Unit 5 & 6 Chapter 57 Addison's and Cushing's Disease Flashcards
What is Addison’s
decrease steroid hormone in the adrenal cortex
(Cortisol)
What is the purpose of Cortisol?
- Purpose: manages how body uses carbs, fats, proteins
- *Keeps inflammations down *Regulates blood sugar *Controls sleep/wake
- Boosts energy so you can handle stress
What are some side effects of of Steroids?
-weight gain
-hyperglycemia
-fluid retention
S/s of Addisons
hypoglycemia
anorexia and weight loss.
high BUN
Dry skin
Vitiligo or
Hyperpigmentation
* Anorexia
* Nausea, vomiting
* Abdominal pain
* Constipation or diarrhea
Weight loss
* Salt craving
* Anemia
Hypotension
Hyponatremia
Hyperkalemia
* Hypercalcemia
* Muscle weakness
* Fatigue
bronze pigment in skin
* Joint and/or muscle pain
Low adrenal androgen levels decrease body, axillary, and pubic hair, especially in women, because the adrenals produce most of the androgens in females
What is the drug of choice for addison’s disease?
A. Tolvaptan
B. Bumetadine
C. Dexamethasone
D. Methadone
C. Dexamethasone
Which electrolyte imbalance would cause major concern and should be reported to the health care provider immediately
A. Potassium 6.0
B. Calcium 12.0
C. Sodium 132
D. Magnesuin 1.2
A. Potassium 6.0
Drug of choice to restore hormanal and electrolyte balance for addisons?
A. Fludrocortisone
B. Bumetadine
C. Hydrochloritiazide
D. Atenolol
A. Fludrocortisone
An additional mineralocorticoid hormone, such as fludrocortisone, may be needed to maintain or restore fluid and electrolyte balance (especially sodium and potassium).
S/e of fludrocortisone?
-fluid retention
What skin asssesment best decribed the patient with Addisons disease?
A. Pallor and pale skin
B. Damp and diaphoretic
C. Bronze skin color
D. Mottling skin
C. Bronze skin color
If your patient who has undergone trauma and is diagnosed with Addison’s disease, what complication would you suspect to occur?
A. Myexadoma coma
B. Thyroid storm
C. Graves disease
D. Addisonian crisis
D. Addisonian crisis
Before a surgical procedure would the provider prescribe in increase of fludrocortidone or decrease for patients with addison’s disease?
A. increase
B. decrease
A. increase
What is the cause of Acute adrenal insufficiency (addisonian crisis)?
It often occurs in response to a stressful event (e.g., surgery, trauma, severe infection), especially when the adrenal hormone output is already reduced.
-a sudden cessation of long-term glucocorticosteroid therapy
patient’swith addison cannot wih stand stress, stress is life threateing
What is your major-concern if your patient’s sodim levels are low?
A. seizure
B. irritability
C. risk for falls
D. fractures
A. seizure
What is your major-concern if your patient’s potassium is high?
A. Cardiac Arrest
B. Myocardial infarction
C. Pulmonary Edema
D. Acute Coronary Syndrome
A. Cardiac Arrest
S/s of Acute Adrenal Insufficiency
(addisonian crisis)
Problems are the same as those of chronic insufficiency but are more severe. However, unless intervention is initiated promptly,sodium levels fall, and potassium levels rise rapidly ( Pereira, 2016 ). Severe hypotension results from the blood volume depletion that occurs with the loss of aldosterone.
-hyponatremia
-hyperkalemia
-hypotention
-hypoglycemia
What medications can treat hyperkalemia?
SELECT ALL THAT APPLY
A. Furosemide
B. Bumetadine
C. Lisinopril
D. Regular Insulin
E. Hydrochloriatize
D. Regular Insulin
B. Bumetadine
A. Furosemide
E. Hydrochloriatize
What ECG changes are expected to see with a patient with addisons disease?
A. ST elevation
B. Depressed t waves
C . Sinus bradycardia
D. Peak T waves
D. Peak T waves
Management for Acute Adreno Insuffiency
Low Hormone
- Start rapid infusion of normal saline or dextrose 5% in normal saline.
- Initial higher doses of hydrocortisone sodium or dexamethasone is administered as an IV bolus.
- Administer additional hydrocortisone sodium by continuous IV infusion over the next 8 hours.
- Give an additional dose of hydrocortisone IM concomitantly with hydration every 12 hours.
- Initiate an H2 histamine blocker (e.g., cimetidine) IV for ulcer prevention.
Management for Acute Adreno Insuffiency
Hyperkalemia
- Administer insulin in units equal to the same number of mg of extra dextrose in normal saline intravenously to shift potassium into cells.
- Give potassium binding and excreting resin.
- Give loop or thiazide diuretics.
- Avoid potassium-sparing diuretics, as prescribed.
- Initiate potassium restriction.
- Monitor intake and output.
- Monitor heart rate, rhythm, and ECG for signs and symptoms of hyperkalemia (slow heart rate; heart block; tall, peaked T waves; fibrillation; asystole).
Management for Acute Adreno Insuffiency
Hypoglycemia
- Administer IV glucose as prescribed.
- Prepare to administer glucagon as needed and prescribed.
- Maintain IV access.
- Monitor blood glucose level hourly.
Nursing Interventions for Addisons Disease
-increase fluid due to hypotention
-increase glucose due to hypoglycemia
-increase salt intake due to hyponatremia(hypertonic solution)
-assess vital signs
-weight patient daily
-
Your patient presents with a serum sodium level of 89. What order would you anticipate the provider to order?
A. Hydrochlorithiazide
B. 3% Sodium Chloride
C. Lactaded Ringers
D. 0.45% Normal Saline
B. 3% Sodium Chloride
What should you restrict for a patient with addisons?
A. Sausage and potato chips
B. Banana and tomatoes
B. Banana and tomatoes
^THIS FOODS ARE HIGH IN POTASSIUM^
DO NOT RESTRICT FOOD HIGH IN SALT IT CAN INDUCE ADRENAL CRISIS
Dosage adjustment may be needed, especially in hot weather when more sodium is lost because of excessive perspiration. Salt restriction or diuretic therapy should not be started without considering whether it might lead to an adrenal crisis.
57.3
Which electrolyte laboratory values indicate to the nurse monitoring a client with adrenal insufficiency undergoing IV therapy with hydrocortisone that the client is responding positively to this drug therapy?
A. Serum sodium 147 mEq/L (mmol/L); serum potassium 7.1 mEq/L (mmol/L)
B. Serum sodium 137 mEq/L (mmol/L); serum potassium 4.9 mEq/L (mmol/L)
C. Serum sodium 127 mEq/L (mmol/L); serum potassium 2.8 mEq/L (mmol/L)
D. Serum sodium 119 mEq/L (mmol/L); serum potassium 6.2 mEq/L (mmol/L)
B. Serum sodium 137 mEq/L (mmol/L); serum potassium 4.9 mEq/L (mmol/L)
