Addisons & Cushings & Pheochromocytoma & Hyperaldosteronism

Function of cortisol

"stress hormone" helps the body deal with stress like in illness and external stress...increases blood glucose (be metabolism of sugar), breaks down fats, proteins, carbs and regulates electrolytes.

Signs and symptoms of Cushings

1. Central obesity--fat mobilizes from extremities 2. Moon face with buffalo hump 3. GI distress due to increased acid 4. Poor wound healing--increased androgens which suppress immune system 5. Purple striae 6. Hirsutism 7. HTN--steroids cause vasoconstriction 8. Weakness 9. Amenorrhea/impotence 10. Water retention 11. Hyperglycemia and hypernatremia 12. Polyuria and thirst 13. Labile mood 14. Frequent infections

Nursing interventions for Addison's disease

1. monitor hypoglycemia and hyperkalemia 2. administer hormone replacement therapy: cortisol (prednisone, hydrocortisone) and aldosterone (Florinef) 3. educate pt. to notify MD if increase in stress/illness 4. take medication regularly....DO NOT stop abruptly 5. Consume enough Na+ 6. wear medical alert bracelet 7. avoid strenuous exercise, stress, illnesses

Nursing interventions for pheochromocytoma

1. monitor vital signs: blood pressure and heart rate 2. monitor hypertensive crisis: SBP >180 or DBP >120 (cause damage to kidneys, eyes, brain, heart) = S&S: headache, vision changes, neuro changes, seizures 3. monitor chest pain (MI), neuro status (stroke), EKG changes, hyperglycemia 4. provide cool, calm, environment

Treatment of pheochromocytoma

Adrenalectomy: bilateral or unilateral removal of adrenal gland Pre-op: prescribed alpha-adrenergic blocker (lower BP and prevent hypertensive crises) during surgery

Causes of Addison's disease

Autoimmune destruction (most common in West), TB (most common in developing world), metastatic carcinoma (most common from lungs), hemorrhaging (trauma), adrenalectomy

Signs and symptoms of pheochromocytoma

Facial Flushing, Fluttering in chest increased heart rate and blood pressure glucose high headaches (sudden and severe) tremors frequent sweating loss of weight increased anxiety and fear growing tumor that causes abdominal pain and pressure heat intolerance tired and weak (constant stimulation)

Causes of primary hyperaldosteronism

Inside adrenals (low renin and high aldosterone) *idiopathic hyperaldosteronism *Conn's syndrome: benign tumor *family genetics

Addisonian crisis s/s

N/V, confusion, abdominal pain, extreme weakness, hypoglycemia, dehydration, decreased BP

Causes of secondary hyperaldosteronism

Outside adrenals (high renin and high aldosterone) *CHF: less cardiac output (low O2) = more renin = more aldosterone *Renal artery stenosis = less blood flow

Addisonian crisis treatment

Shock management Fluid resuscitation using 0.9% NS and 5% dextrose High-dose hydrocortisone IV push

A nurse is caring for a client who has been diagnosed with Cushing's syndrome. The client is at risk of impaired skin integrity related to skin dryness and edema. Which of the following goals would be most appropriate for this client? a. Client will support skin integrity by applying healing ointments and protective measures b. Client will demonstrate a knowledge of the layers of skin and underlying tissues c. Client will have improved body image before discharge from the hospital as evidenced by verbalizing acceptance of skin appearance d. Client's pain will be managed using pharmacologic medications for the next 12 hours

The answer is A. A client with endocrine dysfunction such as Cushing syndrome may be at greater risk of skin changes, including skin breakdown. The nurse should teach the client how to care for the skin, which may involve applying protective ointments and taking measures to keep the skin intact

The nurse is caring for a client with Cushing syndrome. The nurse knows to perform which daily activity? a. Make sure the client is near the nurse's station b. Make sure the scale is near the client's room c. Medications need to be exactly on time d. Linens need to be constantly changed, so make sure they are stocked

The answer is B. Clients with Cushing syndrome are at risk for excessive fluid retention which can cause cardiac stress and hypokalemia. The nurse should anticipate daily weights as one way to monitor the client's fluid retention status.

A patient who is on corticosteroid therapy for treatment of an autoimmune disorder has the following additional drugs ordered. Which one is used to prevent corticosteroid induced osteoporosis? a. potassium b. furosemide c. alendronate d. pantoprazole

The answer is C. Alendronate (Fosamax) is used to prevent corticosteroid induced osteoporosis. Potassium is used to prevent mineralocorticoid effect of hypokalemia. Furosemide is used to decrease sodium and fluid retention from the mineralocorticoid effect. Pantoprazole (Protonix) is used to prevent gastrointestinal irritation from an increase in secretion of pepsin and hydrochloric acid.

A client is experiencing an adrenal crisis due to Addison's Disease. Which of the following would NOT be a priority nursing intervention for this client? a. Monitor for hyponatremia b. Monitor for hypoglycemia c. Monitor for hypocalcemia d. Monitor for fluid volume deficit

The answer is C. Clients in adrenal crisis (severe adrenal insufficiency) are more likely to experience hypercalcemia, NOT hypocalcemia, due to less excretion by the kidneys and calcium being pushed out of the cells.

The nurse walks into a client's room and notices that their skin is a dark bronze color. The nurse knows this could indicate which of the following diseases? a. Alcoholism b. Huntington's disease c. Addison's disease d. Bell's palsy

The answer is C. Clients with Addison's disease can develop bronze colored skin.

A nurse reads in a client's H&P that the client is deficient in a hormone that stimulates the adrenal cortex. What is an appropriate term for this hormone? a. Adrenal cortectomy b. Adrenotropin c. Corticosteroid hormone d. Adrenocorticotropic hormone

The answer is D. "Adrenocortico-" refers to the adrenal cortex specifically. "tropic" refers to a hormone that stimulates a gland to release other hormones.

A client is suffering from excess cortisol excretion as a result of an adenoma on the pituitary gland. Which of the following changes is an expected finding in a client with this condition? Select all that apply. a. Lesions on the peripheral extremities b. Swelling in the neck and throat c. Skin that bruises easily d. Increase in the number of stretch marks e. Fatty tissue deposits in the face and upper back

The answers are: C Excess cortisol leads to easily bruised skin. This is a common symptom of Cushing's syndrome, D Skin changes that may be seen with excess cortisol include purple stretch marks (striae), easy bruising, weight gain, fatty tissue deposits in the midsection, upper back and face, excess body hair in women, and decreased fertility in men, and E Cortisol is a stress hormone secreted from the adrenal glands near the kidneys. Excess cortisol production can cause a number of changes associated with different body systems., including obesity and fatty tissue deposits on the face and upper back.

Pheochromocytoma

a tumor found on the adrenal medulla that secretes excessive amounts of catecholamines

Hyperaldosteronism

adrenal cortex secretes too much aldosterone hormone, which can lead to low levels of potassium in the blood and increased hydrogen ion excretion (alkalosis)

Cushing's disease

caused by inside source like pituitary gland producing too much adrenocorticotropic hormone which causes increased cortisol

Addison's disease

decreased secretion of cortisol and aldosterone

Adrenalectomy

educate about cortisol medication replacement therapy for life after procedure

Cause of pheochromocytoma

genetic disposition and found early to middle age

Catecholamines

have huge influence on how organs and tissues work...produced from stimulation of sympathetic nervous system "fight or flight"

Function of aldosterone

regulates blood pressure through renin angiotensin aldosterone system....retains Na+ and secretes K+

Function of adrenal cortex

releases steroid hormones (corticosteroids) aldosterone and cortisol (glucocorticoids) and sex hormones

Adrenal gland

right and left sit on the kidneys...outer layer: adrenal cortex...middle layer: adrenal medulla (tumors found here)

Chromaffin cells

secretes catecholamines this is what tumor is made of (tends to be benign)...these cells are also found in the heart, head, neck, bladder, spine, and abdomen...if they develop into tumors called Paragangliomas

Other causes of Cushings

tumors/cancer on pituitary gland or adrenal cortex, genetic predisposition

Cushing's

hypersecretion of cortisol

What kind of acid base imbalance is present in hyperaldosteronism?

metabolic alkalosis

Triggers of signs and symptoms of pheochromocytoma

*eating foods with Tyramine (plays a role in BP) *surgery, trauma, injury, stress, medications like MAOIs

Signs and symptoms of hyperaldosteronism

*hypernatremia: polydipsia, swollen dry tongue, increased muscle tone *hypertension: headaches, facial redness (flushing) *hypokalemia: ECG: ST depression and prominent U wave = HEART MONITOR (decreased DTR, constipation and hypoactive bowel sounds, polyuria, diluted urine)

Adrenal medulla

secretes epinephrine (adrenaline), norepinephrine (noradrenaline) and low amount of dopamine in response to body's sympathetic nervous system (fight or flight) via chromaffin cells

Interventions for Cushing

*hypophysectomy (pituitary tumor cause), adrenalectomy, watch for hyperglycemia, hypokalemia, infections, skin breakdown, and provide emotional support

Signs and symptoms of Addison's disease

*Sodium and sugar (very low...cortisol increases blood sugar and aldosterone retains sodium) *salt cravings *tired and weak (muscles) *electrolyte imbalances (hyperkalemia, hypercalcemia) (aldosterone usually secretes K+) *reproductive changes, irregular periods, ED in males *hypotension at risk for vascular collapse *increased pigmentation of skin *diarrhea, nausea, depression

Treatment for hyperaldosteronism

1. lower fluid volume (fluid volume overload can impair airway and breathing) 2. lower aldosterone 3. potassium sparing diuretics like spironolactone 4. adrenalectomy: caution addison's crisis (hypotensive shock)

Diagnosis of pheochromocytoma

24 hr metanephrines and catecholamines

The client needs replacement of the hormones necessary for the regulation of fluid and electrolyte balance within the body. Which hormones will the nurse expect to replace? Select all that apply. a. Renin b. Antidiuretic hormone (ADH) c. Cortisol d. Angiotensin e. Aldosterone

The answers are: B and E. Both ADH and aldosterone regulate the fluid and electrolyte balance through their action on the kidneys. Parathyroid hormone also regulates fluid and electrolyte balance.

A patient is admitted to the hospital with a diagnosis of Cushing syndrome. On physical assessment of the patient, what should the nurse expect to find? a. hypertension, peripheral edema, and petechiae b. weight loss, buffalo hump, and moon face with acne c. abdominal and buttock striae, truncal obesity, and hypotension d. anorexia, signs of dehydration, and hyperpigmentation of the skin

The answer is A. The effects of adrenocorticotropic hormone excess, especially glucocorticoid excess, include weight gain from accumulation and redistribution of adipose tissue, sodium and water retention, glucose intolerance, protein wasting, loss of bone structure, loss of collagen, and capillary fragility leading to petechiae. Clinical manifestations of adrenocortical hormone deficiency include hypotension, dehydration, weight loss, and hyperpigmentation of the skin.

The nurse is performing an admission assessment on a client and notes that the client has a moon-shaped face. The nurse understands that this could indicate which of the following? a. Addison's disease b. Huntington's disease c. Cushing's syndrome d. Down's syndrome

The answer is C. A client with Cushing's syndrome will likely have a moon-shaped face, due to redistribution of fat from the disease process.

Cushing's syndrome

caused by outside source like medication treatment of glucocorticoids (prednisone use)

Negative Feedback loop for cortisol

hypothalamus = releases corticotropin releasing hormone (CRH) = pituitary gland = releases adrenal corticotropic hormone (ACTH) = adrenal cortex = releases cortisol

A 79-year-old client with Cushing's disease has developed some cognitive effects that are impacting his ability to care for himself. Which cognitive effects are most likely to develop in a client with Cushing's disease? a. Seizures b. Memory loss c. Coma d. Aggression

The answer is B. Cushing's disease occurs when the pituitary gland produces excess amounts of adrenocorticotropic hormone. The client can experience changes in body structure, as well as changes in skin, muscles, and cognition. One of the most common cognitive effects associated with Cushing's disease over time is memory loss.

When caring for a patient with primary hyperaldosteronism, the nurse would question an HCP's prescription for which drug? a. ketoconazole b. furosemide c. eplerenone d. spironolactone

The answer is B. Hyperaldosteronism is an excess of aldosterone, which is manifested by sodium and water retention and potassium excretion. Furosemide is a potassium wasting diuretic that would increase the potassium deficiency. Ketoconazole decreases adrenal corticosteroid secretion. Eplerenone and spironolactone are potassium sparing diuretics.

The patient with an adrenal hyperplasia is returning from surgery after an adrenalectomy. The nurse should monitor the patient for what immediate postoperative complication? a. Vomiting b. Infection c. Thromboembolism d. Rapid blood pressure changes

The answer is D. The risk of hemorrhage is increased with surgery on the adrenal glands as well as large amounts of hormones being released in the circulation, which may produce hypertension and cause fluid and electrolyte imbalances to occur for the first 24 to 48 hours after surgery. Vomiting, infection, and thromboembolism may occur postoperatively with any surgery.

What is the priority nursing intervention during the management of the patient with pheochromocytoma? a. administering IV fluids b. monitoring blood pressure c. administering beta adrenergic blockers d. monitoring intake and output and daily weights

The answer is B. Pheochromocytoma is a catecholamine producing tumor of the adrenal medulla, which may cause severe, episodic hypertension and severe, pounding headache; tachycardia; and profuse sweating. Monitoring for dangerously high BP before and after surgery is critical, as is monitoring for BP fluctuations during medical and surgical treatment.

The patient in the emergency department after a car accident is wearing medical identification listing Addison's disease. What should the nurse expect to be included in the care of this patient? a. Low-sodium diet b. Increased glucocorticoid replacement c. Limiting IV fluid replacement therapy d. Withholding mineralocorticoid replacement

The answer is B. The patient with Addison's disease needs lifelong glucocorticoid and mineralocorticoid replacement and has an increased need with illness, injury, or stress, as this patient is experiencing. The patient with Addison's may need large volumes of IV fluid replacement and a high-sodium diet. Withholding mineralocorticoid replacement cannot be done for patients with Addison's disease.

A patient with Addison's disease comes to the ED with complaints of nausea, vomiting, diarrhea, and fever. What interprofessional care should the nurse expect? a. IV administration of vasopressors b. IV administration of hydrocortisone c. IV administration of D5W with 20 mEq KCl d. Parenteral injections of adrenocorticotropic hormone (ACTH)

The answer is B. Vomiting and diarrhea are early indicators of Addisonian crisis and fever indicates an infection, which is causing additional stress for the patient. Treatment of a crisis requires immediate IV hydrocortisone replacement. Large volumes of 0.9% saline and 5% dextrose fluids are given to reverse hypotension and electrolyte imbalances until BP returns to normal. Addison's disease is a primary insufficiency of the adrenal gland and ACTH is not effective, nor would vasopressors be effective with the fluid deficiency of Addison's disease. Potassium levels are increased in Addison's disease and KCl would be contraindicated.

During discharge teaching for the patient with Addison's disease, which statement by the patient indicates that the nurse needs to do additional teaching? a. i should always call the doctor if I develop vomiting or diarrhea b. if my weight goes down, my dosage of steroid is probably too high c. I should double or triple my steroid dose if I undergo rigorous physical exercise d. I need to carry an emergency kit with injectable hydrocortisone in case I can't take my medication by mouth

The answer is B. Weight reduction in the patient with Addison's disease may indicate a fluid loss and a dose of replacement therapy that is too low rather than too high. Because vomiting and diarrhea are early signs of crisis and because fluid and electrolytes must be replaced, patients should notify their HCP if these symptoms occur. Patients with Addison's disease are taught to take two to three times their usual dose of steroids if they become ill, have teeth extracted, or engage in rigorous physical activity and should always have injectable hydrocortisone available if oral doses cannot be taken.

A child with congenital adrenal hyperplasia (CAH) has been admitted because of influenza with vomiting, diarrhea, and a high fever. What interventions would the nurse expect to provide for this child? Select all that apply. a. IV fluids containing a moderately low sodium concentration b. High doses of glucocorticoids administered orally c. Monitoring of electrolyte levels d. A well-balanced diet containing fruits and vegetables e. Antipyretics to reduce the fever f. Clustered care to minimize fatigue

The answer is C, D, E, and F. Monitoring of electrolyte levels is essential with this child. A well-balanced diet containing fruits and vegetables is indicated. There are no dietary restrictions for this child. Antipyretics to reduce the fever would be used. Clustered care to minimize fatigue is always a good idea for very sick children. IV fluids would contain a normal to elevated sodium concentration. High doses of glucocorticoids would be administered intravenously while vomiting is present and then switched to orally when vomiting ceases.

A provider has prescribed hormone replacement therapy for a client who has Addison's disease. The nurse who is caring for this client understands the difference between Addison's disease and Cushing's syndrome as which of the following? a. Addison's causes signs of masculinity in women while Cushing's causes atrophy of skin, tissues, and hair b. Addison's is caused by hyperplasia of the adrenal gland while Cushing's is caused by pituitary enlargement c. Addison's occurs as the result of decreased secretions of hormones while Cushing's occurs as a result of increased secretion d. Addison's requires treatment with lifetime hormone replacement therapy while Cushing's does not

The answer is C. Addison's disease and Cushing's syndrome are two conditions that develop as a result of abnormal secretion of hormones. In the case of Addison's disease, the client does not secrete enough adrenocortical hormones, and the treatment is to ADD glucocorticoid or mineralocorticoi medications as prescribed. In Cushing's syndrome, the client secretes too much cortisol due to a variety of potential factors, including ACTH secreting tumors or a metabolic disorder.

A patient is scheduled for a bilateral adrenalectomy. During the postoperative period, what should the nurse expect related to the administration of corticosteroids? a. reduced to promote wound healing b. withheld until symptoms of hypocortisolism appear c. increased to promote an adequate response to the stress of surgery d. reduced with excessive hormone release during surgical manipulation of adrenal glands

The answer is C. Although the patient with Cushing syndrome has excess corticosteroids, removal of the glands and the stress of surgery require that high doses of corticosteroids (cortisone) be administered postoperatively for several days before weaning the dose. The nurse should monitor the patient's vital signs postoperatively to detect whether large amounts of hormones were released during surgical manipulation, obtain morning urine specimens for cortisol measurement to evaluate the effectiveness of the surgery, and provide dressing changes with aseptic technique to avoid infection as usual inflammatory responses are suppressed.

The nurse is caring for a child hospitalized with acute adrenocortical insufficiency. Just as the acute phase seems to be over, ascending flaccid paralysis occurs. What is the most appropriate nursing action? a. Reassure the family that flaccid paralysis is not problematic. b. Prepare the family for long-term consequences of paralysis. c. Reassure the family that this condition is temporary. d. Prepare the family for impending death.

The answer is C. During the recovery phase, paralysis may develop. It is a temporary, quickly reversible clinical manifestation. Flaccid paralysis is a reversible condition when associated with adrenocortical insufficiency. Flaccid paralysis is problematic if not reversible. Flaccid paralysis is a reversible condition when associated with adrenocortical insufficiency.

What should be included in the interprofessional plan of care for a patient with Cushing disease? a. Lab monitoring for hyperkalemia b. Vital sign monitoring for hypotension c. Counseling related to body image changes d. Diet consultation to determine low protein choices

The answer is C. Elevated corticosteroid levels can cause body changes, including truncal obesity, moon face, and hirsutism in women and gynecomastia in men. Counseling and support should be offered because of the changes in body image. Hypokalemia and hypertension are consistent with Cushing disease. Sodium restriction and potassium supplementation are indicated. High protein choices are necessary to counteract catabolic processes and assist with wound healing

The nurse is working with a client who has been diagnosed with Cushing's syndrome. The nurse has provided teaching about the disease process and management. Which of the following statements by the client demonstrates a need for additional teaching? a. "You are going to monitor my labs closely because electrolyte disturbances are common" b. "I am secreting too much cortisol, which is what's causing my symptoms" c. "I will need to take levothyroxine for the rest of my life" d. "If we don't treat this, it can become life-threatening"

The answer is C. Taking a thyroid medication is necessary for persons with hypothyroidism rather than hyperthyroidism. Taking this drug would cause the condition to worsen.

A patient with mild iatrogenic Cushing syndrome is on an alternate day regimen of corticosteroid therapy. What does the nurse explain to the patient about this regimen? a. it maintains normal adrenal hormone balance b. it prevents ACTH release from the pituitary gland c. it minimizes hypothalamic-pituitary-adrenal suppression d. it provides a more effective therapeutic effect of the drug

The answer is C. Taking corticosteroids on an alternate day schedule is pharmacologic purposes is less likely to suppress ACTH production from the pituitary and prevent adrenal atrophy. This method is not used when corticosteroids are given as hormone therapy. Normal adrenal hormone balance is not maintained nor is it more effective.

A nurse is preparing to start an IV in a client's non-dominant extremity but notes that this arm is edematous. Which of the following are appropriate actions for the nurse to take? Select all that apply. a. Utilize the edematous extremity only if it is non-pitting edema b. Select a distal site in the edematous extremity for cannulation c. Select any site on the non-edematous extremity for cannulation d. Use a transilluminator on the skin to find a proximal vein on the edematous extremity e. Contact the provider to clarify that an IV is necessary

The answer is C. When starting an IV in a client, using an edematous extremity is contraindicated. While it is good practice to cannulate in a non-dominant arm for the client's convenience, it is more important to avoid an area of the body with an abnormal presentation. Test-taking tip: When answering SATA questions, remember that there may only be one right answer.

A patient with a severe pounding headache has been diagnosed with hypertension. However, the hypertension is not responding to traditional treatment. What should the nurse expect as the next step in determining a diagnosis for this patient? a. Administration of β-blocker medications b. Abdominal palpation to search for a tumor c. Administration of potassium-sparing diuretics d. A 24-hour urine collection for fractionated metanephrines

The answer is D. Pheochromocytoma should be suspected when hypertension does not respond to traditional treatment. The 24-hour urine collection for fractionated metanephrines is simple and reliable with elevated values in 95% of people with pheochromocytoma. In a patient with pheochromocytoma, an α-adrenergic receptor blocker is used preoperatively to reduce blood pressure. Abdominal palpation is avoided to avoid a sudden release of catecholamines and severe hypertension. Potassium-sparing diuretics are not needed. Most likely they would be used for hyperaldosteronism, which is another cause of hypertension.

A client with Cushing's syndrome has become more withdrawn from friends and relatives because of changes in appearance. Upon admission to the healthcare center, the nurse gives the client a nursing diagnosis of Social Isolation related to discomfort with others and feelings of rejection by other people. Which of the following nursing interventions is most appropriate in this situation? a. Teach the client to verbalize I feel that you are rejecting me when in social circles b. Help the client to monitor her diet to include more sources of carbohydrates from whole grains and vegetables c. Assist the client with finding a church that she can join d. Help the client to consider what small changes she could make to integrate herself into the community and make new friends

The answer is D. Social isolation can be seen among some clients who struggle with their appearance because of changes due to a disease process, including endocrine dysfunction. Social isolation leads to loneliness and studies show that clients usually feel increasing depression because of lack of social interaction. The nurse may help the client in this situation to make small changes in her lifestyle that could slowly integrate her back into the community where she could meet new people and expand her network of friends.

The nurse is caring for a client who is starting a long-term regimen of glucocorticoids for adrenal insufficiency. Which of the following teaching points is appropriate for the nurse to include when educating the client on this medication? Select all that apply. a. The client should monitor for weight gain and edema b. Glucocorticoids mask the signs of infection c. Glucocorticoids should be used carefully if diabetes mellitus is present d. Glucocorticoids decrease the risk of osteoporosis e. Hyperglycemia is a side effect of glucocorticoids

The answers are A: Weight gain and edema are common side effects of glucocorticoid use, B: Glucocorticoids suppress the immune system and produce anti-inflammatory effects, C: These contribute to hyperglycemia and therefore worsen blood glucose levels, E: Glucocorticoids affect glucose metabolism which causes hyperglycemia.

The nurse is caring for a client with Cushing's syndrome. The nurse knows that this disease is caused by hypersecretion of which of the following hormones? Select all that apply. a. Aldosterone b. Adrenocorticotropic hormone c. Testosterone d. Follicle-stimulating hormone e. Cortisol

The answers are: A Aldosterone, which is the hormone responsible for the secretion of sodium and water from the body, is one of the hormones that is hypersecreted in Cushing's syndrome, B This hormone, also known as ACTH, is often hypersecreted in the client with Cushing's syndrome, C Testosterone, an androgen, is excessively secreted in a client with Cushing's syndrome, along with cortisol and aldosterone, and E Cortisol secreted in excess leads to Cushing's syndrome

A nurse is caring for a client who has been diagnosed with Addison's disease. The nurse is teaching about symptoms of Addisonian crisis in order to best manage and prevent it before it occurs. What symptoms should the client look for that the nurse should include as part of teaching? Select all that apply. a. Generalized weakness b. High blood pressure c. Severe headache d. Sudden pain in the lower back or abdomen e. Dehydration

The answers are: A Generalized weakness could be a sign of an Addisonian crisis, C Severe headache is a symptom to teach this client regarding an Addisonian crisis, D Addison's disease is a type of primary renal insufficiency in which the adrenal glands do not produce enough hormones. The client often has fatigue, muscle weakness, and weight loss. Addisonian crisis is another complication of the condition. It is characterized by sudden pain in the lower back, severe headache, generalized weakness, shock, and dehydration, and E Client teaching should include dehydration as one of the signs of an Addisonian crisis.

A client is newly diagnosed with Addison's disease. The nurse understands that this condition includes a decrease of which of the following hormones? Select all that apply. a. Glucocorticoids b. Androgen c.Insulin d. Mineralcorticoids e. Testosterone

The answers are: A Glucocorticoids are secreted by the adrenal cortex, B This is a hormone also secreted by the adrenal cortex, and D These hormones are secreted by the adrenal cortex, and are deficient in Addison's disease.

The nurse is caring for a client with Cushing's syndrome and reviews the client's most recent CMP. Which of the following electrolyte imbalances is an expected finding for this client? Select all that apply. a. Hypochloremia b. Hypocalcemia c. Hypokalemia d. Hyponatremia e. Hyperglycemia

The answers are: B Low calcium levels are expected in the client with Cushing's syndrome, C Since Cushing's syndrome includes excess aldosterone levels, which cause hypernatremia. When sodium is high in the body, the kidneys excrete more potassium, so hypokalemia is an expected finding, E The excess cortisol presence in Cushing's syndrome leads to hyperglycemia, so this is an expected finding.

A client is admitted to the hospital with primary adrenal insufficiency. Which of the following drugs does the nurse anticipate giving for this condition? Select all that apply. a. Vasopressin b. Growth hormone c. Dexamethasone d. Prednisone e. Prednisolone

The answers are: C Dexamethasone is given to treat primary adrenal insufficiency, D Primary adrenal insufficiency symptoms are due to a hyposecretion of adrenal cortex hormones which are primarily glucocorticoids. These include dexamethasone, hydrocortisone, methylprednisolone and prednisone, and E Prednisone is given to treat primary adrenal insufficiency.