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Chapter 82

Unit 12: Nursing care of clients with endocrine disorders

Addison's disease: (Pg. 904) Adrenocortical insufficiency; caused by damage/dysfunction of adrenal cortex -Mineralcorticoid production & glucocorticoid production is diminished -Low aldosterone & cortisol
Adrenal cortex produces..? Mineralcorticoids (aldosterone), glucocorticoids (cortisol), & sex hormones (adrogens & estrogens)
What is acute adrenal insufficiency known as? Addisonian crisis -rapid onset -medical emergency
Primary causes of addison's disease: Idiopathic autoimmune (majority) Tuberculosis (Adrenal) Histoplasmosis Adrenalectomy Cancer
Secondary causes of Addison's disease Steroid withdrawal, hypophysectomy, pituitaery neoplasm
Chronic addison's disease s/s develop slow or fast? Slowly
S/s: (Pg. 905) wt, craving, color, activity BP, fluids Wt loss, salt craving (low sodium), hyper pigmentation, weak/fatigue Nausea/vomit, dizzy orthostatic hypotension, dehydration
S/s con't: natremia, kalemia, glycemia, calcemia Hyponatremia, hyperkalemia, hypoglycemia, hypercalcemia
Lab tests: electrolytes & ACTH test ATCH infused & cortisol response measured 30 minutes after & 1 hr after -If primary adrenal insufficiency, no rise in cortisol
Dx addison's: ECG ECG lyte imbalances; potassium; dysrhythmias x-ray, ct, mri, radiography (tumor)
Nursing actions: -Fluid imbalances -Lyte imbalances -Saline infusions, orthostatic VS, hydrocortisone bolus -Monitor & treat hyperkalemia; serum k+ & ECG -Give sodium polustyrene sulfonate (Kayexalate), insulin, calcium, glucose & sodium bicarb
Medications: (Pg. 906) Hydrocortisone (Cortef), prednisone (Deltasone), and cortisone -what are they & what to monitor Glucocorticoid; used as an adrenocorticoid replacement for adrenal insufficiency & as anti-inflammatory -wt, bp, lytes -^ dosage during stress/illness -taper dose if discontinuing to avoid acute renal insufficiency -give w food
Symptoms of cushing's syndrome? (might come w glucocorticoid use) wt gain, edema, moon face
Fludrocortisone (Florinef) Mineralcorticoid; replacement in adrenal insufficiency -wt, bp, lytes, htn, ^ dose during stress/illness
What should the client expect when taking Florinef? Mild peripheral edema
What can bring on an addisonian crisis? Sudden stop of meds, severe trauma, stress, infection
Nursing actions during an addisonian crisis: insulin to move potassium into cell give calcium to contract hyperkalemia give sodium polystyrene (Kayealate)
What does sodium polystyrene (Kayealate) do? absorbs potassium
What kind of diuretics can help manage hyperkalemia? Loop or thiazide
Rapid infusion of what should be in place for the crisis? 0.9% sodium chloride (NS)
What can be given for replacement therapy? Hydrocortisone sodium succinate (solu-cortef)
Why can addison's disease cause hypoglycemia? Bc insufficient glucocorticoids causes ^ insulin sensitivity & decreased glycogen s/s: diaphoresis, shaking, tachycardia, headache * have 15g carb snack readily available
Created by: mary.scott260!