Cushing Syndrome System Disorder PDF

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Summary

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Description

ACTIVE LEARNING TEMPLATE:

System Disorder

Espinosa ST UDENT NAME Catherine _____________________________________ Cushing Syndrome DISORDER/DISEASE PROCESS __________________________________________________________

Alterations in Health (Diagnosis) -Risk for infection -Impaired nutritional status -Disturbed body image

Pathophysiology Related to Client Problem Clinical condition that results from chronic exposure to excess corticosteroids, particularly glucocorticoids

49 REVIEW MODULE CHAPTER ___________

Health Promotion and Disease Prevention -Reducing corticosteroid use -Treating underlying cause (e.g. if the cause is a tumor, removal of the tumor) -Supression of secretion of cortisol by drug therapy (e.g. Ketoconazole)

ASSESSMENT

SAFETY CONSIDERATIONS

Risk Factors

Expected Findings

-Iatrogenic administration of exogenous corticosteroids (e.g. prednisone) -Adrenal tumors -Women 20-40 years old

-Weight gain e.g. "moon face," centripetal obesity, "buffalo hump" -Purplish red striae -HTN

Laboratory Tests

Diagnostic Procedures

-Dexamethasone suppression test

-CT Scan

-24 hr urine for free cortisol and 17-ketosteroids

-MRI

-Plasma and salivary cortisol levels

-Petrosal sinus sampling

PATIENT-CENTERED CARE

Nursing Care -Monitor VS, daily weight, and glucose. -Assess for infection. -Monitor for S&S of thromboembolic events, such as pulmonary emboli. -Provide emotional support. -Assess for pain and loss of function.

-Drug Therapy -Surgical Therapy -Radiation Therapy

ACTIVE LEARNING TEMPLATES

-Consider a home health nurse referral esp. for older adults because of need for ongoing evaluation and teaching. -If corticosteriod dosage is tapered too rapidly after surgery, acute adrenal insufficiency may develop.

Complications Medications -Ketoconazole -Mitotane (Lysodren)

Client Education -Teach patient to avoid exposure to extreme temperatures, infections, and emotional situations. -Teach patient to always wear a medic alert bracelet and carry instructions in wallet or purse. -Teach patient to consult with HCP for possible adjustment to corticosteroid dosage and what parameters for dosage change.

-Mifepristone (Korlym)

Therapeutic Procedures

-Drug therapy may have adverse side effects. Assess for S&S of hormone and drug toxicity

-Metyrapone (Metopirone) -Pasireotide (Signifor)

Interprofessional Care -Endocrinologist -Neurosurgeon

-Hyperglycemia -Muscle wasting -Loss of bone matrix resulting in osteoporosis and back pain -Loss of collagen...