T2: Addisons Flashcards
Addison’s disease
hypo function of the adrenals: amounts of all three classes of adrenal corticosteroids (glucocorticoids, mineralocorticoids, and androgens) are reduced.
primary cause of adrenal insufficiency
-Addison’s disease
-Lack of glucocorticoids, mineralocorticoids, and androgens
secondary cause of adrenal insufficiency
-Lack of pituitary ACTH
-Lack of glucocorticoids and androgens
how do we treat addisons disease
- Replacement therapy of steroids “replace sugar sex and salt”
-corticosteroid (sugar) salt tabs
HINT HINT: medication teaching
will be on glucocorticoid and salt for the rest of their life
Causes of Addison’s disease
-Autoimmune
-TB (most common in developing world)
-metastatic carcinoma (most common from lungs)
-loss of glucocorticoids, mineralcorticoids, and androgens
-fungal infections, AIDS
clinical manifestations of addisons disease
*slow (insidious) onset, and include anorexia, nausea, progressive weakness, fatigue, and weight loss.
-hyperpigmentation
-Abdominal pain
-Diarrhea
-Headache
-Orthostatic hypotension
-Salt craving
-Joint pain
Addisonian crisis
acute adrenal insufficiency, a life-threatening emergency caused by insufficient adrenocortical hormones or a sudden sharp decrease in these hormones
Addisonian crisis is triggered by
-stress (from infection, surgery, psychologic distress), -the sudden withdrawal of corticosteroid hormone therapy
- adrenal surgery
-sudden pituitary gland destruction.
tool kit for addisonian crisis
Salt tabs, glucocorticoids (injectable), instructions on how to use them
need to be wearing a medical alert bracelet
Manifestations of glucocorticoid and mineralocorticoid deficiencies
-Hypotension, tachycardia
-Dehydration
-↓ Sodium, ↑ potassium, ↓ glucose
-Fever, weakness, confusion
-Severe vomiting, diarrhea, pain
-Shock → circulatory collapse
what IV solution for addisonian crisis
0.9 NS, but if they are SUPER hyponatremic you can give 3%
what needs to be done for high potassium in addison crisis
-place on cardiac monitor
-kayexalate
what needs to be given for low glucose in addionian crisis
-D5 NS
-acucheck (Q15)
what type of shock is someone in when they are in addisonian crisis
distrubutive
diagnostic studies for addisons disease
-ACTH stimulation test
ACTH stimulation test
*Baseline cortisol and ACTH levels are measured, and the patient is given an IV injection of synthetic ACTH (cosyntropin).
*Cortisol and ACTH levels are rechecked after 30 and 60 minutes. TIMING
normal vs addisons disease reaction to ACTH stimulation test
normal: rise in blood cortisol levels
-addisons: little or no increase in cortisol
when the response to the ACTH test is abnormal, what is done
CRH stimulation test
CRH stimulation test
The patient is given an IV injection of synthetic CRH, and blood is taken after 30 and 60 minutes.
lab findings for addisons
-↑ Potassium
-↓ Chloride, sodium, glucose
-Anemia
-↑ BUN
-ECG changes (*peaked T waves caused by hyperkalemia.)
interprofessional care for addisons
-hormone therapy (hydrocortisone)
-Fludrocortisone (Florinef)
-INCREASE DURING PERIODS OF STRESS
-increase dietary salt intake
HINT HINT: Fludrocortisone (Florinef)
mineralcorticoid replacement for addisons, pt will be on lifelong hormone therapy
interprofessional care for addisonian crisis
-Shock management
-High-dose hydrocortisone replacement
-0.9% saline solution and 5% dextrose (to revers hypotension and electrolyte imbalance until BP returns)
acute care
-Correct fluid and electrolyte imbalance
-Assess vital signs and neurologic status
-Daily weight
-Accurate I and O
-Obtain complete medication history
-Watch for signs of Cushing syndrome
watch for manifestations of cushings
blood pressure, weight gain, weakness, or other manifestations
HINT HINT: patient teaching for dosing: glucocorticoids
divided doses: one on morning, once at night
HINT HINT: patient teaching for dosing: mineralcorticoids
once in the morning (to match circadiam rhythm)
corticosteroids and stress
NEED TO INCREASE DURING TIMES OF STRESS
patient teaching
-Report signs and symptoms of corticosteroid deficiency and excess to HCP
-Carry identification and wear medical ID bracelet
-Emergency kit
-How to administer IM hydrocortisone
-Written instructions
side effects with corticosteroid therapy
-↓ Potassium and calcium
-↑ Glucose and BP
-Delayed healing
-Susceptibility to infection
-Suppressed immune response
-PEPTIC ULCER DISEASE
-Muscle atrophy/weakness
-Mood and behavior changes
-Moon facies, truncal obesity
-Protein depletion
-Risk for acute adrenal crisis if therapy is stopped abruptly
Expected effects of corticosteroid therapy
-Antiinflammatory action
-Immunosuppression
-Maintenance of normal BP
corticosteroid therapy: dietary needs
*diet high in protein, calcium (at least 1500 mg/day), and potassium but low in fat and concentrated simple carbohydrates such as sugar, honey, syrups, and candy.
corticosteroid therapy: Rest and exercise needs
*Identify measures to ensure adequate rest and sleep, such as daily naps and avoidance of caffeine late in the day.
*Develop and maintain an exercise program to help maintain bone integrity.
corticosteroid therapy: Sodium restriction if edema occurs
*Recognize edema and ways to restrict sodium intake to less than 2000 mg/day if edema occurs.
corticosteroid therapy: hyperglycemia
Monitor glucose levels and recognize symptoms of hyperglycemia (e.g., polydipsia, polyuria, blurred vision).
corticosteroid therapy patient teaching
-Should be taken in morning with food to reduce gastric irritation and reduce ulcers
-Must NOT be stopped abruptly
-Needs to INCREASE in times of stress
-Measures to reduce occurrence of osteoporosis (CALCIUM)
