Download - Cushing Syndrome
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CUSHING SYNDROME
RIRIN SRI HANDAYANI
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KELENJAR ADRENAL
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BAGIAN - BAGIANKorteks adrenal terdiri dari daerah secara anatomi dibedakan :
• Zona glomerulosa, menghasilkan mineralokorticoid (aldosterone), yang terutama diatur oleh angiotensin II, kalium , dan ACTH. Juga dipengaruhi oleh dopamine, atrial natriuretic peptide (ANP) dan neuropeptides ..
• Zona fasciculata pada lapisan tengah, dengan tugas utama sintesis glukokortikoid, terutama diatur oleh ACTH. Juga dipengaruhi oleh beberapa sitokin (IL-1, IL-6, TNF) dan neuropeptida
• Lapisan terdalam zona reticularis, tempat sekresi androgen adrenal (terutama dehydroepiandrostenedion [DHEA], DHEA sulfat dan androstenedion) juga glukokortikoid (kortisol and corticosteron).
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CUSHING SYNDROME is……
Cushing’s syndrome is a resultof excessive circulating freecorticosteroids, caused byunnecessary adrenocorticalactivity.
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Causes
• The use of corticosteroid medication.• Excessive secretion of adrenocorticotropic
hormone (ATCH).• Primary hyperplasia.• Ectopic production of ACTH.
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Symptoms• CardiovascularHypertension and heart failure.
• Endocrine and metabolicTruncal obesity.Moon face. Buffalo hump.Sodium retention. Metabolic alkalosis.Hyperglycemia.
• GastrointestinalPeptic ulcers and pancreatitis.
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Symptoms cont..• Muscular Myopathy and muscle weakness.
• DermatologicThinning of skin. Ecchymoses.Striae.
• Psychiatric: Mood alterations and psychoses.
• Immune functionsImpaired wound healing.Increased susceptibility to infections. Decreased inflammatory response.
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Diagnostic Findings
• Urinalysis.• Dexamethasone suppression test.• Serum cortisol testing.• Corticotropin testing.• Blood chemistry analysis.• Salivary free cortisol analysis.• Inferior petrosal sinus sampling.• Ultrasonography, CT scan, MRI.
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Assessment
• Diabetes mellitus.• Muscle weakness and loss of muscle mass.• Hypertension.• Redistribution of fat.• Poor wound healing.• Emotional lability.• Insomnia.
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AssessmentHallmark signs of Cushing’s Synd• Rounded “moon face”• Fatty “Buffalo Hump” between
shoulders• Truncal obesity• Hirsutism (excess facial hair)• Acne, Petechiae• Skin becomes susceptible to
trauma, infection, • bruising, edema • Wounds are slow to heal • Osteoporosis• High Blood Pressure
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Assessment…• Assess patients knowledge of
Cushing’s Syndrome and therapy and their willingness to learn
• Assess patient for changes in physical appearance caused by the glucocorticoid excess
• Assess patients feeling about the changes in appearance and their coping mechanisms
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Assessment…
• Buffalo Hump
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Assessment…
• Striae
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Nursing Diagnoses• Risk for infection related to altered protein metabolism and inflammatory response• Risk for injury related to weakness• Self-care deficit related to weakness, fatigue, and muscle wasting• Disturbed body image related to changes in physical appearance • and decreased activity • Impaired skin integrity related to thin and fragile skin and impaired healing• Disturbed thought process related to mood swings, irritability and depression
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Planning
• Decrease risk of injury• Detect early signs and symptoms of infection• Increase ability to carry out self-care activities• Improve skin integrity• Improve body image• Improve mental functioning• Absence of complications
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Nursing Diagnosis & Interventions
• Risk for injury related to:
Decreased bone density Increased capillaryfragilityPoor wound healin
• Increase calcium, vitamin D and protein in diet
• Assess skin for signs of bruising, breakdown, wounds not healing, changes in height
• Instruct patient about safety
• measures to reduce risk for falls and injury
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• Disturbed body image related to:
Abnormal fat
distribution, moon face, cervicodorsal fat, muscle wasting, striae, hirsutism, acne
• Reassure patient that physical changes are a result of the increased hormone levels and will most likely resolve when those levels return to normal
• Promote coping methods to help patient deal with changes in appearance, clothing and grooming
• Assist patient in locating a support group
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• Risk for infection related to:
Altered protein metabolism and inflammatory response
• Assess patient frequently for signs of
infection such as an increase in temperature.
• Have the patient avoid others with infection.
• Check the mouth, lungs, and skin for early signs of infection.
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• Impaired skin integrity related to:
edema, impaired healing,and thin and fragile skin
• Assess patient’s skin.• Avoid using adhesive
tape.• Encourage and assist
the patient to change positions frequently to prevent skin breakdown
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• Self care deficit related to:
weakness, fatigue, musclewasting, and altered sleeppatterns.
• Assess the patient’s ability to perform self-care activities.
• Encourage moderate activity.
• Patient should be reassured that symptoms will subside with treatment
• Help patient plan rest periods throughout the day.
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Medical Management
• Surgery for tumors of the adrenal and pituitary glands.• Radiation therapy.• Drug therapy
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Monitoring and Managing Potential Complications
• Addisonian crisisMay result from:
◦- withdrawal of corticosteroids◦- adrenalectomy◦- removal of a pituitary tumor.
• Adverse effects of adrenocortical activity
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Promoting Home and Community-Based Care
• Teach the pt with Cushing’s syndrome and the family what problems could arise and how to manage those that cannot be prevented.
• Explain what could happen if the pt stops taking the corticosteroids.• Talk to the pt about dietary modifications.• Teach how to monitor blood glucose levels, blood pressure and weight.
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Promoting Home and Community-Based Care cont.
• Pt that had a adrenalectomy or removal of a pituitary tumor need close monitoring.
• If you are a nurse giving homecare to a pt with Cushing’s syndrome make sure you assess the pt psychological and physical status.
• Emphasize the importance of having a regular medical follow-up, knowing side effects of medications and wearing a medical identification bracelet.
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Evaluation
• Decreases risk of injury• Decreases risk of infection• Increases participation in self-care activities• Attains/maintains skin integrity• Achieves improved body image• Exhibits improved mental functioning• Exhibits absence of complications
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Cushing Syndrome