Nursing Diagnosis for Cushing's Syndrome
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
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
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
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.