Endo cushigs 20saidh 20rheumatoid 1 1

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					Cushing’s Disease
Pg 1439
Patho               Exaggerated actions of the glucocorticoids, causing widespread problems. The problem is seen as excessive
                    secretion of cortisol from the adrenal cortex itself-usually by a benign tumor (adrenal cushing’s disease) , or an
                    oversecretion of adrenocorticotropic hormone (ACTH) from the anterior pituitary ,causing hyperplasia of the
                    adrenal cortex (Pituitary Cushing’s disease), When it is a result of drug therapy (Cushing’s Syndrome)
Risk/               Women
Screening           Endogenous: Bilateral adrenal hyperplasia, pituitary adenoma, malignancies of the lung, GI tract, or pancreas,
                    Adrenal adenomas or carcinomas.
                    Exogenous: Therapeutic use of ACTH-generally for asthma, autoimmune disorders, organ transplantation.
S/S                 Decreased immune system from high levels of corticosteroids killing lymphocyte and shrinking organs
Classic             containing lymphocytes: liver, spleen, and lymph nodes.
                    Acne, hirsutism (hair growth), Clitoral hypertrophy (OMG)! and oligomenorrhea (Infrequent menses) caused
                    from increase in androgen.
                    Buffalo hump (Fat pads on the neck, back, and shoulders), moon face, thin skin, striae (stretch marks) truncal
                    obesity from increased body fat resulting from slow turnover of plasma fatty acids.
                    Hypertension, dependent edema, Easy bruising/petechiae, muscle atrophy, osteoporosis.
                    Salivary cortisol levels are collected by placing a salivary specimen cushion into the cheek. Normal levels are
Dx                  <2.0ng/ml. higher levels indicate hypercortisolism.
                    Urine is tested to measure levels of free cortisol and metabolites of cortisol/androgens generally elevated.
                    Dexamethasone suppression- administer set doses and testing 24hr urine specimens, normally excretion and
                    cortisol levels are suppressed by dexamethasone, and Cushing’s is ruled out.
                    Drug therapy: Drugs that interfere with (ACTH) production – Metopirone
                    Restriction of sodium and fluid, monitor intake and output
                    Surgical-Removal of pituitary adenoma.
Nursing Dx /        Excess fluid volume related to excess water and sodium reabsorption, risk for injury related to skin thinning,
Considerations      poor would healing, and bone density loss, Risk for infection related to immunosuppresions and inadequate
                    primary defenses.
Complications:      Electrolyte imbalances, palpate thyroid gently to avoid over excretion of hormone.
SIADH            Feedback system that regulates ADH doesn’t function
Patho            Problem in which vasopressin (antidiuretic hormone) is secreted even when plasma osmolarity is low or normal. A
                 decrease usually inhibits ADH production and secretion.
Risk/            Malignancies, pulmonary disorders, CNS disorders (Trauma, infection, tumors, stroke, lupus), Drugs (opiods,
Screening        SSRI’s, general anesthesia).
S/S              GI disturbances: low appetite, nausea/vomiting may occur first. Weight gain, Dependent edema is generally NOT
Classic          present due to the increase in water.not salt. Lethargic, headaches, hostility, disorientation, changes in loc,
                 tachycardia, and hypothermia.
Dx               Radioimmunoassay of ADH can diagnose SIADH when ADH levels are high and plasma osmolarity is normal or
                 Fluid restriction: dilute tube feedings with saline rather than plain water and use saline to irrigate GI tubes. Measure
                 weight daily.
                 Drugs: diuretics, Declomycin may help treat-antibiotic with S/E of candidiasis.
Nursing Dx /     Monitor for fluid overload (bounding pulse, increasing neck vein distention, crackles) Pulmonary edema can happen
Considerations   rapid and can lead to death.

                 Dilutional hyponatremia (decreased serum sodium) And expansion of extracellular fluid/the increase in plasma
                 volume causes an increase in glomerular filtration rate/inhibits rennin/aldosterone.

                 Rheumatoid Arthritis
Patho            Autoantibodies are formed that attack healthy tissue, especially the synovium (which lines the
                 joint cavity), causing inflammation, it then involves the articular cartilage, joint capsule, and
                 surrounding ligaments. Synovium thickens and becomes hyperemic, fluid accumulates in the
                 joint space forming a pannus (vascular granulation tissue) erodes articular cartilage and
                 eventually destroys bone.
Risk/            Combination of environmental/ genetic factors
Screening        Female reproductive hormones because affects them more than men.
S/S              Most common in the winter months. Stiffness in the joints, swelling, pain, and fatigue. May
Classic          report generalized weakness and morning stiffness. Early generally occurs in the upper
                 extremities (hands) may be slightly reddened, warm, stiff, and swollen SYSTEMIC: Low-grade
                 fever, fatigue, weakness, anorexia, parenthesis, LATE: Joint deformities (swan neck and ulnar
                 deviation), moderate to severe pain and morning stiffness, systemic-osteoporosis, severe fatigue,
                 anemia, weight loss, peripheral neuropathy, pericarditis, fibrotic lung, renal disease.
                 No one can distinguish
                 Labs: Rheumatoid factor measure the presence of unusual antibodies IgG, IgM that develop in a
Dx               number of diseases, Antinuclear antibody (ANA) measure for unusual antibodies that destroy
                 nuclei of cells and cause tissue death.
                 Erythrocyte sedimentation rate (ESR) confirms inflammation or infection anywhere in the body.
                 X-ray can visualize joint changes
                 Arthrocentesis- Large gauge needle is inserted into the joint to test synovial fluid.
                 Analgesics, antipyretics, and anti-inflammatory agents (Nsaids, Plaquenil, prednisone). Disease
                 modifying ant rheumatic drugs-Methotrexate( Monitor for decreased WBC from bone marrow
Nursing Dx /     Arthrocentesis- Monitor patient for bleeding or leakage of synovial fluid-notify the physician.

               Vasulitis- Inflammation (Same as above) may be seen in organ or body systems. Organ supplied
               by that vessel can be affected-malfunction/failure.
               Sjogren’s syndrome: Dry eyes, dry mouth, dry vagina
               Permanent joint damage.

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