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Adrenal Glands
Disorders
15
Nursing
Undergraduate 3
07/10/2012

Additional Nursing Flashcards

 


 

Cards

Term
Adrenal Gland Hypofxn
Definition
  • May result from inadequate secrete of ACTH, dysfxn of hypothalamic-pituitary control, direct dysfxn of adrenal gland tissue
  • Gradual or quickly with stress
  • Acute adrenocortical insufficiency = adrenal crisis
    • Life threatening manifestations appear quickly and without warning
Term
Adrenal Gland Hypofunction
Definition
  • Insufficiency of adrenocortical steroids = loss of aldosterone and cortisol actions
  • Low cortisol:
    • Decreased gluconeogenesis
    • Depletion of liver and muscle glycogen
    • Hypoglycemia
    • GFR and gastric acid production decrease
  • Low aldosterone secretion:
    • Hyperkalemia - d/t decreased K excretion
    • Hyponatremia and hypovolemia
Term

Adrenal Gland Hypofunction

 

 

Acute adrenal insufficiency

Definition
  • Life threatening
  • Usually d/t stress
  • Without rapid intervention....
    • Sodium falls rapidly
    • Potassium increases rapidly
    • SEVERE hypotension occurs
Term

Addisonian Crisis

 

 

Treatment

Definition
  • Hormone replacement:
    • Rapid infusion of NS or D5NS
    • IV bolus of Solu-Cortef
    • Solu-Cortef IV drip for 8 hrs
    • Hydrocortisone 50 mg IM q 12 hours
    • H2 histamine blocker IV for ulcer prevention
  • Hyperkalemia Mgmt:
    • Insulin with dextrose in NS (shifts K into cells)
    • Kayexelate (excrete K in feces)
    • Loop or thiazide diuretics
    • I/O w/ K restriction
    • Cardiac monitoring
  • Hypoglycemia Mgmt:
    • IV glucose
    • Glucagon
    • Accuchecks hourly
Term

Adrenal Gland Hypofxn

 

 

Assessment

 

Definition
  • ACTH stimulation test - most definitive
    • Given IV then plasma cortisol lvl checked at 30 min, then 1 hr
    • Increased with secondary insufficiency
    • Decreased with primary insufficiency
    • In Addisonian crisis suspects, tx started without test
Term

Adrenal Gland Hypofunction

 

 

Interventions

Definition
  • Daily weights
  • Replacement therapy
  • Caution - salt restricition or diuretic therapy may cause adrenal crisis in these patients
Term
Adrenal Gland Hyperfunction
Definition
  • Hypercortisolism - Cushing's
  • Hyperaldosteronism
  • Excessive androgen production
  • Pheochromocytoma - excessive secretion of catecholamines (epi & norepi)
Term

Adrenal Gland Hyperfunction

 

 

Hypercortisolism

Cushing's Disease

Definition
  • Most common cause of Cushing's disease in spituitary adenoma resulting in bilateral adrenal hyperplasia
  • May be caused by glucocorticoid therapy
  • Excess glucocorticoids affect metabolism and all body systems
  • Redistribution of fat - truncal obesity, buffalo hump, moon face
Term

Adrenal Gland Hyperfunction

 

 

Hypercortisolism

Causes:

Definition
  • Most common = pituitary adenoma (bilat adrenal hyperplasia)
  • Use of glucocorticoids
  • Autoimmune disorders
  • Organ transplants
Term

Adrenal Gland Hyperfunction

 

 

Hypercortisolism

Assesment:

Definition
  • Weight gain
  • HTN
  • Capillary fragility
  • Osteoporosis
  • Thinning skin
  • Increased pigmentation
Term

Hypercortisolism

 

 

Assessment:

 

Definition

Weight gain

HTN

Cap fragility

Osteoporosis

Thinning skin

Increased pigmentation

Lab test = Blood, saliva (from cheek), urine

Term

Hypercortisolism

 

 

Treatment:

 

Definition
  • Hypophysectomy
  • Adrenalectomy
    • Unilateral or bilateral
    • Replacement therapy needed:
      • Lifetime for bilateral
      • Up to two years for unilateral
Term
Hyperaldosteronism
Definition
Primary - excessive secretion of aldosterone from one or both glands; usually caused by adrenal adenoma
Term

Adrenal Gland Hyperfunction

 

 

Hyperaldosteronism

Definition

HTN

Hypernatremia

Hypokalemia

Metabolic acidosis

Surgery is common tx - must wait for potassium lvl to become normal

Term

Adrenal Gland Hyperfunction

 

 

Pheochromocytoma

Definition
  • Usually benign; produces, stores and releases epi and norepi
  • Assess for HTN (hallmark sign); do NOT palpate abdomen
  • Tx - surgery; monitor BP closely post op as HTN is the most serious complication post op
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