UNIVERSITY OF THE EAST RAMON MAGSAYSAY MEMORIAL MEDICAL CENTER INC.

64 Aurora Boulevard, Barangay Doa Imelda, Quezon City 1113 GRADUATE SCHOOL ADVANCED PATHOPHYSIOLOGY OUTLINE OF SLIDE PRESENTATION FOR REPORTING Topic: Adrenocortical Disorders: Addisons disease, Cushings syndrome A. Anatomy and Physiology Brief Introduction of the Anterior Pituitary Gland and the ACTH hormones Essential Functions of the Adrenal Glands and its hormones: 1. Glucocorticoids (Cortisol) 2. Mineralocorticoids (Aldosterone) 3. Sex hormones (Androgen and Estrogen) B. Assessment of the Client with Different Pathological Conditions B.1 Addisons disease 1. History 2. Physical Assessment -General Survey -Skin -Mouth - Heart, Central Vessels -Musculoskeletal -Neurologic 3. Diagnostic Tests - Cortisol level with dexamethasone suppression test - Cortisol plasma level - 17-hydroxystreoids test - 17-ketosteroids test B.2 Cushings syndrome 1. History 2. Physical Assessment -General Survey -Skin - Heart, Central Vessels -Abdomen -Musculoskeletal -Neurologic 3. Diagnostic Tests - Cortisol level with dexamethasone suppression test - Cortisol plasma level - 17-hydroxystreoids test - 17-ketosteroids test C. Pathology of disease condition C. 1 Addisons disease 1. Incidence (Local and Global indices) 2. Risk Factors/ etiology Prepared by: Razel G. Custodio, RN, BSN Submitted to: Teresita A. Custodio, MAN, RN

3. Pathophysiology 4. Clinical Manifestations C. 2 Cushings Syndrome 1. Incidence (Local and Global indices) 2. Risk Factors/ etiology 3. Pathophysiology 4. Clinical Manifestations D. Formulation of Nursing Diagnoses D. 1 Addisons disease 1. Deficient fluid volume may be related to vomiting, diarrhea, increase renal loses, possibly evidenced by delayed capillary refill, poor skin turgor, dry mucus membranes, report of thirst. 2. Decrease Cardiac Output may be related to hypovolemia and altered electrical conduction (dysryhthmia) and/or diminished cardiac muscle mass, possibly evidenced by alterations in vital signs, changes in mentation and irregular pulse/pulse deficit. 3. Fatigue may be related to decreased metabolic energy production, altered body chemistry (fluid, electrolyte and glucose imbalance), possibly evidenced by unremitting overwhelming lack of energy, inability to maintain unusual routines, decreased performance, impaired ability to concentrate and disinterest to surroundings. 4. Disturbed Body Image may be related to changes in skin pigmentation, mucous membranes, loss of axillary/pubic hair, possibly evidenced by verbalization of negative feelings about body and decreased social involvement. 5. Risk for Impaired Physical Mobility- Risk factors may include neuromuscular impairment (muscle wasting/weakness) and dizziness/syncope. 6. Imbalanced nutrition: less than body requirements may be related to glucocorticoid deficiency, abnormal fat, protein and carbohydrate metabolism, nausea, vomiting, anorexia, possibly evidenced by weight loss, muscle wasting, abdominal cramps, diarrhea and severe hypoglycemia. D. 2 Cushings syndrome 1. Risk for excess Fluid Volume- risk factors may include compromised regulatory mechanism (fluid/sodium retention). 2. Risk for Infection- risk factors may include immunosuppressed inflammatory response, skin and capillary fragility and negative nitrogen balance. 3. Imbalanced Nutrition: less than body requirements may be related to inability to utilize nutrients (disturbance of carbohydrate metabolism, possibly evidenced by decreased muscle mass and increased resistance to insulin. 4. Self-care deficit may be related to muscle wasting, generalized weakness, fatigue and demineralization of bones, possibly evidenced by statements of observed inability to complete or performs ADLs. 5. Disturbed Body Image may be related to change in structure/appearance (effects of the disease process), possibly evidenced by negative feelings about body, feelings of helplessness, and changes in social involvement. 6. Sexual Dysfunction may be related to loss of libido, impotence and cessation of menses possibly evidenced by verbalization of concerns and/or dissatisfaction with and alteration in relationship with SO. 7. Risk for Trauma (fractures)- Risk factors may include increased protein breakdown, negative protein balance, demineralization of bones.

Prepared by: Razel G. Custodio, RN, BSN Submitted to: Teresita A. Custodio, MAN, RN

Prepared by: Razel G. Custodio, RN, BSN Submitted to: Teresita A. Custodio, MAN, RN