{
  "name": "Cushing's Disease",
  "slug": "cushings-disease",
  "url": "https://nursingplex.com/care-plans/cushings-disease",
  "category": "Endocrine & Metabolic",
  "summary": "Cortisol excess with fluid retention, fragile skin, hyperglycemia and infection risk.",
  "nursing_diagnoses": [
    "Excess fluid volume",
    "Risk for infection",
    "Disturbed body image",
    "Risk for injury"
  ],
  "overview": [
    "Cushing's syndrome is the clinical picture of chronic glucocorticoid excess; Cushing's disease specifically refers to excess from a pituitary ACTH-secreting adenoma. Exogenous corticosteroid therapy is by far the most common overall cause.",
    "Excess cortisol produces central obesity with thin extremities, moon face, buffalo hump, purple striae, thin fragile skin, easy bruising, muscle wasting, osteoporosis, hyperglycemia, hypertension, hypokalemia, mood disturbance and immunosuppression that masks infection.",
    "Nursing care protects fragile skin and bones, monitors glucose, potassium and blood pressure, guards aggressively against infection, and supports the patient through significant body image change while treatment — surgery, radiation or steroid tapering — takes effect."
  ],
  "key_facts": [
    {
      "label": "Masked infection",
      "text": "Cortisol blunts fever and inflammation; a low-grade temperature or vague malaise may be the only sign of serious infection."
    },
    {
      "label": "Electrolytes",
      "text": "Expect hypernatremia with fluid retention and hypokalemia; monitor for weakness and arrhythmia."
    },
    {
      "label": "Post-adrenalectomy",
      "text": "After surgery patients swing to cortisol deficiency and need lifelong replacement with stress dosing."
    },
    {
      "label": "Never stop steroids abruptly",
      "text": "Exogenous cases must be tapered to avoid adrenal crisis."
    }
  ],
  "nursing_priorities": [
    "Prevent and detect infection early.",
    "Protect skin integrity and prevent fractures and falls.",
    "Manage hyperglycemia, hypertension and fluid overload.",
    "Correct electrolyte imbalance.",
    "Support body image and mood; prepare for surgical management and hormone replacement."
  ],
  "assessment": {
    "subjective": [
      "Reports of weakness, especially rising from a chair or climbing stairs",
      "Complaints of weight gain, appearance change and easy bruising",
      "Reports of mood swings, irritability, depression or insomnia",
      "Reports of increased thirst, urination or slow wound healing",
      "Women may report menstrual irregularity and hirsutism"
    ],
    "objective": [
      "Truncal obesity, moon facies, supraclavicular and dorsocervical fat pads",
      "Thin skin, purple abdominal striae, ecchymoses, poor wound healing",
      "Hypertension, edema, weight gain",
      "Hyperglycemia, hypokalemia, hypernatremia, leukocytosis with lymphopenia",
      "Elevated 24-hour urinary free cortisol, late-night salivary cortisol or failed dexamethasone suppression"
    ],
    "related_factors": [
      "Pituitary ACTH-secreting adenoma or adrenal tumor",
      "Ectopic ACTH production, often from small cell lung cancer",
      "Long-term exogenous corticosteroid therapy",
      "Catabolic effects of cortisol on protein, bone and skin"
    ]
  },
  "goals": [
    "The client will remain free from infection.",
    "The client will maintain intact skin and remain free from fractures and falls.",
    "The client will maintain blood glucose, potassium and blood pressure within target ranges.",
    "The client will express feelings about appearance and identify realistic expectations for reversal after treatment."
  ],
  "interventions": [
    {
      "title": "Infection and safety",
      "points": [
        "Screen for subtle infection signs; check temperature and wound sites regularly.",
        "Use meticulous hand hygiene and limit exposure to ill contacts.",
        "Assess fall risk from proximal muscle weakness and provide assistive devices.",
        "Take fracture precautions: gentle transfers, clutter-free environment, no aggressive physiotherapy."
      ]
    },
    {
      "title": "Skin and metabolic care",
      "points": [
        "Handle skin gently; use paper tape, lift rather than drag, and moisturize.",
        "Inspect skin and bony prominences daily; reposition frequently.",
        "Monitor glucose and administer insulin or oral agents as ordered.",
        "Track blood pressure, weight, intake and output; restrict sodium and provide potassium-rich foods as prescribed."
      ]
    },
    {
      "title": "Psychological and treatment support",
      "points": [
        "Acknowledge distress about appearance and explain that many changes reverse with treatment.",
        "Anticipate mood lability and provide consistent, non-judgmental support.",
        "Prepare the patient for transsphenoidal surgery or adrenalectomy and postoperative steroid replacement.",
        "For exogenous cases, coordinate a slow supervised taper and teach stress-dose rules."
      ]
    }
  ],
  "patient_teaching": [
    "Explain the importance of never stopping corticosteroids abruptly.",
    "Teach infection precautions and to report any fever, cough or wound change promptly.",
    "Review a high-protein, high-calcium, low-sodium, low-carbohydrate diet.",
    "Teach medical-alert identification and stress-dose steroid instructions after adrenal surgery."
  ]
}