NLE Endocrine & Metabolic Nursing — Adrenal DisordersConcept Map

Concept

Adrenal Anatomy & Physiology

Sub Concepts

• Adrenal Cortex (produces glucocorticoids, mineralocorticoids, androgens)
• Adrenal Medulla (produces catecholamines)
• HPA Axis (Hypothalamic-Pituitary-Adrenal feedback loop)
• Cortisol regulation via ACTH and CRH
• Circadian rhythm of cortisol secretion

Relationship To Central

Foundation for understanding all adrenal disorders

Concept

Cushing's Syndrome - Hypercortisolism

Sub Concepts

• Pathophysiology: Chronic excess glucocorticoid
• Causes: Exogenous (most common), Endogenous (Cushing's disease, adrenal tumor, ectopic ACTH)
• Clinical Manifestations: Moon face, buffalo hump, truncal obesity, thin extremities
• Skin changes: Purple striae, thin fragile skin, easy bruising
• Metabolic effects: Hyperglycemia, hypertension, hypokalemia
• Musculoskeletal: Osteoporosis, muscle weakness, poor wound healing
• Diagnostic tests: 24-hour urinary free cortisol, dexamethasone suppression test, ACTH level
• Nursing management and pharmacological interventions
• Post-adrenalectomy care and complications

Relationship To Central

Excess cortisol state requiring recognition and management

Concept

Addison's Disease - Adrenal Insufficiency

Sub Concepts

• Pathophysiology: Primary (autoimmune) vs Secondary (steroid withdrawal, pituitary failure)
• Clinical Manifestations: Hypotension, hyponatremia, hyperkalemia
• Hypoglycemia, weight loss, anorexia, nausea/vomiting/diarrhea
• Hyperpigmentation (bronze skin) - specific to primary Addison's
• Salt craving and dehydration
• Diagnostic tests: Low cortisol, ACTH stimulation test, electrolyte panels
• Lifelong hormone replacement: Glucocorticoid and mineralocorticoid
• Patient education: Never abruptly stop steroids, stress dosing
• Medical alert bracelet and emergency hydrocortisone kit

Relationship To Central

Deficient cortisol and aldosterone requiring lifelong replacement

Concept

Addisonian (Adrenal) Crisis - Life-Threatening Emergency

Sub Concepts

• Etiology: Stress, infection, trauma, surgery, abrupt steroid withdrawal
• Clinical presentation: Profound hypotension, shock, severe hyponatremia
• Severe hyperkalemia with cardiac dysrhythmias, hypoglycemia
• High fever, severe GI symptoms, vascular collapse
• Immediate priorities: IV hydrocortisone, IV fluids (NS with dextrose)
• Hyperkalemia management and cardiac monitoring
• Identification and treatment of precipitating factors
• Continuous monitoring of vitals, glucose, and electrolytes

Relationship To Central

Acute decompensation requiring immediate intervention

Concept

Pheochromocytoma - Catecholamine Excess

Sub Concepts

• Pathophysiology: Catecholamine-secreting tumor of adrenal medulla
• Classic triad: Severe headache, palpitations, profuse diaphoresis
• Severe paroxysmal hypertension, tremor, anxiety, flushing
• Hyperglycemia and metabolic effects
• Diagnostic tests: 24-hour urine metanephrines and VMA
• Imaging: CT/MRI for tumor localization
• Pre-operative management: Alpha-blockers FIRST, then beta-blockers
• Critical caution: DO NOT palpate abdomen (risk of hypertensive crisis)
• Surgical treatment: Adrenalectomy
• Post-operative management: Monitor for hypotension and adrenal insufficiency

Relationship To Central

Benign tumor requiring surgical intervention and careful pre-operative management

Concept

Corticosteroid Therapy - Cross-Cutting Concept

Sub Concepts

• Never abruptly discontinue steroids - always taper
• Mechanism of adrenal suppression with chronic use
• Stress dosing during physical illness or trauma
• Administration: Take with food in the morning
• Side effects: Hyperglycemia, hypertension, fluid retention, hypokalemia
• Immunosuppression and masked infection signs
• Osteoporosis risk and bone protection strategies
• Mood changes and psychological effects
• Patient adherence and medical alert systems

Relationship To Central

Essential knowledge for managing adrenal disorders and preventing crises

Concept

Primary Hyperaldosteronism (Conn's Syndrome)

Sub Concepts

• Aldosterone-secreting adrenal adenoma
• Sodium and water retention with potassium loss
• Resistant hypertension (difficult to control)
• Hypokalemia complications: Weakness, cramps, arrhythmias, polyuria
• Metabolic alkalosis
• Absence of edema despite sodium retention
• Potassium-sparing diuretics (spironolactone) management
• Surgical intervention: Adrenalectomy

Relationship To Central

Related adrenal cortex disorder affecting sodium-potassium balance

Concept

Nursing Process Application in Adrenal Disorders

Sub Concepts

• Assessment: NANDA nursing diagnoses related to fluid/electrolyte imbalance
• Imbalanced Nutrition: More or less than body requirements
• Risk for Infection related to immunosuppression
• Risk for Injury related to osteoporosis and musculoskeletal weakness
• Disturbed Body Image related to physical changes
• Ineffective Coping related to mood changes
• Fluid and Electrolyte Management (Maslow hierarchy prioritization)
• Planning: Expected outcomes and prioritization
• Intervention: Monitoring, patient education, safety measures
• Evaluation: Achievement of health outcomes

Relationship To Central

Systematic approach to patient care aligned with RA 9173 and Philippine nursing standards

To

Cushing's Syndrome

From

Adrenal Cortex - Glucocorticoids

Strength

strong

Relationship

Excess cortisol production leads to Cushing's syndrome manifestations

To

Addison's Disease

From

Adrenal Cortex - Mineralocorticoids

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strong

Relationship

Deficient aldosterone causes hyponatremia, hyperkalemia, and hypotension

To

Addisonian Crisis

From

Cushing's Syndrome

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strong

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Risk if adrenalectomy performed; cortisol production suddenly stops after surgery

To

Addisonian Crisis

From

Addison's Disease

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strong

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Crisis occurs when stress or stressor exceeds remaining adrenal capacity; direct progression if untreated

To

Addison's Disease

From

Corticosteroid Therapy

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Chronic steroid use causes secondary adrenal insufficiency through suppression of HPA axis

To

Cushing's Syndrome

From

HPA Axis Feedback

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ACTH level distinguishes pituitary (high ACTH) from adrenal tumor (low ACTH) causes

To

Pheochromocytoma

From

Adrenal Medulla - Catecholamines

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strong

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Excessive catecholamine secretion from medullary tumor causes classic triad

To

Hypertensive Crisis

From

Pheochromocytoma

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strong

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Abdominal palpation or beta-blocker alone can precipitate dangerous hypertensive emergency

To

Hypokalemia

From

Cushing's Syndrome

Strength

moderate

Relationship

Cortisol has some mineralocorticoid effect; causes potassium wasting and hypokalemia

To

Hyperkalemia

From

Addison's Disease

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strong

Relationship

Deficient aldosterone reduces potassium excretion, causing dangerous hyperkalemia

To

Hypokalemia

From

Primary Hyperaldosteronism

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strong

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Aldosterone excess directly causes potassium loss and hypokalemia complications

To

Osteoporosis

From

Cushing's Syndrome

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strong

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Excess cortisol increases bone resorption and decreases calcium absorption

To

Infection Risk

From

Cushing's Syndrome

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strong

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Excess cortisol suppresses immune function; infections develop silently with masked signs

To

Hyperpigmentation

From

Addison's Disease

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strong

Relationship

High ACTH in primary Addison's stimulates melanocyte activity causing bronze skin

To

Pre-operative Alpha-Blocker

From

Pheochromocytoma

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Relationship

Alpha-blockade must precede beta-blockade to prevent unopposed alpha-mediated hypertensive crisis

To

IV Hydrocortisone

From

Addisonian Crisis

Strength

strong

Relationship

IV steroid is the immediate life-saving priority in crisis management

To

Hyperkalemia

From

Addisonian Crisis

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strong

Relationship

Life-threatening hyperkalemia in crisis requires urgent treatment with calcium, insulin, bicarbonate

To

Adrenal Suppression

From

Corticosteroid Therapy

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Relationship

Chronic exogenous steroids suppress endogenous ACTH and cortisol production

To

Addison's Management

From

Stress Dosing

Strength

strong

Relationship

Patients must increase glucocorticoid dose during physical stress to prevent crisis

To

Hypertension

From

Cushing's Syndrome

Strength

moderate

Relationship

Cortisol has mineralocorticoid effects causing sodium/water retention and HTN

To

Hypotension

From

Addison's Disease

Strength

strong

Relationship

Deficient aldosterone causes sodium/water loss leading to hypovolemia and hypotension

To

Post-adrenalectomy Hemorrhage

From

Adrenal Anatomy

Strength

moderate

Relationship

Adrenal glands are highly vascular; surgical removal requires vigilant hemorrhage monitoring

To

Fluid and Electrolyte Imbalance

From

NANDA Nursing Diagnoses

Strength

strong

Relationship

Core nursing diagnoses across all adrenal disorders based on electrolyte abnormalities

To

Addisonian Crisis Prioritization

From

Maslow Hierarchy

Strength

strong

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Physiological safety needs (correction of shock, electrolytes) are highest priority in crisis

To

Nursing Management

From

RA 9173

Strength

moderate

Relationship

Philippine nursing practice law mandates scope of practice in adrenal disorder care and medication administration