6 Cushing’s Disease Nursing Care Plan

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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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Deficient Knowledge

Nursing Diagnosis

May be related to

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  • Lack of experience with Cushing’s disease.

Possibly evidenced by

  • Repeated hospital admissions for complications.
  • Repeated questioning.
  • Verbalized misconceptions.

Desired Outcomes

  • Client will verbalize an understanding of Cushing’s disease and guidelines for therapy.
  • Client will implement appropriate therapy.
Nursing Interventions Rationale
Assess the client’s level of knowledge of Cushing’s disease and its treatment regimen. An individualized teaching plan begins with an assessment of the client’s previous knowledge and understanding of the disorder. The client or family must understand the disease process and receive specific instructions related to treatment, methods to control symptoms, signs of infection, complications, and indicators of when to notify the physician. Cushing’s disease may cause alterations in the level of consciousness because of the effects of cortisol on hippocampal neurons. The client may have impaired memory. This change may limit the client’s ability to learn new information.
Discuss the following diagnostic test to the client: Some of the tests requires cooperation in collecting urine specimens over an extended period.
  • Computed tomography, magnetic resonance imaging, and selected arteriography.
These diagnostic studies are used to localize adrenal tumors and may identify pituitary tumors.
  • Urine free cortisol, 17-ketosteroids (17-KS), 17-hydroxycorticosteroids (17-OHCS).
Urine free cortisol involves collecting urine several times over a 24-hour and then testing it for cortisol. An adult with levels of cortisol higher than 50 to 100 mcg per day would be considered high. In Cushing’s disease, urine free cortisol, levels of 17-OHCS (metabolites of cortisol) and 17-KS (metabolites of androgens) are increased.
This is used to evaluate adrenal gland function by measuring how cortisol levels change in response to an injection of dexamethasone. It is typically used to diagnose Cushing’s syndrome.
Anticipate the need to discuss or reinforce the probable treatment in correcting the hypersecretion of hormone:
  • If iatrogenic: Gradual discontinuation of excessive administration of corticosteroids as the client’s condition permits.
When Cushing’s disease is secondary to the prolonged administration of glucocorticoids, treatment is focused on discontinuing the medication. This approach requires a gradual lowering of the dose over time to decrease the risk for adrenal insufficiency if the drug is stopped suddenly. If the client’s condition does not allow for discontinuing glucocorticoids, attempts will be made to adjust the dose and frequency of administration to minimize suppression of the normal hypothalamic-pituitary-adrenal function.
  • If an intrinsic adrenocortical disorder: Probable surgery for removal of the adenoma, tumor, or adrenal glands.
Adrenalectomy is the treatment of choice for the client with an adrenal tumor or adrenal hyperplasia that is causing the increased levels of serum cortisol.
  • If a disorder secondary to pituitary hypersecretion: Transsphenoidal pituitary tumor resection or irradiation.
Surgical removal of the tumor by transsphenoidal hypophysectomy is the treatment of choice if Cushing’s syndrome is caused by pituitary tumors. Radiation therapy may be used as part of the management of these clients.
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See Also

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Endocrine and Metabolic Care Plans

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