Cushing’s disease, also known as hypercortisolism, is a rare but severe hormonal disorder that affects many individuals worldwide. It is caused by an excess of cortisol, a hormone produced by the adrenal glands. Patients with Cushing’s disease present with various symptoms, including weight gain, hypertension, and muscle weakness, which can significantly impact their quality of life. As a nurse, you play a crucial role in the care of patients with Cushing’s disease. In this article, we will provide an overview of Cushing’s disease nursing care plans and nursing diagnosis to help you provide comprehensive care for your patients.
What is Cushing’s Disease?
Cushing’s Disease (Cushing’s Syndrome; Hypercortisolism; Adrenal Hyperfunction) is a cluster of clinical abnormalities caused by excessive levels of adrenocortical hormones (particularly cortisol) or related corticosteroids and, to a lesser extent, androgens and aldosterone. The disorder is caused by adrenocortical hyperplasia (overgrowth of the adrenal cortex) secondary to pituitary overproduction of adrenocorticotropic hormone (ACTH), benign or malignant adrenal tumors that release excess glucocorticoids into the blood, prolonged or excessive administration of corticosteroids. The disease results in altered fat distribution, compromised immune system, disturbances in protein metabolism, and fluid and electrolyte imbalances.
Nursing Care Plans
Changes in the physical appearance associated with Cushing’s disease can have a notable influence on the client’s body image and emotional well-being. The focus of this care plan is promoting skin integrity, improving body image, decreasing the risk of injury, and improving thought processes.
Here are six (6) nursing care plans (NCP) and nursing diagnoses for Cushing’s disease or Cushing’s syndrome:
- Risk For Excess Fluid Volume
- Risk For Injury
- Risk For Infection
- Deficient Knowledge
- Disturbed Body Image
- Disturbed Thought Processes
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.
- 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.
- 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.
Recommended nursing diagnosis and nursing care plan books and resources.
Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.
Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues and on electrolytes and acid-base balance.
NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023
The definitive guide to nursing diagnoses is reviewed and approved by the NANDA International. In this new version of a pioneering text, all introductory chapters have been rewritten to provide nurses with the essential information they need to comprehend assessment, its relationship to diagnosis and clinical reasoning, and the purpose and application of taxonomic organization at the bedside. A total of 46 new nursing diagnoses and 67 amended nursing diagnostics are presented.
Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions from NANDA-I 2021-2023 and an alphabetized listing of nursing diagnoses covering more than 400 disorders.
Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis…. subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!
All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database MUST READ!
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
- Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
Other nursing care plans related to endocrine system and metabolism disorders:
- Acid-Base Balance
- Addison’s Disease | 3 Care Plans
- Cushing’s Disease | 6 Care Plans
- Diabetes Mellitus Type 1 (Juvenile Diabetes) | 4 Care Plans
- Diabetes Mellitus Type 2 | 17 Care Plans
- Diabetic Ketoacidosis (DKA) and Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS) | 4 Care Plans
- Eating Disorders: Anorexia & Bulimia Nervosa | 7 Care Plans
- Fluid and Electrolyte Imbalances
- Gestational Diabetes Mellitus | 4 Care Plans
- Hyperthyroidism | 7 Care Plans
- Hypothyroidism | 3 Care Plans
- Obesity | 5 Care Plans
- Thyroidectomy | 5 Care Plans