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Addison's disease
pn 141 test 1 book: med surg nursing pg 351
| Question | Answer |
|---|---|
| who does it occur most frequently in | wm underthe age of 60 |
| does the adrenal cortex hypo or hyer function | hypo |
| what causes the destruction of the adrenal cortex | an autoimmune response |
| the destructionof the adrenal cortex leads to the reduced levels of what three things | mineralocorticoids, glucocorticoids, androgens |
| is the onset of addisons slow or fast | slow |
| manifestations usually develop when >___ % of the adrenal gland is destroyed | 90% |
| are the ACTH levels elevated or low | elevated |
| are the aldosterone and cortisol elevated or low | low |
| What is addisonian crisis | (aka adrenal crisis) a serious, life threatening response to acute adrenal insufficiency |
| addisonian crisis: what usually precipitates it | major stressors like surgery, trauma, or severe infections, abrupt withdrawal of corticosteroid medications |
| addisonian crisis: s/s of it | hypotension, rapid and weak pulse, extreme weakness, confusion resulting from circulatory collapse or shock, high potassium, cardiac dysrhythmias |
| addisonian crisis: high levels of potassium can cause what | cardiac dysrhythmias |
| addisonian crisis: tx | ICU, iv meds (fluids, glucose, sodium, glucocorticoids), keep warm and quiet, |
| s/s: integumentary | bronze color over knuckles, knees and elbows |
| s/s: ms system | muscle weakness, joint pain |
| s/s: cv system | postural hypotension, weak and irregular pulse |
| s/s: cns | dizziness, lethargy, depression |
| s/s: GI system | anorexia, N/V, salt cravings |
| meds given to treat | cortisol replacement |
| cortisol replacement can cause what | cushing's syndrome |
| labs that Dx it | low levels of cortosol and aldosterone, and urinary 17 ketosteroids |
| Dx: what will ct or MRI reveal | atrophy of the adrenal glands |
| tx: | replacing corticosteroids and mineralcorticoids, diet high in sodium |
| med: what is given to replace cortisol | hydrocortisone |
| med: what is given to replace mineralcorticoids | fludrocortisone (florinef) |
| when are increased doses of corticosteroids & mineralcorticoids needed; why | during times of stress; to prevent addisonians crisis |
| med: corticosteriods: names | cortisone (CORTONE), hydrocortisone (cortef), prednisone (deltasone), |
| med: corticosteriods: what is it used for | to replace glucocorticoids in acute and chronic adrenal insufficiency |
| med: corticosteriods: why is it given with food | to reduce ulcers |
| med: corticosteriods: pt should report an increase in ______ when taking this med | BP, edema, Wt gain, bruising and weakness (cushing s/s |
| how much water should they drink a day, | 3,000 ml, |
| why does pt skin darken | b/c acth stimulates melanom |
| why does HR increase | it increases to comensates |
| why do arrhythmias occur | b/c aldosterone is is being lost too so so potassium levels increase and sodium levels decrease; so the BP is low and HR is high. |
| is BG high or low | low |
| is the onset slower or faster | slower; manis do not develop until >90% of the adrenal gland is destoyed |
| is sodium low or high | low |
| is cortisol low or high | low |
| is potassium low or high | high |
| Tx: | fluids, glucocorticoids, mineralcorticoids |
| mineralcorticoids (aldosterone): action | control salt and water balance, they conserve sodium and excrete potassium, used for addisons |
| mineralcorticoids (aldosterone): when do adverse reactions occur | when dose is too high or prolonged, or pt is withdrawn rapidly |
| mineralcorticoids (aldosterone): adverse reactions | edema, HTN, CHF, increased sweating, hypokalemia, |
| steroid dosing: what should pt know if about dosing if they are under stress | increase the dose |
| Nursing Dx: what are some | fluid volume deficit, electrolyte imbalance, risk for injury, knowledge deficit |
Created by:
jmkettel
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