1 / 34

Understanding Addison’s Disease: Etiology, Diagnosis & Treatment

Explore the key aspects of Addison's disease including its etiology, clinical manifestations, complications, diagnostic studies, collaborative care, nursing interventions, patient teaching, and corticosteroid therapy. Gain insights into primary vs. secondary adrenal insufficiency and critical considerations in managing this condition effectively.

ringer
Download Presentation

Understanding Addison’s Disease: Etiology, Diagnosis & Treatment

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Addison’s Disease Chapter 50

  2. Case Study iStockphoto/Thinkstock • S.C., a 30-year-old woman, comes to the ED with syncope after standing up. • You notice that her skin is hyperpigmented over her joints and on her palms.

  3. Case Study iStockphoto/Thinkstock • She tells you that she has just been very tired and weak lately. • She has recently lost 15 lb without trying. • She has no significant medical history.

  4. Case Study iStockphoto/Thinkstock • The ED physician suspects S.C. may have primary adrenal insufficiency. • What is Addison’s disease? • How does it differ from secondary adrenal insufficiency?

  5. Etiology and Pathophysiology • Primary • Addison’s disease • Lack of glucocorticoids, mineralocorticoids, and androgens • Secondary • Lack of pituitary ACTH • Lack of glucocorticoids and androgens

  6. Etiology and Pathophysiology • Autoimmune response against adrenal cortex • TB, infarction, fungal infections, AIDS, metastatic cancer • Iatrogenic (drugs, adrenalectomy)

  7. Clinical Manifestations • Not evident until 90% of adrenal cortex is destroyed • Insidious onset • Progressive weakness • Fatigue • Weight loss • Anorexia

  8. Hyperpigmentation

  9. Case Study iStockphoto/Thinkstock • For what additional clinical manifestations will you assess in S.C.?

  10. Clinical Manifestations • Orthostatic hypotension • Hyponatremia and salt craving • Hyperkalemia • Nausea and vomiting • Diarrhea • Irritability, depression

  11. Complications • Addisonian crisis • Acute adrenal insufficiency • Insufficient or sudden, sharp decrease in hormones • Life-threatening • Various triggers

  12. Case Study iStockphoto/Thinkstock • What clinical manifestations, displayed by S.C., would indicate that she is experiencing an acute adrenal insufficiency?

  13. Complications • Manifestations of glucocorticosteroid and mineralocorticoid deficiencies • Hypotension, tachycardia • Dehydration • ↓ Sodium, ↑ potassium, ↓ glucose • Fever, weakness, confusion • Severe vomiting, diarrhea, pain • Shock → circulatory collapse

  14. Case Study iStockphoto/Thinkstock • What diagnostic studies would you expect the health care provider to order for S.C.?

  15. Diagnostic Studies • ↓ Serum and urinary cortisol • ACTH levels • ↑ In primary adrenal insufficiency • ↓ In secondary adrenal insufficiency • ACTH stimulation test • Distinguishes between primary and secondary disease

  16. Diagnostic Studies • ↓ Urinary cortisol and aldosterone • ↑ Potassium • ↓ Chloride, sodium, glucose • Anemia • ↑ BUN • ECG changes • CT scan, MRI

  17. Case Study iStockphoto/Thinkstock S.C.’s laboratory values reveal • ↑ ACTH • ↓ Plasma cortisol • ↓ Sodium • ↓ Glucose • ↑ Potassium

  18. Case Study iStockphoto/Thinkstock • Do these laboratory values reflect primary or secondary adrenal insufficiency? • What treatment would you expect the health care provider to prescribe?

  19. Collaborative Care • Correct underlying cause • Hormone therapy • Hydrocortisone • Increase during periods of stress • Fludrocortisone (Florinef) • Increase dietary salt intake

  20. Collaborative Care • Addisonian crisis • Shock management • High-dose hydrocortisone replacement • 0.9% saline solution and 5% dextrose

  21. Nursing Implementation • Acute intervention • Frequent assessment necessary • Assess vital signs and signs of fluid and electrolyte imbalance • Monitor trends in laboratory values • Monitor mental status and weight • Obtain complete medication history • Watch for signs of Cushing syndrome

  22. Nursing Implementation • Acute intervention • Protect against infection • Assist with daily hygiene • Protect from extremes • Light • Noise • Temperature

  23. Case Study iStockphoto/Thinkstock • What critical patient teaching about her medication should you provide S.C.? • What lifestyle modifications should she make?

  24. Nursing Implementation • Patient teaching • Dosing • Glucocorticoids in divided doses • Mineralocorticoids once in the morning • Reflects normal circadian rhythm • Decreases side effects of corticosteroids • Need to increase corticosteroids during times of stress

  25. Nursing Implementation • Patient teaching • Signs and symptoms of corticosteroid deficiency and excess • Wear medical ID bracelet • If patient takes mineralocorticoid, needs to check BP, increase salt intake, and know what to report to health care provider

  26. Nursing Implementation • Patient teaching • Emergency kit • How to administer IM hydrocortisone • Written instructions

  27. Corticosteroid Therapy • Effective in treating variety of disorders • Complications and side effects with long-term use • Potential benefits must be weighed against risks

  28. Corticosteroid Therapy • Expected effects of corticosteroid therapy • Antiinflammatory action • Immunosuppression • Maintenance of normal BP

  29. Corticosteroid Therapy • Side effects • ↓ Potassium and calcium • ↑ Glucose and BP • Delayed healing • Susceptibility to infection • Suppressed immune response

  30. Corticosteroid Therapy • Side effects • 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

  31. Corticosteroid TherapyPatient Teaching • Should be taken in the morning with food to reduce gastric irritation • Must not be stopped abruptly • Needs to increase in times of stress • Measures to reduce occurrence of osteoporosis

  32. Corticosteroid TherapyPatient Teaching • Dietary needs • Rest and exercise needs • Sodium restriction if edema occurs • Need to monitor for hyperglycemia • Notify health care provider if epigastric pain develops • Need to prevent injury/infection • Inform all health care providers

  33. Audience Response Question The nurse administers corticosteroids to a patient with acute adrenal insufficiency. The nurse determines that treatment is effective if what is observed? • The patient is alert and oriented. • The patient’s lung sounds are clear. • The patient’s urinary output decreases. • The patient’s potassium level is 5.7 mEq/L.

  34. Audience Response Question An IV hydrocortisone infusion is started before a patient is taken to surgery for a bilateral adrenalectomy. Which explanation, if given by the nurse, is most appropriate? • “The medication prevents sodium and water retention after surgery.” • “The drug prevent clots from forming in the legs during your recovery from surgery.” • “This medicine is given to help your body respond to stress after removal of the adrenal glands.” • “This drug stimulates your immune system and promotes wound healing.”

More Related