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NURS 642 (Nephrology) EXAM 3 STUDY GUIDE LATEST UPDATED RATED A.
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NURS 642 (Nephrology) EXAM 3 STUDY GUIDE LATEST UPDATED RATED A.
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NURS 642 (Nephrology) EXAM 3 STUDYGUIDE LATEST UPDATED RATED A.
Adrenocortical Insufficiency Lab Findings
✔✔Cosyntropin is unable to stimulate an increase in serum cortisol >20
Plasma ACTH level elevated
Acute Adrenal Insufficiency Symptoms
✔✔headache, lassitude, N/V/D, abdominal pain
confusion, coma, high fever, dehydration
hypotension, shock, recurrent hypoglycemia
Adrenocortical Insufficiency DDX
✔✔other causes of hypotension/shock
other causes hyperkalemia
other causes hyponatremia
isolated hypoaldosteronism
,secondary adrenal insufficiency (hypopituitarism)
Adrenocortical insufficiency Lab Findings
✔✔Hyponatremia, Hyperkalemia, Hypercalcemia, Hypoglycemia
Plasma Cortisol level <3
COsyntropin stim test is positive
Plasma ACTH markedly elevated (>200)
Diagnostics for Adrenocortical Insufficiency
✔✔CT Abd to assess adrenal glands---enlargement (neoplasm, granuloma)
calcification (pheochromocytoma)
Adrenocortical Insufficiency Treament
✔✔corticosteriod replacement (hydrocortisone in acute, pred in OP)
most cases require fludrocortisone (mineralcorticoid) replacement as well
Treat infections immediately
Treat hypoglycemia with D5W
,careful monitoring of electrolytes, renal function
Cushing syndrome general considerations
✔✔excessive corticosteroids, generally caused by corticosteroid drugs
Cushing Disease general considerations
✔✔ACTH hypersecretion from pituitary adenoma or nonpituitary neoplasm
more than 3x more common in women than men
Cushing Syndrome S&S
✔✔Central Obesity, moon face, buff hump
supraclavicular fat pads, protuberant abdomen, thin extrem
muscle atrophy causes weakness
sexual dysfunction
acne, superficial skin infections, easy bruising, impaired wound healing
hirsutism
, Cushing DDx
✔✔Chronic alcoholism
DM
Depression
Primary hyperaldosteronism
Cushing labs
✔✔Hyperglycemia, Hypokalemia without hypernatremia
Leukocytosis
Midnight serum cortisol level >7.5 indicative
24 hour free cortisol and creatinine
Plasma ACTH after dx <20 indicates prob adrenal tumor . High or norm ACTH
indicates pituitary or ectopic tumors
Cushings Diagnostics
✔✔MRI pituitary
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