NUR 317 L33 addison's disease

interprofess care

- manage underlying cause - hormone therapy - hydrocortisone. increase during periods of stress. fludrocortisone - increase dietary salt intake

clinical manni more

- abd pain - diarrhea - HA - orthostatic hypotension - salt craving - joint pain

etiology secondary

- lack of ACTH - lack of glucocorticoids and androgens

pt teaching

Dosing •Glucocorticoids in divided doses •Mineralocorticoids once in the morning •Reflects normal circadian rhythm •Decreases side effects of corticosteroids •Need to increase corticosteroids during times of stress

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

The patient is alert and oriented. The patient in acute adrenal insufficiency will have the following clinical manifestations: hypotension, tachycardia, dehydration, hyponatremia, hyperkalemia, hypoglycemia, fever, weakness, and confusion. Collaborative care will include administration of corticosteroids. An outcome that would indicate patient improvement would be improved level of consciousness (i.e., alert and oriented).

etiology primary addison's disease

lack of glucocorticoids, mineralcorticoids, and androgens

clinical manni

slow onset: - anorexia - nausea - progressive weakness - fatigue - weight loss - hyperpigmentation disease often advanced before diagnosed

•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? • "The medication prevents sodium and water retention after surgery." • "The drug prevent clots from forming in the legs during your recovery from surgery." • "This medicine is given to help your body respond to stress after removal of the adrenal glands." • "This drug stimulates your immune system and promotes wound healing."

•"This medicine is given to help your body respond to stress after removal of the adrenal glands." Rationale: Hydrocortisone is administered IV during and after a bilateral adrenalectomy to ensure adequate responses to the stress of the procedure.

patho

•80% of cases caused by an autoimmune response -•Antibodies destroy adrenal cortex •Results in a loss of •Glucocorticoid •Mineralocorticoid Adrenal androgen hormones

dx studies: CRH stimulation test

•Abnormal ACTH test response •IV injection of synthetic CRH •Blood drawn after 30 and 60 minutes -•High ACTH levels with no cortisol indicates Addison's disease -•Absence of ACTH or delayed response common in secondary adrenal insufficiency

complications: addisonian crisis

•Acute adrenal insufficiency •Insufficient or sudden, sharp decrease in hormones •Life-threatening Various triggers

Expected effects of corticosteroid therapy

•Antiinflammatory action •Immunosuppression Maintenance of normal BP

dx studies: ACTH stimulation test

•Baseline levels of cortisol and ACTH •IV injection of synthetic ACTH •Levels rechecked after 30 and 60 minutes -•↑ Blood cortisol levels is normal -•Little or no ↑ in cortisol levels in Addison's disease -•High ACTH level in primary adrenal insufficiency

patho: autoimmune polyglandular syndrome

•Co-occurring endocrine conditions •Type 1 diabetes •Autoimmune thyroid disease •Pernicious anemia •Celiac disease •Most common in white females

Corticosteroid Therapy Patient Teaching cont

•Dietary needs •Rest and exercise needs •Sodium restriction if edema occurs •Need to monitor for hyperglycemia •Notify health care provider if epigastric pain develops •Need to prevent injury/infection •Inform all health care providers

Corticosteroid Therapy

•Effective in treating many diseases and disorders •Complications and side effects with long-term use •Potential benefits must be weighed against risks

acute care

•Frequent assessment necessary •Correct fluid and electrolyte imbalance -•Assess vital signs and neurologic status -•Daily weight -•Accurate I and O •Obtain complete medication history •Watch for signs of Cushing syndrome •Guard against infection •Assist with daily hygiene •Protect from extremes -•Light -•Noise -•Temperature

manifestations of addisonian crisis are those of glucocorticoid and mineralocorticoid deficiencies

•Hypotension, tachycardia •Dehydration •↓ Sodium, ↑ potassium, ↓ glucose •Fever, weakness, confusion •Severe vomiting, diarrhea, pain Shock → circulatory collapse

pt teaching

•Report signs and symptoms of corticosteroid deficiency and excess to HCP •Carry identification and wear medical ID bracelet •Emergency kit •How to administer IM hydrocortisone •Written instructions

•Addisonian crisis

•Shock management •High-dose hydrocortisone replacement •0.9% saline solution and 5% dextrose

Corticosteroid Therapy Patient Teaching

•Should be taken in morning with food to reduce gastric irritation •Must not be stopped abruptly •Needs to increase in times of stress •Measures to reduce occurrence of osteoporosis

dx studies

•↑ Potassium •↓ Chloride, sodium, glucose •Anemia •↑ BUN •ECG changes CT scan, MRI

Corticosteroid Therapy Side effects

•↓ Potassium and calcium •↑ Glucose and BP •Delayed healing •Susceptibility to infection •Suppressed immune response •Peptic ulcer disease •Muscle atrophy/weakness •Mood and behavior changes •Moon facies, truncal obesity •Protein depletion •Risk for acute adrenal crisis if therapy is stopped abruptly