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Chapter 82
Unit 12: Nursing care of clients with endocrine disorders
| Question | Answer |
|---|---|
| Addison's disease: (Pg. 904) | Adrenocortical insufficiency; caused by damage/dysfunction of adrenal cortex -Mineralcorticoid production & glucocorticoid production is diminished -Low aldosterone & cortisol |
| Adrenal cortex produces..? | Mineralcorticoids (aldosterone), glucocorticoids (cortisol), & sex hormones (adrogens & estrogens) |
| What is acute adrenal insufficiency known as? | Addisonian crisis -rapid onset -medical emergency |
| Primary causes of addison's disease: | Idiopathic autoimmune (majority) Tuberculosis (Adrenal) Histoplasmosis Adrenalectomy Cancer |
| Secondary causes of Addison's disease | Steroid withdrawal, hypophysectomy, pituitaery neoplasm |
| Chronic addison's disease s/s develop slow or fast? | Slowly |
| S/s: (Pg. 905) wt, craving, color, activity BP, fluids | Wt loss, salt craving (low sodium), hyper pigmentation, weak/fatigue Nausea/vomit, dizzy orthostatic hypotension, dehydration |
| S/s con't: natremia, kalemia, glycemia, calcemia | Hyponatremia, hyperkalemia, hypoglycemia, hypercalcemia |
| Lab tests: electrolytes & ACTH test | ATCH infused & cortisol response measured 30 minutes after & 1 hr after -If primary adrenal insufficiency, no rise in cortisol |
| Dx addison's: ECG | ECG lyte imbalances; potassium; dysrhythmias x-ray, ct, mri, radiography (tumor) |
| Nursing actions: -Fluid imbalances -Lyte imbalances | -Saline infusions, orthostatic VS, hydrocortisone bolus -Monitor & treat hyperkalemia; serum k+ & ECG -Give sodium polustyrene sulfonate (Kayexalate), insulin, calcium, glucose & sodium bicarb |
| Medications: (Pg. 906) Hydrocortisone (Cortef), prednisone (Deltasone), and cortisone -what are they & what to monitor | Glucocorticoid; used as an adrenocorticoid replacement for adrenal insufficiency & as anti-inflammatory -wt, bp, lytes -^ dosage during stress/illness -taper dose if discontinuing to avoid acute renal insufficiency -give w food |
| Symptoms of cushing's syndrome? (might come w glucocorticoid use) | wt gain, edema, moon face |
| Fludrocortisone (Florinef) | Mineralcorticoid; replacement in adrenal insufficiency -wt, bp, lytes, htn, ^ dose during stress/illness |
| What should the client expect when taking Florinef? | Mild peripheral edema |
| What can bring on an addisonian crisis? | Sudden stop of meds, severe trauma, stress, infection |
| Nursing actions during an addisonian crisis: | insulin to move potassium into cell give calcium to contract hyperkalemia give sodium polystyrene (Kayealate) |
| What does sodium polystyrene (Kayealate) do? | absorbs potassium |
| What kind of diuretics can help manage hyperkalemia? | Loop or thiazide |
| Rapid infusion of what should be in place for the crisis? | 0.9% sodium chloride (NS) |
| What can be given for replacement therapy? | Hydrocortisone sodium succinate (solu-cortef) |
| Why can addison's disease cause hypoglycemia? | Bc insufficient glucocorticoids causes ^ insulin sensitivity & decreased glycogen s/s: diaphoresis, shaking, tachycardia, headache * have 15g carb snack readily available |
Created by:
mary.scott260!
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