Addison's Disease Flashcards
Etiology and Pathophysiology of Addison’s Disease:
In secondary adrenocortical insufficiency, corticosteroid and androgen levels are deficient, but ________ are usually normal.
ACTH deficiency may be caused by pituitary disease or suppression of the _________ axis because of the administration of exogenous corticosteroids.
mineralocorticoids
hypothalamic-pituitary
Etiology and Pathophysiology of Addison’s Disease:
The most common cause of Addison’s disease in the United States is an _______ response.
Adrenal tissue is destroyed by antibodies against the patient’s own adrenal cortex.
Although tuberculosis causes Addison’s disease worldwide, it is now an uncommon cause in the United States. Other causes include infarction, fungal infections (e.g., ________), acquired immunodeficiency syndrome (AIDS), and metastatic cancer.
autoimmune
histoplasmosis
Etiology and Pathophysiology of Addison’s Disease:
Iatrogenic Addison’s disease may be due to adrenal hemorrhage, often in relation to _______ therapy, chemotherapy, _______ (Nizoral) therapy for AIDS, or bilateral adrenalectomy for adrenal tumors.
anticoagulant
ketoconazole
Clinical Manifestations of Addison’s Disease:
Because manifestations do not tend to become evident until 90% of the ______ is destroyed, the disease is often advanced before it is diagnosed.
The manifestations have a very slow (insidious) onset and include progressive weakness, fatigue, weight loss, and anorexia as primary features.
adrenal cortex
Clinical Manifestations of Addison’s Disease:
_________: This is caused by ncreased secretion of ACTH causes the striking feature of bronze-colored skin. It is seen primarily in sun-exposed areas of the body, at pressure points, over joints, and in the creases, especially palmar creases.
Hyperpigmentation
Clinical Manifestations of Addison’s Disease:
Other manifestations of adrenal insufficiency are orthostatic hypotension, _________, salt craving, _________, nausea and vomiting, and diarrhea. Irritability and depression may also occur.
hyponatremia
hyperkalemia
Complications of Addison’s Disease:
Patients with adrenocortical insufficiency are at risk for acute adrenal insufficiency which is also called _______ which is a life-threatening emergency caused by insufficient adrenocortical hormones or a sudden sharp decrease in these hormones.
ADDISONIAN CRISIS
Complications of Addison’s Disease:
______ is triggered by (1) stress (e.g., from infection, surgery, psychologic distress), (2) the sudden withdrawal of corticosteroid hormone therapy (which is often done by a patient who lacks knowledge of the importance of this therapy), (3) adrenal surgery, or (4) sudden pituitary gland destruction.
Addisonian crisis
Complications of Addison’s Disease:
During __________, severe manifestations of glucocorticoid and mineralocorticoid deficiencies are exhibited, including hypotension (particularly postural), tachycardia, dehydration, hyponatremia, hyperkalemia, hypoglycemia, fever, weakness, and confusion.
Addisonian crisis
Complications of Addison’s Disease:
GI manifestations include severe vomiting, diarrhea, and pain in the abdomen.
_____ may occur in the lower back or legs.
Hypotension may lead to shock.
________ associated with adrenal insufficiency is often unresponsive to the usual treatment Ex. vasopressors and fluid replacement.
Pain
Circulatory collapse
Diagnostic Studies for Addison’s Disease:
Adrenal insufficiency is characterized by decreased serum and urinary cortisol levels.
______ levels will be increased in primary adrenal insufficiency and decreased in secondary disease.
________
ACTH
Diagnostic Studies for Addison’s Disease:
Primary adrenal insufficiency is confirmed when cortisol levels fail to rise over basal levels with an ACTH stimulation test:
#1: 0.25 – 1mg of synthetic ACTH given IV
#2: Plasma cortisol levels obtained at 30 min & 1 hour
#3: Normally, the cortisol level ______ within 1 hour
In Primary insufficiency – cortisol response is ______
In secondary insufficiency – response is ______
doubles
absent/decreased
increased
Diagnostic Studies for Addison’s Disease:
Urine levels of _______ and ________ are low.
Other abnormal laboratory findings in some cases include hyperkalemia, hypochloremia, hyponatremia, hypoglycemia, anemia, and increased BUN levels.
free cortisol
aldosterone
Diagnostic Studies for Addison’s Disease:
An ECG may show low voltage and peaked T waves caused by ________.
______ or ______ may be used to identify causes other than autoimmune including tumors, fungal infections, tuberculosis, or adrenal calcification.
Hyperkalemia
CT scans and MRI
Collaborative Care for Addison’s disease:
Treatment of adrenocortical insufficiency is focused on management of the underlying cause when possible.
The mainstay of treatment for the adrenocortical insufficiency is hormone therapy.
________, the most commonly used form of hormone therapy, has both glucocorticoid and mineralocorticoid properties.
During situations associated with stress, the glucocorticoid dosage must be increased to prevent addisonian crisis.
Mineralocorticoid replacement with _______ is administered daily.
_____ in the diet needs to be increased.
Hydrocortisone
fludrocortisone (Florinef)
Salt
Collaborative Care of Addisonian Crisis:
Addisonian crisis is a life-threatening emergency necessitating aggressive management.
Treatment must be directed toward shock management and high-dose hydrocortisone replacement.
With high doses of steroids, initiate intravenous ________.
Large volumes of _____ and _____ are administered to reverse hypotension and electrolyte imbalances until BP returns to normal.
Treatment should also include to treat hyperkalemia give _______and hypoglycemia.
H2 histamine blockers
NS solution and D5W
kayaxalate
Nursing Interventions for Addison’s Disease:
When the patient with Addison’s disease is hospitalized, nursing management is focused on ________ the patient while correcting fluid and electrolyte imbalance.
Frequently assess vital signs and signs of fluid volume deficit and electrolyte imbalance.
Monitor trends in serum ______, _____, and ______ levels.
Establish baseline data regarding mental status, vital signs, and weight.
monitoring
glucose, sodium, and potassium
Obtain a complete medication history to determine potential drugs that can interact with corticosteroids. These drugs include _____, _____, ______, ______, and ______.
Note changes in blood pressure, weight gain, weakness, or other manifestations of Cushing syndrome.
Oral hypoglycemics, cardiac glycosides, oral contraceptives, anticoagulants, and NSAIDs
Acute Nursing Interventions for Addison’s Disease:
In addition, protect against exposure to infection, and assist with daily hygiene.
Protect the patient from _____, _____, and environmental temperature extremes.
The patient cannot cope with these stresses because of the inability to produce corticosteroids.
noise
light
Patient Education Nursing Interventions for Addison’s Disease:
Dosing: Glucocorticoids are usually given in _____ divided doses: two thirds in the morning and one third in the afternoon. Mineralocorticoids are given ____ daily, preferably in the morning. _______ contains both glucocorticoids and mineralocorticoids. _________ has only mineralocorticoids.
This dosage schedule reflects normal circadian rhythm in endogenous hormone secretion and decreases the side effects associated with corticosteroid therapy.
three
once
Hydrocortisone
Fludrocortisone
Patient Education Nursing Interventions for Addison’s Disease:
Patients with Addison’s disease are unable to tolerate physical or emotional stress without _______ their dose of exogenous corticosteroids. Long-term care revolves around recognizing the need for extra medication and techniques for stress management. Examples of situations necessitating an increase in the dose of corticosteroid are fever, influenza, extraction of teeth, and _______, such as playing tennis on a hot day or running a marathon.
increasing
rigorous physical activity
Patient Education Nursing Interventions for Addison’s Disease:
If vomiting or diarrhea occurs, as may happen with ________, notify the health care provider immediately because electrolyte replacement and parenteral administration of cortisol may be necessary. Overall, patients who take their medications consistently can anticipate a normal life expectancy.
influenza
Patient Education Nursing Interventions for Addison’s Disease:
Teach the patient about the signs and symptoms of corticosteroid _____ and ______ (Cushing syndrome) and to report these signs to their health care provider so the dose can be individually adjusted. It is critical that the patient wear an ______ (e.g., MedicAlert) and carry a wallet card stating the patient has Addison’s disease so that appropriate therapy can be initiated in case of an emergency.
deficiency and excess
identification bracelet
Patient Education Nursing Interventions for Addison’s Disease:
Instruct patients using mineralocorticoid therapy _______ how to take their BP and to report any significant changes to their health care provider like weight gain, edema, increased blood pressure. Provide written instructions as to when the dose should be changed.
fludrocortisone [Florinef])
