[adrenal + -ectomy]
Excision of one or both adrenal glands.
Vital signs, central venous pressure, and urine output must be monitored frequently. Signs and symptoms of hypocorticism must be assessed hourly for the first 24 hr; significant changes must be reported to the surgeon immediately. Additional IV glucocorticoids are given as prescribed. The patient must be monitored for early indications of shock or infection and for alterations in blood glucose and electrolyte levels. To counteract shock, IV fluids and vasopressors must be administered as prescribed, and the patient's response evaluated every 3 to 5 min. Increased steroids to meet metabolic demands are needed if additional stress, e.g., infection, occurs. Other medications, including analgesics, are given as prescribed, and the patient's response is evaluated. The room must be kept cool and the patient's clothing and bedding changed often if he or she perspires profusely (a side effect of surgery on the adrenal gland). The abdomen must be assessed for distention and return of bowel sounds. Physical and psychological stresses must be kept to a minimum. Steroid medications may not be needed or may be discontinued in a few months to a year after unilateral adrenalectomy, but lifelong replacement therapy will be needed after bilateral adrenalectomy. The patient must learn to recognize the signs of adrenal insufficiency, that sudden withdrawal of steroids can precipitate adrenal crisis, and that continued medical follow-up will be needed so that steroid dosage can be adjusted during stress or illness. Patients should take steroids in a two-thirds a.m. and one-third p.m. dosing pattern to mimic diurnal adrenal activity, with meals or antacids to minimize gastric irritation. Adverse reactions to steroids, e.g., weight gain, acne, headaches, diabetes, and osteoporosis, must be explained.
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