Nursing Care Plan for Cushing’s Disease

Pathophysiology

Similar to Cushing’s syndrome which is much more common, Cushing’s disease is a condition where the pituitary gland secretes too much hormone (ACTH) causing an overproduction of cortisol (stress hormone). It causes weight gain around the trunk and waist with fat loss in the less and arms. Patients may also develop a hump on the upper back  that is caused by abnormal fat deposits. This disease weakens the immune system and can cause mood disorders such as anxiety and depression.

Etiology

Cushing’s disease is caused by a tumor or excess growth (hyperplasia) on the pituitary gland. Cushing’s syndrome is similar in its production of excess cortisol, but is usually a result of other disease processes.  As the pituitary secretes more hormone (ACTH), it stimulates the adrenal glands to produce more cortisol (stress hormone).  Cortisol controls blood sugar levels, how the body uses carbohydrates, fats and proteins and reduces the immune system’s response to inflammation, therefore making the patient more susceptible to infection.

Desired Outome

Manage symptoms, maintain normal blood pressure and a blood glucose level within appropriate range

Cushing’s Disease Nursing Care Plan

Subjective Data:

  • Back pain
  • Weakness
  • Irregular menstrual cycles
  • Shortness of breath
  • Poor concentration

Objective Data:

  • Red, ruddy face
  • Upper body obesity with thinning arms and legs
  • Acne or skin infections
  • Hypertension
  • Uncontrolled diabetes
  • Tachycardia
  • Tachypnea

Nursing Interventions and Rationales:

  1. Assess and monitor cardiac and respiratory status; perform 12-lead EKG to rule out cardiac involvement
    • Shifts in fluid balance and electrolytes may cause arrhythmias and difficulty breathing.
  2. Monitor fluid and electrolyte balance; I & O, fluid restrictions as necessary
    • Overproduction of cortisol causes the body to retain sodium and water which can cause cardiac stress and hypokalemia.
  3. Administer medications as appropriate to manage symptoms
    • Antihypertensives- monitor blood pressure closely as changes in cortisol levels may cause rapid changes in blood pressure

      Diuretics- to treat fluid retention and prevent excess strain on the heart
  4. Monitor vital signs for hypertension
    • Excess stress hormone (cortisol) causes an increase in blood pressure. Monitor closely and administer medications as necessary
  5. Manage blood glucose level
    • Excess cortisol can cause blood sugar to fluctuate. Monitor blood glucose levels regularly and notify MD if outside patient’s target area. Treat hypoglycemia with juice and crackers, but watch for rapid spikes afterwards.
      Treat hyperglycemia by having the patient drink water and notify MD if necessary.
  6. Promote rest
    • Long term stress and elevated cortisol levels can weaken the immune system and increase the risk of developing bacterial infections.
  7. Monitor for signs of infection: Fever, Wounds that are not healing, Changes in appetite or bowel habits, Nausea / vomiting
    • Cortisol suppresses the immune system and increases the risk of infection. Obvious signs of infection may be masked, so take note of subtle signs.
  8. Prepare patient for surgery to treat disease
    • Medication can help manage the symptoms, but there is currently no medication that can fully treat the disease. Surgery to remove the pituitary tumor(s) or adrenal glands is the most common treatment for the disease.
  9. Reduce risk of infections
    • Avoid unnecessary exposure to people with infections; stress the importance of good hand hygiene to patient and family members / caregivers
  10. Educate and encourage positive body image
    • Changes in the appearance can give the patient a negative self-image and lead to anxiety and depression. Reassure patient and educate them about the changes in fat distribution associated with the disease. Promote an atmosphere of acceptance and encourage the patient to verbalize feelings.
  11. Nutrition and lifestyle education: Quit smoking, Limit or avoid alcohol, Low sodium diet
    • Incorporate and educate patient about good dietary and lifestyle choices. Low sodium diet may be supplemented with high potassium foods and low protein to promote a stronger immune system. Encourage exercise as tolerable.

References

Date Published - Nov 1, 2018
Date Modified - Nov 1, 2018