Medical-surgical Nursing Demystified

(Sean Pound) #1

CHAPTER 8 Endocrine System^349



  • Positive ACTH stimulation test; ACTH acts on the adrenal cortex to stimu-
    late adrenal hormone secretion. An infusion of ACTH is given and the test is
    positive if the infusion fails to raise the cortisol level.

  • Abnormal adrenal glands appear on CT scan.


TREATMENT



  • Administer cortisone or hydrocortisone to replace cortisol.

  • Administer fludrocortisone to regulate sodium and potassium balance.

  • Maintain fluid balance.


NURSING DIAGNOSES



  • Fatigue related to disease state

  • Risk for deficient fluid volume

  • Disturbed body image related to disease state


NURSING INTERVENTION



  • Monitor fluids and electrolytes.

  • Weigh the patient daily.

  • Suggest bone density test for osteoporosis due to decrease in mineralo-
    corticoids.

  • Explain to the patient:

    • Medication must be taken every day.

    • Wear a medical alert bracelet.

    • Keep an emergency supply of medication available.




Cushing’s Syndrome


WHAT WENT WRONG?


The adrenal cortex secretes an excess of glucocorticoids or the pituitary gland an
excess of ACTH as a result of either a pituitary tumor, adrenal tumor, or from on-
going glucocorticoid therapy.


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