Patho
What is Addison's disease?
An adrenocortical insufficiency due to damage or dysfunction of the adrenal cortex
What is the most common cause of PRIMARY addison's disease
Idiopathic autoimmune dysfunction
What are common symptoms of Addison’s disease?
Muscle weakness, fatigue, hypotension, anorexia, GI symptoms, and dark skin pigmentation.
What is the first-line medication for hormone replacement in Addison’s disease?
Hydrocortisone
What kind of diet is recommended for patients with Addison’s disease?
High sodium diet
Which hormones are decreased in Addison’s disease?
Aldosterone and cortisol
Name two infectious causes of addison's disease
TB and histoplasmosis
What is the ACTH stimulation test used for?
Diagnosing Addison’s disease by checking adrenal response to ACTH.
What IV therapy is given during acute adrenal insufficiency?
IV fluids with dextrose and sodium.
What should patients carry for emergencies?
Hydrocortisone emergency kit
What does decreased cortisol lead to?
Hypoglycemia, fatigue, and muscle weakness
What are two causes of SECONDARY addison's disease
Steroid withdrawal and pituitary neoplasm
Name one electrolyte abnormality in Addison’s disease.
Hyponatremia or hyperkalemia.
Name a diuretic that may be used in Addison’s disease management.
Furosemide
Name two lifestyle modifications for Addison’s disease.
Avoid alcohol and caffeine; reduce stress.
What does decreased aldosterone lead to?
Hyponatremia, hyperkalemia, hypotension, and dehydration
What is the difference between primary and secondary causes of addison's disease
Primary - problem with the adrenal glands themselves
Secondary - problem with the pituitary gland not making enough ACTH
Why is an ECG performed in Addison’s disease?
To monitor for dysrhythmias
What medication replaces mineralocorticoids in Addison’s disease?
Fludrocortisone
What is the priority nursing intervention during Addisonian crisis?
Prevent circulatory shock and restore fluid volume.
A nurse is assessing a client with Addison’s disease. Which finding should the nurse expect related to increased melanocyte stimulation?
A) Pallor of the skin
B) Jaundice
C) Dark pigmentation of the skin and mucosa
D) Erythematous rash
dark pigmentation of skin and mucosa
rationale: decreased cortisol causes increased secretion of ACTH, which has melanocyte-stimulating hormone properties, leading to hyperpigmentation of the skin and mucous membranes
A nurse is caring for a client with secondary adrenal insufficiency. Which past surgical history should the nurse identify as contributing to this condition?
A) Thyroidectomy
B) Hypophysectomy
C) Adrenalectomy
D) Cholecystectomy
hypophysectomy
rationale: secondary adrenal insufficiency results from pituitary gland dysfunction; hypophysectomy (removal of the pituitary gland) decreases ACTH secretion, which reduces adrenal stimulation, causing adrenal insufficiency
A client with Addison’s disease is scheduled for diagnostic imaging to assess adrenal gland function. Which of the following diagnostic tools would be appropriate? (Select all that apply.)
A) CT scan
B) MRI
C) Electroencephalogram (EEG)
D) X-ray
E) Colonoscopy
CT scan, MRI, X-ray
rationale: CT scan, MRI, and X-ray can visualize the adrenal glands to assess for tumors, calcifications, or structural abnormalities
A nurse is teaching a client with Addison’s disease about discontinuing their hydrocortisone therapy. Which statement by the client indicates understanding?
A) "I can stop taking the medication if I feel better."
B) "I should taper off the medication gradually if needed."
C) "I will stop taking it before surgery to prevent complications."
D) "I will never stop taking my medication abruptly."
"i will never stop taking my medication abruptly"
rationale: stopping glucocorticoid therapy abruptly can cause Addisonian crisis
A nurse is teaching a client with Addison’s disease about lifestyle modifications. Which statement by the client demonstrates understanding of how to prevent complications related to their condition?
A) "I will limit my sodium intake to prevent fluid retention."
B) "I will avoid strenuous exercise on hot days to prevent dehydration."
C) "I will skip my morning steroid dose if I am feeling nauseous."
D) "I will take my medications only when I feel symptoms coming on."
"i will avoid strenuous exercise on hot days to prevent dehydration"
rational: pts with Addison’s disease are at risk for dehydration and hypotension due to decreased aldosterone; avoiding strenuous activity in heat helps prevent fluid loss and Addisonian crisis