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Outline
Overview
Pathophysiology
The adrenal glands, located above the kidneys, fail to produce an adequate amount cortisol, aldosterone or androgens. Cortisol is a glucocorticoid that influences the body’s ability to respond to stress and produce energy. Aldosterone is a mineralocorticoid that maintains the sodium-potassium balance that regulates blood pressure. Androgens are responsible for sexual development of men and the influence of muscle mass and sense of well-being in men and women.
Etiology
A decrease in adrenal gland function may be caused by an autoimmune disease that damages the adrenal glands in which the body attacks the adrenal glands as if they were a foreign body. Damage to these glands may also be a result of severe infection of the adrenal glands, tuberculosis, or the spread of cancer.
Desired Outcome
Maintain adequate hormone levels for optimized ability to create energy and respond to stress and electrolyte balance to regulate blood pressure
Addison’s Disease (Primary Adrenal Insufficiency) Nursing Care Plan
Subjective Data:
- Fatigue
- Lower back / leg pain
- Abdominal pain
- Irritability / depression
- Reports significant weight loss
Objective Data:
- Decreased blood pressure
- Electrolyte imbalance
- Decreased sodium
- Increased potassium
- Severe vomiting, diarrhea
- Dehydration
- Loss of consciousness
Nursing Interventions and Rationales
- Monitor weight
- Encourage oral fluids
- Minimize stress and assist with activities / provide rest periods
- Monitor nutrition
- I & O – monitor intake and output
- Assess vitals; temperature, blood pressure and heart rate – watching for orthostatic changes and hyperpyrexia
- A decrease of 15 mm Hg or more and increase in heart rate (normal <100bpm) may indicate reduced circulation of fluids such as with dehydration
- Increased temperature may be a sign of Addisonian crisis due to hormonal and fluid imbalance
- Monitor EKG for signs of hyperkalemia
- Lack of Aldosterone means increased sodium excretion and increased potassium retention.
- Signs of hyperkalemia will include peaked T waves and prolonged QRS complex.
- Monitor for signs of dehydration by noting mucus membranes and skin turgor
- Administer Medications
- Kayexalate
- Cortef or Cortone
- Prednisone
- Florinef
- Kayexalate – Can be given orally or by enema to reduce potassium levels
- Cortef or Cortone and prednisone may be given orally or IV to increase cortisol levels
- Florinef – Given orally to promote replacement and retention of sodium and water
References
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