THE ADRENAL GLAND DISORDER

PRIMARY ALDOSTERONISM or HYPERALDOSTERONISM (CONN’S SYNDROME)

Data Base
A. General information: Etiology and Pathophysiology
1. Aldosterone, a mineralocorticoid secreted in response to the renin-angiotensin system and ACTH, causes the kidneys to retain
sodium and excrete potassium and hydrogen
2. Usually caused by an adenoma of the adrenal cortex, but may also be caused by hyperplasia or carcinoma
3. Caused by tumor or hyperplasia of adrenal gland
B. Clinical findings
1. Subjective: muscle weakness and cramping; polydipsia, polyuria; paresthesia; headache
2. Objective:
a. Hypertension
b. Hypokalemia
c. Hypernatremia
d. Visual changes
e. Metabolic alkalosis
f. Elevated urinary aldosterone levels
g. Cardiac arrhythmias (due to hypokalemia)
h. Renal damage: proteinuria, decreased urine specific gravity and increased urinary aldosterone
3. Diagnostic tests
a. Serum potassium decreased, alkalosis
b. Urinary aldosterone levels elevated
C. Therapeutic interventions
1. Surgical removal of the tumor
2. Temporary management with spironolactone
3. Occasionally a bilateral adrenalectomy involving lifelong corticosteroid therapy is necessary

Nursing Care of Clients with Primary Aldosteronism

A. ASSESSMENT
1. Vital signs
2. Electrolyte levels
3. Intake and output, urine specific gravity
4. Motor and sensory functions for alterations
5. Cardiac dysrhythmias as a result of hypokalemia

B. ANALYSIS/NURSING DIAGNOSES
1. Fatigue related to muscle weakness
2. Deficient fluid volume related to polyuria
3. Excess fluid volume related to excess sodium retention

C. PLANNING/IMPLEMENTATION
1. Monitor vital signs, particularly BP; I & O, daily weights, regulate fluid intake
2. Encourage continued medical supervision
3. Maintain sodium restriction as ordered, preoperatively
4. Administer glucocorticoids preoperatively, as prescribed, to prevent adrenal hypofunction
5. Administer spironolactone (Aldactone) and potassium supplements as ordered to promote fluid balance; medication is potassium-
sparing diuretic and aldosterone antagonist; administer antihypertensive as prescribed
6. Prepare the client for an adrenalectomy if indicated
7. Care for the client after a bilateral adrenalectomy
a. Monitor vital signs, hemodynamic state, and blood glucose level
b. Administer steroids with milk and antacid
c. Protect the client from infection and stressful situations
d. Explain drug and side effects to client
e. Instruct the client to carry medical alert identification card
4. Provide dietary instruction; encourage intake of foods high in potassium and avoidance of foods that contain sodium
5. Provide client teaching and discharge planning concerning
a. Instruct the client regarding the need for glucocorticoids following adrenalectomy
b. Use and side effects of medication if the client is being maintained on spironolactone therapy
c. Signs of symptoms of hypo/hyperaldosteronism
d. Need for frequent blood pressure checks and follow-up care

D. EVALUATION
1. Maintains blood pressure at an acceptable level
2. Selects food low in sodium and high in potassium
3. Performs routine ADL without fatigue

HTTP://WWW.COLLEGEOFNURSING.CJB.NET ST. MICHAEL’S COLLEGE, INC – ILIGAN CITY