Unit 12: Nursing care of clients with endocrine disorders
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| Addison's disease: (Pg. 904) | Adrenocortical insufficiency; caused by damage/dysfunction of adrenal cortex
-Mineralcorticoid production & glucocorticoid production is diminished
-Low aldosterone & cortisol
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| Adrenal cortex produces..? | Mineralcorticoids (aldosterone), glucocorticoids (cortisol), & sex hormones (adrogens & estrogens)
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| What is acute adrenal insufficiency known as? | Addisonian crisis
-rapid onset
-medical emergency
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| Primary causes of addison's disease: | Idiopathic autoimmune (majority)
Tuberculosis (Adrenal)
Histoplasmosis
Adrenalectomy
Cancer
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| Secondary causes of Addison's disease | Steroid withdrawal, hypophysectomy, pituitaery neoplasm
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| Chronic addison's disease s/s develop slow or fast? | Slowly
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| 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
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| S/s con't: natremia, kalemia, glycemia, calcemia | Hyponatremia, hyperkalemia, hypoglycemia, hypercalcemia
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| Lab tests: electrolytes & ACTH test | ATCH infused & cortisol response measured 30 minutes after & 1 hr after
-If primary adrenal insufficiency, no rise in cortisol
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| Dx addison's: ECG | ECG lyte imbalances; potassium; dysrhythmias
x-ray, ct, mri, radiography (tumor)
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| 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
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| 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
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| Symptoms of cushing's syndrome? (might come w glucocorticoid use) | wt gain, edema, moon face
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| Fludrocortisone (Florinef) | Mineralcorticoid; replacement in adrenal insufficiency
-wt, bp, lytes, htn, ^ dose during stress/illness
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| What should the client expect when taking Florinef? | Mild peripheral edema
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| What can bring on an addisonian crisis? | Sudden stop of meds, severe trauma, stress, infection
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| Nursing actions during an addisonian crisis: | insulin to move potassium into cell
give calcium to contract hyperkalemia
give sodium polystyrene (Kayealate)
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| What does sodium polystyrene (Kayealate) do? | absorbs potassium
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| What kind of diuretics can help manage hyperkalemia? | Loop or thiazide
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| Rapid infusion of what should be in place for the crisis? | 0.9% sodium chloride (NS)
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| What can be given for replacement therapy? | Hydrocortisone sodium succinate (solu-cortef)
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| 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
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