Unit 6 - Cushing's Disease

A client has an adrenal tumor and is scheduled for a bilateral adrenalectomy. During preoperative teaching, the nurse teaches the client how to do deep-breathing exercises after surgery. What should the nurse tell the client to do?

"Hold your abdomen firmly with a pillow, and take several deep breaths."

A client diagnosed with Cushing's syndrome is admitted to the hospital and scheduled for a dexamethasone suppression test. What should the nurse do during this test?

Administer 1 mg of dexamethasone orally at night and obtain serum cortisol levels the next morning

As the nurse assists the postoperative client out of bed, the client reports having gas pains in the abdomen. To reduce this discomfort, what should the nurse do?

Encourage the client to ambulate.

A client who is recovering from a bilateral adrenalectomy has a client-controlled analgesia (PCA) system with morphine sulfate. What should the nurse do to manage safe administration of the morphine?

Evaluate pain control at least every 2 hours.

The nurse should monitor the client with Cushing's disease for which finding?

Hypokalemia

Adrenal function is affected by the drug ketoconazole, an antifungal agent used to treat severe fungal infections. How is this effect manifested?

Ketoconazole suppresses adrenal steroid secretion.

Bone resorption is a possible complication of Cushing's disease. To help the client prevent this complication, what should the nurse recommend to the client?

Maintain a regular program of weight-bearing exercise.

The client with Cushing's disease needs to modify dietary intake to control symptoms. In addition to increasing protein, which strategy would be most appropriate?

Restrict sodium.

The client who has undergone a bilateral adrenalectomy is concerned about persistent body changes and unpredictable moods. What should the nurse teach the client about these changes?

The body and mood will gradually return to normal.

A client undergoing a bilateral adrenalectomy has postoperative prescriptions for hydromorphone hydrochloride 2 mg to be administered subcutaneously every 4 hours as needed for pain. Why should the nurse administer hydromorphone in small doses? A small dose is:

as potent as morphine in larger doses.

A client has had a bilateral adrenalectomy. For which potential complication should the nurse assess the client?

delayed wound healing

In the early postoperative period after a bilateral adrenalectomy, the client has a temperature of 101°F (38.3°C). What should the nurse assess first to determine the cause of the elevated temperature?

lung expansion

The nurse is caring for a client who is scheduled for an adrenalectomy. Which drug may be included in the preoperative prescriptions to prevent Addison's crisis following surgery?

methylprednisolone sodium succinate intravenously

A client has had an adrenalectomy. What is the priority goal for this client in the first 24 hours after surgery?

preventing adrenal crisis

After a bilateral adrenalectomy for Cushing's disease, the client will receive periodic testosterone injections. What is the expected outcome of these injections?

stimulated protein metabolism

Which information should the nurse include in the teaching plan of a female client with bilateral adrenalectomy?

The client will need steroid replacement for the rest of her life

A client with Cushing's disease tells the nurse that the health care provider (HCP) said the morning serum cortisol level was within normal limits. The client asks, "How can that be? I'm not imagining all these symptoms!" The nurse's response will be based on which information?

The excessive cortisol levels seen in Cushing's disease commonly result from loss of the normal diurnal secretion pattern.