Slide 1

Lets move to the Adrenal Glands In this space, please draw an adrenal gland. Where does it live, what is its shape? Does it communicate with the kidney? Did you include the inner and outer part of the adrenal gland? Slide 2 Lots of Group Activities so lets get into our groups Group 1: Group 2: Group 3: Group 4: Group 5: Group 6: Slide 3 Now come up with a Name of your Group Group 1: Group 2: Group 3: Group 4: Group 5: Group 6: Slide 4 What are the 2 parts of the Adrenal Gland??? Inner part is the _________ ________ What does the inner part secrete or release? _____________________ ______________________ Slide 5 What are the 2 parts of the Adrenal Gland??? Outer part is the _________ ________ What does the outer part secrete or release? _____________________ ______________________ Slide 6 Sugar.Salt.and Sex Slide 7 Lets go with the Adrenal Cortex first.. 3 Hormone types: Glucocorticoids (Cortisol) Mineralocorticoids (Aldosterone) Androgens (Testosterone) Or..Sugar, Salt and Sex Activity: Giving you 10 minutes, get in your group and create a jingle, song or rap about these 3 types of hormones.. Slide 8 Disorder #1 Cushings Disease We are nurses taking care of a patient with Cushings Syndrome What is Cushings syndrome? Too much _______________ What is a synthetic form of cortisol that you have probably administered in clinical to your patients? Syndrome vs Disease.. Slide 9 Too much Cortisol. What do you remember about cortisol or side effects of glucocorticoids? Write down here what you remember.. Slide 10 Do you need to look up cortisol? Consult with your team and combine what you all know about cortisol? Record data here: _______________________ Slide 11 Cushings Syndrome vs Cushings Disease Syndrome is iatrogenically induced, how? ________________________ Cushings disease could be caused by a tumor causing too much cortisol release. Where could the tumor be located? 1. ________________ 2._____________ 3. ___________________ Slide 12 Textbook Pic of Cushings Syndrome/Disease Slide 13 Can we live without glucocorticoids or cortisol? What does cortisol do in our body? CHO (carbohydrate) metabolism Fatty acid mobilization Protein catabolism Ding ding Slide 14 Function of Cortisol or Glucocorticoids: ***CHO Metabolism What happens when we break down carbohydrates? Increase in amount of glucose formed Increase in amount of glucose released Therefore a major complication is _______________________ Slide 15 Function of Cortisol: *****Fat metabolism What happens when we mobilize fatty acids somewhere unusual? Therefore we see some classic body image changes in our patient-name these here: ________________ Slide 16 Re Group for a POC Activity Develop a plan of care for a patient with Cushings Disease What are the priorities? What can the nurse expect to see in this patient? Slide 17 Function of Cortisol: ****Protein breakdown or catabolism What happens in Cushings syndrome with protein breakdown, how does this look in our patients? ____________________________ Slide 18 Re Group for a POC Activity Develop a plan of care for a patient with Cushings Disease What kind of things can the nurse call the physician about in preventing complications in this patient? SBAR ideas? Slide 19 Clinical reasoning. If glucocorticoids have a mineralocorticoid like effect, what would we see in our patients? Slide 20 Too much Aldosterone or Hyperaldosteronism Excessive retention of Na and H2O Excessive excreting of K+ So what would we see in clinical in our patients? _______________________ Slide 21 Still in the Adrenal Cortexnow 2 nd major group of hormones Mineralocorticoids or Aldosterone You know thiswhat does aldosterone do? What stimulates its release? Slide 22 Still in the Adrenal Cortexnow 3 rd major group of hormones Androgens or Testosterone What happens if females have too much testosterone? _____________ Slide 23 What diagnostic tests could help diagnose Cushings Disease? Serum cortisol levels Serum ACTH levels CT scan of abdomen or adrenals MRI of brain to detect if pituitary adenoma 24 hour urine for cortisol Slide 24 Normal Cortisol Levels Slide 25 What would we expect to see in Cushings, what would the graph look like? Try to draw here So in summary, what effects the release of cortisol? ________________________ What would the serum levels of cortisol be at 8am vs 8pm? ________________________ Slide 26 Collaborative Management of Cushings Disease Need to know what first????? _____________________________ Open adrenalectomy or laparoscopic adrenalectomy if tumor or cancer of adrenal gland What if it is an ectopic tumor releasing too much ACTH? How would this be managed or treated? __________________________ What other surgery could be necessary? ______________________________________ Slide 27 Medications-Cushings Disease Mitotane (Lysodren) which suppresses cortisol production if surgery not an option Ketoconazole (Nizoral) inhibits cortisol synthesis Activity: Look up doses and routes of these medications and list as would be on the MAR Slide 28 Medications-Cushings Disease Mitotane (Lysodren) Ketoconazole (Nizoral) Why would these be called a medical adrenalectomy Slide 29 Write a detail nurses note on the appearance of the clients skin or Prednisone skin Slide 30 Prednisone skin documentation Skin is fragile, thin and has decreased elasticity. Multiple areas on all 4 extremities of dark purple bruises. Slide 31 What assessment findings would you document? Slide 32 What does Cortisol do to the immune system? What would you have in your POC? ______________________ Slide 33 Cushings Disease-During Slide 34 Cushings Disease-After Treatment Slide 35 Now the innermost part of Adrenal Gland What is it called? _________________________ What does it release? 1.___________________ 2.___________________ What response does it trigger? ____________________________ Slide 36 Ok lets summarize, how to collaboratively intervene in patient with Cushings disease/syndrome? Slide 37 Disorder #2 Hyperaldosteronism Too much aldosterone secretion What does aldosterone do? _________________ Usually caused by a tumor on Adrenal cortex Slide 38 Clinical Manifestations: Hyperaldosteronism Headache due to Na and H2O retention HTN due to Na and H2O retention K+ excretion which leads to ________ muscle weakness, fatigue cardiac dysrhythmias usually no edema Slide 39 Diagnostic Tests: Hyperaldosteronism urinary K+ plasma aldosterone levels with low plasma renin levels---WHY? CT scan will reveal adenoma of adrenal gland EKG changes Slide 40 Collaborative Management of Hyperaldosteronism Low sodium diet K+ sparing diuretic such as aldactone How will this help perfectly??? ___________________________ Calcium channel blockers to treat the elevated blood pressure Adrenalectomy Slide 41 Disorder #3 Addisons Disease Which famous President had Addisons Disease? Slide 42 What is Addisons Disease Too little of Sugar, Salt, and Sex glucocorticoids mineralocorticoids androgens Slide 43 Not enough Cortisol? POC priorities ________________________ Slide 44 Not enough Aldosterone..POC priorities ______________________ Salt cravingwhy? Not enough Androgenswhat could be a priority? ______________________ Slide 45 Diagnostic Studies-Addisons Disease Serum cortisol levels or Urine cortisol high or low Hypo or hyper kalemic? Serum glucose levels or Serum aldosterone levels high or low? EKG peaked T waves due to hyperkalemia Slide 46 In summary Low bp F & E imbalances Hypoglycemic Hyponatremia Hyperkalemia Nausea and Vomiting Dehydration Anxiety, irritable Slide 47 Addisonian Crisis or Acute Adrenal Crisis Severe hypotension Tachycardia Severe nausea and vomiting Hypovolemic shock Hypoglycemia Hyponatremia Hyperkalemia Slide 48 Emergency Treatment- Addisonian Crisis or Adrenal Crisis Rapid infusion of IV fluids (D5NS) Frequent VS and I & O May need to administer vasopressors to bring up blood pressure Solucortef IVP until enough glucocorticoid on board Slide 49 Collaborative Management Addisons Disease Oral glucocorticoids 2/3 dose in am 1/3 dose in pm DOC is Cortate po Oral mineralocorticoid Florinef 0.1mg po Lifelong hormone replacement Stress management Slide 50 Patient Teaching-Addisons ding ding Salt additives for excess heat or humidity Daily glucocorticoid replacement Daily mineralocorticoid replacement List of all meds Medical identification device in wallet, or in the form of a bracelet or necklace Conditions requiring larger dose of hormones (surgery, trauma, happy stress) IM glucocorticoid administration by patient (100mg hydrocortisone kit) Slide 51 Disorder #4 Pheochromocytoma-in the Adrenal Medulla Rare, benign tumor of the adrenal medulla Oh no, what are we going to see a hyper secretion of??? ___________________ Slide 52 Clinical Manifestations Hallmark is hypertension-200/150 or > NE and Epinepherine released sporadically Deep breathing Profound sweating due to peripheral vasoconstriction Pounding HR Headache Visual disturbances Spells or paroxysmal attacks Triggers can be from bladder distension, exposure to cold, emotional distress Slide 53 Pheochromocytoma- Diagnostic Studies Increase serum NE and Epinepherine levels Increase in urine metabolites of NE and Epinepherine CT scan of adrenal gland(s) MRI of adrenal gland(s) Slide 54 Collaborative Management- Pheochromocytoma Adrenergic Blocker 1. Minipress to decrease bp Beta blocker 1. Inderal to decrease HR and bp and force of contraction also helps reduce anxiety Monitor vs Adrenalectomy-usually laporoscopic If having episode, elevate HOB and complete bedrest Slide 55 During surgery.and post op Potent vasodilator Regitine or Nipride administered due to manipulation of tumor in the medulla and surge of NE and Epi BP may be elevated initially, but can bottom out post operatively, why? If not a surgical candidate, then drug Demser (drug which inhibits catecholamine synthesis) is given