Addison's Disease (Adrenocortical insufficiency)

Question 1

what is Addison’s disease?

Answer 1

-insufficient production of steroids
-can be chronic or acute
-high ACTH

Question 2

diagnostic tests for Addison’s disease

Answer 2

Cortisol levels
-ATCH levels
-ACTH stimulation tets

Question 3

ACTH stimulation tests

Answer 3

-use cosyntropin
-should be done in morning
-abnormal result is greater than or equal to 18

Question 4

Adrenal insufficiency causes

Answer 4

-metastatic cancers
-autoimmune or idiopathic atrophy
-infections (TB)
-surgical removal of the adrenal glands
-medications
-multiple pharmacological therapies

Question 5

multiple pharmacological therapies that cause Adrenal insufficiency

Answer 5

-daily corticosteroids for 2-4 weeks may suppress function of the adrenal cortex
-sudden treatment STOP may result in adrenal insufficiency symptoms

Question 6

chronic adrenal insufficiency clinical manifestations

Answer 6

-muscle weakness
-GI symptoms
-dark pigmentation of skin
-hypoglycemia
-apathy
-emotional lability
-hypotension
-low serum sodium
-high serum potassium
-chronic dehydration

Question 7

acute adrenal insufficiency clinical manifestations

Answer 7

severe hypotension, hypovolemic shock

Question 8

when does an Addisonian crisis occur?

Answer 8

when there’s an acute drop in adrenocorticoids due to sudden discontinuation of glucocorticoid medications or when induced by severe trauma, infection, or stress

Question 9

Addisonian crisis signs

Answer 9

-hypotension
-cyanosis
-nausea
-vomiting
-signs of shock develop
-pallor
-headache
-abdominal pain
-diarrhea
-confusion/restlessness

Question 10

Addisonian crisis nursing priorities

Answer 10

-hypovolemia, hyponatremia, hyperkalemia, hypoglycemia
-VS
-IV access & fluids (D50 & NS)
-administer hydrocortisone sodium as IV bolus initially then as transfusion
-administer insulin, dextrose, calcium & sodium polystyrene sulfonate
-vasopressors in BP low

Question 11

Corticosteroid therapy

Answer 11

-suppress inflammation & autoimmune response, control allergic reactions & reduce transplant rejection

Question 12

potential side effects of corticosteroid therapy

Answer 12

-CV: HTN, thrombophlebitis, thromboembolism, accelerated atherosclerosis
-immunologic: high risk of infection & masking infection
-ophthalmologic: glaucoma, corneal lesions
-musculoskeletal: poor wound healing, osteoporosis, muscle wasting, increased risk for long bone fractures
-metabolic: increased BG, steroid withdrawal symptoms
-appearance: weight gain, acne
-fluid & electrolyte imbalances

Question 13

nursing actions for adrenal insufficiency

Answer 13

-monitor weight, VS, BP, electrolytes
-increase steroid usage during periods of stress of illness if indicated
-taper dose if discontinuing
-administer food to decrease gastric effects

Question 14

patient teaching

Answer 14

-notify provider of stress of illness
-report manifestations of weakness or dizziness
-do not discontinue meds suddenly