6 Cushing’s Disease Nursing Care Plan

Risk For Excess Fluid Volume

Individuals diagnosed with Cushing’s disease face a potential threat of fluid overload owing to various factors. Among these, heightened cortisol levels can lead to the retention of sodium and water, as well as hinder proper cardiac function. Moreover, some patients may encounter weight gain, which can exacerbate the risk of excess fluid volume. To alleviate this condition, it is crucial to keep a watchful eye on fluid intake and output, in addition to managing cortisol levels and associated comorbidities.

Nursing Diagnosis

• Risk for Excess Fluid Volume

May be related to

• Retention of water and sodium is caused by an excess of cortisol and mineralocorticoid levels.

Possibly evidenced by

• Not applicable. A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred and nursing interventions are directed at prevention.

Desired Outcomes

• The client will be normovolemic as evidenced by stable weight (or loss attributed to fluid loss), urinary output 30ml/hr or greater, balanced intake and output, absence or reduction of edema, HR less than 100 beats per minute, and absence signs of pulmonary congestion.

Nursing Assessment and Rationales

1. Assess for signs of circulatory overload such as crackles, dyspnea, edema, distended neck veins, shortness of breath, and tachypnea.
Detection of signs of circulatory overload will help in the immediate intervention. Due to excessive glucocorticoid and mineralocorticoid secretion, the client is predisposed to water and sodium retention.

2. Assess for cardiac dysrhythmias
As the level of potassium decreases in Cushing’s syndrome, the chances of abnormal heart rhythms increase.

3. Monitor vital signs, especially BP and HR.
Cushing’s disease may result in increased blood pressure resulting from the expanded fluid volume with sodium and water retention. Tachycardia happens as a compensatory response to circulatory overload.

4. Monitor the client’s sodium and potassium levels.
Excessive cortisol causes sodium and water retention, edema, and increased potassium excretion. Mineralocorticoids regulate sodium and potassium secretion, and excess levels cause marked sodium and water retention as well as marked hypokalemia.

Nursing Interventions and Rationales

1. Instruct the client to elevate feet when sitting down.
This position decreases fluid accumulation in the lower extremities.

2. Instruct the client to reduce fluid intake as indicated.
Limiting fluid intake is important in preventing circulatory overload.

3. Encourage the client to have low sodium and high potassium diet.
Too much sodium in the diet promotes fluid retention and weight gain. There should be adequate potassium in the diet since the elevation of cortisol levels causes hypokalemia.

4. Administer antihypertensive medications as prescribed.
Cortisol and mineralocorticoid excess causes increase blood pressure as a result of sodium and water retention.

5. Administer diuretics as prescribed.
Diuretics promote sodium and water excretion. Potassium-sparing diuretics such as Spironolactone (Aldactone) may also be prescribed to prevent additional loss of potassium.