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Nursing care focuses on supporting the patient through acute episodes of inflammation and teaching measures to prevent future inflammatory attacks. Maintaining patient fluid and electrolyte balance is particularly important. Encourage the patient to drink 3000 mL of fluid per

256 Cushing's Syndrome day, unless it is contraindicated. Implement measures to prevent skin breakdown in the perianal area.

Provide frequent rest periods. Maintain adequate nutritional status using calorie counts. Other measures include assisting the patient with frequent oral hygiene; providing small, frequent meals with rest periods interspersed throughout the day; monitoring intravenous fluids and total parenteral nutrition as prescribed; and noting the patient's serum albumin levels.

Encourage patients to express their feelings and refer them for more extensive counseling as needed. Also, discuss measures to diminish stressful life situations with the patient and family.

• Evidence of stability of vital signs, hydration status, bowel sounds, and electrolytes

• Response to medications; tolerance of foods; ability to eat and select a well-balanced diet, and weight gains or losses

• Location, intensity, and frequency of pain; factors that relieve pain

• Number of diarrheal episodes and stool characteristics

• Presence of complications: Fistulae, skin breakdown, abscess formation, infection

Emphasize measures that will help prevent future inflammatory episodes, such as getting plenty of rest and relaxation, reducing stress, and maintaining proper diet (high protein, low residue). Teach the patient to recognize the signs of incipient inflammatory attacks. Explain all the prescribed medications, including the actions, side effects, dosages, and routes. Be certain the patient understands signs of possible complications, such as an abscess, fistula, hemorrhage, or infection, and the need to seek medical attention if any of them occurs. Caution the patient to be vigilant with skin care, especially in the perianal area. Instruct the patient to assess frequently for breakdown in this area and seek medical attention if it should occur.

Cushing's syndrome is defined as the clinical effects of increased glucocorticoid hormone. It can be characterized by an excess production of glucocorticoids (primarily cortisol) by the cortex of the adrenal gland, but it is most commonly due to therapy with glucocorticoid drugs. Cortisol is an essential hormone for many body functions, including maintaining normal electrical excitation of the heart, blood glucose level, nerve cell conduction, and adequate circulatory volume, and for metabolizing proteins, fats, and carbohydrates.

Overproduction of glucocorticoids leads to a host of multisystem disorders in metabolism, water balance, wound healing, and response to infection. Complications affect almost every system of the body. Increased calcium resorption from bones may lead to osteoporosis and bone fractures. A blunted immune response causes a high risk for infection, as well as poor wound healing. Cushing's syndrome may also mask even life-threatening infections. Gastrointestinal (GI) irritation may lead to peptic ulcers, and both insulin resistance and glucose intolerance can cause hyperglycemia.

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