NR 452 /NR 452 METABOLIC AND ENODCRINE DISORDERS STUDY GUIDE. LATEST. Addisons Disease
Overview
1. Hyposecretion of adrenal cortex hormones
2.
... [Show More] Decreased levels of glucocorticoids and mineralocorticoids leads to
a. Electrolyte imbalances
b. Decreased vascular volume
3. Fatal if untreated
Nursing Points
General
1. Adrenal Cortex
a. Glucocorticoids
i. Cortisol
ii. Glucose & Fat Metabolism
iii. Anti-inflammatory
b. Mineralocorticoids
i. Aldosterone
ii. Regulate fluid and electrolytes
c. Sex hormones (Androgens)
i. Testosterone, Estrogen
ii. Control physical features
iii. Control hair distribution
2. Adrenal Medulla
a. Epinephrine (Adrenaline)
b. Norepinephrine (Noradrenaline)
c. Fight or Flight Response
Assessment
1. Cardiovascular
a. Hypotension
b. Tachycardia
2. Metabolic
a. Weight loss
3. Integumentary
a. Hyperpigmentation (bronzing)
4. Electrolytes
a. Hyperkalemia
b. Hypercalcemia
c. Hyponatremia
d. Hypoglycemia
5. Addisonian Crisis
a. Acute exacerbation
b. Severe electrolyte disturbance
Therapeutic Management
1. Replace adrenal hormones
a. Corticosteroids
i. Hydrocortisone
ii. Prednisone
2. Addisonian Crisis
a. Monitor electrolytes and cardiovascular status closely
b. Administer adrenal hormones as ordered
c. Administer electrolyte replacement as needed
Nursing Concepts
1. Fluid & Electrolytes
a. Monitor Vital Signs
b. Monitor electrolytes (potassium, sodium, calcium)
c. Replace electrolytes as needed
2. Hormone Regulation
a. Administer replacement adrenal hormones as needed
b. Lifelong medication therapy needed
3. Glucose Metabolism
a. Monitor glucose levels
b. Treat low blood sugar
Patient Education
1. Increase salt and water intake if exercising
2. S/s of Addisonian Crisis
3. May require increased medication dosing if ill, notify provider
Addisons Assessment
STEROID
S-Suagar and sodium low
T-Tired and muscle weakness
E-Electrolyte imbalance of high Potassium and high Calcium
R-Reproductive change
O-lOw blood pressure
I-Increased pigmentation of the skin
D-Diarrhea and nausea, Depression
Adrenal Gland Hormones
The 3 S's
S-Sugar (Glucocorticoids)
S-Salt (Mineralcorticoids)
S-Sex (Androgens)
Addison’s Disease (Primary Adrenal Insufficiency)
The adrenal glands, located above the kidneys, fail to produce an adequate amount cortisol,
aldosterone or androgens. Cortisol is a glucocorticoid that influences the body’s ability to
respond to stress and produce energy. Aldosterone is a mineralocorticoid that maintains the
sodium-potassium balance that regulates blood pressure. Androgens are responsible for sexual
development of men and the influence of muscle mass and sense of well-being in men and
women.
A decrease in adrenal gland function may be caused by an autoimmune disease that damages the
adrenal glands in which the body attacks the adrenal glands as if they were a foreign body.
Damage to these glands may also be a result of severe infection of the adrenal glands,
tuberculosis, or the spread of cancer.
maintain adequate hormone levels for optimized ability to create energy and respond to stress
and electrolyte balance to regulate blood pressure
Subjective Data
Fatigue
Lower back / leg pain
Abdominal pain
Irritability / depression
Reports significant weight loss
Objective Data
Decreased blood pressure
Electrolyte imbalance
o Decreased sodium
o Increased potassium
Severe vomiting, diarrhea
o Dehydration
Loss of consciousness
Nursing Intervention(ADPIE) Rationale
Monitor weight Lack of appetite due to decreased levels of cortisol may cause
significant decrease in body weight
Encourage oral fluids
Deficiency of cortisol may lead to anorexia and impaired GI
function. Encourage oral fluids to help maintain adequate
sodium levels and avoid dehydration.
Minimize stress and assist with
activities / provide rest periods
Simple stress and overexertion can cause a life-threatening
Addisonian crisis due to lack of corticosteroids that help the
body react to and manage stress.
Monitor nutrition
Aldosterone deficiency causes the kidneys to excrete sodium
which may result in salt cravings. Encourage patients to
increase salt intake and supplements as necessary to prevent
hyponatremia. Encourage patients to eat high protein / low
carb snacks and meals as tolerated followed by rest periods to
prevent fatigue due to hypoglycemia and to facilitate
digestion.
I & O – monitor intake and output Monitor urine for decreased output (desired >30ml/hr),
concentration and color which may be darker
Assess vitals; temperature, blood
pressure and heart rate – watching
for orthostatic changes and
hyperpyrexia
A decrease of 15 mm Hg or more and increase in heart
rate (normal <100bpm) may indicate reduced
circulation of fluids such as with dehydration
Increased temperature may be a sign of Addisonian
crisis due to hormonal and fluid imbalance
Monitor EKG for signs of
hyperkalemia
Lack of Aldosterone means increased sodium
excretion and increased potassium retention.
Signs of hyperkalemia will include peaked T waves
and prolonged QRS complex.
Monitor for signs of dehydration Tenting of the skin and dry mucous membranes indicate
by noting mucus membranes and
skin turgor dehydration., which is common due to vomiting and anorexia.
Administer Medications
Kayexalate
Cortef or Cortone
Prednisone
Florinef
Kayexalate – Can be given orally or by enema to
reduce potassium levels
Cortef or Cortone and prednisone may be given orally
or IV to increase cortisol levels
Florinef – Given orally to promote replacement and
retention of sodium and water
Cushings Syndrome
Overview
1. Hypersecretion of glucocorticoids leading to elevated cortisol levels
2. Greater incidence in women
3. Life threatening if untreated
Nursing Points
General
1. Causes
a. Adrenal or Pituitary Tumor
i. Pituitary gland controls adrenal hormones
b. Overuse or Chronic use of Corticosteroids
2. Adrenal Cortex
a. Glucocorticoids
i. Cortisol
ii. Glucose & Fat Metabolism
iii. Anti-inflammatory
b. Mineralocorticoids
i. Aldosterone
ii. Regulate fluid and electrolytes
c. Sex hormones (Androgens)
i. Testosterone, Estrogen
ii. Control physical features
iii. Control hair distribution
3. Adrenal Medulla
a. Epinephrine (Adrenaline)
b. Norepinephrine (Noradrenaline)
c. Fight or Flight Response
2. Cushing’s Syndrome
a. Excess Cortisol
b. Excess Aldosterone
c. Excess Androgens
Assessment
1. Cardiovascular
1. Hypertension
2. Signs of Heart Failure
2. Metabolic
1. Redistribution of Fats
2. Moon Face
3. Buffalo Hump
3. Integumentary
1. Excess hair
2. Striae on abdomen
3. Fragile skin
4. Peripheral edema
4. Electrolytes
1. Hypokalemia [Show Less]