Independent College Faisalabad

1. Because of steroid excess, the patient who has undergone a bilateral adrenalectomy is at an increased risk for a. malnutrition. b. emboli. c. delayed wound healing. d. postoperative confusion. 3 steroids: a) sugar – G – Glucocorticoid b) salt – M – Mineralocorticoid – Aldosterone c) sex – A – Androgen “main branch ng SSS nasa Kamuning > GMA” *sodium attracts water *Inc fluid > inc pressure > aldosterone triggers fluid retention *aldosterone is released when there is DHN in the body – compensatory mech to prev further DHN *inc SSS > inc blood viscosity > delayed wound healing 2. Bone resorption is a possible complication of Cushing’s disease. Which of the following interventions should the nurse recommend to help the patient prevent this complication? a. Limit dietary vitamin D intake. b. Maintain a regular program of weight bearing exercise. – calcium is retained ; paglabas ng calcium sa buto > inc serum calcium ; hanggang nadedetermine ng bone na need niya ng calcium, ireretain niya c. Increase the amount of potassium in the diet. d. Perform isometric exercises. 3. Cushing‟s disease is manifested by the excessive secretion of corticosteroids. The hormones involved are a. glucocorticoids, aldosterone, and androgens. b. adrenocorticotropic hormone. c. glucocorticoids and aldosterone. d. catecholamines. *CUSHING'S DISEASE - hypersecretion of SSS *inc SUGAR: truncal obesity / central body / pearshaped ; manipis ang arms at manipis ang legs - buffalo hump: fat pads at your neck or back - poor wound healing *inc SALT: moon face *inc SEX: hirsutism - excessive body hair, - virilization/virilism: nagmumukhang lalaki - hair sa chest, beard, mustache sa babae *Dx: inc cortisol level, hyperglycemia, hypernatremia, hypokalemia, hypertension *WOF: Fluid overload * Conn's syndrome: hyperaldosteronism > severe HPN - give potassium sparring diuretic - "lactone" MGT: LAHAT NG SOBRA BAWASAN, LAHAT NG KULANG DAGDAGAN - low sodium diet - high K diet - glucocorticoid antagonist: prev excessive release of glucocorticoid: Mitotane for life - surgery: Adrenalectomy - surgical removal of adrenal gland > WOF: Addison's dse kasi tinanggal yung adrenal glands *ADDISONS - hyposecretion of SSS - bronze skin - dec aldosterone: hyponatremia - PISO: Potassium in, sodium out (inversely proportional) - hyperkalemia *Fluid vol def: DHN, hypotension, *Dx: dec cortisol, hypogly, hypoNa, hyperK, hypotension *WOF: Fluid vol def > addisonian crisis - exacerbated addison's dse > severe s/sx *Mgt: - high sodium diet - low Potassium diet - glucorticoid agonist for life 4. A 42-year-old female patient reports that she has gained weight and that her face and body are “rounder,” while her legs and arms have become thinner. A tentative diagnosis of Cushing‟s disease is made. When examining this patient, the nurse would expect to find a. decreased body hair. b. bruised areas on the skin. c. muscle hypertrophy in the extremities. d. postural hypotension. *Cushing’s > fluid retention > edematous > inc capillary fragility > extravasation > easily bruised