Nursing management of endo disorders

  1. Adrenal Medulla
    • Sympathetic nervous system
    • - release of catecholamines
    • --- epinephrine and norepinephrine
    • --- fight or flight
    • - released directly into bloodstream
    • - work on adrenergic receptor
    • think incr HR, dec GI/GU, eye dilated
  2. Adrenal Cortex
    • secretes more than 50 different hormones
    • assists in body's response to stress
    • classified:
    • - glucocorticoids (cortisol)
    • - mineralcorticoids (aldosterone)
    • - androgens
  3. Adrenal medulla
    pheochromocytoma
    • catecholamine secreting tumor
    • familial tendency
    • usually unilateral benign (not cancer)
    • think SNS- incr hr, rr etc
    • pheo-cat
  4. Pheo-cat
    patho
    • secretion of excessive epi/noreepi
    • - SNS stimulation
    • - severe stress response (constant stress)
    • - secretion can be low, constant, and/or intermittent
    • ** hypermetabolic state
  5. Pheo- Cat
    classical triad
    • headache
    • diaphoresis
    • palpitations
    • - in a pt with HTN
    • think fight or flight response
    • duration 1mins- 1 hrs
  6. Pheo-Cat
    five H's of Pheocat
    • HTN-styolic >200
    • H/a- vasocontriction
    • hyperhidrosis- excessive sweating
    • hypermetabolic- everything moving
    • hyperglycemia
    • also fifth decade
  7. Pheo-Cat
    dx
    • Good H&P- looking at s/s
    • Urine VMA
    • - catecholamine metabolite- breakdown
    • - 24 urine
    • plasma catecholamines- increase
    • CT/MRI- adenomas
    • incre glu, glucosuria
  8. Pheo- Cat
    management
    medical
    • bedrest with HOB elev- dec metabolic demand, control bp (dec)
    • control HTN
    • - alpha & beta blocker
    • - ca channel blockers
    • - cardiac monitor
    • prepare for surgery
    • - definitive tx (end result get them prepare)
  9. pheo-cat management
    surgery
    • primary tx- adrenalectomy
    • 2 complications:
    • - excessive hormone release (HTN crisis- palpitation, tachy
    • - hypotension & hypoglycemia- cortex which secrete aldosterone + BS
    • lifelong steriod if bilat
    • 25% will continue with HTN
  10. Addison's disease
    • adrenal insufficiency
    • 75% autoimmune/idiopathic
    • - also infection, metastatic tumor
    • sudden cessation of glucocorticoid, bilateral adrenalectomy hypopitutarism, radiation
  11. Addison disease
    patho
    • autoimmune
    • - most common cause with lymphocyte inflitration of adrenal cortex
    • gradual destruction
    • s/s when 90% destroy
  12. addison disease
    manifestation general
    • mild fatigue, muscle weakness
    • N/V
    • irritability
    • wt loss
    • postural hypotension
    • think low cortical level
  13. addison disease
    manifestation- decreased mineralcorticoid
    • aldosterone deficit
    • dehydration
    • hypoatremia
    • orthostatic hypotension
    • wt loss
    • salt craving
    • hyperkalemia
    • (lose fluids)
  14. Addision
    manifestation- decre glucorticoids
    • hypoglycemia
    • hypotension
    • increased melanocyte stimulating hormone & ACTH
    • - Addisonian tan*
    • JFK
  15. addison disease
    manifestation androgens
    • body not answering to the feedback mechanism
    • amenorrhea
    • **in men, testicular androgens usually compensate
  16. addison disease
    dx test
    • dec corticol level
    • decr cosuntropin stimulation test- ACTH (give them steriods)
    • CT/MRI
    • dec/undetected aldosterone
    • hypoantremia, hyperkalemia
    • hypoglycemia- lack of corticol
    • decreased 17 K-S 24 hr urine
  17. addison disease
    management
    • glucocorticoid replacement
    • diet
    • mineralcorticoid replacement- for BP
    • safety precaution- FVD, hypotension etc
  18. addison disease
    glucocoticoid replacement
    education
    • adhering to regimen
    • self injection when PO unable
    • incre dose with md order
    • id bracelet
    • MD f/u
    • maybe lifelong prednisone
  19. addison disease
    diet
    • incre NA t0 4-6 g/d
    • low K
    • encourage po fluids- 3L/d
    • sm, frequent, high protein, mod CHO meals
    • large late night snack- because u don't want the bs to drop overnight
  20. addison disease
    mineralcorticoid replacement
    • if cant maintain BP w/increased NA
    • intake & IVF
    • Florinef
    • - monitor HTN
    • - monitor I&O, wt, skin tugor K
    • make sure Na normal levels
Author
Prittyrick
ID
319263
Card Set
Nursing management of endo disorders
Description
endo
Updated