Cushing’s Disease Nursing Diagnosis & Care Plan

Cushing’s disease is a condition characterized by excessive cortisol production in the body, typically caused by a pituitary tumor. This nursing diagnosis is crucial for healthcare providers to understand, as it can significantly impact a patient’s overall health and quality of life. Cushing’s disease is often associated with other nursing diagnoses such as altered nutrition, impaired skin integrity, and risk for infection.

Causes (Related to)

Cushing’s disease can result from various factors that lead to excessive cortisol production. The following are common causes of Cushing’s disease:

• Pituitary adenoma: A benign tumor in the pituitary gland that produces excess adrenocorticotropic hormone (ACTH), stimulating cortisol production.
• Exogenous glucocorticoid use: Long-term use of corticosteroid medications for conditions such as asthma, rheumatoid arthritis, or lupus can lead to Cushing’s syndrome.
• Ectopic ACTH-producing tumors: Rarely, tumors outside the pituitary gland (e.g., in the lungs or pancreas) can produce ACTH, leading to Cushing’s syndrome.
• Adrenal gland tumors: In some cases, tumors in the adrenal glands can produce excess cortisol.

Signs and Symptoms (As evidenced by)

Cushing’s disease manifests with a variety of signs and symptoms. During a physical assessment, a patient with Cushing’s disease may present with one or more of the following:

Subjective: (Patient reports)

• Muscle weakness
• Fatigue
• Mood changes (depression, irritability, anxiety)
• Decreased libido
• Menstrual irregularities in women

Objective: (Nurse assesses)

• Weight gain, especially in the face (moon face), upper back (buffalo hump), and abdomen
• Thin, fragile skin that bruises easily
• Purple or red stretch marks on the abdomen, thighs, breasts, and arms
• Acne
• Hirsutism (excessive hair growth) in women
• A rounded, ruddy face
• High blood pressure
• High blood sugar
• Osteoporosis and increased risk of fractures
• Proximal muscle weakness (difficulty rising from a chair or climbing stairs)

Expected Outcomes

The following are common nursing care planning goals and expected outcomes for Cushing’s disease:

• The patient will demonstrate an improved understanding of Cushing’s disease and its management.
• The patient will show signs of improved cortisol levels through laboratory tests.
• The patient will maintain stable blood pressure and blood glucose levels.
• The patient will report reduced symptoms such as muscle weakness and fatigue.

Nursing Assessment

The first step in nursing care is the assessment, during which the nurse will gather physical, psychosocial, emotional, and diagnostic data. The following section covers subjective and objective data related to Cushing’s disease.

1. Obtain a comprehensive health history.
   Review the patient’s medical history, including any long-term use of corticosteroids, previous endocrine disorders, or recent changes in health status.
2. Perform a thorough physical examination.
   Assess for characteristic physical signs of Cushing’s disease, such as central obesity, moon face, buffalo hump, and purple striae.
3. Measure vital signs.
   Monitor blood pressure, heart rate, and temperature. Hypertension is common in Cushing’s disease.
4. Assess skin integrity.
   Examine the skin for thinning, easy bruising, and stretch marks. Note any signs of infection or poor wound healing.
5. Evaluate muscle strength.
   Assess proximal muscle strength, particularly in the legs and arms. Patients may have difficulty rising from a seated position or climbing stairs.
6. Monitor blood glucose levels.
   Check blood glucose regularly, as Cushing’s disease can lead to insulin resistance and diabetes.
7. Assess for mood changes and cognitive function.
   Evaluate the patient’s emotional state and cognitive abilities, as Cushing’s disease can affect mental health and cognition.

Nursing Interventions

Nursing interventions and care are essential for managing Cushing’s disease. In the following section, you’ll learn about possible nursing interventions for a patient with Cushing’s disease.

1. Provide patient education.
   Teach the patient about Cushing’s disease, its causes, symptoms, and treatment options. Explain the importance of medication adherence and follow-up care.
2. Monitor and manage blood pressure.
   Regularly check blood pressure and administer antihypertensive medications as prescribed. Encourage lifestyle modifications to support healthy blood pressure.
3. Assist with blood glucose management.
   Monitor blood glucose levels and administer insulin or oral hypoglycemic agents as ordered. Teach the patient about proper diet and exercise to manage blood sugar.
4. Implement skin care measures.
   Teach the patient proper skin care techniques to prevent breakdown and infection. If mobility is impaired, assist with regular repositioning and the use of pressure-relieving devices.
5. Support muscle strength and mobility.
   Encourage regular, gentle exercise as tolerated. Assist with physical therapy and occupational therapy referrals as needed.
6. Provide emotional support.
   Offer empathetic listening and support for patients dealing with mood changes or body image issues. Facilitate referrals to mental health professionals if needed.
7. Assist with medication management.
   Administer medications as prescribed, which may include cortisol-lowering drugs or hormone replacement therapy. Monitor for side effects and educate the patient on proper use.

Nursing Care Plans

Nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for Cushing’s disease.

Nursing Care Plan 1: Imbalanced Nutrition: More than body requirements

Nursing Diagnosis: Imbalanced Nutrition: More than body requirements related to altered metabolism secondary to hypercortisolism as evidenced by weight gain, central obesity, and increased appetite.

Related factors: Excessive cortisol production, altered metabolism, increased appetite

Nursing Interventions and Rationales:

1. Assess and document the patient’s weight, BMI, and eating habits.
   Rationale: Establishes a baseline and helps monitor progress.
2. Collaborate with a dietitian to develop a balanced, calorie-controlled meal plan.
   Rationale: Ensures proper nutrition while managing weight gain associated with Cushing’s disease.
3. Educate the patient on the importance of portion control and healthy food choices.
   Rationale: Helps the patient to make informed dietary decisions.
4. Encourage regular physical activity as tolerated.
   Rationale: Promotes weight management and improves overall health.
5. Monitor blood glucose levels and educate on diabetes management if applicable.
   Rationale: Cushing’s disease can lead to insulin resistance and diabetes.

Desired Outcomes:

• The patient will demonstrate an understanding of proper nutrition and its role in managing Cushing’s disease.
• The patient will show stabilization or a gradual decrease in weight over time.
• The patient will maintain blood glucose levels within the target range.

Nursing Care Plan 2: Impaired Skin Integrity

Nursing Diagnosis: Risk for Impaired Skin Integrity related to effects of hypercortisolism on skin tissue as evidenced by thin, fragile skin, easy bruising, and presence of striae.

Related factors: Excessive cortisol production, thinning of skin, decreased collagen synthesis

Nursing Interventions and Rationales:

1. Assess skin integrity daily, noting any new bruises, tears, or striae.
   Rationale: Early detection allows for prompt intervention and prevention of complications.
2. Implement a gentle skincare routine, including mild cleansers and moisturizers.
   Rationale: Helps maintain skin hydration and minimizes the risk of skin breakdown.
3. Teach patient strategies to prevent skin injury, such as using padded armrests and avoiding sharp objects.
   Rationale: Reduces the risk of accidental skin tears and bruising.
4. Encourage proper nutrition and hydration to support skin health.
   Rationale: Adequate nutrients and hydration are essential for skin integrity.
5. Apply protective dressings to areas at high risk for breakdown if needed.
   Rationale: Provides additional protection for vulnerable skin areas.

Desired Outcomes:

• The patient will demonstrate improved skin integrity with no new bruising or skin tears.
• The patient will verbalize understanding of skin care techniques and prevention strategies.
• The patient will maintain adequate hydration and nutrition to support skin health.

Nursing Care Plan 3: Activity Intolerance

Nursing Diagnosis: Activity Intolerance related to proximal muscle weakness secondary to hypercortisolism as evidenced by difficulty rising from a seated position and climbing stairs.

Related factors: Muscle wasting due to excessive cortisol, fatigue, altered metabolism

Nursing Interventions and Rationales:

1. Assess the patient’s current level of mobility and strength.
   Rationale: Establishes a baseline for planning interventions and monitoring progress.
2. Collaborate with physical therapy to develop an appropriate exercise plan.
   Rationale: Tailored exercises can help improve muscle strength and overall mobility.
3. Encourage regular rest periods between activities.
   Rationale: Prevents excessive fatigue and allows for energy conservation.
4. Teach energy conservation techniques for daily activities.
   Rationale: Helps patient manage daily tasks despite muscle weakness.
5. Monitor for signs of exertion or distress during activities.
   Rationale: Ensures patient safety and prevents overexertion.

Desired Outcomes:

• The patient will demonstrate gradual improvement in muscle strength and endurance.
• The patient will report decreased fatigue during daily activities.
• The patient will perform activities of daily living with minimal assistance.

Nursing Care Plan 4: Risk for Infection

Nursing Diagnosis: Risk for Infection related to immunosuppression secondary to hypercortisolism as evidenced by delayed wound healing and increased susceptibility to infections.

Related factors: Impaired immune function due to excessive cortisol, altered skin integrity, potential diabetes

Nursing Interventions and Rationales:

1. Assess for signs and symptoms of infection regularly.
   Rationale: Early detection allows for prompt treatment of infections.
2. Implement strict hand hygiene protocols for staff and visitors.
   Rationale: Reduces the risk of pathogen transmission.
3. Educate the patient on infection prevention strategies, including hand washing and wound care.
   Rationale: Assists the patient to take an active role in infection prevention.
4. Monitor blood glucose levels and maintain good glycemic control.
   Rationale: High blood sugar increases the risk of infections.
5. Ensure up-to-date vaccinations as appropriate.
   Rationale: It provides additional protection against preventable infections.

Desired Outcomes:

• The patient will remain free from signs and symptoms of infection.
• The patient will demonstrate proper hand hygiene and wound care techniques.
• The patient will maintain blood glucose levels within the target range.

Nursing Care Plan 5: Disturbed Body Image

Nursing Diagnosis: Disturbed Body Image related to physical changes associated with Cushing’s disease as evidenced by verbalization of dissatisfaction with appearance and avoidance of social situations.

Related factors: Weight gain, facial rounding, hirsutism, striae

Nursing Interventions and Rationales:

1. Assess the patient’s perception of body image and its impact on daily life.
   Rationale: Provides insight into the patient’s emotional state and coping mechanisms.
2. Provide empathetic listening and encourage expression of feelings.
   Rationale: Validates the patient’s emotions and builds trust.
3. Educate on the temporary nature of some physical changes and potential improvements with treatment.
   Rationale: Offers hope and motivation for adherence to treatment plan.
4. Collaborate with mental health professionals for additional support if needed.
   Rationale: Addresses deeper psychological impacts of body image disturbance.
5. Teach strategies for managing appearance-related concerns (e.g., skincare, grooming techniques).
   Rationale: Empower the patient to take control of their appearance within their abilities.

Desired Outcomes:

• The patient will verbalize improved acceptance of body image.
• The patient will demonstrate increased participation in social activities.
• The patient will utilize positive coping strategies to manage body image concerns.

References

1. Nieman, L. K. (2020). Cushing’s syndrome: Update on signs, symptoms and biochemical screening. European Journal of Endocrinology, 183(1), R45-R57.
2. Pivonello, R., Isidori, A. M., De Martino, M. C., Newell-Price, J., Biller, B. M., & Colao, A. (2016). Complications of Cushing’s syndrome: state of the art. The Lancet Diabetes & Endocrinology, 4(7), 611-629.
3. Sharma, S. T., Nieman, L. K., & Feelders, R. A. (2015). Cushing’s syndrome: epidemiology and developments in disease management. Clinical Epidemiology, 7, 281-293.
4. Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, and outcomes. Elsevier Health Sciences.
5. Herdman, T. H., & Kamitsuru, S. (Eds.). (2018). NANDA International nursing diagnoses: Definitions & classification 2018-2020. Thieme.
6. Lacroix, A., Feelders, R. A., Stratakis, C. A., & Nieman, L. K. (2015). Cushing’s syndrome. The Lancet, 386(9996), 913-927.