Post on 31-Jan-2023
IntroductionCushing syndrome occurs when your body is exposed to high
levels of the hormone cortisol for a long time. The most common cause of Cushing syndrome, sometimes called hypercortisolism, is the use of oral corticosteroid medication. The condition can also occur when your body makes too much cortisol.Too much cortisol can produce some of the hallmark signs of
Cushing syndrome — a fatty hump between your shoulders, a rounded face, and pink or purple stretch marks on your skin. Cushing syndrome can also result in high blood pressure, bone loss and, on occasion, diabetes.Treatments for Cushing syndrome can return your body's
cortisol production to normal and noticeably improve your symptoms. The earlier treatment begins, the better your chances for recovery.
The adrenal axis (hypothalamic-pituitary-adrenal axis) refers to a complex set of interactions and feedback loops between the hypothalamus, pituitary and adrenal glands. This system regulates the bodies response to stress, immune function, energy expenditure, mood, emotions & libido. It is therefore an incredibly important body system which can cause huge problems if it malfunctions.• Cortisol
Cortisol is a steroid hormone (glucocorticoid)which is released under stress & low steroid levels.
It’s main function is to increase blood glucose levels by promoting gluconeogenesis.
Cortisol also suppresses the immune system & increases fat, protein & carb metabolism.Random Fact!You may recognise cortisol’s pharmaceutical name which is HydrocortisoneHydrocortisone is used to reduce inflammation leveraging Cortisol’s immunosuppresive effect
• AldosteroneAldosterone is also a steroid
hormone (mineralocorticoid). It’s main function is to increase blood volume. It causes reabsorption of sodium and water as well as causing excretion of potassium
Random Fact!Drugs that interfere with the secretion or action of Aldosterone are in used as antihypertensivesAn example is Spironolactone which blocks Aldosterone receptors
How Cortisol Works• Corticotrophic releasing hormone (CRH) is secreted from
the Hypothalamus• This release is influenced by stress levels, time of
day & serum cortisol levels• CRH travels in the blood & binds to specific receptors
on the Pituitary Gland• This binding causes increased production
of ACTH (adrenocorticotrophic hormone)• ACTH is released into the blood stream where it travels
to the Adrenal glands• ACTH binds to specific receptors on the Adrenal Cortex• This stimulates the Adrenal Cortex to
release Cortisol into the blood• Cortisol enables the body to cope with stress in a more
effective manner• Increased levels of Cortisol also have
an immunosuppresive effect• Blood glucose is also increased via breakdown
of glycogen, protein & fat• Increased serum Cortisol inhibits production
of CRH & ACTH via negative feedback.
Use of corticosteroid medications
Stimulates anterior pituitary gland
Pituitary produces increased ACTH
ACTH stimulates adrenal cortex to
release glucocorticoidsArrest of growth
ObesityMusculoskeletal ChangesGlucose IntoleranceExcessive Protein
CatabolismHyoerglycemia
Increased AldosteroneSodium and Water
RetentionIncreased Plasma Volume
Increased BP
Patient’s Profile• Name: A.M.P.• Age: 20 years old• Birthdate: July 31, 1993• Birth place: Tampus, Boac, Marinduque
• Religion: Catholic• Sex: Female• Address: Tampus, Boac, Marinduque
Review of SystemsCardiovascular• Hypertension
Endocrine• Truncal Obesity• Moon Face• Buffalo Hump• Menstrual
Irregularities
Metabolic• Sodium Retention
• Hypokalemia• Altered Calcium Metabolism
Immune• Decreased inflammatory responses
• Impaired wound healing
• Increased susceptibility to infection
Skeletal• Osteoporosis• Spontaneous Fractures
Muscular• Myopathy• Muscle WeaknessGastrointestinal• Peptic Ulcer• PancreatitisDermatologic• Thinning of Skin• Striae• Acne
Nursing PrioritizationNursing Diagnosis Prioritization RationaleRisk for injury High Safety of patient
is always of great concern
Risk For Infection Medium Although there is still no
infection, the patient is still at risk, so close
monitoring is important.
Disturbed Body Image
Low Patient’s perception of
herself may also be affected. It is
a must that we also give
attention to this aspect.
Drug StudyDrug Name
Machanism of Action
Dose Side Effects
Indications
Contraindication
Nursing responsibility
hydrocortisone
Binds to intracellular glucocorticoid receptorsand suppresses inflammatory andimmune responses by: inhibiting neutrophil and monocyte accumulationat inflammation site and suppressingtheir phagocytic and bactericidalactivitystabilizing lysosomal membranes
Adults. 20 to 240 mg daily as a single doseor in divided doses.I.V. INFUSION OR I.V., I.M., OR SUBCUTANEOUSINJECTION (HYDROCORTISONE SODIUM PHOSPHATE);I.M. INJECTION (HYDROCORTISONE)Adults. 15 to 240 mg daily as a single doseor in divided doses. Usual: One-half to onethirdthe oral dose.DOSAGE ADJUSTMENT Dosage increased tomore than 240 mg daily if needed to treatacute disease.I.V. INFUSION; I.V. OR I.M. INJECTION(HYDROCORTISONE SODIUM SUCCINATE)Adults. 100 to 500 mg every 2, 4, or 6 hr.
CNS: Ataxia, behavioral changes, depression,dizziness, euphoria, fatigue, headache,CV: Arrhythmias (from hypokalemia), fatembolism, heart failure,
To treat severe inflammation or acuteadrenal insufficiency
Hypersensitivity to hydrocortisone or itscomponents, idiopathic thrombocytopenicpurpura (I.M.), intestinal conditions prohibitingintrarectal steroids (P.R.), recentlive-virus vaccination, systemic fungalinfection
Advise patient to take daily dose of hydrocortisoneat 9 a.m.• Instruct patient to take tablets or oral suspensionwith milk or food.• Teach patient how to use foam or enemaform, if prescribed.• Caution patient not to stop drug abruptlywithout first consulting prescriber.
Discharge Planning• MedicationThe physician prescribed Hydrocortisone 240mg/daily
orally. • ExerciseEncourage the patient to assist in performing active
and passive range of motion exercise and isometric exercises (muscle atrophy) for good blood circulation.
• TreatmentFor the treatment, the physician order for continuous
prescription of Hydrocortisone 240mg a day.
• Health teachingConduct a health teaching to the client that includes encouraging on
good hygiene and performing activities that the patient can do, encourage taking a bath every day to provide comfort, wellness and good skin integrity, advising the patient to increase fluid intake and high protein diet for good recovery of energy. Also fruits like banana, apple, and vegetables.
• Out-patientRemind the patient to come for the follow-up check up assigned by the
physician.
• DietAdvice the patient to have low salt diet, high-protein diet, incrased
calcium intake or low fat diet, high fiber and high protein intake.
• SpiritualEncourage patient to have frequent praying to help his spiritual needs