Nursing Care Plan for Addison’s Disease (Primary Adrenal Insufficiency)

Pathophysiology

The adrenal glands, located above the kidneys, fail to produce an adequate amount cortisol, aldosterone or androgens. Cortisol is a glucocorticoid that influences the body’s ability to respond to stress and produce energy. Aldosterone is a mineralocorticoid that maintains the sodium-potassium balance that regulates blood pressure. Androgens are responsible for sexual development of men and the influence of muscle mass and sense of well-being in men and women.

Etiology

A decrease in adrenal gland function may be caused by an autoimmune disease that damages the adrenal glands in which the body attacks the adrenal glands as if they were a foreign body. Damage to these glands may also be a result of severe infection of the adrenal glands, tuberculosis, or the spread of cancer.

Desired Outome

maintain adequate hormone levels for optimized ability to create energy and respond to stress and electrolyte balance to regulate blood pressure

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 Interventions and Rationales:

  1. Monitor weight
    • Lack of appetite due to decreased levels of cortisol may cause significant decrease in body weight
  2. Encourage oral fluids
    • Deficiency of cortisol may lead to anorexia and impaired GI function. Encourage oral fluids to help maintain adequate sodium levels and avoid dehydration.
  3. Minimize stress and assist with activities / provide rest periods
    • Simple stress and overexertion can cause a life-threatening Addisonian crisis due to lack of corticosteroids that help the body react to and manage stress.
  4. Monitor nutrition
    • Aldosterone deficiency causes the kidneys to excrete sodium which may result in salt cravings. Encourage patients to increase salt intake and supplements as necessary to prevent hyponatremia. Encourage patients to eat high protein / low carb snacks and meals as tolerated followed by rest periods to prevent fatigue due to hypoglycemia and to facilitate digestion.
  5. I & O – monitor intake and output
    • Monitor urine for decreased output (desired >30ml/hr), concentration and color which may be darker
  6. Assess vitals; temperature, blood pressure and heart rate - watching for orthostatic changes and hyperpyrexia
    • A decrease of 15 mm Hg or more and increase in heart rate (normal <100bpm) may indicate reduced circulation of fluids such as with dehydration

      Increased temperature may be a sign of Addisonian crisis due to hormonal and fluid imbalance
  7. 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.
  8. Monitor for signs of dehydration by noting mucus membranes and skin turgor
    • Tenting of the skin and dry mucous membranes indicate dehydration., which is common due to vomiting and anorexia.
  9. 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

References

Date Published - Oct 31, 2018
Date Modified - Nov 1, 2018