ArtsAutosBooksBusinessEducationEntertainmentFamilyFashionFoodGamesGenderHealthHolidaysHomeHubPagesPersonal FinancePetsPoliticsReligionSportsTechnologyTravel

Nursing Diagnosis for Cushing's Syndrome

Updated on May 25, 2012

Cushing’s syndrome is a condition caused by having a prolonged elevation of cortisol in the body. It can be caused by over-secretion of cortisol from the adrenal glands (secondary to adrenal adenoma or carcinoma), long-term treatment with steroids, or over-stimulation of the adrenal glands caused by a tumor in the pituitary gland(referred to as “Cushing’s disease) or nearby gland (ectopic ACTH syndrome) (NIH 2008).

Because cortisol is responsible for many functions in the body, such as helping to maintain blood pressure, reducing inflammation, balancing the effects of insulin and regulating metabolism, an excessive amount produces various symptoms. Common signs and symptoms of Cushing’s syndrome include a “moon” face, a buffalo hump on the back, tendency to bruise, hypertension, edema, straie (stretch marks), weakness, weakened bones, hirsutism (excessive hair), diabetes, immunosuppression, and changes in mood (Porth, C. 2005)

Diagnosis of Cushing’s disease is usually made using a combination of tests. The most common tests are the 24-hour urinary free cortisol test, midnight plasma and late-night salivary cortisol measurement tests and the low-dose dexamethasome suppression test (NIH, 2008). These tests help to determine that there is indeed an excess of cortisol; however, another test is needed to determine the cause of the cortisol increase. People with depression, anxiety disorders, alcoholism, obesity, and unmanaged diabetes may exhibit similar signs and symptoms as Cushing’s disease, without having the actual disease. The dexamethasone-corticotropin-releasing hormone test helps distinguish those with actual Cushing’s and those with “pseudo”-Cushing’s disease. It can also help to determine if an ectopic or pituitary tumor exists (Porth, 2005).

Treatment for Cushing’s disease involves eliminating the use of glucocorticoids or removing the tumor responsible for the excessive cortisol. This procedure is known as a transsphenoidal adenomectomy. Removal of the tumor causes the ACTH level to fall below normal, so patients will be given a replacement of cortisol such hydrocortisone or prednisone. Most patients can stop taking the replacement in a few years, once the body is able to compensate, but some patients will need to remain on the medications for the rest of their lives. Other treatments for Cushing’s disease include chemotherapy, radiation and cortisol-inhibiting drugs (NIH). Common cortisol-inhibiting drugs include ketoconazole (Nizoral) and aminoglutethimide (Cytadren). The main side effect of ketoconazole is ventricular dyrhythmias which are seen when the drug is given in high doses (Kee, J. Hayes, E. McCuistion, L. 2009).

Appropriate nursing diagnoses for Cushing’s syndrome include:

1. Risk for Infection r/t immunosuppression

Interventions:

1. Teach client and staff meticulous handwashing

Rationale- Limits client’s exposure to potential infection causing agents

2. Screen and limit visitor who may have infections

Rationale- Protects client from sources of infection

3. Promote adequate rest and nutrition

Rationale- Promoting rest and adequate nutrition limits fatigue and enhances immune system natural defense mechanism

2. Excessive fluid volume r/t altered water and mineral metabolism

Interventions:

1. Monitor for cardiac dysrhythmias

Rationale- Electrolyte imbalances can cause dysrthymias and should be reported to physician.

2. Encourage frequent repositioning if client is on bed rest

Rationale- Frequent repositioning helps maintain skin integrity

3. Administer potassium sparing diuretics, as ordered

Rationale- Used with caution to control edema and ascites, to increase water secretion while sparing potassium

3. Disturbed body image r/t altered appearance

1. Ensure a positive attitude when caring for patient

Rationale- Shows acceptance and encourages expectation for positive outcomes

2. Encourage client to express feelings about physical appearance

Rationale- Helps identify concerns and discuss realistic expectations about treatment outcomes

3. Promote family and friends to visit and interact with patient

Rationale- Facilitates acceptance and provides support



References:

Black, J. & Hawk, J. (2009). Medical-Surgical Nursing: Clinical Management for Positive Outcomes. St. Louis, MO: Saunders Elsevier.

Follin, S., Mill, E., & Munden, J. (Eds). (2006). Diseases: A nursing process approach to excellent care. Philadelphia, PA: Lippincott Williams & Wilkins.

Kee, J. Hayes, E. McCuistion, L. (2009). Pharmacology: A Nursing Process Approach. St. Louis, MO: Saunders Elsevier

National Institutes of Health (2008). Cushing’s Disease. Retrieved from: http://endocrine.niddk.nih.gov/pubs/cushings/cushings.aspx

Porth, C. (2005). Pathophysiology: Concepts of Altered Health States. Philadelphia, PA: Lippincott, Williams, and Wilkins.

Swearingen, P. (2008). All-In-One Care Planning Resource. St. Louis, MO: Mosby Elsevier.

Comments

    0 of 8192 characters used
    Post Comment

    No comments yet.

    working

    This website uses cookies

    As a user in the EEA, your approval is needed on a few things. To provide a better website experience, hubpages.com uses cookies (and other similar technologies) and may collect, process, and share personal data. Please choose which areas of our service you consent to our doing so.

    For more information on managing or withdrawing consents and how we handle data, visit our Privacy Policy at: https://hubpages.com/privacy-policy#gdpr

    Show Details
    Necessary
    HubPages Device IDThis is used to identify particular browsers or devices when the access the service, and is used for security reasons.
    LoginThis is necessary to sign in to the HubPages Service.
    Google RecaptchaThis is used to prevent bots and spam. (Privacy Policy)
    AkismetThis is used to detect comment spam. (Privacy Policy)
    HubPages Google AnalyticsThis is used to provide data on traffic to our website, all personally identifyable data is anonymized. (Privacy Policy)
    HubPages Traffic PixelThis is used to collect data on traffic to articles and other pages on our site. Unless you are signed in to a HubPages account, all personally identifiable information is anonymized.
    Amazon Web ServicesThis is a cloud services platform that we used to host our service. (Privacy Policy)
    CloudflareThis is a cloud CDN service that we use to efficiently deliver files required for our service to operate such as javascript, cascading style sheets, images, and videos. (Privacy Policy)
    Google Hosted LibrariesJavascript software libraries such as jQuery are loaded at endpoints on the googleapis.com or gstatic.com domains, for performance and efficiency reasons. (Privacy Policy)
    Features
    Google Custom SearchThis is feature allows you to search the site. (Privacy Policy)
    Google MapsSome articles have Google Maps embedded in them. (Privacy Policy)
    Google ChartsThis is used to display charts and graphs on articles and the author center. (Privacy Policy)
    Google AdSense Host APIThis service allows you to sign up for or associate a Google AdSense account with HubPages, so that you can earn money from ads on your articles. No data is shared unless you engage with this feature. (Privacy Policy)
    Google YouTubeSome articles have YouTube videos embedded in them. (Privacy Policy)
    VimeoSome articles have Vimeo videos embedded in them. (Privacy Policy)
    PaypalThis is used for a registered author who enrolls in the HubPages Earnings program and requests to be paid via PayPal. No data is shared with Paypal unless you engage with this feature. (Privacy Policy)
    Facebook LoginYou can use this to streamline signing up for, or signing in to your Hubpages account. No data is shared with Facebook unless you engage with this feature. (Privacy Policy)
    MavenThis supports the Maven widget and search functionality. (Privacy Policy)
    Marketing
    Google AdSenseThis is an ad network. (Privacy Policy)
    Google DoubleClickGoogle provides ad serving technology and runs an ad network. (Privacy Policy)
    Index ExchangeThis is an ad network. (Privacy Policy)
    SovrnThis is an ad network. (Privacy Policy)
    Facebook AdsThis is an ad network. (Privacy Policy)
    Amazon Unified Ad MarketplaceThis is an ad network. (Privacy Policy)
    AppNexusThis is an ad network. (Privacy Policy)
    OpenxThis is an ad network. (Privacy Policy)
    Rubicon ProjectThis is an ad network. (Privacy Policy)
    TripleLiftThis is an ad network. (Privacy Policy)
    Say MediaWe partner with Say Media to deliver ad campaigns on our sites. (Privacy Policy)
    Remarketing PixelsWe may use remarketing pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to advertise the HubPages Service to people that have visited our sites.
    Conversion Tracking PixelsWe may use conversion tracking pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to identify when an advertisement has successfully resulted in the desired action, such as signing up for the HubPages Service or publishing an article on the HubPages Service.
    Statistics
    Author Google AnalyticsThis is used to provide traffic data and reports to the authors of articles on the HubPages Service. (Privacy Policy)
    ComscoreComScore is a media measurement and analytics company providing marketing data and analytics to enterprises, media and advertising agencies, and publishers. Non-consent will result in ComScore only processing obfuscated personal data. (Privacy Policy)
    Amazon Tracking PixelSome articles display amazon products as part of the Amazon Affiliate program, this pixel provides traffic statistics for those products (Privacy Policy)