A. General
information
1.
Primary adrenocortical insufficiency; hypofunction of
the adrenal cortex causes decreased secretion of the mineralocorticoids,
glucoccorticoids, and sex hormones
2.
Relatively
rare disease caused by
a.
Idiopathic atrophy of the adrenal cortex; possibly
due to an autoimmune process
b.
Destruction of the gland secondary to tuberculosis or
fungal infection
B. Assessment
findings
1.
Fatigue, muscle weakness
2.
Anorexia, nausea, vomiting, abdominal pain, weight
loss
3.
History of frequent hypoglycemic reactions
4.
Hypotension, weak pulse
5.
Bronzelike pigmentation of the skin
6.
Decreased capacity to deal with stress
7.
Diagnostic tests: low cortisol levels, hyponatremia,
hyperkalemia, hypoglycemia
1.
Administer hormone replacement therapy as ordered
a.
Glucocorotoids (cortisone, hydrocortisone): to
simulate diurnal rhythm of cortisol release, give 2/3 of dose in early morning
and 1/3 dose in afternoon
b.
Mineralocorticoids: fludrocortisone acetate
(Florinef)
2.
Monitor vital signs
3.
Decrease stress in the environment
4.
Prevent exposure to infection
5.
Provide rest periods; prevent fatigue
6.
Monitor I & O
7.
Weigh daily
8.
Provide small, frequent feedings of diet high in
carbohydrates, sodium, and protein to prevent hypoglycemia and hyponatremia and
provide proper nutrition
9.
Provide client teaching and discharge planning
concerning
a.
Disease process; signs of adrenal insufficiency
b.
Use of prescribed medications for lifelong
replacement therapy; never omit medications
c.
Need to avoid stress, trauma, and infections, and to
notify physician if these occur as medication dosage may need to be adjusted
d.
Stress management techniques
e.
Diet modification (high in protein, carbohydrates,
and sodium)
f.
Use of salt tablets (if prescribed) or ingestion of
salty foods (potato chips) if experiencing
g.
Importance of alternating regular exercise with rest
periods
h.
Avoidance of strenuous exercise especially in hot
weather
A. General
information
1.
Severe exacerbation of Addison’s disease caused by
acute adrenal insufficiency
2.
Precipitating factors
a.
Strenuous activity, infection, trauma, stress failure
to take prescribed medications
b.
Latrogenic: surgery on pituitary or adrenal glands,
rapid withdrawal of exogenous steroids in a client on long-term steroid therapy
B.
Assessment findings: severe generalized muscle
weakness, severe hypotension, hypovolemia, shock (vascular collapse)
C.
Nursing interventions
1.
Administer IV fluids (5% dextrose in saline, plasma)
as ordered to treat vascular collapse
2.
Administer IV glucocoricoids (hydrocortisone
[Solu-Cortef]) and vasopressors as ordered
3.
If crisis precipitated by infection, administer
antibiotics as ordered
4.
Maintain strict bed rest and eliminate all forms of
stressful stimuli
5.
Monitor vital signs, I & O, daily weights
6.
Protect client from infection
7.
Provide client teaching and discharge planning are
the same as for Addison’s disease