Nursing Care Plan (NCP) for Addison’s Disease (Primary Adrenal Insufficiency)
You're watching a preview. 300,000+ students are watching the full lesson.
Included In This Lesson
Study Tools For Nursing Care Plan (NCP) for Addison’s Disease (Primary Adrenal Insufficiency)
NURSING.com students have a 99.25% NCLEX pass rate.
Outline
Lesson Objectives for Addison’s Disease (Primary Adrenal Insufficiency) Nursing Care:
- Understanding Pathophysiology:
- Comprehend the pathophysiological mechanisms underlying Addison’s disease, including the insufficient production of adrenal hormones and its impact on systemic function.
- Recognition of Clinical Manifestations:
- Identify and recognize the clinical manifestations associated with Addison’s disease, such as fatigue, hypotension, electrolyte imbalances, and hyperpigmentation, to facilitate early detection and intervention.
- Medication Management:
- Gain proficiency in the administration and monitoring of medications, particularly glucocorticoids and mineralocorticoids, essential for hormone replacement therapy in individuals with Addison’s disease.
- Balancing Fluid and Electrolytes:
- Develop skills in assessing and maintaining fluid and electrolyte balance, recognizing the potential for hyponatremia and hyperkalemia in individuals with adrenal insufficiency.
- Patient Education and Lifestyle Management:
- Educate patients on the importance of medication adherence, symptom recognition, and lifestyle modifications, including stress management and dietary considerations, to optimize their quality of life while living with Addison’s disease.
Pathophysiology of Addison’s Disease (Primary Adrenal Insufficiency):
- Adrenal Cortex Dysfunction:
- Addison’s disease primarily results from dysfunction of the adrenal cortex, leading to insufficient production of cortisol (glucocorticoids) and aldosterone (mineralocorticoids).
- Autoimmune Destruction:
- In the majority of cases, Addison’s disease is caused by autoimmune destruction of the adrenal cortex. Autoantibodies target and damage the adrenal cells, impairing hormone synthesis.
- Tuberculosis and Infections:
- In some instances, adrenal insufficiency may result from infections, particularly tuberculosis, affecting the adrenal glands and disrupting normal hormonal production.
- Genetic Factors:
- Rarely, genetic factors may contribute to adrenal insufficiency. Inherited conditions affecting adrenal function can lead to deficient cortisol and aldosterone synthesis.
- Hemorrhage or Infarction:
- Adrenal hemorrhage or infarction, often associated with severe bacterial infections or bleeding disorders, can compromise blood supply to the adrenal glands, causing adrenal insufficiency.
Etiology of Addison’s Disease (Primary Adrenal Insufficiency):
- Autoimmune Adrenalitis:
- The most common cause of Addison’s disease is autoimmune adrenalitis, where the body’s immune system mistakenly attacks and damages the adrenal glands, leading to a gradual loss of function.
- Infections, Especially Tuberculosis:
- Infections, particularly tuberculosis, can contribute to adrenal insufficiency by causing inflammation and damage to the adrenal glands, impairing their ability to produce hormones.
- Genetic Factors:
- Genetic predisposition plays a role in some cases of Addison’s disease. Specific genetic mutations or familial patterns may increase the risk of developing adrenal insufficiency.
- Hemorrhage or Infarction:
- Adrenal hemorrhage or infarction, often associated with severe bacterial infections or bleeding disorders, can compromise blood supply to the adrenal glands, resulting in adrenal insufficiency.
- Medication-Induced Adrenal Suppression:
- Prolonged use of certain medications, such as glucocorticoids, can suppress the adrenal glands over time, leading to a state of adrenal insufficiency when the medication is discontinued abruptly.
Desired Outcome for Addison’s Disease (Primary Adrenal Insufficiency) Nursing Care:
- Stabilized Hormone Levels:
- Achieve and maintain stable cortisol and aldosterone levels within the normal range, optimizing metabolic functions and electrolyte balance.
- Symptom Management:
- Effectively manage and alleviate symptoms associated with adrenal insufficiency, such as fatigue, hypotension, weight loss, and hyperpigmentation, enhancing the patient’s overall well-being.
- Prevention of Adrenal Crisis:
- Minimize the risk of adrenal crisis by ensuring adequate hormone replacement therapy adherence, patient education, and prompt recognition of potential stressors that may precipitate crisis situations.
- Optimal Fluid and Electrolyte Balance:
- Attain and maintain optimal fluid and electrolyte balance, preventing complications such as hyponatremia and hyperkalemia commonly associated with adrenal insufficiency.
- Enhanced Quality of Life:
- Improve the patient’s quality of life by providing comprehensive care, addressing psychological aspects, and supporting lifestyle modifications, promoting independence and a sense of well-being.
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 Assessment for Addison’s Disease (Primary Adrenal Insufficiency):
- Medical History:
- Collect a detailed medical history, with a focus on autoimmune conditions, infections, genetic factors, and medication use, to identify potential causes and contributing factors.
- Symptom Assessment:
- Assess the patient for symptoms of adrenal insufficiency, including fatigue, weakness, weight loss, hypotension, hyperpigmentation, gastrointestinal disturbances, and salt cravings.
- Vital Signs Monitoring:
- Monitor vital signs regularly, paying close attention to blood pressure, heart rate, and temperature, as fluctuations may indicate adrenal dysfunction.
- Electrolyte Levels:
- Obtain and monitor electrolyte levels, especially sodium and potassium, to assess for imbalances that commonly occur in adrenal insufficiency.
- Blood Glucose Monitoring:
- Monitor blood glucose levels, as adrenal insufficiency can impact glucose regulation. Assess for signs of hypoglycemia or hyperglycemia.
- Stressors and Triggers:
- Identify potential stressors and triggers that may precipitate adrenal crises, such as infections, trauma, surgery, or emotional stress, to implement preventive measures.
- Skin Examination:
- Perform a thorough skin examination to assess for hyperpigmentation, a characteristic sign of adrenal insufficiency, which may indicate increased melanin production.
- Patient Education Needs:
- Assess the patient’s understanding of the condition, medication adherence, and ability to manage stress. Identify educational needs and provide information on self-care, medication management, and recognizing signs of adrenal crisis.
Outcomes for Addison’s Disease (Primary Adrenal Insufficiency) Nursing Care:
- Stable Hormonal Levels:
- Achieve and maintain stable cortisol and aldosterone levels within the normal range to support metabolic functions, blood pressure regulation, and electrolyte balance.
- Symptom Improvement:
- Witness improvement in symptoms associated with adrenal insufficiency, such as fatigue, weakness, hypotension, and gastrointestinal disturbances, contributing to enhanced patient well-being.
- Prevention of Adrenal Crisis:
- Successfully prevent adrenal crises through patient education, early recognition of stressors, and adherence to hormone replacement therapy, ensuring the avoidance of life-threatening complications.
- Optimal Fluid and Electrolyte Balance:
- Attain and sustain optimal fluid and electrolyte balance, preventing complications like hyponatremia and hyperkalemia, which are common in adrenal insufficiency.
- Enhanced Quality of Life:
- Improve the overall quality of life for individuals with Addison’s disease by addressing psychological aspects, providing ongoing support, and promoting patient empowerment and independence in managing their condition.
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 an increase in heart rate (normal <100bpm) may indicate reduced circulation of fluids such as with dehydration
- Increased temperature may be a sign of an 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
Evaluation for Addison’s Disease (Primary Adrenal Insufficiency) Nursing Care:
- Hormonal Levels:
- Monitor and evaluate cortisol and aldosterone levels regularly to ensure they remain within the target range, indicating effective hormone replacement therapy and metabolic stability.
- Symptom Resolution:
- Assess the resolution or improvement of symptoms associated with adrenal insufficiency, such as fatigue, weakness, and hypotension, indicating successful management of the condition.
- Adherence to Medication Regimen:
- Evaluate the patient’s adherence to the prescribed medication regimen, emphasizing consistent and timely administration, to ensure hormonal replacement therapy’s ongoing effectiveness.
- Prevention of Adrenal Crises:
- Review the patient’s ability to recognize and manage stressors, evaluating the effectiveness of preventive measures in avoiding adrenal crises and associated complications.
- Quality of Life Improvement:
- Assess the overall quality of life, considering physical and psychological aspects, to determine the impact of nursing interventions on enhancing the patient’s well-being and independence.
References
- https://www.mayoclinic.org/diseases-conditions/addisons-disease/symptoms-causes/syc-20350293
- https://www.niddk.nih.gov/health-information/endocrine-diseases/adrenal-insufficiency-addisons-disease
- https://www.webmd.com/a-to-z-guides/understanding-addisons-disease-treatments
Unlock the Complete Study System
Used by 300,000+ nursing students. 99.25% NCLEX pass rate.
- Full lesson outlines
- NCLEX simulator (SIMCLEX)
- 6,500+ practice questions
- 2,000+ lesson videos
- 300+ cheatsheets
200% NCLEX Pass Guarantee.
No Contract. Cancel Anytime.
Transcript
We are going to make a care plan for Addison’s disease. Addison’s disease is when the adrenal glands, which are located above the kidneys, fail to produce an adequate amount of cortisol, aldosterone, or androgens. Some things that we want to be mindful of with taking care of these patients are EKG monitoring. We want to get frequent vital signs. We want to assess these patients for what’s called an Addisonian crisis. We would like to monitor I’s and O’s and we want to assess for dehydration. The desired outcome with Addison’s patients is to make sure we maintain adequate hormone levels for optimized ability to create energy and respond to stress. And, we want to keep those electrolytes balanced and help regulate their blood pressure. When these patients come in to see you, they are going to have a list of complaints. One of the things that they are going to tell you, some of the objective things that they’re going to say is they are going to complain about being fatigued or tired.
Okay. They’re also going to complain of pain. So they’re going to have lower back pain, leg pain, abdominal pain, or they are going to be in pain. They’re also going to be, you’re going to notice they’re going to be irritable. They are going to, uh, complain of being depressed and they are going to, uh, report significant weight loss. These patients are going to be thin. Um, these patients, when you see them and you’re going to observe them. Some of the objective things that you’re going to notice is you’re going to notice that on their vital signs, they are going to have low BP. They’re going to have decreased blood pressure. Their electrolytes are going to be way out. So you may see them with hyponatremia or low sodium, or hyperkalemia. Uh, they’re going to have high potassium. They’re also going to have severe vomiting and diarrhea.
They’re going to be losing those electrolytes that way. They’re also going to have some dehydration as well as it’s possible that they’ll have some, uh, loss of consciousness. So when, uh, caring for these patients, some things that we want to focus on, the first thing that we want to do is we want to get them hooked up to an EKG, and we want to monitor for signs of high potassium or hyperkalemia. And the reason why is because they have low aldosterone levels. And aldosterone is just a hormone that regulates sodium and potassium. It retains potassium and it loses sodium. So if aldosterone is low because of Addison’s, that means potassium is high. So low aldosterone equals high K. The next thing we want to do is we want to monitor for signs of dehydration. We want to take a look at their mucus membranes, their skin turgor.
Remember, if a patient is tense, when you assess the skin turgor, that means that they are dehydrated. And this is very common when the patient has severe diarrhea and vomiting. Following that, we want to encourage oral fluids when necessary. And we want to make sure that we monitor their ins and outs, and we want to make sure we let them know that we will need to institute some IV fluids if they are not able to take PO because of the vomiting. The low cortisol levels, uh, create a space where they’re not able to drink. Uh, they are not able to maintain their adequate sodium level and, uh, they have decreased urine output. So, their urine output is decreased. Okay. The urine will be concentrated and much darker as well. We want to make sure we administer appropriate medication. So, there’s three medications off the top that we want to think of if we want to think about Kayexalate, which is something that’s given to reduce potassium levels.
Okay, excellent. And just in K exit K exit. So the K is going out. Cortef or any type of steroid prednisone, that’s going to increase cortisol levels. And then, also Florinef. That’s also going to, uh, promote replacement and retention of sodium. So we want to make sure we keep that sodium in water. Finally, we want to keep their vitals in the front and an increased temperature can indicate an Addisonian crisis, uh, in the decreased BP can indicate dehydration. Some key points that we want to focus on when taking care of these patients. Uh, first thing, the adrenal glands, when they fail to produce an adequate amount of, uh, hormones, cortisol, aldosterone, and androgens, that’s when a patient can develop Addison’s disease. Some things that they’re going to tell you, pain, think pain, abdominal pain, leg pain, back pain. They’re going to be irritable, uh, weight loss. We’re going to notice some, uh, low BP, some hypotension, low sodium increased, uh, potassium levels. Also, they’re going to have some vomiting and diarrhea. They’re going to be dehydrated, Medications that we’re going to administer, Kayexalate to lower that K uh, Cortef have to increase that cortisol level and Florinef, enough to increase their sodium levels. We want to do EKG and frequent vitals because the EKG is going to show any arrhythmias because of the hyperkalemia, the increased potassium and a fever may indicate Addisonian crisis.
We love you guys, and we want you to go out and be your best self today. And as always, happy nursing.
Study Faster with Full Video Transcripts
99.25% NCLEX Pass Rate vs 88.8% National Average
- Full lesson outlines
- NCLEX simulator (SIMCLEX)
- 6,500+ practice questions
- 2,000+ lesson videos
- 300+ cheatsheets
200% NCLEX Pass Guarantee.
No Contract. Cancel Anytime.
🚨PRICE INCREASE COMING
Lock in Lifetime Access at OVER 50% Off
reg $499 → $199
or 5 payments of $39.99
Ends January 17
BSN 2 STUDY PLAN
Concepts Covered:
- Community Health Overview
- Labor Complications
- Pregnancy Risks
- Emergency Care of the Cardiac Patient
- EENT Disorders
- Cardiovascular Disorders
- Childhood Growth and Development
- Newborn Care
- Prenatal Concepts
- Newborn Complications
- Communication
- Neurologic and Cognitive Disorders
- Musculoskeletal Disorders
- Disorders of the Thyroid & Parathyroid Glands
- Gastrointestinal Disorders
- Infectious Disease Disorders
- Labor and Delivery
- Postpartum Care
- Postpartum Complications
- Respiratory Disorders
- Fundamentals of Emergency Nursing
- Oncology Disorders
- Musculoskeletal Trauma
- Substance Abuse Disorders
- Lower GI Disorders
- Central Nervous System Disorders – Brain
- Immunological Disorders
- Disorders of the Adrenal Gland
- Hematologic Disorders
- Noninfectious Respiratory Disorder
- Integumentary Disorders
- Liver & Gallbladder Disorders
- Disorders of Pancreas
- Eating Disorders
- Microbiology
- Renal Disorders
- Female Reproductive Disorders
- Peripheral Nervous System Disorders
- Upper GI Disorders
- Integumentary Disorders
- Urinary Disorders
- Neurological Emergencies
- Learning Pharmacology