Disorders of the Adrenal Gland Lecture

7/29/2019 Disorders of the Adrenal Gland Lecture

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Disorders of the Adrenal

GlandPrepared by:

John Paulo C. Reyes, RN


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What is the adrenal gland?


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The hormones of Adrenal

Cortex? Remember the 3 S:

S-altS-ugar

S-ex


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The hormones of Adrenal

Medulla:

Catecholamines:

Epinephrine

Norepinephrine


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Cushings syndrome

Cushings syndrome

(hyperadrenalism)

Cause: overproduction ofhormones secreted form the

adrenal cortex, excessive

steroidal use, tumors of theadrenal glands


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Steroids may causehyperglycemia

S/S: rounded moon face, heavyabdomen that hangs down, thinarms and legs, backache as thedisease worsens, edema,

decreased urinary output,hypokalemia, hypernatremia,hyperglycemia, HTN, poor woundhealing, ecchymosis, Buffalo

hump, easy bruising Lab elevated cortisol level If develop during childhood,puberty begins early for boys andthe girls develop masculine traits.


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Tx: depend on cause,

removal, of adrenal gland,adrenocortical hormones are

given.

Nursing Considerations

Prevent injury and infection

Monitor weight, v/s, labs:electrolytes, glucose levels


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Manifestations:


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C- ortisol level increase

U- nusual Changes in appearance

S- upraclavicular fat pads(Buffalo

hump)

H- irsutism I- ncrease blood pressure

N- eutropenia

G- eneralized muscle wasting and

weakness; glucose elevation


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Therapeutic Interventions:

Reduced externally administeredcorticosteroids

Hypophysectomy if lesion in pituitary

gland is causing hypersecretionAdrenalectomy

Adrenal enzyme inhibitors

Potassium supplements

High-protein diet with Na restriction


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Nursing management:

Monitor v/s; MIOW; MBGE

Protect from infection

Encourage ventilation of feelingsbecause of changes in image and

sex drive

Minimize stress in theenvironment

Instruct regarding diet


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Adrenalectomy

Monitor v/s, hemodynamics and bloodglucose

Administer steroids with antacid, PPI

and H-2 blockers Protect from stress and infection

Monitor BP, for hypotension

Explain drug and side effects

Instruct to carry medic-alert bracelet


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Nursing management:

C- heck v/s especially BP

U- rine output and weight monitoring

S- tress management

H- igh protein diet

I- mage concern

N- eutropenia precaution

G- lucose monitoring


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Addisons Disease

Rare Cause-TB, CA, infection or the gland

atrophies for unknown reasons S/S-Decreased production of adrenal

hormones which results in fluid andelectrolyte imbalances, hypoglycemia Darkening of the skin and mucosa

Dehydration, anemia and wt. Loss

BP decreases

Thin hair

Stress may cause adrenal shock (low BP, n/v/d,h/a, restless


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Manifestations:


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Therapeutic interventions:

Replacement of hormones:

Glucocorticoid- metabolic

imbalance

Mineralocorticoid- electrolyte

imbalance

Additional hormones duringillness/stress

High carbohydrate; high protein

diet


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Nursing management:

Monitor v/s

Observe for clinical findings of sodium

and potassium

MIOW

Administer steroids with antacid, PPI

and H2-blockers

Assign a private room to preventinfection


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Limit number of visitors

Advise to avoid stress Client teaching of s/sx

Instruct to wear a medic-alert band

DietAdminister anti-emetics to prevent

fluid and electrolyte loss by vomiting

Teach the need for lifelong therapy ofsteroid and the need to increase

dosage in times of stress


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Adrenocorticoids

Interfere with the release of importantfactors in the normal inflammatory &

immune response

Increase fat and glucose formationand promote protein catabolism

Used for hormonal replacement

therapy Oral, IM/IV, inhalation, intraarticular,

topical


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Examples of Adrenocorticoids

Glucocorticoids

Long-acting: dexamethasone

(Decadron)

Intermediate acting:

methylprednisolone

Short-acting: hydrocortisone (Solu-cortef)

Mineralocorticoids:

Fludrocortisone


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Major side effects:

Cushingoid appearance HTN

Hyperglycemia

Mood changes GI irritation and ulcer formation

Cataracts and glaucoma

Hypokalemia Leukopenia, osteoporosis

Musculinization in females


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Nursing care

Administer oral prep. With foods, milk,or antacid

Monitor weight, BP, glucose and

electrolytesAvoid infection

Assess for GI bleeding

Notify physician if fever/sore throatoccurs


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Avoid immunizations

Avoid salts; encourage foods high inpotassium

Avoid NSAIDs and OTC drugs

Avoid missing, changing orwithdrawing drug suddenly

Withdraw drug gradually to permit

adrenal recovery Teach to take the drug as directed


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A- norexia

D- ecrease cortisol level

D- ecrease capacity to handle

stress I- ncrease skin pigmentation

S- evere weakness; severe

DHN

O- bvious weight loss

N- ausea and vomiting


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Addisons management

Nursing Considerations Replace fluid

5-6 small meals/day with snacks

Monitor for decreased blood pressure of

dizziness

Protect from falls

Accurate I & Os including food

Specific gravity of urine Daily wts

Teach importance of follow up visits

Protect from stressful situations


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Nursing Intervention:

A- dminister hormonal replacement

D- iet( SFF, high in protein, carbs and

Na)

I- nfection precaution

S- tress management

O- utput, intake and weight daily

N- ote for untoward manifestation

leading to complication


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Pheochromocytoma:

Catecholamine-secretingtumor of the adrenal medulla;

usually benignCauses increase secretion of

epinephrine and

norepinephrineFamilial tendency, peak

incidence 25 to 50 years of


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Manifestations:

Headache

Visual disturbances

PalpitationsAnxiety


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Manifestations:

Hypertension

Tachycardia

Diaphoresis

Tremors

Hyperglycemia

Brain attack

Blindness(rare)


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Diagnosis:

Increase levels of plasma and urinarycatecholamines and

VMA(vanillylmandelic acid)

VMA in 24 hour urine:Teach the client about foods and

medications to be avoided before the

testHave the client void at the beginning

of the 24-hour time period and

discard.


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Place urine from every voiding

into collection containerEnsure that appropriate

preservative is used and the

container is kept refrigerated

Have the client void at the end

of 24-hour time period andplace the urine in the container


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Therapeutic interventions:

Surgical removal of the tumor

Antihypertensive and anti-

dysrhythmic agents:Nitroprusside

Propanolol

phentolamine


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Nursing management:

BP with client in upright and horizontalpositions

Administer IVFs as ordered before andafter surgery to maintain blood volume

Decrease environmental stimulation

If bilateral adrenalectomy is performed:

Instruct regarding maintenance doses of

steroidsPostop: Take antihypertensives and

monitor BP until stable


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Disorders of the Adrenal Gland Lecture

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