Nursing 212

Health Differences Across the Lifespan 2 Study Guide • Prevent tetany by early identification of hypocalcemia (serum calcium less than 8mg/dL); evidenced muscle twitches or numbness of toes, extremities, and lips; check for positive Chvostek’s and Trousseausigns • Maintain patent IV site • Monitor for laryngeal nerve damage, noting ability to speak loudly, quality, and tone of voice (hoarseness may be temporary after surgery) • Use analgesics to control surgical pain Cushing’s Syndrome Cushing’s syndrome is caused by hyperactivity of the adrenal cortex with excessive glucocorticoid secretion. Other causes include adenoma or carcinoma of the adrenal cortex or the pituitary gland (causes excessive secretion of ACTH). The increase in ACTH triggers the adrenal cortex to release large amounts of cortisol (moon face, buffalo hump). Elevated serum cortisol causes life threatening changes in physiological, psychological, andmetabolic functioning. Incidence is greater in women; the usual age of onset is 30-40 years. Primary Cushing’s disease is caused by a tumor of the adrenal cortex. Secondary Cushing’s disease is caused by a disorder of the pituitary or hypothalamus (causing increased ACTH and hyperplasia of adrenal cortex) or by an ectopic tissue (such as ACTH producing cancer of lung, bronchi, or pancreas). Iatrogenic is long term use of glucocorticoid medication such as steroids. Signs and symptoms of Cushing’s syndrome include weight gain, especially truncal obesity, buffalo hump, and moonface (caused by fat redistribution). Elevated serum cortisol, sodium, and glucose and lowered calcium and potassium are also symptoms. Serum ACTH can be elevated or decreased with a positive ACTH suppression test. There is an elevated urine 17KS; normal BUN. Treatment: • Possible radiation therapy for pituitarygland • Single or bilateral Adrenalectomy orHypophysectomy • Assist client to achieve fluid, electrolyte, glucose, and calcium balance • Analyze daily weight and I&O • Promote safety (uncluttered walking area, adequate lighting, assistive walking devices to prevent falls as needed; use stable, nonskid shoes or slippers • Prevent infection before and after surgery • Assist client to use effective coping strategies and encourage client to discussfeelings about change in physical appearance • Diet high in protein, vitamin B, and vitamin C to support immune system; supplemental potassium and calcium Medications include: metapyrone (directly inhibits cortisol production and secretion by adrenal cortex); ocetreotide (Sandostatin), a somatostatin analog that suppresses ACTH secretion; mitotane (Lysodren), which suppresses function of AC and decreases corticosteroid metabolism, thus decreasing serum cortisol

©2018

Achieve

Page 69

of 136

Made with FlippingBook - professional solution for displaying marketing and sales documents online