Page 363 - Critical Care Nursing Demystified

348 CRITICAL CARE NURSING DeMYSTIFIED

Nursing Diagnosis Expected Outcomes
Cushingʼs syndrome—disturbed Patient will show a gradual loss of body weight
physical appearance A generalized improvement of physical
appearance will occur
Muscle strength will be increased
Patient will develop a more positive body image

Nursing Interventions
Provide a low calorie, high vitamin diet.
Monitor daily weights.

Limit water intake to reduce sodium and water retention.
Measure intake and output.
Assess for signs of edema.
Encourage self-care methods to improve personal appearance, such as good
grooming and attractive clothing.
Teach and practice range of motion exercises to improve muscle strength and
dexterity. Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.

Hyperaldosteronism
What Went Wrong? The culprit is an oversecretion of the aldosterone hormone
produced by the adrenal glands. The syndrome results from sodium retention
and excretion of potassium by the kidneys.
Primary causes of this disorder include adrenal tumors or adrenal hyperplasia
(Conn’s syndrome).
Secondary causes of this disorder could be a nonadrenal reason such as renal
stenosis, chronic renal disease, and renin-secreting tumors.

3 Hallmark Signs and Symptoms Hypernatremia, hypertension, and headache are
caused by sodium retention. An increased loss of potassium creates hypokalemia
and the additional symptoms of muscle weakness, fatigue, glucose intolerance,
and metabolic alkalosis, which could further lead to cramps, tetany, or cardiac
arrhythmias.

5 Interpreting Test Results Normal aldosterone value is 2 to 9 ng/dL. Levels
greater than 10 ng/dL signify hyperaldosteronism. Levels higher than 50 ng/dL
indicate an adenoma.
A surgical adrenalectomy is usually the recommended treatment of choice.
Prior to surgery, the patient is placed on a low-sodium diet and potassium-
sparing diuretics such as