6 Cushing’s Disease Nursing Care Plan

By
Paul Martin, BSN, R.N.
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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 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 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 diagnosis for Cushing’s disease or Cushing’s syndrome:

  1. Risk For Excess Fluid Volume
  2. Risk For Injury
  3. Risk For Infection
  4. Deficient Knowledge
  5. Disturbed Body Image
  6. Disturbed Thought Processes
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Risk For Injury

Nursing Diagnosis

May be related to

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  • Decreased bone density.
  • Generalized fatigue and weakness.
  • Increased capillary fragility.
  • Poor wound healing.

Possibly evidenced by

  • [not applicable for risk diagnosis]

Desired Outcomes

  • Client will be free of fractures or soft tissue injuries.
  • Client will implement measures to prevent injury.
Nursing Interventions Rationale
Assess the skin frequently to check for reddened areas, skin breakdown, tearing, or excoriation. Cushing’s disease causes thinning of the skin because cortisol causes the breakdown of some dermal proteins along with the weakening of small blood vessels. Therefore the skin may become so weak which allows it to be damaged easily.
Assess the skin for signs of bruising. The accumulation of fat caused by Cushing’s syndrome stretches the skin which is already thin and weakened due to cortisol action, causing it to hemorrhage and stretch permanently, healing by fibrosis.susceptible to rupture with minimal trauma. The client may experience easy bruising.
Assess the client for decreased height and kyphosis (forward rounding of the back). Excessive cortisol causes decreased bone formation,  increased bone resorption, increased renal calcium excretion, and decreased calcium absorption from the intestines. These changes can result in decreased bone density and the development of osteoporosis. Spinal compression fractures lead to decreased height and an exaggerated anterior-posterior curvature of the thoracic spine (kyphosis).
Assess the feces for occult blood. Occult blood positive on the feces may be an early indicator of gastrointestinal bleeding.
Ask the client about problems with poor wound healing. Increased cortisol levels increase the catabolism of peripheral tissues. Impaired nitrogen metabolism associated with Cushing’s disease contributes to impaired protein synthesis and delayed wound healing.
Prepare the client for a bone density evaluation. This diagnostic procedure provides information about the loss of bone density.
Instruct the client about keeping the skin clean and moisturized. Excessive dryness or excessive moisture increases the risk for skin breakdown.
Discuss with client safety measures for ambulation and daily activities. Precaution with activities is done to reduce the occurrence of trauma that can result in injury, bruising, or bleeding. Cushing’s disease is associated with loss of bone density and development of osteoporosis. The client is at risk for pathological fractures as a result of minor stress on the weaker bones. The client needs to assess the home and work environment for hazards that would contribute to falls. These hazards include loose rugs, highly waxed or wet floors, and stairs with poor lighting or inadequate handrails.
Apply direct pressure over venipuncture sites, injection sites, or wounds for at least 1 minute or longer. Due to capillary fragility, the client is prone to bleed easily. Direct pressure over the site helps control bleeding and reduce bruising.
Instruct the client in activities to decrease risk for bleeding:

  • Use an electric razor.
  • Use a soft toothbrush.
 Electric razor reduces the risk of cutting the skin when shaving while soft toothbrush decreases trauma to the gums.
Assist the patient with ambulation and hygiene when weak and fatigued. Use assistive devices during ambulation to prevent falls and fractures.  Ensure adequate lighting in the room,
Instruct the patient to correct body mechanics To avoid pain or injury during activities.
Encourage the client to eat a high-fiber diet with adequate fluid intake. These measure minimizes the risk for developing constipation, which can result in lower GI bleeding.
Encourage the client to eat a high-protein diet. Eating a high-protein diet can help prevent the muscle loss associated with Cushing syndrome.
Encourage the client to increase dietary intake of calcium, and vitamin D. Client with Cushing’s disease develop osteoporosis (fragile bones). Calcium and vitamin D are important in strengthening bones.
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See Also

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