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
Disturbed Body Image
May be related to
- Abnormal fat distribution along with edema resulting in moon face, cervicodorsal fat (buffalo hump), trunk obesity.
- Disturbed protein metabolism resulting in muscle wasting, capillary fragility, and wasting of bone matrix: ecchymosis, osteoporosis, slender limbs, striae (usually purple).
- Increased production of androgens (giving rise to virilism in women; hirsutism [abnormal growth of hair]).
Possibly evidenced by
- Change in social behavior (withdrawal, isolation, flamboyancy).
- Compensatory use of concealing clothing.
- Refusal to discuss or acknowledge being.
- Verbal preoccupation with changed body.
- Verbal identification of feeling about altered body structure.
- Client will verbalize feelings about the changes in appearance, sexual function and activity level.
- Client will demonstrate enhanced body image and self-esteem as evidenced by ability to look at, touch, talk about, and care for actual and perceived altered body parts and functions.
|Assess the client’s coping mechanism.||Previously successful coping skills may be inadequate in the present situation.|
|Assess for any changes in personal appearance caused by the cortisol excess.||These changes may include fullness and rounding of the face (moon face), added fat on the back of neck (buffalo hump), excessive weight gain, red cheeks (plethora), increased body and facial hair and Hyperpigmentation of skin, hair, and mucous membranes occurs as a result of the increased level of melanocyte-stimulating hormones and ACTH.|
|Assess client’s feelings about their changed appearance and coping mechanism.||Negative statements about changes in appearance indicate a disturbed body image. The client may withdraw from social interaction. Depression may occur.|
|Reassure the client that the physical changes are a result of the elevated hormone levels and most will resolve when those levels return to normal||Information helps the client develop realistic expectations about the changes in the physical appearance. This information may enhance the client’s willingness to participate in recommended treatments.|
|Encourage the client to verbalize feelings about the body image changes||It is worthwhile to encourage the client to separate feelings about changes in body structure or function from feelings about self-worth. The expression of feelings can enhance the client’s coping strategies.|
|Promote an atmosphere of acceptance and positive caring.||Client asks other people for feedback about their appearance. When the nurse responds to the client in an accepting manner, it supports the client’s adjustment to his or her appearance.|
|Promote coping methods to deal with the client’s change in appearance (e.g., adequate grooming, flattering clothes).||Learning methods to compensate for changes in appearance enhances the client’s self-esteem. Helping clients remember how they managed body image issues in the past may facilitate an adjustment to the current issues.|
|Refer to local support groups.||Being exposed to people with same experiences provide social support. Members of a support group may offer coping strategies that have proven successful.|
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Endocrine and Metabolic Care Plans
Nursing care plans related to the endocrine system and metabolism:
- 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 | 13+ 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