Addison’s DiseaseArielle Howard

Ariel Baker Brittany Martin

O PATHOPHYSIOLOGY• A chronic condition that results from the

partial or complete destruction of the adrenal cortex

• Causes deficiencies of the adrenocortical secretions: glucocorticoids, sex hormones, and mineral corticoids

Cortisol, Aldosterone, Androgens and Estrogens

Prevalence and Risk FactorsO Addison’s disease is

rare O 1/100,000 peopleO Effects all age groups

(More common between ages 30 – 50)

O More prevalent in women but can effect men as well

O Primary Adrenal insuff.O Idiopathic Autoimmune

Dysfunction (majority)O TuberculosisO HIV, CancerO AdrenalectomyO Fungal Infections

O Secondary Adrenal insuff.O Steroid withdrawalO HypophysectomyO Pituitary neoplasm

CLINICAL FINDINGSSubjective Objective

O FatigueO Muscle weaknessO Muscle/joint painO Salt cravingO NauseaO Anorexia

(decrease in appetite)

O Irritability

O HyperpigmentationO HypotensionO HypoglycemiaO HyperkalemiaO VomitingO DiarrheaO Mouth lesionsO Decrease in body

hair

OCORTISONE• Action: Inhibits multiple inflammatory

cytokines; produces multiple glucocorticoid and mineral corticoid effects.

• Adrenal insufficiency: 25-300mg PO QD-QOD

• Major side effects: Circulatory collapse, thrombophlebitis, embolism, necrotizing angiitis, CHF, GI hemorrhage, pancreatitis, thrombocytopenia

• Nursing Considerations: Monitor BP; weight; 2hr postprandial glucose; chest x-ray if prolonged tx; Electrolytes (k+); I&O ratio (decreasing output and increasing edema); Plasma cortisol levels (norm: 6-23mcg/dL); signs of infection (drug masks infection); cardiac symptoms (edema, HTN)

Treatments MedicationsO Fludrocortisone

O Aldosterone replacement

O Oral corticosteroidO Hydrocortisone/

PrednisoneO Cortisol

replacementO Oral or injection:

O INJECTION given when patient is experiencing N/V or during an Addisonian Crisis

*Hormone replacement is used to correct the insufficient levels of steroids the adrenal

glands can not produce.* Increase in sodium

intake*Life long drug maintenance is

required .

Nursing Diagnosis /Considerations

O Electrolyte Imbalance r/t vomiting and diarrhea AEB hyperkalemia and hyponatremia

O Imbalanced nutrition: less than body requirements r/t anorexia AEB 20% decrease in weight and inadequate food intake

O Monitor patient frequently for dysrhythmias

O administer NaCl IV to increase sodium

O Administer Insulin or Kayexalate

O Administer an antiemetic as tolerated by the patient

O Provide high calorie snacks and finger foods

O Daily weightO Nutritional supplements

Patient EducationO Increase salt intake during hot weather and

heavy exerciseO Never skip a dose. This could lead to an

Addisonian crisisO Learn to recognize the symptoms of an

Addisonian crisis. Ex: pain in lower back, severe vomiting and diarrhea , extreme weakness, fainting. Contact physician immediately.

O Wear Med alert tag O Frequently monitor weight O Reframe from stressful activities

Pertinent Nursing •Monitor for fluid deficits and hypernatremia •Monitor and treat hyperkalemia

Obtain serum potassium and ECG Administer sodium polystyrene sulfonate (Kayexalate),

insulin, calcium, glucose, and sodium bicarbonate •Monitor and treat hypoglycemia

Perform frequent neurologic checks, monitor for S/S of hypoglycemia, and check serum glucose

Administer food and/or supplemental glucose• Maintain a safe environment

Provide assistance ambulating, raise side rails and prevent falls by keeping floors clear

Addison’s Pictures

N-Clex QuestionO A nurse is reviewing serum laboratory

results for a client who has Addison’s disease. Which of the following findings should the nurse expect?

Soduim 130mEg/L Potassium 5.1 mEg/L Calcium 10.6 mEg/L Magnesium 2.5 Meg/L Glucose 65mg/dL Phosphorus 2.4 mg/dL

N-Clex AnswerO Sodium 130 (135-145)O Potassium 5.1 (3.5-5.0)O Calcium 10.6 (8.0-10.5)O Glucose 65 (70-110)

ReferencesO Lewis, S. M. (2011). Medical-surgical

nursing: Assessment and management of clinical problems. St. Louis, Mo: Elsevier/Mosby

O ATI RN Medical Surgical Nursing Edition 8.0 (Chapter 94)

O www.cdc.govO http://jama.jamanetwork.com/article.

aspx?articleid=201884