Hyperaldosteronism

Hyperaldosteronism Nursing Care Plans Diagnosis and Interventions

Hyperaldosteronism NCLEX Review Care Plans

Nursing Study Guide on Hyperaldosteronism

Hyperaldosteronism is a condition characterized by excessive production of aldosterone.

Aldosterone is a major mineralocorticoid hormone produced by the adrenal gland, specifically in the zona glomerulosa, the outermost layer of the adrenal cortex.

It plays a role in the regulation of sodium and water in the body, thereby affecting blood pressure.

Hyperaldosteronism can be classified into primary hyperaldosteronism and secondary hyperaldosteronism.

The clinical manifestations are the same for both classifications, but laboratory and diagnostic tests yield different results.

It can range from mild to severe, but it can also be undiagnosed in some cases.

Hyperaldosteronism is estimated to be seen in 10% of cases of hypertension. It is also more prevalent in women than in men.

Signs and Symptoms of Hyperaldosteronism

Hyperaldosteronism is mostly suspected in patients with high blood pressure and low potassium level.

This is because aldosterone works by signalling the kidneys to absorb back sodium and excrete potassium.

Therefore, the signs and symptoms of hyperaldosteronism share similarities with hypokalemia symptoms.

  • High blood pressure
  • Low potassium level
  • The feeling of constant tiredness
  • Headache
  • Muscle weakness
  • Numbness

Causes of Hyperaldosteronism

Many cases of hyperaldosteronism can have different causes.

Primary aldosteronism occurs due to a problem or disorder on the adrenal gland.

The following are the possible reasons:

  • Conn syndrome – this is a rare condition that causes overproduction of aldosterone.
  • Bilateral adrenal hyperplasia
  • Unilateral adrenal hyperplasia
  • Ectopic aldosterone-secreting tumors
  • Aldosterone-producing adrenocortical carcinomas, familial hyperaldosteronism type 1

On the other hand, secondary aldosteronism occurs because of the excessive activation of the renin-angiotensin-aldosterone system (RAAS). The following are the possible causes:

  • Renin-producing tumor
  • Renal artery stenosis
  • Ventricular heart failure
  • Pregnancy
  • Cor pulmonale
  • Cirrhosis with ascites

Complications of Hyperaldosteronism

The most common complication of hyperaldosteronism is the higher risk of developing cardiovascular diseases especially in individuals with hypertension.

The following are the possible complications of hyperaldosteronism:

  1. Problems related to high blood pressure – persistent or prolonged high blood pressure can lead to the following:
  2. Heart attack, heart failure, and other heart problems
  3. Stroke
  4. Kidney disease or kidney failure
  5. Problems related to hypokalemia or low blood potassium level
  6. Weakness
  7. Irregular heart rhythm
  8. Muscle cramps
  9. Excessive thirst and urination

Diagnosis of Hyperaldosteronism

Different tests can be performed to support the diagnosis of hyperaldosteronism.

Additional tests may also be made to identify the possible source of increased aldosterone production.

  • Blood tests – to measure renin and aldosterone level. Having a high aldosterone level and low renin level may suggest primary hyperaldosteronism. Blood testing may also include sodium and potassium levels to identify the degree of effect the disease has on these electrolytes.  Also, it is often noted that the potassium level may be low in people with hyperaldosteronism.
  • Salt-loading test – this test involves the oral intake of a high salt diet for 72 hours. On the third day, a 24-hour urine collection will be taken which will then be subjected to lab testing. Salt loading test can also be done thru blood testing instead of urine sampling.
  • Abdominal CT scan – a scan can help identify the presence of tumors which can be the cause of the increased production of aldosterone.
  • Adrenal vein blood test – this procedure involves the insertion of a small tube in the vein, typically in the groin, which is threaded into the adrenal veins. A blood sample is then taken from the right and left adrenal veins to be tested for aldosterone levels. High aldosterone on one side signifies hyperaldosteronism. 

Reference ranges for aldosterone levels are as follows:

  • Plasma aldosterone, supine position and with normal sodium diet: 2-9 ng/dl (55 – 250 pmol/L)
  • Plasma aldosterone, upright position (standing or seated for at least 2 hours) and with normal sodium diet: 2 to 5 times the supine value
  • Urine aldosterone: 5 – 20 μmg/24 hr (14 – 56 nmol/24 hr)

Treatment of Hyperaldosteronism

The treatment option for hyperaldosteronism is directed to the possible cause of the disease.

The primary goal, however, is to manage the levels of aldosterone in the body to control the signs and symptoms and prevent further complications.

  1. Treatment for adrenal gland tumor
  2. Surgery – Surgical removal of the gland with the tumor is recommended in hyperaldosteronism. This treatment may help settle the signs and symptoms of the disease and completely treat the condition in about 50-70% of cases.
  3. Aldosterone-blocking drugs – medications that can stop the production of aldosterone can be used to treat hyperaldosteronism. These are also the treatment of choice in individuals who are not fit to have surgical removal of the adrenal gland with the tumor. In other cases, hyperaldosteronism is caused by the overactivity of both adrenal glands. Surgery will not be an option since partial removal of the glands will not control hypertension and other symptoms of the disease. Complete removal of the glands can cause Addison’s disease and will require the person with hyperaldosteronism to take corticosteroids for life. Therefore, the use of aldosterone-blocking medication may only be the only option to treat the condition.
  4. Treatment for overactivity of both adrenal glands
  5. Medications – the use of aldosterone-blocking drugs can also be used as a treatment option for individuals with hyperaldosteronism caused by overactivity of both adrenal glands.
  6. Lifestyle changes – medications and other treatments for hyperaldosteronism are more effective when combined with healthy food choices and lifestyle modifications.  

Nursing Care Plans for Hyperaldosteronism

Nursing Care Plan 1

Decreased cardiac output secondary to increased vascular resistance due to hypertension secondary to hyperaldosteronism, as evidenced by high blood pressure level of 170/89, shortness of breath, high aldosterone levels, fatigue and inability to do ADLs as normal

Desired outcome: The patient will be able to maintain adequate cardiac output.

             Interventions                          Rationale
Assess the patient’s vital signs and characteristics of heart beat at least every 4 hours. Observe for signs of decreasing peripheral tissue perfusion such as slow capillary refill, facial pallor, cyanosis, and cool, clammy skin.To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment. The presence of signs of decreasing peripheral tissue perfusion indicate deterioration of the patient’s status which require immediate referral to the physician.
Administer prescribed medications for hypertension and hyperaldosteronism.  The category or type of drugs depend on the average blood pressure reading, underlying conditions, and complications. These include vasodilators (direct or indirect), diuretics, and cardiac workload reducers. The use of aldosterone-blocking drugs can also be used as a treatment option for individuals with hyperaldosteronism caused by overactivity of both adrenal glands.  
Administer supplemental oxygen, as prescribed. Discontinue if SpO2 level is above the target range, or as ordered by the physician.To increase the oxygen level and achieve an SpO2 value within the target range.
Educate patient on stress management, deep breathing exercises, and relaxation techniques.Stress causes a persistent increase in cortisol levels, which has been linked to people with hypertension. Chronic stress may also cause an increase in adrenaline levels, which tend to increase the heart rate, respiratory rate, and blood sugar levels. Reducing stress is also an important aspect of dealing with fatigue.
Encourage healthier food options. Refer the patient to a dietitian as needed.Medications and other treatments for hyperaldosteronism are more effective when combined with healthy food choices and lifestyle modifications. 
Prepare the patient for surgery if indicated.Surgical removal of the gland with the tumor is recommended in hyperaldosteronism. This treatment may help settle the signs and symptoms of the disease and completely treat the condition in about 50-70% of cases.

Nursing Care Plan 2

Nursing Diagnosis: Electrolyte Imbalance related to hypokalemia secondary to hyperaldosteronism as evidenced by serum potassium level of 2.9 mmol/L, high aldosterone levels, polyuria, increased thirst, weakness, tachycardia, and fatigue

Desired Outcome: Patient will be able to re-establish a normal electrolyte and fluid balance.

InterventionRationale
Obtain daily blood sample from the patient.Biochemistry is needed to check for the level of serum potassium
Place the patient on high potassium diet as per the physician’s order.To replace potassium lost by the body. The recommended dietary replacement for potassium is 40 to 60 mEq/L/day.
 Administer a slow intravenous potassium solution as prescribed. A slow intravenous potassium solution is given to raise the potassium level in the blood stream. This must be given at a controlled slow rate as potassium solution may cause a burning sensation on the infusion site.
Start a strict input and output monitoring.To accurately measure the input and output of the patient.
If the patient is on diuretics regimen, switch to potassium-sparing diuretics as prescribed.To achieve the therapeutic goal of diuretics without contributing to further potassium loss.

Nursing Care Plan 3

Nursing Diagnosis: Activity intolerance related to muscular weakness secondary to hyperaldosteronism, as evidenced by fatigue, overwhelming lack of energy, verbalization of tiredness, generalized weakness, and shortness of breath upon exertion

Desired Outcome: The patient will demonstration active participation in necessary and desired activities and demonstrate increase in activity levels.

InterventionsRationales
Assess the patient’s activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try.To create a baseline of activity levels and mental status related to fatigue and activity intolerance.
Encourage progressive activity through self-care and exercise as tolerated. Explain the need to reduce sedentary activities such as watching television and using social media in long periods. Alternate periods of physical activity with 60-90 minutes of undisturbed rest.To gradually increase the patient’s tolerance to physical activity.
Teach deep breathing exercises and relaxation techniques.   Provide adequate ventilation in the room.To allow the patient to relax while at rest and to facilitate effective stress management. To allow enough oxygenation in the room.
Refer the patient to physiotherapy / occupational therapy team as required.To provide a more specialized care for the patient in terms of helping him/her build confidence in increasing daily physical activity.

Other possible nursing diagnosis:

  • Fatigue
  • Acute Pain
  • Risk for Organ Failure (Cardiac or Renal)

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines and policies and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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