room Treatment as ordered

Pathophysiology and Etiology

Inadequate thyroid hormone secretion: Slowing of ALL metabolic process Myxedema (severe hypothyroidism) coma

s/s of this life threatening event (hypothermia, hypotension, hypoventilation) A client with hypothyroidism experiencing infection, trauma or excessive chills or taking narcotics, sedatives or tranquilizers can lapse into myxedemic coma

Assessment Findings: Signs and Symptoms

Slow metabolic rate; Lethargy; Weight gain (despite low caloric intake); Dry skin; Menstrual disorders Naps frequently during the day Forgetful and has chronic headaches Mask like facial expression, yet client is irritable Tongue may be enlarged, lips swollen and there may be edema of the eyelids Temperature and pulse rate are decreased, client intolerant to cold Enlarged heart; Atherosclerosis; Anemia Hair coarse and sparse and tends to fall out Voice low pitched and hoarse, slow speech Numbness or tingling in arms or legs unrelieved by position change. Diagnostic findings: Serum TSH increased, T3, T4- show no response in primary but may show a response if failure of the pituitary to secrete TSH; FT4 decreased; RAI uptake may be decreased

Medical Management: Thyroid replacement therapy Dessiccated Thyroid extract Synthetic products such as Synthroid or Cytomel Low dose given initially and then increased or decreased until optimal dose is achieved

Nutrition
Until normal metabolism wt gain is experience even if caloric intake is low Low Calorie diet to attain or maintain normal weight. High Fiber diet promotes satiety and regularity. Additional modifications such as low-fat, low cholesterol and low-sodium diets are necessary if the client has cardiovascular complications.

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Pathophysiology and Etiology

Follicular adenoma most common benign thyroid lesion (thyroid nodule is most likely this type) Papillary carcinoma is the most common malignant lesion

Usually occurs in client who received radiation treatments to the head or neck region in the past. Tends to spread only to nearby lymph nodes and rarely to other parts.

Assessment Findings

Vague, unaware of lesion Swelling in the neck Benign tumors cause symptoms of hyperthyroidism Nodular thyroid; Hoarseness; Swallowing difficulty; Biopsy (confirms diagnosis); Physical examination Suspected when gland is firm and palpable and when results of RAI studies show poor concentration in the suspect area.

Medical and Surgical Management

Thyroidectomy considered if difficulty swallowing, noticeable neck swelling Modified radical neck dissection is indicated if there is metastasis After thyroidectomy- hormone replacement is given to restore thyroid function and suppress TSH Iodine is administered to destroy remaining thyroid tissue as well as to treat lymph node metastasis, if present.
Nursing Management MD explains the planned treatment and outcome Emotional support Handling body fluids RAI: Postoperative; Radiation precautions

No symptoms treatment is usually not needed; nodule examined yearly

Pathophysiology and Etiology

Assessment Findings

Iodine deficiency Goitrogenic foods: peanuts, soybeans or taking certain drugs such as lithium Nontoxic Goiter: Enlarged thyroid, usually with no symptoms of thyroid dysfunction Nodular goiters: One or more areas of hyperplasia. Enlarged thyroid gland Sense of fullness in neck, Difficulty swallowing and breathing as the thyroid presses on the trachea and esophagus Thyroid scan: shows enlarged gland, and decreased uptake of I, result inconclusive Depends on cause Foods high in iodine (seafood and iodized salt); Potassium iodide to supplement iodine intake may be given Thyroidectomy if gland is grossly enlarged.

Medical Management

Nursing Management Monitor for and relieve respiratory symptoms

Elevate HOB

Provide appropriate diet

High in iodine and iodized salt, ie: bread, milk, eggs, meat and spinach. Soft diet if difficulty swallowing

Inflammation of the thyroid gland can be acute, subacute or chronic Pathophysiology and Etiology

Types: Acute; Subacute; Hashimotos Acute: Most common in children, appears to result from bacterial infection of the gland. Rare due to antibiotics Subacute: Can follow upper respiratory viral infection Hashimotos: Chronic, autoimmune in nature High fever, malaise, and swollen Tender thyroid gland Subacute produces symptoms of a swollen and painful or painless gland. Chills, fever and malaise aprx 2 weeks after infection when has a viral etiology Signs of HYPERthyoidism: tachycardia, tremors, intolerance of heat, wt. loss, emotional irritability. Once gland destoryed HYPOthyroidism: such as lethargy, wt gain, weakness, constipation, and dry hair develop Diagnostic findings: Thyroid scan; Lab tests

Assessment Findings: Signs and Symptoms

Medical and Surgical Management Antibiotics; Analgesics (pain and discomfort); Corticosteroids (reduce inflammation); Thyroid HRT Surgery is required if the gland becomes excessively large Nursing Management
Depends on type and severity Antipyretics for fever Elevate HOB, if difficulty breathing Soft diet- difficulty swallowing d/t enlargement Surgery: wound instructions, avoid excessive strain on neck, scar concern (minimal, collared shirts)
Symptoms of hyperthyroidism, hypothyroidism, and hypoparathyroidism notify MD if they occur Reviews dosage and adverse effects of each drug Teaching plan (replacement in AM, same time everyday to avoid insomnia and CNS stimulation and side effects that require MD notification (chest pain, tachycardia, and dyspnea)

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Pathophysiology and Etiology

Primary or secondary condition Primary: Adenoma; Increased secretions of PTH increased urinary of phosphorus and loss of calcium from bones. Renal stones may develop as calcium becomes concentrated in the urine. Secondary: Increased secretions in response to hypocalcemia which may result from vitamin D deficiency, chronic renal failure, large doses of thiazide diuretics and excessive use of laxatives and calcium supplements

Assessment Findings: Signs and Symptoms

Excessive calcium in the bloodFatigue; Hypotonic muscles Skeletal tenderness and pain on bearing weight; bones may break with little or no trauma (pathologic fractures) Cardiac dysrhythmias N/V, constipation. Formation of stones in urinary tract, pyelonephritis and uremia

Assessment Findings: Diagnostic Findings Laboratory tests (elevated serum calcium and decreased phosphorus w/o other causes of hypercalcemia MRI; CT scan- IDs parathyroid adenoma if it is present. Parathormone levels are elevated in hyperparathyroidism Medical and Surgical Management Sodium, phosphorus replacements Surgery for hypertrophied glandular tissue or of an individual tumor
Determine how many glands are removed, one or more left in place, necessary for calcium and phosphurus metabolism

Nursing Management Monitor I and O; Urinary calculi (flank pain and decreased urine output) Self-care; Safe environment to prevent falls and injury Encourage fluid intake Frequent rest periods and monitor fatigue level Provide postoperative care (monitor for symptoms of hypoparathroidism) Client education: Effects of disease; Adherence to treatment

Pathophysiology and Etiology

Deficiency of parathormoneHypocalcemia Trauma to the glands; inadvertent removal of all or nearly all these structures during thyroidectomy or parathyroidectomy Idiopathic form rare. May be autoimmune Causes hyperexcitability and parathesias

Assessment Findings: Signs and Symptoms Main symptomTetany; numbness and tingling in the fingers or toes or around the lips. A voluntary movement may be followed by involuntary jerking spasm. Chvosteks sign: If a nurse taps the clients facial nerve, the clients mouth twitches and jaw tightens. + reaction Trousseaus sign: Placing a bp cuff an waiting 3 minutes, the nurse may observe the client spam of the hand (carpopedal spasm), evidence by hand flexing inward Laryngeal spasm can occur causing dyspnea with long crowing respirations as air passes around the constriction Cyanonsis may be present, client in danger of asphyxia and cardiac dysrhythias, In chronic neuromuscular irritability, constipation or diarrhea, numbness and tingling of the arms and legs, loss of tooth enamel, and muscle pain. Assessment Findings: Diagnostic Findings Serum: Calcium (decreased) and phosphorus (increased); urine levels of both are decreased Radiographs: in chronic increased bone density

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Medical Management:

Nursing Management

IV calcium salt to treat tetany and severe hypoparathyroidism Endotracheal intubation; Mechanical ventilation; if acute respiratory distress occurs Administration of oral calcium, Vit D or Vitamin D2 (calciferol); which increases the serum calcium level Frequent monitoring of serum and urine calcium levels Diet high in calcium and low is phosphorus

Alert for signs of tetany and assess for Chvostek and Trousseaus signs If has chronic hypoparathyroisism, complete medical, drug, and allergy history Effects of hypocalcemia Emergency trach, ventilation, IV, if severe Assist with ADLs, minimize stress until serum calcium levels approach normal Educate about therapy, s/s of hypocalcemia and hypercalcemia

Clients with hyperparathyroidism should use a low calcium diet, and drink at least 3-4 L of fluid daily to dilute the urine and prevent renal stones. Client with hypoparathyroism need more calcium and vitamin D than can be provided through food alone, yet they should be encouraged to eat foods rich in calcium such as milk, yogurt, green leafy vegetables, and fortified orange juice. Carbonate beverages should be avoided because they are high in phosphorus

Pathophysiology and Etiology

Assessment Findings: Signs and Symptoms Assessment Findings: Diagnostic Findings

Medical Management
Laboratory tests; Radiographs; CT scan

Primary: Destruction of adrenal cortex Secondary: Surgical removal, hemorrhagic infarction, hypopituitarism, medications

Nursing Management

Daily corticosteroid replacement therapy

Take drugs at intervals prescribed Never increase, decrease or omit drug dose unless advised by MD, omitting the dose can cause original symptoms to return If N/V/D appear contact MD Read food labels carefully that you include foods that are part of the diet and avoid those that are not. Diet adherence is necessary

Clients with either primary or secondary adrenal insuffiency are at risk for addisonian crisis, a life threatening emergency Pathophysiology and Etiology
Extreme stress; Trauma; Salt deprivation Exposure to cold, overexcertion If untreated coma and death can result

Assessment Findings

Sudden or gradual Anorexia, nausea, headache, intensfication of hypotension, restlessness or fever Unless corticosteroid dose is increased to meet the demand, client progresses to acute adrenal crisis decreased bp shock Diagnosis: symptoms and history

Medical Management EMERGENCY!!!

Nursing Management

Corticosteroids given IV Antibiotics b/c of extremely low resistance to infection Recognition of s/s of adrenal crisis and accurate administration of corticosteroids Observe clients with acute adrenal crisis Frequent vitals, special attention to heart rate and rhythm Signs of hyponatremia and hyperkalemia Keep client warm and quiet as possible until treatment is initiated.

Tumor of the adrenal medulla that causes hyperfunction Pathophysiology and Etiology
Benign tumor Excessive catecholamine secretion
Epinephrine and norepinephrine

People who should be assessed: HTN that is difficult to control, take more than 4 medications to control their bp or develop HTN before 35 y.o.

Excessive secretion of epinephrine leads to HTN and increases the potential for CVA, palpitations and tachycardia

Assessment Findings: Elevated BP; Tremors; Hyperglycemia; Polyuria ; Vertigo, headache, N/V Diagnostic Findings: 24-hour urine (vanillylmandelic acid markedly increased); CT; MRI (reveal tumor) Ultrasonography; Retrograde pyelography Medical, Surgical Management: Unilateral adrenalectomy; Drug therapy: Phentolamine given before surgery to control HTN Demser used to decrease hypertensive attacks

Nursing Management
Monitors BP closely when initiating drug therapies or during dose changes. Notify MD of a sudden decrease in BP If client undergoes adrenalectomy, assesses for s/s of acute adrenal insuffieciency

Excessive secretion of hormone by the adrenal cortex Pathophysiology and Etiology:

Excess ACTH0 Tumors (benign or malignant Corticosteroids, long term usage

Assessment Findings: Signs and Symptoms

Medical and Surgical Management :

Cushingoid syndrome (Physical changes-suppression of the inflammatory response, hyperglycemia, hypokalemia, hypernatremia, with subsequent wt. gain and elvated bp,women acquire secondary male characteristics, both sexes have decreased sexual drive Muscle wasting Moon face; Buffalo hump; Wounds; Masculinization; Kyphosis Depression and psychosis Diagnostic findings: Dexamethasone suppression test; 24-hour urine; Blood test; Radiographs; IV pyelogram; CT; MRI Radiation Drug therapy- diuretics for edema, antihypertensive agent a diet low in sodium and carbs controls edema and blood glucose level, Antibiotics for infection Surgery- adrenalectomy

Pathophysiology and Etiology

Aldosterone: Secreting adenoma

Assessment Findings
Muscle weakness, fatigue, cardiac dysrhythmias; Headache; Increased urine; Hypertension Laboratory tests; CT; MRI; Adrenal venography

Medical and Surgical Management

Unilateral adrenalectomy Drug therapy (Spironolactone) Antihypertensive agent; Diet therapy (Sodium restricted)

Nursing Management
Vitals q4 or as ordered Marked elevations to MD Is and Os, weight ever 2-7days Daily examination of extremities for edema Monitor for signs of hypokalemia and hypernatremia

Surgical removal of the adrenal gland(s). Adrenal are surgically approached by means of an abdominal incision or flank incision under and following the position of the 12th rib. Preoperative: Reduce anxiety and understanding for surgery and post-op events Postoperative:
if pheochromocytoma monitors bp frequently IV corticosteriods

Observe for problems such as hemorrhage, atelectasis, and pneumothorax Vitals frequently and for signs of adrenal insufficiency
If insufficiency occurs notify MD immediately. Never omit administering corticosteroids.

Function of the adrenal glands include providing a physiologic response to stress, suppressing inflammation, raising blood sugar levels, conserving sodium to maintain blood volume and blood pressure, and contributing hormones that affect sexual characteristics Follow treatment regimen Care for wound as directed Adhere to medicaton schedule Obtain sufficient sleep and rest Keep appointments Avoid infections and stressful situations Carry ID indicating that the adrenal glands have been surgically removed Seek immediate medical help if it is not possible to take prescribed corticosteroids.

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