Mateo, Ella Rose A.

BSN 3 - BLK 4

Assessment and Management of Patients with Endocrine

Disorders (Part-2)

Written Assignment:

1. Differentiate between hyperparathyroidism and hypoparathyroidism.

Complete a short-written summary of education to provide to a patient for
self-care at home; 2. Using the nursing process as a framework, prepare a
care plan for a patient with Cushing syndrome.

1. Hyperparathyroidism is a condition in which the parathyroid gland produces too

much parathyroid hormone (PTH), leading to high levels of calcium in the blood. The
most common cause of hyperparathyroidism is a noncancerous growth (adenoma) on
one of the parathyroid glands. Symptoms may include weakness, fatigue, bone pain,
kidney stones, and osteoporosis. Treatment options include medication, surgery, and
lifestyle changes.

On the other hand, hypoparathyroidism occurs when the parathyroid gland

produces too little PTH, leading to low levels of calcium in the blood. The most
common cause of hypoparathyroidism is damage to the parathyroid gland during
thyroid surgery. Symptoms may include muscle cramps, spasms, tingling,
numbness, and seizures. Treatment options include calcium and vitamin D
supplements, medication, and lifestyle changes.

Complete a short-written summary of education to provide to a patient for

self-care at home.

Self-care education for patients with hyperparathyroidism or hypoparathyroidism

may include:

 Maintaining a balanced and healthy diet that includes adequate calcium and
vitamin D

 Staying hydrated by drinking plenty of water.

 Engaging in regular physical activity and exercise.

 Avoiding smoking and excessive alcohol consumption.

 Following medication and treatment plans as prescribed by healthcare providers.

 Monitoring and managing symptoms, such as bone pain or muscle cramps, by

consulting healthcare providers as needed.

2. Using the nursing process as a framework, prepare a care plan for a

patient with Cushing syndrome.

Assessment:

 Obtain a thorough medical history and assess for signs and symptoms of
Cushing syndrome, such as weight gain, hypertension, muscle weakness, and
elevated blood sugar levels.

 Monitor vital signs, including blood pressure, heart rate, and respiratory rate.

 Assess for any physical changes, such as a rounded "moon" face or a "buffalo
hump" on the upper back.

 Evaluate the patient's emotional and mental status for signs of depression,
anxiety, or other mood disorders.

Diagnosis:

 Impaired skin integrity related to fragile skin and poor wound healing.

 Imbalanced nutrition: less than body requirements related to increased appetite

and decreased metabolism.

 Risk for infection related to immunosuppression.

 Disturbed body image related to physical changes.

Planning:

 Promote skin integrity by encouraging the use of moisturizers and gentle

cleansing techniques.

 Provide a well-balanced diet that is low in fat and sugar, high in protein, and rich
in essential vitamins and minerals.

 Monitor and prevent infections by following strict hand hygiene, implementing

isolation precautions if necessary, and administering prophylactic antibiotics.

 Provide emotional support and counseling to help the patient cope with physical
changes and manage mood disorders.

Implementation:

 Administer medication as prescribed by the healthcare provider, such as cortisol-

lowering agents or medication to control blood sugar levels.

 Provide wound care and assist with dressing changes as needed to promote
healing.

 Educate the patient on the importance of a healthy diet and regular exercise to
promote weight loss and improve metabolic function.

 Encourage the patient to seek emotional support and counseling as needed.

Evaluation:

 Monitor and document the patient's response to treatment, including any

changes in vital signs, physical appearance, or emotional well-being.

 Reassess the nursing care plan as needed and make modifications to promote
optimal patient outcomes.

Group Assignment:

Addison disease and Cushing syndrome are both adrenal disorders. As a

group, compare their causes, clinical manifestations, management, and
nursing interventions.

Addison Disease Cushing Syndrome

Causes Addison's disease is Cushing's syndrome is

caused by damage to the caused by prolonged
adrenal glands, which are exposure to high levels of
located on top of the the hormone cortisol. This
kidneys. The damage may may be due to
be due to autoimmune overproduction of cortisol
disorders, infections such by the adrenal glands,
as tuberculosis, cancer, or usually caused by a tumor
surgical removal of the in the pituitary gland
adrenal glands. In some (Cushing's disease) or
cases, the cause is adrenal glands, or it may
unknown. be due to long-term use of
corticosteroid medications
for conditions such as
asthma or rheumatoid
arthritis.

Clinical manifestations 1. Hypoglycemia and low 1. Persistent

basal metabolic rate → hyperglycemia, which may
muscular Weakness and result in the development
fatigability of diabetes mellitus.
 2. Emotional/mental 2. Protein tissue wasting
changes like depression, and excessive deamination
irritability, and anxiety of amino acids
apprehension caused by
hypoglycemia 3. Abnormal fat
distribution (in conjunction
and hypovolemia. with edema), which results
in moon face (round face),
3. Ineffective ability to Buffalo hump
cope with stress. (supraclavicular fat pad on
the person’s neck), and
4. Hyperpigmentation: truncal obesity (weight
bronzed pigmentation of gain) with slender/thin
the skin (eternal tan). limbs; striae on the trunk.

4. Increase susceptibility
to infection and poor
wound healing

5. Emotional/mental
changes including mood
swings, euphoria, and
depression.

Management Cortisone (Cortone), Mitotane (Lysodren): an

prednisone (Deltasone), agent toxic to the adrenal
hydrocortisone (Solu- cortex that inhibits the
Cortef). Hydrocortisone is production of
usually the drug of choice glucocorticoids by the
for adrenocortical adrenal gland.
replacement because it
has both glucocorticoids Metyrapone (Metopirone):
and mineralocorticoid decrease cortisol
properties. production in patients who
do not respond to
Fludrocortisone (Florinef) mitotane therapy
for mineralocorticoid
deficiency. Administer Aminoglutethimide
after a meal or with an (Cytadren): blocks cortisol
antacid to lessen gastric production.
irritation and the possible
development of a peptic
ulcer.

Nursing intervention Achieving normal fluid and (Preoperative)

electrolyte balance
Maintaining skin integrity
Protecting Well-Being
Encouraging active
Increasing Activity participation in self-care
Tolerance
Strengthening body image
Observe for early signs of
Addisonian Crisis (Acute Diet: provide low-calorie,
adrenal insufficiency). It low-carbohydrate, low-fat,
may be precipitated by and low-sodium, but with
physiologic stress, such as ample amount of protein,
surgery, infection, trauma, potassium, and calcium
dehydration. content (dairy products,
broccoli).

Assess the person

carefully for signs of
severe hypertension.

Protect people with

Cushing’s syndrome from
exposure to an infectious
 organism.

Postoperative Care

1. Observe for signs of

shock

2. Measure urine hourly

and observe for oliguria

3. Monitor closely for

infection because
glucocorticoid
administration interferes
with immune function;

maintain sterile technique,

clean environment, and
good handwashing.

4. Monitor thyroid function

tests and provide HRT, as
ordered, after
hypophysectomy.

5. Encourage coughing,
turning, and deep
breathing to prevent
dangerous respiratory
infection.

6. Monitor fluid intake and

output and urine-specific
gravity to detect DI
caused by ADH deficiency
after hypophysectomy.

Web Assignment:

Research the Internet to find therapeutic uses of corticosteroid therapy.

Summarize your findings

Corticosteroid therapy is the use of synthetic steroids to reduce inflammation and

treat various medical conditions. It has therapeutic uses in treating inflammatory
conditions, allergies, skin conditions, cancer, transplantation, and autoimmune
diseases. However, it also has associated risks and side effects. Patients should work
closely with healthcare providers to determine if the benefits of corticosteroid
therapy outweigh the risks for their specific condition.

CASE STUDY: Cushing Syndrome

Patient Profile: Tom is a 29-year-old high school teacher. He seeks the advice of his health
care provider because of changes in his appearance over the past year.

Subjective Data
• Reports weight gain (particularly through his midsection), easy bruising, and edema of his
feet, lower legs, and hands
• Has been having increasing weakness and insomnia

Objective Data
• Physical examination: BP 150/110; 2+ edema of lower extremities; purplish striae on
abdomen; thin
extremities with thin, friable skin; severe acne of the face and neck
• Blood analysis: Glucose 167 mg/dL; white blood cell (WBC) count 13,600/mm3;
lymphocytes 12%;
red blood cell (RBC) count 6.6 million/mm3; K+ 3.2 mEq/L

Critical Thinking & Discussion Questions

1. Discuss the probable causes of the alterations in Tom’s laboratory results.

Tom's laboratory results suggest several alterations that are common in Cushing syndrome.
The high glucose level (hyperglycemia) may be due to the increased secretion of cortisol,
which can cause insulin resistance. The high WBC count (leukocytosis) and decreased
lymphocyte percentage (lymphopenia) may be due to the immunosuppressive effects of
cortisol. The high RBC count (erythrocytosis) may be due to the effects of cortisol on
erythropoietin secretion. The low potassium level (hypokalemia) may be due to the effects of
cortisol on renal potassium excretion.

2. Explain the pathophysiology of Cushing syndrome.

Cushing syndrome is a disorder characterized by excess secretion of cortisol by the adrenal

gland, or by prolonged exposure to high levels of corticosteroid medications. This results in a
wide range of physiologic effects, including hyperglycemia, hypertension, muscle wasting,
osteoporosis, immune suppression, and changes in fat distribution.

3. What diagnostic testing would identify the cause of Tom’s Cushing syndrome?

Diagnostic testing that would identify the cause of Tom's Cushing syndrome may include
imaging tests such as MRI, CT scan, or PET scan to identify any tumors in the adrenal gland
or pituitary gland. Blood tests may also be done to measure cortisol levels in the blood and
assess the response of the adrenal gland to other hormones.

4. What is the usual treatment of Cushing syndrome?

The usual treatment for Cushing syndrome depends on the underlying cause. If the condition
is caused by long-term corticosteroid use, the treatment may involve tapering or stopping
the medication gradually. In cases where the condition is caused by a tumor in the adrenal
gland, surgical removal of the tumor may be necessary. In some cases, medication may be
used to inhibit the production of cortisol.

5. What is meant by a “medical adrenalectomy”?

"Medical adrenalectomy" refers to the use of medication to suppress the function of the
adrenal gland. This treatment is used in cases where surgical removal of the adrenal gland is
not possible or not preferred by the patient.

6. Priority Decision: What are the priority nursing responsibilities in the care of this patient?

The priority nursing responsibilities in the care of this patient include monitoring vital signs,
electrolyte levels, and blood glucose levels, providing emotional support and counseling, and
educating the patient about proper medication management, dietary recommendations, and
the signs and symptoms of adrenal crisis.

7. Priority Decision: Based on the assessment data presented, what are the priority nursing
diagnoses? Are there any collaborative problems?

Risk for electrolyte imbalance related to hypokalemia

Risk for injury related to weakness and balance disturbance
Impaired skin integrity related to thin, friable skin and severe acne. Collaborative problems
may include the need for surgical intervention to remove the adrenal tumor and the need for
close monitoring of blood pressure and blood glucose levels.