1. General information
    1. Removal of one or both adrenal glands
    2. Indications
      1. Tumors of adrenal cortex (Cushing's syndrome, hyperaldosteronism) or medulla (pheochromocytoma)
      2. Metastatic cancer of the breast or prostate
  2. Nursing interventions: preoperative
    1. Provide routine pre-op care.
    2. Correct metabolic/cardiovascular problems.
      1. Pheochromocytoma: stabilize blood pressure.
      2. Cushing's syndrome: treat hyperglycemia and protein deficits.
      3. Primary hyperaldosteronism: treat hypertension and hypokalemia.
    3. Administer glucocorticoid preparation on the morning of surgery as ordered to prevent acute adrenal insufficiency.
  3. Nursing interventions: postoperative
    1. Provide routine post-op care.
    2. Observe for hemorrhage and shock.
      1. Monitor vital signs, I&O.
      2. Administer IV therapy and vasopressors as ordered.
    3. Prevent infections (suppression of immune system makes clients especially susceptible).
      1. Encourage coughing and deep breathing to prevent respiratory infection.
      2. Use meticulous aseptic technique during dressing changes.
    4. Administer cortisone or hydrocortisone as ordered to maintain cortisol levels.
    5. Provide general care for the client with abdominal surgery.
  4. Provide client teaching and discharge planning concerning
    1. Self-administration of replacement hormones
      1. Bilateral adrenalectomy: lifelong replacement of glucocorticoids and mineralocorticoids
      2. Unilateral adrenalectomy: replacement therapy for 6-12 months until the remaining adrenal gland begins to function normally
    2. Signs and symptoms of adrenal insufficiency
    3. Importance of follow-up care


Anonymous said...

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