Here is the nursing management for patients with Addison's disease and Cushing syndrome in 5 points each: Addison's disease nursing management (5 marks): 1. Monitor vital signs closely and watch for signs of adrenal crisis like hypotension. 2. Administer glucocorticoid and mineralocorticoid replacement therapy as prescribed, such as hydrocortisone and fludrocortisone. 3. Provide a low-stress environment and rest periods to prevent fatigue. 4. Encourage high sodium and high carbohydrate diet to prevent hypoglycemia and hyponatremia. 5. Monitor fluid balance closely and weigh patient daily to watch for dehydration or fluid overload.

2. Puja gupta
B.S.c Nursing

3. At the end of this session all the students will be
able to diagnose and provide nursing care to
the patient suffering from adrenal disorders.

4. Addison's disease Cushing syndrome
Definition
Addison’s disease, also
known as primary adrenal
insufficiency and
hypocortisolism, is a long
term endocrine disorder in
which the adrenal glands do
not produce enough steroid
hormone.
Definition
Cushing syndrome is a
clinical condition that results
from chronic exposure to
excess corticosteroids,
particularly glucocoticoids.

5. Addison's disease Cushing syndrome
Causes
- All 3 classes of adrenal
corticosteroids are decrease
in Addison’s disease
Glucocorticoids
Mineralocorticoids
Androgens
-Idiopathic
Causes
Primary- adrenocortical
tumors/ hyperplasia
Secondary- also called a
cushing’s disease
Pituitary hyperplasia
and pituitary tumors

6. Addison's disease Cushing syndrome
Causes
-Autoimmune response:
Adrenal tissue is
destroyed by antibodies
against the patient’s own
adrenal cortex.
- Tuberculosis, hemorrhage,
histoplasmosis (fungal
infection), AIDS
Causes
Ectopic secretion of
ACTH(ACTH secreting
tumors located outside
the pituitary gland e.g.,
bronchogenic carcinoma)
Latrogenic (prolonged
use of corticosteroids)

7. Addison's disease Cushing syndrome
Sign and Symptoms
1. Glucocorticoids
General appearance: Weight
loss
Sign and Symptoms
1. Glucocorticoids
General appearance :
Truncal obesity, thin
extremities, rounding of
face(moon face), fat deposits
on back of neck and
shoulders (buffalo hump)

8. Addison's disease Cushing syndrome
Sign and Symptoms
1. Glucocorticoids contd…
Integumentary : Bronzed or
smoky hyperpigmentation of
face, neck , hands, buccal
membranes, nipples,
genitalia and scars.
Sign and Symptoms
1. Glucocorticoids contd…
Integumentary :Thin, fragile
skin , purplished red striae,
poor wound healing

9. Addison's disease Cushing syndrome
Sign and Symptoms
1. Glucocorticoids contd…
Cardiovascular: Hypotension
Sign and Symptoms
1. Glucocorticoids contd…
Cardiovascular:
Hypervolemia, hypertension
, edema of lower limbs

10. Addison's disease Cushing syndrome
Sign and Symptoms
1. Glucocorticoids contd…
Gastrointestinal : Anorexia,
nausea and vomiting,
diarrhea
Sign and Symptoms
1. Glucocorticoids contd…
Gastrointestinal : Increased in
secretion of pepsin and HCL
acid, risk of peptic ulcer
disease and anorexia

11. Addison's disease Cushing syndrome
Sign and Symptoms
1. Glucocorticoids contd…
Renal :Hyponatremia and
hyperkalemia
Musculoskeletal system :
Fatigue, progressive
weakness
Sign and Symptoms
1. Glucocorticoids contd…
Renal : Glycosuria
Musculoskeletal system :
Muscle wasting in
extremities, fatigue,
osteoporosis, weakness ,
fracture

12. Addison's disease Cushing syndrome
Sign and Symptoms
2. Mineralocorticoids
Fluid and electrolytes:
sodium loss, hyperkalemia
Cardiovascular:
hypovolemia
Sign and Symptoms
2. Mineralocorticoids
Fluid and electrolytes:
marked sodium and water
retention, edema ,
hypokalemia
Cardiovascular:
hypervolemia , hypertension

13. Addison's disease Cushing syndrome
Sign and Symptoms
3. Androgens
Integumentary : decreased
axillary and pubic hair (in
women)
Reproductive : no effect in
men , decreased libido in
women
Musculoskeletal system :
decrease in muscle size and
tone
Sign and Symptoms
3. Androgens:
Integumentary : hirsutism,
hyperpigmentation
Reproductive: menstrual
irregularities, gynecomastia
Musculoskeletal system :
muscle wasting and
weakness

17. Addisionion crisis
Life threatening condition in which there is drop
corticosteroid leading to:
 Severe hypotension
 Hypoglycemia weakness
 Hyperkalemia
 Vascular collapse (shock)

18. Addison's disease Cushing syndrome
Diagnostic studies
1. History collection
2. Physical examination
3. Serum cortisol level
4. Serum ACTH
5. Urine cortisol and
aldosterone (low)
6. CT scan and MRI
pituitary and adrenal gland
Diagnostic studies
1. History collection
2. Physical examination
3. Mental status examination
4. Elevated plasma cortisol
level
5. Urine cortisol level higher
than normal range of 80 to
120 mcg/24 hr indicate
Cushing syndrome
6. CT scan and MRI of
pituitary and adrenal gland

19. Addison's disease Cushing syndrome
Management
 Monitor vitals hourly
Administration and
replacement of steroids e.g.,
hydrocortisone intravenously
IV drip is usually
necessary to reverse shock
Treat hypoglycemia
Treat infection
Management
Adrenalectomy : if tumor
is present
Transphenoidal approach:
for removal of pituitary
tumor using microsurgical
technique
Cobalt radiation : to treat
pituitary cushing's
Adrenolytic agent

20. Addison's disease Cushing syndrome
Nursing Management
Nursing diagnosis:
Deficiency fluid volume
related to renal losses of
sodium and water
Activity intolerance
related to decreased cortisol
production and fatigue
Risk for injury related to
ineffective stress response
Nursing Management
Nursing diagnosis:
Impaired skin integrity
related to edema, impaired
healing, and thin and fragile
skin
Disturbed body image
related to altered physical
appearance, impaired sexual
functioning and decreased
activity level

21. Addison's disease Cushing syndrome
Nursing Management Nursing Management
Nursing diagnosis
Risk for injury related to
weakness
Risk for infection related
to altered protein metabolism
and inflammatory response
Risk for activity
intolerance

22. Addison's disease Cushing syndrome
Nursing Management
Nursing intervention
Administer hormone
replacement therapy as
ordered
1. Glucocorticoids
(cortisone,
hydrocortisone): to
stimulate diurnal
rhythm of cortisol
release , give 2/3 dose
in early morning and
1/3 dose in afternoon.
Nursing Management
Nursing intervention
Promoting skin integrity
•Use of adhesive tape is
avoided, because it can
irritate the skin and tear
the fragile tissue when
tape is removed
•Frequently assess skin
and bony prominences
and encourage and assist
patient to change
positions frequently to
prevent skin breakdown

23. Addison's disease Cushing syndrome
Nursing Management
Nursing intervention
contd…
2. Mineralocorticoids :
fludrocortisone acetate
Monitor vital sign
Decrease stress in the
environment
Nursing Management
Nursing intervention
contd…
Improving body image
•Discuss with patient
about the effect the
changes have had on their
self concept and
relationships with other

24. Addison's disease Cushing syndrome
Nursing Management
Nursing intervention
contd…
Prevent exposure to
infection
Provide rest period;
prevent fatigue
Monitor input and output
Weight daily
Nursing Management
Nursing intervention
contd…
Weight gain and edema may
be modified by a low-
carbohydrate, low-sodium,
high-protein diets.

25. Addison's disease Cushing syndrome
Nursing Management
Provide small frequent
feedings of diet high in
carbohydrates, sodium, and
protein to prevent
hypoglycemia and
hyponatremia and provide
proper nutrition
Nursing Management
Decreasing risk of injury
•Establishing a protective
environment helps to
prevent fall, fractures,
and other injuries to
bones and soft tissues
•Foods high in protein,
calcium and vitamin D
are recommended to
minimize muscle wasting
and osteoporosis

27. 1. Prof. Gyanand Mandal, Textbook of Medical
Surgical Nursing, 6th edition, june 2019, Safal
publication house pvt. Ltd. Baneshwor, Kathmandu.
Page no. 406 to 409
2. Brunner and Suddarth’s Textbook of Medical
Surgical Nursing, South Asian Edition, Volume 1 .
Wolters kluwer (India) Pvt.Ltd., New Delhi. Page
No. 1088-1093

28. 3) S N CHUGH, Textbook of Medical Surgical Nursing,
First edition, Avichal Publishing Company. Page No.
606 -609
4) Lalita rai, Textbook of Medical Surgical Nursing 1
and 2 , second edition , Akshav publication
Kathmandu . Page no. 490 to 492

29. 5)http://prepareformedicalexams.blogspot.com/2
017/06/regarding-cushing-syndrome-
answer.html

30. Write nursing management of patient having
Addison's disease and Cushing
syndrome?(5+5marks)