a nurse is caring for a client who has pheochromocytoma
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hey everyone its sarah thread sterner sorry and calm and in this video Im going to be doing an intellect review over pheochromocytoma this video is part of an Inc Lex review series over the endocrine system so if youre studying that system be sure to check out my other videos so what Im going to do in this video is Im going to talk about the path oh the signs and symptoms the nursing interventions and how this condition is diagnosed and as always over here on the side or in the description below you can access the resources that go along with this lecture such as the quiz so lets get started first lets start out talking about what is pheochromocytoma what is this big long word well this condition is where a tumor is found on the adrenal medulla that secretes excessive amount of catecholamines so lets dive into the pathophysiology lets look and see whats going on in this condition and help us do this lets look at the key players that play a role in this condition okay the first key player is the adrenal glands you have two adrenal glands that set on top of your kidneys you have a Riyad renal gland and your left adrenal gland and here is your adrenal gland if you sliced it in half and what you have as your outer layer is the cortex the adrenal cortex and in the middle layer is your adrenal medulla and that is what we are interested in in this particular lecture because this is where your tumors are and inside your adrenal medulla our cells and these cells are called chromaffin cells and this is what actually secretes those catecholamine so lets talk a little bit about the adrenal medulla the adrenal medulla via the chromaffin cells secrete catecholamines and it secretes epinephrine which is also called adrenalin norepinephrine which is also known as noradrenaline and low amounts of dopamine in response to your bodys sympathetic nervous system once your sympathetic nervous system it is where it stimulates your body to fight or fly its like whenever you were walking in the woods you see a easily bear what whenever you see that your body processes that its going to secrete these catecholamines to get you out of there and save your life and it does all this through those chromaffin cells now what are the chromaffin cells theyre found in the adrenal medulla and they are the these cells are the ones that were actually secrete the catecholamines and this is what your tumor tends to be made up of in pheochromocytoma these tumors tend to be benign not malignant usually and they are also found in other places in the body such as the heart the head the neck the bladder the spine and abdomen and these can turn into tumors in these areas but if they develop in tumors in those areas thats not called a pheochromocytoma its called a paraganglioma so if you develop that there that is what that is called now lets talk a little bit about these catecholamines because that is the big problem with this whole issue with pheochromocytoma you have excessive amounts of catecholamines particularly norepinephrine and epinephrine being secreted in the body and its wreaking havoc on your body so catecholamines play a huge role in how the organs and tissues work it plays a role from your heart to your glucose to everything and again its produced whenever your sympathetic nervous system is stimulated so what does it do normally these are normally good things that it does in the body whenever we need that fight-or-flight response for instance back to the woods analogy whenever walking in the woods we see a grizzly bear we want our body to respond properly by doing these following things to get us out of danger so what it does is that it increases our heart rate and blood pressure why do we want that we need all of that extra blood flow which is going to be rich in oxygen to go to our muscles in our body to run and get out of there and help us with our breathing so we can run away from that bear another thing is its going to increase our glucose the liver is going to release its stores of glucose through many processes like gluconeogenesis and were going to get some glucose because we were going to need it our cells are going to need it because were going to be running and trying to get away also increases fat metabolism which which is going to be broken down for fuel again well need that its going to increase our basal metabolic rate help us burn some calories its going to increase thermogenesis which is going to increase the body temperature and its going to make us feel fear and anxiety which is a good thing in the case of seeing the grizzly bear so that gets us out of the forest in a
way so it determines how were going to respond to danger but with pheochromocytoma these people arent in the woods seeing a grizzly bear theyre just living life normally and they will get these symptoms which well go over here in a second on them whenever they dont necessarily need them a lot of times what happens that patient will present to the ER over and over with extremely high blood pressure theyre feeling an impending doom anxious scared and first maybe physician doesnt know what it is they attributed it to an anxiety attack or something like that and then they decide to look further into this and they see that the patient has a pheochromocytoma which well go over in the diagnosing part so um these patients can develop more than one tumor in an adrenal gland and it can be in one or both of them it tends to be in one adrenal gland most commonly the cause of pheochromocytoma tends to be a genetic disposition and it tends to be found early to middle age okay so what are your signs and symptoms of this condition what do you need to know for NCLEX says nursing lecture exam the big signs and symptoms okay to help you remember them remember the mnemonic fight and flight because thats going to help you remember hey this is the sympathetic nervous system norepinephrine and epinephrine going on here its causing us to fill these symptoms and this patient litter is in fight-or-flight mode because theyre releasing all those catecholamines to help from this tumor so f-for facial flushing this is from the excessive hypertension the biggest things what youre going to see in pheochromocytoma thats going to cause the biggest problem is hypertension they can go into a hypertensive crisis so thats the biggest issues and these little asterisks at your seam and purplish red is the most common signs and symptoms okay the other F is fluttering in the chest also called palpitations feel their heart racing they will have I for increased heart rate and blood pressure huge that will be one of the biggest hell tell signs now also G for glucose will be high hyperglycemia why because thats what catecholamines do anyways they increase the blood sugar so theyll have hyperglycemia age for headaches these will be sudden they can come in episodes and they will be severe again this is really due to that increased blood pressure going on in the body t4 trimmers f4 frequent sweating and again this is because they have increased thermogenesis going on they have an increased metabolic rate going on and they have that high blood pressure so theyre going to have episodes of sweating for no apparent reason l4 loss of weight because catecholamines burn calories I for increase anxiety and fear that again is tied back to water body wants us to do if we do see danger wants us to feel scared and anxious and here these patients even though they have nothing stimulating them to feel that way they will feel that because well this tumor is causing the catecholamines to do G and they may have a growing tumor from in these adrenal glands that will grow and put pressure on abdomen which can cause pressure or pain h4 heat intolerance and t4 tired and weight just from that constant stimulation the anxiety the high blood pressure their heart rate racing now these signs and symptoms can come in episodes and can be triggered by certain things such as eating foods with tyramine contribute Irene plays a role in blood pressure regulation so um food that they may report that they a cause an episode of those signs and symptoms are foods that are aged fermented or pickled like cheeses wine specifically red wine smoked dried meats banana sauerkraut chocolate can trigger that also any type of surgery trauma physical trauma to the body injury emotional stress or medications like monoamine oxidase inhibitors can trigger signs and symptoms to cause that tumor to start secreting excessive amounts of catecholamines now how is this diagnosed from a nursing standpoint just need to be aware of this because one way this is diagnosed is through a 24-hour urine and if the patients hospitalized or will be going home with this youll need to educate them how to do that and 24 hour urine will look for catecholamines and meta nephrons men and Efrain is a our metabolites formed from when the body breaks down catecholamines so if you have excessive amounts of those in the urine chances are youre dealing with a tumor that is releasing catecholamines like in pheochromocytoma now this is high what will happen is that the doctor will want to further evaluate this may order a MRI or a CT scan of the adrenal glands to look for the tumor on the adrenal glands another thing also ordered is a blood test to measure those med nephrons okay so what is the treatment for pheochromocytoma and then well get into nursing
interventions okay treatment typically tends to be an adrenalectomy this is where they remove the adrenal gland it can be bilateral where they really remove both if theres tumors in both of them or unilateral where they just remove one and typically with this and from a nursing standpoint you need to know that patients may be prescribed by the doctor a an alpha at anergic blocker and the reason for this think back to this why would they prescribe them this pre-op usually about ten days of three weeks before their surgery because these patients are dealing with major blood pressure issues so this medication will help bring that blood pressure down and prevent a hypertensive crisis of the patient entering that during surgery now two nursing interventions what are you going to do for this patient okay the first thing you want to do is you want to monitor their bottle signs very closely because remember these patients are going to have theyre going to be tachycardic and theyre going to be hypertensive so you want to be making sure youre checking them regularly also you want to monitor them to make sure theyre not entering into whats called hypertensive crisis this is where the systolic would be greater than 180 or the diastolic greater than 120 for a long period of time because this causes major problems and damage to the kidneys the eyes the brain and the heart and signs and symptoms of this could be a headache vision changes neuro status changes in seizure another thing which goes along with that all that high blood pressure pounding on that heart and Pitts in that risk for developing a my cardial infarction so you want to make sure youre watching make sure they need to report chest pain if they start having any or neuro status changes because theyre at risk for stroke EKG changes and watching that blood sugar for hyperglycemia also because this patient remember has those constant catecholamines being release its caught causing them to be heat and tolerant they feel anxious very fearful they need a calm cool environment to keep them not from being overstimulated because if they get stimulated with this they will and their blood pressure will shoot up even higher and their heart rate which will cause problems so we want to keep it keep them calm another thing per doctors order if theyre going to go for an adrenalectomy and like I discussed earlier usually whats prescribed pre-op tably preoperatively is called an alpha at an Arctic blocker some of these drugs include like card or a mini press Hytrin and how this drug works is that it blocks norepinephrine whenever you block that that decreases those catecholamines which in turn is going to give you decrease that blood pressure so this will help decrease the blood pressure whenever they go for surgery itll prevent them from entering into a hypertensive crisis during surgery however with this medication the ALF a detergents you want to watch for reflex tachycardia because what happens is that when this blood pressure decreases because remember it is blocks norepinephrine the bodys going to try to compensate for that decrease of blood pressure so itll cause tachycardia reflex tachycardia as a response that decreased blood pressure and it can also cause orthostatic hypotension so a lot of times once the blood pressure gets under control the physician may order a beta blocker along with this like labetalol or inderal to help with that tachycardia they may get and to also help decrease that blood pressure so what you want to do is a nurse you want to monitor them their blood pressure and heart rate make sure theyre responding normally to that and other education issues and things you want to watch out for while theyre hospitalized you wanna make sure that theyre getting a good high-calorie diet because remember theyre burning calories and fat like crazy so we need to make sure were giving their body proper nutrition no caffeine energy dreams are smoking because these cause vasoconstriction we got enough of that going on in the body right now so we want to make sure they avoid that and if theyre going for their adrenal ectomy you just want to make sure that theyre aware that depending on if they had had a bilateral or unilateral theyre going to be on hormone replacement therapy so if theyre going to go for a bilateral adrenalectomy where theyre removing both adrenal glands theyll have to be on glucocorticoids and mineral corticoids for life if theyre just having one removed with a unilateral adrenalectomy theyll need to be on glucocorticoids for up to two two years so that is an Inc Lex review about pheochromocytoma now go to my website register nurse orange calm and take that free quiz I will test your knowledge on this lecture and be sure to check out the other videos in this series and thank you so much for watching and please consider subscribing to this YouTube channel
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