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
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- Spring '17
- Endocrine System, Anterior pituitary