Ward Class

An Online Resource Site For Student Nurses

Welcome

Ward Class is an online resource for student nurses. Created with the aim of helping student nurses cope with the demands of nursing school and clinicals, it offers free downloads, notes, sample NCPs, sample drug studies, study aids, news and updates, and practical tips to its users.

Site Announcement

The December 2012 PRC Nursing Board Exam Result is already available here at Ward Class and at Pinoy R.N.




Endocrine Disorders: Pheochromocytoma

  • a rare catecholamine-secreting tumor usually found in the adrenal medulla that secretes excessive amounts of epinephrine and norepinephrine
  • typically benign, less than 10% of cases are malignant
  • occurs in men and women, usually during the middle age but rarely after age 60
  • cause is unknown but some cases appear to be hereditary
  • complications include cerebral hemorrhage, cardiac failure, and even death
Assessment Findings
  • hypertension (may be persistent, fluctuating, intermittent, or paroxysmal)--> principal manifestation
  • pounding headaches
  • hyperglycemia and glucosuria
  • tachycardia, apprehension, palpitations
  • profuse sweating, cold extremities
  • nausea, vomiting
  • dilated pupils
  • diagnostic tests:
  1. increased levels of plasma catecholamines
  2. increased levels of urinary catecholamines and urinary vanillylmandelic acid (VMA)--> normal levels of urinary catecholamines is up to 14 mg per 100 ml urine while normal urinary VMA levels is less than 7 mg in 24 hours.
  3. presence of tumor on CT and MRI
Medical Management
  • medications are given to patients with pheochromocytoma to control hypertension
Surgical Management
  • the primary treatment of a pheochromocyoma is adrenalectomy or the removal of one or both adrenal glands (depending on tumor location)
Nursing Management
  1. monitor vital signs, especially blood pressure changes-->severe hypertension can precipitate a cerebrovascular accident and/or sudden blindness
  2. administer antihypertensive medications as ordered
  3. promote rest and decrease stressful stimuli--> acute attacks may be precipitated by emotional stress, physical exertion, and change in position
  4. monitor urine tests for glucose and acetone--> clients with pheochromocytoma may present with manifestations of diabetes mellitus
  5. for clients on 24-hour VMA testing--> instruct to avoid vigorous and prolonged exercise and intake of coffee, tea, chocolate, bananas, and vanilla-flavored food at least two days prior to and during urine collection (note: clincians may also order client to stop taking medications like methyldopa, L-Dopa, paracetamol at least three days prior to urine collection as well)
  6. provide high-calorie, well-balanced diet
  7. instruct patient to avoid smokinga nd stimulants like coffee and tea--> may influence catecholamine release
  8. for clients with an adrenalectomy, observe for BP changes-- clients are at risk for shock due to a drastic drop in catecholamine levels
  9. provide client teaching on possibility of lifeslong steroid replacement (for bilateral adrenalectomy)
Prognosis

If pheochromocytoma is discovered early, it can be usually removed surgically. Without early interevention, patients with pheochromocytoma are at risk for cerebral hemorrhage and cardiac failure.

Prevention

There are no known ways to prevent pheochromocytoma. But with early diagnosis and intervention, complications may be prevented.


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