Pheochromocytoma

By Sierra Cortez-Deleon, Kirsten Pham,

Camelle Sison, & Andrew Granillo
Agenda
 Case Study Presentation
 Pathophysiology
 Signs and symptoms
 Diagnostics
 Treatment
 Nursing Diagnosis
 Goals
 Interventions
 Integrative Therapy Patient/Family Education Plan
What is Pheochromocytoma?

(UCSF Department of Surgery, 2018).  

(News Medical Life Sciences, 2018).
(Adams & Urban, 2016). 
Diagnostics and Treatment
Diagnostics: Treatment:
o Urine test o Surgery:
o Catecholamines o Adrenalectomy
o Metanephrines o Bilaterally or unilaterally

o MRI or CT scan

o Blood test
o Epinephrine
o Norepinephrine
o Dopamine
 CT scan showing (R) adrenal mass
(R) adrenal mass with calcification 

(Garg, Garg, & Urumdas, 2018). (Elzein, Aljaberi, AlFiaar, & Alghamdi, 2016).
Nursing Diagnosis #1

Decreased cardiac output related to increased

vascular resistance secondary to hypertensive crisis
as evidence by blood pressure of 198/136 mmHg,
decreased SpO2 of 92%, increased chest
palpitations within the last six months, and patient
stating, “my heart is racing even while at rest.”
Short-term goal:

Patient’s blood pressure will be maintained within a

systolic of 165-175 mmHg and diastolic of 110-120
mmHg by the end of the shift.
Interventions

1. Administer blood pressure medication and provide

oxygenation (Ignatavicius & Workman, 2016).

2. Monitor and record blood pressure before and after

medication administration (Ackley, Madwig, & Makic, 2017).

3. Integrate aromatherapy by putting lavender essential oil on

a cotton ball for patient to inhale (Salamati, Mashouf & Mojab,
2017).
Long-term goal:

Patient will verbalize an understanding of his

condition and the importance of health maintenance
such as keeping his blood pressure below
150/100mmHg by time of discharge.
Interventions:
1. Educate the patient about medications prescribed and the
importance of medication compliance (Ackley, Madwig, &
Makic, 2017).

2. Implement dietary restrictions such as a low sodium and

low saturated fat diet such as the DASH diet (Saneei,
Hashemipour, Kelishadi, Rajaei, & Esmmaillzadeh, 2013).

3. Promote therapeutic measures such as music therapy to

maintain health (Murrock & Bekhet, 2016).
Nursing Diagnosis #2

Anxiety related to major health status change

as evidence by diaphoresis, respirations of 24
breaths per minute, increased chest
palpitations, heart rate of 110 beats per
minute, and patient stating, “I’m feeling
anxious all the time” and “I’m nervous because
I’ve never had surgery before.”
Short-term goal:

Patient’s respirations will decrease to 18

breaths per minute, heart rate reduced to
85 bpm, and patient will feel comfortable
pursuing with surgery by the end of the
shift.
Interventions:
1. Diffuse three to four drops of lavender oil via humidifier
(Moore, 2013).

2. Encourage patient to participate in deep breathing

exercises by using the incentive spirometer and incorporating
pursed-lips breathing 10 times per hour (Ackley, Madwig, &
Makic, 2017).

3. Eliminate environmental barriers from patient’s room, such

as dimming the lights and reducing non-essential noise
(Ackley, Madwig, & Makic, 2017).
Long-term goal:

Patient will identify, verbalize, and

demonstrate techniques to control
anxiety by time of discharge.
Interventions:
1. Educate the patient on the triggers of anxiety and
how to eliminate these events from daily life (Ackley,
Madwig, & Makic, 2017).

2. Promote the benefits of chamomile tea and have

patient incorporate chamomile tea into meals (Salina,
2015).

3. Encourage the use of therapeutic touch and healing

touch techniques (Ackley, Madwig, & Makic, 2017).
 Patient/Family Education Plan
Patient: Family:
• Medication compliance • Provide brochures on
• DASH DIET pheochromocytoma and potential
• Smoking and alcohol cessation support groups
• Avoid caffeine • Maintain calm environment for the
• Self-monitoring of blood pressure patient at home
• Stress management (exercise, deep • Be involved with scheduling follow-up
breathing, aromatherapy) appointments
• Follow up care and appointments
• After adrenalectomy, educate about
hormone replacement
NCLEX Question #1
A patient is diagnosed with pheochromocytoma. From
your nursing knowledge, you know that the patient will
present with hypertension, diaphoresis, and palpitations
due to excessive catecholamine production from the?
A. Adrenal Cortex
B. Adrenal Zona Fasciculata
C. Adrenal Medulla
D. Adrenal Glomerulosa
NCLEX Question #1 Answer
A patient is diagnosed with pheochromocytoma. From
your nursing knowledge, you know that the patient will
present with hypertension, diaphoresis, and palpitations
due to excessive catecholamine production from the?
A. Adrenal Cortex
B. Adrenal Zona Fasciculata
C. Adrenal Medulla
D. Adrenal Glomerulosa
NCLEX Question #2
When would the RN intervene during the assessment
performed by the student nurse?
A. Auscultating the heart
B. Lightly palpating the abdomen on upper
quadrants
C. Taking blood pressure on both arms
D. Assessing respirations
NCLEX Question #2 Answer
When would the RN intervene during the assessment
performed by the student nurse?
A. Auscultating the heart
B. Lightly palpating the abdomen on upper
quadrants
C. Taking blood pressure on both arms
D. Assessing respirations
References
Ackley, B. J., Ladwig, G. B., & Makic, M. B. F. (2017). Nursing diagnosis handbook: An evidence-based
guide to planning care (11th ed.). Saint Louis, MO: Elsevier, Inc.
Adams, M.P. & Urban, C. Q. (2016). Pharmacology: Connections to nursing practice (3rd ed.). Hoboken,
New Jersey: Pearson Education, Inc. ISBN -13: 978-0-13-392361-2
Elzein, F., Aljaberi, A., AlFiaar, A., & Alghamdi, A. (2016). A large isolated hydatid cyst of the adrenal
gland: A case report and review of the literature. Case Reports in Endocrinology, 2016(4). Retrieved
from http://dx.doi.org/10.1155/2016/9237903
Garg, S. K., Garg, P., & Urumdas, M. (2018). An interesting presentation of pheochromocytoma. Indian
Journal of Critical Care Medicine, 22(1), 40-42. Retrieved from
http://web.a.ebscohost.com.nuls.idm.oclc.org/ehost/pdfviewer/pdfviewer?vid=0&sid=ecbc4d2c
7aef-4504-9ff1-2286c5ee81b1%40sdc-v-sessmgr04.
Ignatavicius, D. D. & Workman, M. L. (2016). Medical-surgical nursing: Patient centered collaborative
care (8th ed.). St. Louis, MO: Elsevier.
References
Murrock, C. & Bekhet, A. (2016). Concept analysis: Music therapy. Research and Theory

for Nursing Practice, 30(1), 44-59. Retrieved from

http://connect.springerpub.com/content/sgrrtnp/30/1/44?sigma-login=has

destination&implicit-login=true.

News Medical Life Sciences. (2018). Adrenal Disorders. Retrieved from https://www.news-medical.net/health/Adrenal-Disorders.aspx.

Salamati, A., Mashouf, S., & Mojab, F. (2017). Effect of inhalation of lavender essential oil on vital signs in open heart surgery icu. Iranian Journal of
Pharmaceutical Research:

IJPR, 16(1), 404-409.

Salina, S. (2015). Chamomile's calming properties may be real. Environmental Nutrition, 38(2), 3. Retrieved from

http://web.a.ebscohost.com.nuls.idm.oclc.org/ehost/detail/detail?vid=0&sid=3e781a83-f203-4a05-9883

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Saneei, P., Hashemipour, M., Kelishadi, R., Rajaei, S., & Esmaillzadeh, A. (2013). Effects of recommendations to follow the dietary approaches to stop

hypertension (DASH) diet v. usual dietary advice on childhood metabolic syndrome: A randomised cross-over clinical trial. The British Journal of

Nutrition, 110(12), 2250-9. doi:http://dx.doi.org.nuls.idm.oclc.org/10.1017/S0007114513001724.

Soltani, A., Pourian, M., & Davani, B. M. (2016). Does this patient have pheochromocytoma? A systematic review of clinical signs and

symptoms. Journal of Diabetes and Metabolic Disorders, 15(6). BioMed Central Ltd. https://doi.org/10.1186/S40200-016-0226-X.

UCSF Department of Surgery. (2018). General Information About Pheochromocytoma and Paraganglioma. Retrieved from

https://surgery.ucsf.edu/conditions--procedures/pheochromocytoma.aspx.