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Chapter 7  CARE OF THE PATIENT WITH ENDOCRINE DISORDERS        349


                                 Aldactone (spironolactone)
                                 Inspra (eplerenone)
                                 Midamor (amiloride)
                                 Cytadren (aminoglutethimide)

                                 Antihypertensive medications are also administered.
                               Pheochromocytoma
                               What Went Wrong?   This is a tumor of the adrenal medulla that produces an exces-
                               sive release of catecholamines such as epinephrine and norepinephrine, resulting
                               in severe hypertension. Consequences of undiagnosed and untreated pheochro-
                               mocytoma include diabetes mellitus, cardiomegaly, uncontrolled hypertension,
                               and death.

                               Hallmark Signs and Symptoms  Profuse diaphoresis, tachycardia, anxiety, palpitations,
                               pallor, tremors, weakness, nausea, chest or abdominal pain, and a severe, pounding
                               headache. These attacks can be brought on by opioids, antihypertensives, radio-
                               logic contrast dye, and tricyclic antidepressants and can last from a few minutes to
                               several hours.

                               Interpreting Test Results  CAT scans and MRI will be used to localize a suspected    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.
                               tumor. A 24-hour urine test to determine excessive levels of catecholamines or
                               their metabolites is conducted and will show elevated results in a person with
                               pheochromocytoma.


                               Prognosis
                               This type of endocrine tumor is successfully treated through surgical intervention.



                                CASE STUDY


                                J.F.K., a 64-year-old male, is admitted to the critical care unit in Addisonian crisis. He is
                                exhibiting signs of tachycardia and extreme dehydration. Laboratory results reveal
                                the electrolyte imbalances of hyponatremia, hyperkalemia, and hypoglycemia.


                                QUESTIONS
                                1.  Discuss the initial care protocols for this patient.
                                2.  What are the causes of Addison’s disease?
                                3.   How much of the adrenal gland is destroyed before clinical signs and symp-
                                   toms of Addison’s disease become apparent?
                                4.  Discuss expected laboratory fi ndings.
                                5.  Develop an correctly written nursing diagnosis for this individual.
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