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.
- Risk For Excess Fluid Volume
- Risk For Injury
- Risk For Infection
- Deficient Knowledge
- Disturbed Body Image
- Disturbed Thought Processes
May be related to
- Lack of experience with Cushing’s disease.
Possibly evidenced by
- Repeated hospital admissions for complications.
- Repeated questioning.
- Verbalized misconceptions.
- Client will verbalize an understanding of Cushing’s disease and guidelines for therapy.
- Client will implement appropriate therapy.
|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.|
||These diagnostic studies are used to localize adrenal tumors and may identify pituitary tumors.|
||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:|
||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.|
|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.|
||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.|
Recommended nursing diagnosis and nursing care plan books and resources.
- Nursing Care Plans: Nursing Diagnosis and Intervention (10th Edition)
An awesome book to help you create and customize effective nursing care plans. We highly recommend this book for its completeness and ease of use.
- Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
A quick-reference tool to easily select the appropriate nursing diagnosis to plan your patient’s care effectively.
- NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023 (12th Edition)
The official and definitive guide to nursing diagnoses as reviewed and approved by the NANDA-I. This book focuses on the nursing diagnostic labels, their defining characteristics, and risk factors – this does not include nursing interventions and rationales.
- Nursing Diagnosis Handbook, 12th Edition Revised Reprint with 2021-2023 NANDA-I® Updates
Another great nursing care plan resource that is updated to include the recent NANDA-I updates.
- Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5(TM))
Useful for creating nursing care plans related to mental health and psychiatric nursing.
- Ulrich & Canale’s Nursing Care Planning Guides, 8th Edition
Claims to have the most in-depth care plans of any nursing care planning book. Includes 31 detailed nursing diagnosis care plans and 63 disease/disorder care plans.
- Maternal Newborn Nursing Care Plans (3rd Edition)
If you’re looking for specific care plans related to maternal and newborn nursing care, this book is for you.
- Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care (7th Edition)
An easy-to-use nursing care plan book that is updated with the latest diagnosis from NANDA-I 2021-2023.
- All-in-One Nursing Care Planning Resource: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health (5th Edition)
Definitely an all-in-one resources for nursing care planning. It has over 100 care plans for different nursing topics.
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database
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
- – Respiratory Acidosis Nursing Care Plan
- – Respiratory Alkalosis Nursing Care Plan
- – Metabolic Acidosis Nursing Care Plan
- – Metabolic Alkalosis Nursing Care Plan
- 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 | 10 Care Plans
- – Fluid Balance: Hypervolemia & Hypovolemia
- – Potassium (K) Imbalances: Hyperkalemia and Hypokalemia
- – Sodium (Na) Imbalances: Hypernatremia and Hyponatremia
- – Magnesium (Mg) Imbalances: Hypermagnesemia and Hypomagnesemia
- – Calcium (Ca) Imbalances: Hypercalcemia and Hypocalcemia
- Gestational Diabetes Mellitus | 4 Care Plans
- Hyperthyroidism | 7 Care Plans
- Hypothyroidism | 3 Care Plans
- Obesity | 4 Care Plans
- Thyroidectomy | 5 Care Plans