N201 Week 6 Addison's Disease

Watch for signs of Cushing's syndrome once we incorporate corticosteroids. What are the signs? (3)

Increased BP Weight gain Weakness

The nurse administers corticosteroids to a patient with acute adrenal insufficiency. The nurse determines that treatment is effective if what is observed? a. the patient is alert and oriented b. the patient's lung sounds are clear c. the patient's urinary output decreases d. the patient's potassium level is 5.7 mEq/L

a. the patient is alert and oriented

Manifestations of hypoglycemia

altered LOC; confusion

Addison's is not evident until how much of the adrenal cortex is destroyed?

90%

ACTH Stimulation test...IV injection of synthetic ACTH....little or no increase in cortisol levels indicate what?

Addison's Disease

Manifestations of Addison's (5)

Hypotension Tachycardia Dehydration Decreased Sodium and Glucose Increase potassium

Pt. has low sodium and high sugar. What can we give?

D5% in NS

Diagnostic Tests (K, Na, Ca, WBC, BUN/Crea)

K: increased Ca: increased WBC: increased BUN/Crea: increased Na: decreased

Which of the following patients is priority? a. patient with Cushing's with a sugar of 344 mg/dL b. a patient with Addison's disease with a BP of 80/55 mm Hg c. a patient with hyperthyroidism with elevated T3 and T4 d. a patient with hypothyroidism with elevated TSH

b. a patient with Addison's disease with a BP of 80/55 mm Hg

What is the priority finding to report for a patient who was taking 50 mg of prednisone for the last 3 weeks? a. blood in the urine and pain during urination b. patient left her purse with her medications at home during vacation c. weight gain d. craving for salty sugary food

b. patient left her purse with her medications at home during vacation

An IV hydrocortisone infusion is started before a patient is taken to surgery for a bilateral adrenalectomy. Which explanation, if given by the nurse, is most appropriate? a. "The medication prevents sodium and water retention after surgery." b. "The drug prevent clots from forming in the legs during your recovery from surgery." c. "This medicine is given to help your body respond to stress after removal of the adrenal glands." d. "This drug stimulates your immune system and promotes wound healing."

c. "This medicine is given to help your body respond to stress after removal of the adrenal glands."

A patient is one day post bilateral adrenalectomy. Which of the following requires immediate attention of the nurse. a. nausea and vomiting b. 6/10 surgical incision pain c. BP of 84/50 mm Hg d. RBS of 140 mg/dL

c. BP of 84/50 mm Hg

Sodium restriction if what occurs?

edema

During bilateral adrenalectomy, what do you expect to happen to the dose of hydrocortisone?

increase dose (increase corticosteroids during times of stress)

Addison's disease has high or low potassium?

increased

Addisonian crisis

insufficient or sudden, sharp decrease in hormones

Clinical manifestations of Addison's (4) (Na, Glucose, K, BP)

orthostatic hypotension hyponatremia hypoglycemia hyperkalemia

Corticosteroid therapy can cause what? (5) ( (1) GI, (2) Musculo., (1) Face, (1) Neuro.)

peptic ulcer disease muscle atrophy weakness moon face mood changes

Gradual onset of Addison's Disease (5)

progressive weakness fatigue weight loss anorexia hyperpigmentation

What is one trigger of Addisonian Crisis?

sudden cessation of corticosteroid treatment

What is the purpose of giving pts. with Addison's D5NS ?

to treat hypotension and electrolyte imbalances until BP returns to normal

Addison's disease

too little cortisol (Steroids)

Are pts. with Addison's at higher risk for dysrhythmias due to increased potassium levels?

yes

Is Addisonian crisis life threatening?

yes

We increase sodium intake for pts. with Addison's?

yes