T2: Addisons

Question 1

Addison’s disease

Answer 1

hypo function of the adrenals: amounts of all three classes of adrenal corticosteroids (glucocorticoids, mineralocorticoids, and androgens) are reduced.

Question 2

primary cause of adrenal insufficiency

Answer 2

-Addison’s disease
-Lack of glucocorticoids, mineralocorticoids, and androgens

Question 3

secondary cause of adrenal insufficiency

Answer 3

-Lack of pituitary ACTH
-Lack of glucocorticoids and androgens

Question 4

how do we treat addisons disease

Answer 4

• Replacement therapy of steroids “replace sugar sex and salt”
  -corticosteroid (sugar) salt tabs

Question 5

HINT HINT: medication teaching

Answer 5

will be on glucocorticoid and salt for the rest of their life

Question 6

Causes of Addison’s disease

Answer 6

-Autoimmune
-TB (most common in developing world)
-metastatic carcinoma (most common from lungs)
-loss of glucocorticoids, mineralcorticoids, and androgens
-fungal infections, AIDS

Question 7

clinical manifestations of addisons disease

Answer 7

*slow (insidious) onset, and include anorexia, nausea, progressive weakness, fatigue, and weight loss.
-hyperpigmentation
-Abdominal pain
-Diarrhea
-Headache
-Orthostatic hypotension
-Salt craving
-Joint pain

Question 8

Addisonian crisis

Answer 8

acute adrenal insufficiency, a life-threatening emergency caused by insufficient adrenocortical hormones or a sudden sharp decrease in these hormones

Question 9

Addisonian crisis is triggered by

Answer 9

-stress (from infection, surgery, psychologic distress), -the sudden withdrawal of corticosteroid hormone therapy
- adrenal surgery
-sudden pituitary gland destruction.

Question 10

tool kit for addisonian crisis

Answer 10

Salt tabs, glucocorticoids (injectable), instructions on how to use them
need to be wearing a medical alert bracelet

Question 11

Manifestations of glucocorticoid and mineralocorticoid deficiencies

Answer 11

-Hypotension, tachycardia
-Dehydration
-↓ Sodium, ↑ potassium, ↓ glucose
-Fever, weakness, confusion
-Severe vomiting, diarrhea, pain
-Shock → circulatory collapse

Question 12

what IV solution for addisonian crisis

Answer 12

0.9 NS, but if they are SUPER hyponatremic you can give 3%

Question 13

what needs to be done for high potassium in addison crisis

Answer 13

-place on cardiac monitor
-kayexalate

Question 14

what needs to be given for low glucose in addionian crisis

Answer 14

-D5 NS
-acucheck (Q15)

Question 15

what type of shock is someone in when they are in addisonian crisis

Answer 15

distrubutive

Question 16

diagnostic studies for addisons disease

Answer 16

-ACTH stimulation test

Question 17

ACTH stimulation test

Answer 17

*Baseline cortisol and ACTH levels are measured, and the patient is given an IV injection of synthetic ACTH (cosyntropin).
*Cortisol and ACTH levels are rechecked after 30 and 60 minutes. TIMING

Question 18

normal vs addisons disease reaction to ACTH stimulation test

Answer 18

normal: rise in blood cortisol levels
-addisons: little or no increase in cortisol

Question 19

when the response to the ACTH test is abnormal, what is done

Answer 19

CRH stimulation test

Question 20

CRH stimulation test

Answer 20

The patient is given an IV injection of synthetic CRH, and blood is taken after 30 and 60 minutes.

Question 21

lab findings for addisons

Answer 21

-↑ Potassium
-↓ Chloride, sodium, glucose
-Anemia
-↑ BUN
-ECG changes (*peaked T waves caused by hyperkalemia.)

Question 22

interprofessional care for addisons

Answer 22

-hormone therapy (hydrocortisone)
-Fludrocortisone (Florinef)
-INCREASE DURING PERIODS OF STRESS
-increase dietary salt intake

Question 23

HINT HINT: Fludrocortisone (Florinef)

Answer 23

mineralcorticoid replacement for addisons, pt will be on lifelong hormone therapy

Question 24

interprofessional care for addisonian crisis

Answer 24

-Shock management
-High-dose hydrocortisone replacement
-0.9% saline solution and 5% dextrose (to revers hypotension and electrolyte imbalance until BP returns)

Question 25

acute care

Answer 25

-Correct fluid and electrolyte imbalance -Assess vital signs and neurologic status -Daily weight -Accurate I and O -Obtain complete medication history -Watch for signs of Cushing syndrome

Question 26

watch for manifestations of cushings

Answer 26

blood pressure, weight gain, weakness, or other manifestations

Question 27

HINT HINT: patient teaching for dosing: glucocorticoids

Answer 27

divided doses: one on morning, once at night

Question 28

HINT HINT: patient teaching for dosing: mineralcorticoids

Answer 28

once in the morning (to match circadiam rhythm)

Question 29

corticosteroids and stress

Answer 29

NEED TO INCREASE DURING TIMES OF STRESS

Question 30

patient teaching

Answer 30

-Report signs and symptoms of corticosteroid deficiency and excess to HCP -Carry identification and wear medical ID bracelet -Emergency kit -How to administer IM hydrocortisone -Written instructions

Question 31

side effects with corticosteroid therapy

Answer 31

-↓ Potassium and calcium -↑ Glucose and BP -Delayed healing -Susceptibility to infection -Suppressed immune response -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

Question 32

Expected effects of corticosteroid therapy

Answer 32

-Antiinflammatory action -Immunosuppression -Maintenance of normal BP

Question 33

corticosteroid therapy: dietary needs

Answer 33

*diet high in protein, calcium (at least 1500 mg/day), and potassium but low in fat and concentrated simple carbohydrates such as sugar, honey, syrups, and candy.

Question 34

corticosteroid therapy: Rest and exercise needs

Answer 34

*Identify measures to ensure adequate rest and sleep, such as daily naps and avoidance of caffeine late in the day. *Develop and maintain an exercise program to help maintain bone integrity.

Question 35

corticosteroid therapy: Sodium restriction if edema occurs

Answer 35

*Recognize edema and ways to restrict sodium intake to less than 2000 mg/day if edema occurs.

Question 36

corticosteroid therapy: hyperglycemia

Answer 36

Monitor glucose levels and recognize symptoms of hyperglycemia (e.g., polydipsia, polyuria, blurred vision).

Question 37

corticosteroid therapy patient teaching

Answer 37

-Should be taken in morning with food to reduce gastric irritation and reduce ulcers -Must NOT be stopped abruptly -Needs to INCREASE in times of stress -Measures to reduce occurrence of osteoporosis (CALCIUM)