Hyper Function (Cushing’s Syndrome)

Subject: Medical and Surgical Nursing I (Theory)

Overview

Hyper function of the adrenal cortex increase the production of cortisol leads to Cushing's syndrome, Cushing's syndrome is a spectrum of clinical abnormalities caused by excess corticosteroids particularly glucocorticoids. It causes are Prolonged administration of high doses of corticosteroids, etc. Depletion of protein results in osteoporosis fracture of spine back ache bone pain, loss of collagen support of skin resulting in the ecchymosis at trauma sites, etc are its symptoms. The patient with excessive cortical secretion needs skilled nursing care. During the acute period, the primary focus of care is on high priority needs of support coping, restore fluid balance and prevent infection and injuries. Surgery can be used for its treatment Bilateral adrenalectomy, Subtotal adrenalectomy, etc.

Cushing's syndrome is a spectrum of clinical abnormalities brought on by an excess of corticosteroids, specifically glucocorticoids. Hyperfunction of the adrenal cortex increases cortisol production, leading to Cushing's syndrome.

Etiology

  • Long-term administration of high corticosteroid dosages
  • ACTH (secreting pituitary tumor) (secreting pituitary tumor)
  • Either a carcinoma or an adenomas that produce cortisol within the adrenal cortex.

Clinical manifestation

  • Alteration in protein metabolism
    • Proximal muscular atrophy, widespread weariness, and weakness.
    • Protein deficiency causes osteoporosis, which leads to spine fractures, backaches, and bone soreness.
    • Ecchymosis occurs at trauma sites as a result of a loss of collagen support for the skin.
    • Wounds don't heal well.
  • Altered far metabolism
    • Abnormal deposition of fat in the face.
    • Producing moon face and obesity .
    • Increased body weight .
  • Altered carbohydrate metabolism
    • Diabetes mellitus....
  • Altered inflammatory and immune response
    • The person sensitive to viral and fungal infections.
  • Water and mineral metabolism
    • Sodium and water retention may cause increase weight, edema, Hypertension and renal colic.
  •  Alteration in emotional stability
    • Irritability anxiety, depressive and poor concentration psychosis and sleeping disorders.
  •  Excessive androgen activity
    • Thinning of hair, acne, change in menstrual cycle.

Diagnostic evaluation

  • History and physical examination
  • Mental status examination
  • Plasma cortisol level
  • Plasma ACTH level
  • Complete blood count
  • Blood chemistries for sodium potassium and glucose
  • 24hours urine for free cortisol examination
  • CT scan
  • MRI of visual field

Medical management

Pharmacological management

  • Adrenocorticoids
  • Radiation therapy
  • Treatment of the tumor – surgical removal or radiation
  • Exogenous corticosteroid therapy

Surgical management

  • Bilateral adrenalectomy
  • Subtotal adrenalectomy
  • Adrenomedullary tumor resection
  • Transsphenoidal resection

Nursing management

Care from a qualified nurse is required for the patient with high cortical secretion. The basic goals of therapy during the acute phase are to encourage coping, restore fluid balance, and prevent infection and injury.

  • Decrease stressors :-
    • Maintain continuity of care
    • Explain every step of the process in detail.
    • Avert loud noises and rapid temperature fluctuations
  • Monitor physiological coping:-
    • Every 2-4 hours, take a vital sign.
    • Make sure your heart rate and blood pressure are steady.
  • Control fluid volume:-
    • Limit fluid intake as directed.
    • As required, offer a sodium-free diet.
    • As directed, give potassium replacement through oral food consumption.
    • Rich in potassium.
    • Track your weight each day.
    • Keep the IO chart.
  • Prevent infection
    • Check the temperature four hours a day.
    • Limit the number of employees and visitors.
    • Prior to breakfast, after a meal, and before going to bed.

Pre- operative interventions

  • Give comforting care.
  • Eat a high-protein, high-calorie diet to maintain your nutritional status.
  • Assist in redressing an electrolyte and fluid imbalance.
  • Support for hormonal therapy.
  • Before surgery, administer the glucocorticoids and IV fluids as directed.

Postoperative management

  • Recognize the electrolyte imbalance, blood pressure change, blood glucose change, fluid change, and adrenal crisis complications from surgery.
  • Offer solutions to reduce the impact of postural hypertension.
  • Examine the impact of posture on variations in blood pressure.
  • Offer precautions to lessen immunosuppressed patients' risk of infection.
  • Give corticosteroids.
  • I.V. for 24 to 48 hours, followed by oral.
  • Mineralocorticoids should be replaced in patients who have had bilateral adrenalectomy.
  • Assist the patient's family in understanding hormone replacement therapy

References

  • en.wikipedia.org/wiki/Adrenocortical_hyperfunction
  • hopkinsmedicine.org › Health Library
  • Mandal, G. (August 2013). A Textbook of Adult Health Nursing (2nd ed.). Dilllibazar kathmandu: Makalu publication house. Retrieved August 2013
  • ncbi.nlm.nih.gov/pubmed/1576032
Things to remember
  • Hyper function of the adrenal cortex increase the production of cortisol leads to Cushing's syndrome
  • Depletion of protein results in osteoporosis fracture of spine back ache bone pain
  • Sodium and water retention may cause increase weight, edema, Hypertension and renal colic.
  • Treatment of the tumor – surgical removal or radiation
  • Maintain nutritional status with high protein, high-calorie diet.
  •  Assess effects of posture on blood pressure variation.
Questions and Answers

Cushing's syndrome is a spectrum of clinical abnormalities brought on by an excess of corticosteroids, particularly glucocorticoids. Hyperfunction of the adrenal cortex increases cortisol production, leading to Cushing's syndrome.

 

Clinical manifestation:

  • Alteration in protein metabolism:

    • Proximal muscle atrophy, widespread fatigue, and weakness.
    • Protein deficiency causes osteoporosis, which leads to spine fractures, backaches, and bone pain.
    • Ecchymosis occurs at trauma sites as a result of a loss of collagen support for the skin.
    • Wounds don't heal well.

  • Altered far metabolism:

    • Abnormal fat accumulation in the face.
    • Producing obesity and the moon face.
    • A rise in body weight.

  • Altered carbohydrate metabolism:

    • Diabetes mellitus

  • Altered inflammatory and immune response:

    • The susceptible individual to bacterial and viral illnesses

  • Water and mineral metabolism:

    • Weight gain, edema, hypertension, and renal colic can all be brought on by sodium and water retention.

  • Alteration in emotional stability:

    • Anger, irritability, depression, poor concentration, psychosis, and sleeping problems.

  • Excessive androgen activity:

    • Hair loss, acne, and a change in menstrual cycle.

Diagnostic evaluation:

  • A background check and physical assessment
  • Assessment of the mental state
  • Amount of plasma cortisol
  • Amount of plasma ACTH
  • Thorough blood count
  • Blood tests for glucose, salt, and potassium
  • 24-hour urine collection for a free cortisol test
  • An MRI
  • Visual field MRI

Medical management:

  • Pharmacological management:

    • Adrenocorticoids
    • Radiation therapy
    • Treatment of the tumor – surgical removal or radiation
    • Exogenous corticosteroid therapy

  • Surgical management

    • Bilateral adrenalectomy
    • Subtotal adrenalectomy
    • Adrenomedullary tumor resection
    • Transsphenoidal resection

  • Nursing management:

    • The patient suffering from excessive cortical secretion requires professional nursing care. During the acute period, the primary focus of care is on high-priority needs such as coping support, fluid balance restoration, and infection and injury prevention.

  • Decrease stressors :

    • Maintain care continuity
    • Slowly and clearly explain the entire operation.
    • Keep away from loud noises and temperature fluctuations.

  • Monitor physiological coping:

    • Every 2-4 hours, take a vital sign.
    • Make sure your heart rate and blood pressure are steady.

  • Control fluid volume:

    • Limit fluid intake as directed.
    • As required, offer a sodium-free diet.
    • As directed, give potassium replacement through oral food consumption.
    • Rich in potassium
    • Track your weight each day
    • Keep the IO chart.

  • Prevent infection:

    • Check the temperature four hours a day.
    • Limit the number of employees and visitors
    • Prior to breakfast, after a meal, and before going to bed.

  • Pre- operative interventions:

    • Give comforting care
    • Eat a high-protein, high-calorie diet to maintain your nutritional status.
    • assist in redressing an electrolyte and fluid imbalance.
    • support for hormonal therapy
    • Before surgery, administer the glucocorticoids and IV fluids as directed.

  • Postoperative management:

    • Identify surgical complications such as adrenal crisis, altered blood pressure, blood glucose, fluid, and electrolyte imbalance.
    • Give advice on how to reduce the effects of postural hypertension.
    • stocking with elastic.
    • Analyze the impact of posture on variations in blood pressure.
    • Provide measures to lower the immunosuppressed patients' risk of infection.
    • Give a course of oral and intravenous corticosteroids during a 24- to 48-hour period.
    • Mineralocorticoids are replaced in patients who have undergone bilateral adrenalectomy.
    • Educate the patient's family about hormone replacement therapy

© 2021 Saralmind. All Rights Reserved.