Buy a Nursing essay from

Left your Nursing Assignment to the last minute? Let a qualified expert do your Nursing essay for you and deliver it before your deadline!

Buy Nursing essay Papers
Calculate your paper price
Pages (550 words)
Approximate price: -

Cushing’s Syndrome Nursing Care Plan & Management


  • Cushing’s Syndrome results from excessive secretion of one or all of the adrenocortical hormones which includes glucocorticoid cortisol (predominant type), the mineralocorticoid aldosterone, and the adrogenital corticoids.
Types of Cushing’s Syndrome:
  1. Pituitary Cushing’s syndrome (Cushing’s disease) is the most common cause of Cushing’s syndrome, and stems from hyperplasia of both adrenal glands caused by over stimulation by adrenocorticotropic hormone (ACTH), usually from pituitary adenoma. The syndrome mostly affects women between ages 20 and 40.
  2. Adrenal Cushing’s syndrome is associated with adenoma or carcinoma of the adrenal cortex. The disease may recur after surgery.
  3. Ectopic Cushing’s syndrome results from autonomous ACTH secretion by extrapituitary tumors (such as the lungs) producing excess ACTH.
  4. Iatrogenic Cushing’s syndrome is caused by exogenous glucocorticoid administration.
Cushing's Syndrome
The most common cause of Cushing syndrome is side effects from taking anti-inflammatory steroid medications for conditions such as asthma and rheumatoid arthritis. The second most common cause is Cushing’s disease, which occurs when the pituitary gland makes too much of the hormone ACTH. ACTH stimulates the adrenal glands to produce cortisol. Cushing’s disease affects women more often than men. Cushing syndrome can also be caused by the following:
  • Tumor of the pituitary gland or adrenal gland
  • Tumor elsewhere in the body (ectopic Cushing syndrome)
1. Signs and symptoms of excess glucocorticoid (cortisol) secretion:
  • Weight gain or obesity.
  • Heavy trunk; thin extremities.
  • Fat pad (Buffalo Hump) in neck and supraclavicular area.
  • Rounded face (moon face); plethoric, oily complexion.
  • Skin – fragile and thin; striae and ecchymosis, acne.
  • Musculoskeletal – muscle wasting causes by excessive catabolism, osteoporosis, characteristic kyphosis, back ache.
  • Mental disturbances – mood changes, psychosis.
  • Increased susceptibility to infections.
2. Manifestation of excess mineralocorticoid (aldosterone) secretion:
  • Hypertension
  • Hypernatremia, hypokalemia
  • Weight gain
  • Expanded blood volume
  • Edema
3. Manifestation of excess androgens:
  • Females experience virilism (masculinization) with hirsutism (excessive growth of hair on the face and midline of trunk); atrophied breast, enlarged clitoris, masculinized voice, loss of libido, hermaphroditism (if exposed in utero).
  • Males – loss of libido.
Diagnostic Evaluation
  • Excessive plasma cortisol levels and loss of diurnal variation.
  • Increased blood glucose levels, decreased serum potassium level.
  • Plasma ACTH elevated in patients with pituitary tumors, very low in patients with adrenal tumor.
  • Eosinophils decreased on complete blood count.
  • Elevated urinary 17-hydroxycorticoids and 17-ketogenic steroids.
  • Overnight dexamethasone suppression test, possibly with cortisol urinary excretion measurement, to check for:
    • Unsuppressed cortisol level in Cushing’s syndrome cause by adrenal tumors.
    • Suppressed cortisol level in Cushing’s disease caused by pituitary tumor.
  • Skull X-ray detects erosion of the sella turcica by a pituitary tumor; CT scan and ultrasonography locate tumor.
Primary Nursing Diagnosis
  • Fluid volume excess related to abnormal retention of sodium and water
Medical Management
Treatment is usually directed at the pituitary gland because most cases are due to pituitary tumors rather than tumors of the adrenal cortex
  • Surgical removal of the tumor ( transphenoidal hypophysectomy) is the treatment of choce (90% success rate)
  • Radiation of the pituitary gland is successful but takes several months for symptom control
  • Adrenalectomy is performed in patients with primary adrenal hypertrophy
  • Post operatively, temporary replacement therapy with hydrocortisone maybe necessary until the adrenal glands begin to respond normally ( maybe several moths)
  • If bilateral adrenalectomy was performed lifetime replacement of adrenal cortex hormones is necessary
  • Adrenal enzyme inhibitors ( E.g. metyrapone or mitotine) maybe used with ectopic ACTH- secreting tumors that cannot be totally removed; monitor closely for inadequate adrenal function and side effects
  • If Cushing’s syndrome results from exogenous corticosteroids, taper the drug to the minimum level or use alternate-day therapy to treat the underlying disease
Pharmacologic Intervention
  • Mitotane 2–16 g per day in divided doses PO an antineoplastic, inhibits activity of adrenal cortex; used to treat inoperable adrenocortical carcinomas and Cushing’s syndrome
  • Cyproheptadine 4 mg 2–3 times a day PO an antihistamine agent ; serotonin antagonist, inhibits the release of ACTH from pituitary gland; drug is considered last resort and often causes no improvement
  • Other Drugs: Aminoglutethimide inhibits cholesterol synthesis, and metyrapone partially inhibits adrenal cortex steroid synthesis. These drugs may be used in conjunction with surgery or radiation if the tumor is not completely resectable or if complete remission is not expected.
Nursing Intervention
  • Monitor intake and output, daily weights, and serum glucose and electrolytes.
  • Monitor for signs of infection because risk is high with excess glucocorticoids.
  • After hypophysectomy, monitor for diabetes insipidus, hypothyroidism, and other endocrine changes.
  • Assess the skin frequently to detect reddened areas, skin breakdown or tearing, excoriation, infection or edema.
  • Handle skin and extremity gently to prevent trauma; prevent falls by using siderails.
  • Avoid using adhesive tape on the skin to reduce trauma on its removal.
  • Encourage the patient to turn in bed frequently or ambulate to reduce pressure on bony prominences and areas of edema.
  • Assist the patient with ambulation and hygiene when weak and fatigued. Use assistive devices during ambulation to prevent falls and fractures.
  • Help the patient to schedule exercise and rest. Advise the patient how to recognize signs and symptoms of excessive exertion.
  • Instruct the patient to correct body mechanics to avoid pain or injury during activities.
  • Provides foods low in sodium to minimize edema and provide foods high in potassium (bananas, orange juice, tomatoes) and administer potassium supplements as prescribed to counteract weakness re;ated to hypokalemia.
  • Report edema and signs of fluid retention.
  • Encourage the patient to verbalize concerns about the illness, changes in appearance, and alters role function.
  • Explain to female patient who has benign adenoma or hyperplasia that, with proper treatment, evidence of masculinization can be reversed.
Documentation Guidelines
  • Physical response: Vital signs, neurological assessment, cardiopulmonary assessment, wound healing, signs of infection (fever, wound drainage, productive cough), important laboratory deviations (serious electrolyte imbalances, alterations in glucose levels)
  • Nutrition: Daily weights, appetite, food tolerance, food preference, response to diet teaching, calorie count if indicated
  • Emotional response: Concerns over body image, self-concept, mood, affect
Discharge and Home Healthcare Guidelines
Describe the pathophysiology of the disease. Identify factors that aggravate the disease (stress, changes in diet, injury), as well as the signs and symptoms. Explore complications of the disease, and ask whom to notify if they occur. Describe the treatment plan and expected effects, as well as possible complications. Describe all medications, including the name, dosage, action, side effects, route, and importance of lifelong dosing if indicated.

Nursing Care Plan

Nursing Diagnosis
  1. Risk for injury and Risk for infection related to weakness and changes in protein metabolism and inflammatory response.
  2. Self-care Deficit: weakness, feeling of tiredness, muscle atrophy and changes in sleep patterns.
  3. Impaired skin integrity related to edema, impaired healing and the skin is thin and fragile.
  4. Disturbed Body Image related to changes in physical appearance, sexual dysfunction and decreased activity levels.
  5. Disturbed Thought Processes related to fluctuations in emotions, irritability and depression.
Reference Sample


Ask our team

Want to contact us directly? No problem. We are always here for you.

Frequently Asked Buy a Nursing essay Questions

See all
Is your service confidential?

When you place an order with our company, we ask you to provide us with such personal information as your name, phone number, and email address. We need this data to keep you updated on the important things related to your order or account, and never share it with any third parties. We also don’t use your contact details for spamming you.

Please note that our support team may contact you using only the phone number(s) stated on our website, such +1 (248) 599-2414 and/+44 (151) 528-2636. In order to secure our mutual cooperation, please do not communicate with those who introduce themselves as essaypapers support staff and reach you from different phone numbers.

Also, remember that we never ask you to provide your credit card information via phone conversations. You should enter this information only on PayPal or Gate2Shop billing forms when making an online payment on our website. The essaypapers support administrator will send a confirmation letter to your personal order page when your payment is received.

We also use a secure encrypted connection and do not store your private data if we do not need it anymore. For more details about how we ensure your confidentiality, check our Privacy Policy, which completely complies with the GDPR.

We offer original model papers that can be used legally in a number of ways if properly referenced:

  • As a source of arguments or ideas for your own research
  • As a source of additional understanding of the subject
  • Direct citing

Nonetheless, check your college’s/university’s policies, including their definition of plagiarism and paraphrasing before using our services. Make conscious decisions in regards to your education.

How do I order a paper from essaypapers?

We take care not only of your academic success, but also of your experience with us. That’s why we have made the process of placing your order as easy and fast as possible—usually, it takes no more than 2-3 minutes.

Let’s have a closer look at the simple steps you need to go through for submitting your order:

Fill in the order form.

Be sure to include specific instructions regarding your paper and to upload any of the required materials. If you have any questions while specifying your paper’s information, just click on the info sign at the end of every field name and you will see a detailed tip on what exact information is required.

Proceed with the payment.

After you are through with the order form, you will need to make a payment via a preferable system. Right after that, you will be automatically provided with your personal order page where you can track your order’s progress, provide additional requirements, and send messages to your writer or support manager.

A personal writer is assigned to your order.

Our qualified staff will choose the most suitable writer whose skills and experience match your field of study and paper’s details. In case the writer must have any particular software or literature in order to get the Nursing Assignment done, please do not forget to mention this in your initial instructions.

Your paper is completed and delivered to your personal order page.

When the writer finishes your paper, it is delivered to your personal order page as a PDF document, available for preview only. You will be able to download an editable MS Word version of the order right after you click the “Approve” button in the “Files” tab of your personal order page. If any changes are to be applied to the paper, you are always welcome to request a free revision with a new deadline for the writer (be sure to check more information about this in our revision policy).

You can check how easy the process is by going to the order page and submitting your paper details right now.

Is there a money-back guarantee? If yes, how can I receive a refund?

You can get more details about possible types and terms of refunds on our official money-back guarantee page.

How will I receive a completed paper?

You will get the first version of your paper in a non-editable PDF format within the deadline. You are welcome to check it and inform us if any changes are needed. If everything is okay, and no amendments are necessary, you can approve the order and download the .doc file. If there are any issues you want to change, you can apply for a free revision and the writer will amend the paper according to your instructions.

If there happen to be any problems with downloading your paper, please contact our support team.

What if I’m not satisfied with my order?

If your paper needs some changes, you can apply for a free revision that is available for 7 days after your paper is approved. To use this option, you have a “Revision” button on your personal page.

After the 7-day period, you cannot apply for a free revision, though you still can use a paid revision option. The price of such a revision will differ depending on the number of amendments needed to be done. Please contact our support team to find out how we can help you with the amendments to your paper.

If you think our writer didn’t manage to follow your instructions, and as a result, your paper is of poor quality, please contact us and we will do our best to solve the problem.

If the revisions didn’t give the desired result, you can apply for a refund. Our dispute department will process your inquiry to find out what kind of refund we can give you. To find out more, please visit our money-back guarantee page.

How do I request a refund?

You can’t apply for a refund on certain stages of your order, like when the order is not finished by the writer yet.

When the paper is delivered, the “Refund” button on your personal order page becomes clickable.

On the relevant tab of your personal order page, you will also be able to choose the type of refund you’re demanding and the reason why you applying for it. As soon as you do that, our dispute department will start working on your inquiry. All kinds of refunds concerning the quality or the lateness of your paper should be requested within 14 days from the time the paper was delivered, as in 14 days your paper, will be automatically approved.

Your inquiry should be submitted by clicking the “Refund” button on your personal order page only.

Order your essay today and save 15% with the discount code NURSINGHELP