Cushing's Disease Nursing Care Plan
Cortisol excess with fluid retention, fragile skin, hyperglycemia and infection risk.
Quick answer
A Cushing's Disease nursing care plan centers on prevent and detect infection early; protect skin integrity and prevent fractures and falls; manage hyperglycemia, hypertension and fluid overload. Priority nursing diagnoses are Excess fluid volume, Risk for infection, Disturbed body image, Risk for injury. The plan below gives assessment cues, measurable goals, 3 intervention sets with rationales, and patient teaching.
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 numbers to know
Masked infection
Cortisol blunts fever and inflammation; a low-grade temperature or vague malaise may be the only sign of serious infection.
Electrolytes
Expect hypernatremia with fluid retention and hypokalemia; monitor for weakness and arrhythmia.
Post-adrenalectomy
After surgery patients swing to cortisol deficiency and need lifelong replacement with stress dosing.
Never stop steroids abruptly
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.
Nursing assessment
Subjective data
- 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 data
- 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
Key nursing diagnoses
Goals and expected outcomes
- 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.
Nursing interventions and rationales
Infection and safety
- 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.
Skin and metabolic care
- 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.
Psychological and treatment support
- 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 and family 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.
How to build this plan
- 1Assess the patient. Collect subjective and objective data through interview, physical assessment, labs and chart review. Complete, accurate data is the foundation of every later step.
- 2Analyze and cluster the data. Group related cues, compare them with normal findings, and identify patterns that point to actual or potential problems.
- 3Formulate nursing diagnoses. Write the problem statement using a recognized diagnostic label plus related factors and evidence (problem related to cause as evidenced by signs).
- 4Set priorities. Rank diagnoses as high, medium or low using ABCs, Maslow's hierarchy and the patient's own stated priorities. Life-threatening problems come first.
- 5Establish goals and outcomes. Write SMART, patient-centered outcomes: specific, measurable, attainable, realistic and time-bound (short-term and long-term).
- 6Select nursing interventions. Choose independent, dependent and collaborative actions that are safe, evidence-based and matched to the outcome.
- 7Provide rationales. State the scientific reason each intervention works. Rationales are what turn a task list into clinical reasoning.
- 8Evaluate the plan. Compare the patient's actual response with the expected outcome: met, partially met or not met — then continue, revise or discontinue.
- 9Document and communicate. Record the plan and the patient's response in the health record so the whole team works from the same information.
Summarized for study use. Always follow your school's or facility's approved care plan format and current clinical policy.
Practice Cushing's Disease questions
These concepts are tested on the ATI proctored exams below — every set has answers and rationales.
More Endocrine & Metabolic care plans
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Care plan writing guides
Common questions
What are the nursing diagnoses for Cushing's Disease?
Priority nursing diagnoses for Cushing's Disease: Excess fluid volume; Risk for infection; Disturbed body image; Risk for injury.
What are the nursing interventions for Cushing's Disease?
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. Handle skin gently; use paper tape, lift rather than drag, and moisturize. Inspect skin and bony prominences daily; reposition frequently.
What are the nursing care goals for Cushing's Disease?
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.
What should you assess in a patient with Cushing's Disease?
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; 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
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