Physiological Integrity Q 42

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A client has had a unilateral adrenalectomy to remove a tumor. To prevent complications, the most important measurement in the immediate postoperative period for the nurse to take is:

  

     A. Blood pressure

     B. Temperature

     C. Output

     D. Specific gravity

    

    

Correct Answer: A. Blood pressure

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Blood pressure is the best indicator of cardiovascular collapse in the client who has had an adrenal gland removed. The remaining gland might have been suppressed due to the tumor activity. Primary adrenal insufficiency occurs after bilateral adrenalectomy. Signs and symptoms are volume depletion, hypotension, hyponatremia, hyperkalemia, fever, abdominal pain. Patients are managed by replacement therapy based on glucocorticoids (hydrocortisone or cortisone), mineralocorticoids (fludrocortisone) in cases of confirmed corticoids or aldosterone deficiency, respectively.

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Option B: Temperature would be an indicator of infection. Patients in the adrenal crisis typically present with profoundly impaired well-being, hypotension, nausea and vomiting, and fever responding well to parenteral hydrocortisone administration. Infections are the major precipitating causes of adrenal crisis.

Option C: Decreased output would be a clinical manifestation but would take longer to occur than blood pressure changes. The clinician must be able to work-up and manage patients with adrenal masses, both functional and non-functional, to treat these patients with minimal morbidity. When planning for adrenalectomy, considerations of hormonal changes and preoperative preparation for these changes is as important and demands as much of the surgeon’s attention as the technical aspects of the case.

Option D: Specific gravity changes occur with other disorders. Adrenalectomy has been shown to have a relatively low risk of postoperative complications, with an overall rate of 3.6%. Improved patient outcomes and decreased hospital costs have been demonstrated when adrenalectomy is performed by a high-volume adrenal surgeon (>/=6 adrenalectomies/year).

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