MEDICAL SURGICAL NURSING: ENDOCRINE 1.8.12
NURSE ANGIE 2018
Adrenal cortex disorders: Addison’s Disease
Adrenal insufficiency characterized by decreased secretion of adrenal cortex hormones.
Pathophysiology
Assessment
Addison's disease is caused by too little or absent cortisol release from the adrenal cortex.
Remember in Addison’s disease you add cortisol. Patients will also have low sodium and increased
potassium levels.
Medications that can
cause a need to increase
glucocorticoid dosage
‣ phenytoin (dilantin),
barbiturates, rifampin
‣ (Rifadin), and antacids. in
addition estrogen inhibits
steroid metabolism
H: Hypotension
E: Emaciation
S: Serum sodium and glucose
low
T: Tan skin
A: Alopecia
N: No feelings (depression)
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Treatments
Hydrocortisone IV
5% dextrose in normal saline
Vasopressors
Antibiotics
Laboratory Findings:
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Skull films
CT
MRI
Elevated potassium levels
Plasma cortisol will be low
ACTH stimulation test
Urinary hydrocortisone and ketocorticoids will decrease
CAUSES
‣ Autoimmune disease
‣ Infections such
tuberculosis, HIV, or
fungal infections.
‣ Hemorrhage into the
adrenal glands
Complications
INTERVENTIONS
Education
‣ Monitor vital signs esp. HR and
rhythm and intake and output.
‣ Monitor WBC count.
‣ Monitor sodium, potassium and
glucose levels.
‣ High protein diet, high carbs and
high sodium and low potassium
diet. Avoid OTC.
‣ Monitor addisonian crisis caused
by stress, trauma or infection.
‣ Client will need life long
corticosteroid therapy.
‣ Adverse effects of
corticosteroid therapy
and prevention
techniques
‣ Special instruction for
patients who are
diabetics and
management of blood
glucose when taking
corticosteroids
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‣ ADDISONIAN CRISIS :
‣ Acute adrenal insufficiency
‣ Assessment: severe
Hypotension, shock, severe
lower back, abdominal and
leg pain. Severe headache.
‣ Interventions: prepare to
administer glucocorticoids
IV, hydrocortisone
succinate. Then oral
glucocorticoids and
mineralocorticoids. Monitor
BP and neuro status,
monitor I&O, monitor
sodium, potassium, and
glucose. IV fluids, bed rest
and quiet environment.
Prevent infection.
NCLEX PRACTICE
NURSE ANGIE 2018
CASE STUDY
Questions
1. A patient with Addison's disease comes to the
emergency department with complaints of
nausea, vomiting, diarrhea, and fever. What
collaborative care should the nurse expect?
2. During discharge teaching for the
patient with Addison's disease, which
statement by the patient indicates
that the nurse needs to do additional
teaching?
a. IV administration of vasopressors
b. IV administration of hydrocortisone
c. IV administration of D5W with 20 mEq KCl
d. Parenteral injections of adrenocorticotropic
hormone (ACTH)
a. "I should always call the doctor if I develop vomiting
or diarrhea."
b. "If my weight goes down, my dosage of steroid is
probably too high."
c. "I should double or triple my steroid dose if I
undergo rigorous physical exercise."
d. "I need to carry an emergency kit with injectable
hydrocortisone in case I can't take my medication by
mouth."
ANSWERS AND EXPECTED FINDINGS
1.
Answer: b. Vomiting and diarrhea are early indicators of Addisonian crisis and fever indicates an infection, which is
causing additional stress for the patient. Treatment of a crisis requires immediate glucocorticoid replacement and IV
hydrocortisone, fluids, sodium, and glucose are necessary for 24 hours. Addison's disease is a primary insufficiency of the
adrenal gland and adrenocorticotropic hormone (ACTH) is not effective, nor would vasopressors be effective with the
fluid deficiency of Addison's disease. Potassium levels are increased in Addison's disease and KCl would be
contraindicated.
2.
Answer b. A weight reduction in the patient with Addison's disease may indicate a fluid loss and a dose of replacement
therapy that is too low rather than too high. Because vomiting and diarrhea are early signs of crisis and because fluid and
electrolytes must be replaced, patients should notify their health care provider if these symptoms occur. Patients with
Addison's disease are taught to take two to three times their usual dose of steroids if they become ill, have teeth
extracted, or engage in rigorous physical activity and should always have
injectable hydrocortisone available if oral doses cannot be taken.
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