Study 5 Adrenal Disorders and Nursing Care with 12 free online flashcards. Review key terms, definitions, and concepts with this interactive flashcard deck.
What is adrenal insufficiency?
Adrenal insufficiency is inadequate cortisol production. It may be primary, from adrenal gland damage, or secondary or tertiary, from reduced ACTH or suppression of the hypothalamic-pituitary-adrenal axis.
Which findings can suggest primary adrenal insufficiency?
Primary adrenal insufficiency can reduce both cortisol and aldosterone, causing findings such as salt craving, dehydration, low sodium, high potassium, and skin darkening.
How does secondary or tertiary adrenal insufficiency differ from primary disease?
Secondary or tertiary insufficiency can follow reduced pituitary ACTH or hypothalamic-pituitary-adrenal axis suppression, often after prolonged glucocorticoid therapy. Aldosterone is usually preserved.
What should adrenal insufficiency assessment include?
Assess vital signs, hydration, weight, mental status, and glucocorticoid history. Evaluation may include cortisol, ACTH, corticotropin stimulation, renin, aldosterone, and electrolytes.
What medicines are commonly used for long-term adrenal insufficiency replacement?
Hydrocortisone commonly replaces cortisol. People with primary disease and aldosterone deficiency may also need fludrocortisone; doses and monitoring are individualized.
What medication guidance should people with adrenal insufficiency follow?
Take medication as prescribed and never stop long-term glucocorticoids abruptly. Follow an individualized stress-dose plan during illness and an emergency plan if vomiting prevents oral medication.
What can trigger an adrenal crisis?
Triggers include infection, fever, surgery, trauma, and persistent vomiting or diarrhea. Crisis may occur when stress needs exceed replacement or reveal previously unrecognized disease.
What are warning signs of adrenal crisis?
Warning signs include profound weakness, severe hypotension or shock, dehydration, abdominal symptoms, confusion, and possible hypoglycemia.
What is the initial nursing response to suspected adrenal crisis?
Activate emergency response, notify the treating team, assess airway, breathing, circulation, mental status, and vital signs, establish IV access, and prepare for urgent resuscitation.
How are fluid deficits supported and treatment monitored in adrenal crisis?
Rapid IV isotonic saline is commonly used; add dextrose when indicated, including for hypoglycemia. Frequently reassess and monitor vital signs, mental status, intake and output, glucose, sodium, and potassium.
How do Cushing syndrome and Cushing disease differ?
Cushing syndrome results from prolonged exposure to excess cortisol, including prescribed glucocorticoids. Cushing disease is the specific form caused by an ACTH-secreting pituitary tumor.
What findings may occur with Cushing syndrome?
Possible findings include progressive weight gain, central fat accumulation, rounded face, upper-back fat, thin skin, easy bruising, purple stretch marks, proximal muscle weakness, mood changes, hypertension, and hyperglycemia.
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