Frequent oral care gentle gargling provide low fat

frequent oral care, gentle gargling
- Provide low fat, low cholesterol, low calorie diet
Adrenal cortex-hypofunction
Addison’s disease : characterized by a decrease in secretions of corticosteroids. Autoimmune.
- Primary: problem is in the adrenal cortex (hypofunction of the adrenal cortex)
- Secondary: problem is outside of the adrenal gland (lack of pituitary ACTH secretion)
In Addison’s disease all three classes of adrenal corticosteroids (glucocorticoids,
mineralocorticoids, and androgens) are reduced.
In secondary adrenocortical insufficiency, corticosteroids and androgens are deficient but
mineralocorticoids rarely are
s/s: when there’s too little glucocorticoid: weight loss, hyperpigmentation or bronzing of the
skin, hypotension, abdominal pain. Cramping, anorexia, diarrhea, generalized fatigue and
weakness, immunosuppressed, anemia, hyponatremia, hypokalemia, dehydration, volume
deficit, emotional lability, may have irritability and fever
if mineralocorticoid is down: hyponatremia, hyperkalemia, hypovolemic shock, hypotension
if androgen are down: decreased pubic hair, no effect for men/women other then decreased
muscle size and tone
labs:

- Acth stimulation test: give acth and if the symptoms of the patient goes away, then you
know the problem is primary Addison’s, but If they do not go away then the problem is
secondary its in the adrenal gland itself
- Electrolytes
- 24-hour urine for free cortisol: discard first void to get accurate measurement put it
under brown basket and in ice and check for cortisol in the urine. If it’s less than 50
MCG per day then the patient has Addison’s. if its greater than 100 MCG a day then the
patient has Cushing’s
- MRI, ct, ekg for baseline
Treatment:
- Daily glucocorticoids TWICE a day
- 2/3 must be given in the am, 1/3 in the pm. If its 100mg pill, give 66mg, 1/3 is 33
- Daily mineralocorticoids (florinef)
- Salt additives (excess heat or humidify)
- Increase doses of cortisol (hydrocortisone) if they are experiencing stress
Addison’s crisis: life threatening emergency, die within an hour. Profound insufficient corticoids
- Bradycardia to asystole
- Severe hypotension
- Cardiopulmonary arrest
- Cardiogenic and hypovolemic and hypoglycemic SHOCK.
- Patient will often times complain of generalized weakness, fatigue, comatose
For hypoglycemia  give d50 or dextrose IV fluids or snacks and small meals
- Accucheck every 2-4 hours
- Monitor serum sodium
- Cardiopulmonary assessment every 2-4 hours
- Head of bed elevated
- Oxygen at stand by
- 12 lead EKG
- Replace potassium
- Increase activity gradually
- Adequate rest, calm environment
- Promote meticulous skin care and frequent oral care
- Explain all procedures
- Monitor for s/s of shock
- Fluid volume deficit  i/o daily weight, skin turgor,
- Nutrition  high calorie diet
- Safety  avoid rugs, adequate lighting
- Provide referral