Mr. Bates is admitted to the surgical ICU following left adrenalectomy. He is sleepy but easily aroused. An IV containing hydrocortisone is running. The nurse planning care for Mr. Bates knows it is essential to include which of the following nursing interventions at this time?
A. Monitor blood glucose levels every shift to detect the development of hypo- or hyperglycemia.
B. Keep flat on back with minimal movement to reduce the risk of hemorrhage following surgery.
C. Administer hydrocortisone until vital signs stabilize, then discontinue the IV.
D. Teach Mr. Bates how to care for his wound since he is at high risk for developing postoperative infection.
Correct Answer: A. Monitor blood glucose levels every shift to detect development of hypo- or hyperglycemia.
Hydrocortisone promotes gluconeogenesis and elevates blood glucose levels. Following adrenalectomy, the normal supply of hydrocortisone is interrupted and must be replaced to maintain the blood glucose at normal levels. Care for the client following adrenalectomy is similar to that for any abdominal operation.
Option B: The client is encouraged to change position, cough, and deep breathe to prevent postoperative complications such as pneumonia or thrombophlebitis. Most patients will be able to eat, drink, and walk around normally the day after surgery. If the client has open adrenalectomy, they might have to wait longer to resume eating, drinking, and moving around normally. To prevent blood clots from forming, they’ll be encouraged to walk around as soon as it is safe to do so.
Option C: Maintenance doses of hydrocortisone will be administered IV until the client is able to take it by mouth and will be necessary for six months to two years or until the remaining gland recovers. The patients who have undergone unilateral adrenalectomy become steroid-dependent. Therefore, sufficient replacement of glucocorticoid is needed during the postoperative period.
Option D: The client undergoing adrenalectomy is at increased risk for infection and delayed wound healing and will need to learn about wound care, but not at this time while he is in the ICU. A clinical practice guideline stated that glucocorticoid replacement after surgery is required until the HPA axis recovers and the mean period of replacement is eighteen months after unilateral adrenalectomy.