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Addison's Disease - Coggle Diagram
Addison's Disease
Signs, Symptoms, and Assessment
Decreased blood glucose (Lilley et al., 2018)
Monitoring of client blood glucose levels, watching for symptoms of hypoglycemia such as poor concentration, slurred speech, and staggered gait
Poor stress response (Lilley et al., 2018)
Fatigue (Lilley et al., 2018)
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Weight loss and decreased appetite (Lilley et al., 2018)
Monitor client intake and output, inquire about client's appetite, examine client over time to see if there is a change in mass, weigh client if necessary
Frequent infections (Lilley et al., 2018)
Monitor client for general signs of infection such as elevated temperature, chills, sweats, pain, new or worsening cough, etc.
Low blood pressure (Mayo Clinic, 2020)
Monitoring of vital signs, specifically blood pressure, watching for downward trends
Hyperpigmentation of the skin (Mayo Clinic, 2020)
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Gastrointestinal problems (Mayo Clinic, 2020)
Assess for vomiting, diarrhea, or abdominal pain
Client Education
Client should be taught to recognize activities leading to low blood glucose, how to recognize the signs, and to keep high sugar snacks/drinks on hand to quickly reverse a hypoglycemic state
Client should monitor own weight and appetite and make sure they are supplementing their diet accordingly
Client should be aware of orthostatic hypotension and get up slowly from a seated or lying down position slowly
Client should be taught the early signs of infection in the body and to seek treatment early accordingly due to reduced ability to fight infection
Client should be taught about the importance of adhering to their steroid replacement medication regimen due to the risk of adrenal crisis
Client should be encouraged to increase their fluid intake in daily life, client may also need sodium supplements during particularly hot or humid periods
Client should take care to avoid stressful situations when possible. If unavoidable, client will want to self monitor vital signs as possible and seek medical attention if they notice a decrease in their LOC, BP, or just any overall serious changes
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Nursing Interventions
Client is at risk of dehydration evidenced by reduced sodium and water retention and GI disturbances like vomiting or diarrhea (Nurselabs, 2022)
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Assess vitals, paying particular attention to BP and HR
Assess amount and characteristics (colour, concentration) of urine
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Assess ECG for additional signs of hyperkalemia, sharp peaked T wave, widened QRS complex
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If serious, administer client IV fluids
Client is at risk for imbalanced nutrition as evidence by decreased GI enzymes, loss of appetite, and GI upset such as nausea and vomiting (Nurselabs, 2022)
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Work with client to develop a menu they like and can tolerate, may require family to prepare and bring in meals
Monitor blood glucose, administer insulin if indicated
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Client may need to have several smaller meals or snacks through the day instead of three larger meals
Client is at risk for decreased cardiac output evidenced by reduced blood pressure related to low cortisol levels and heightened risk for shock from low corticosteroid levels such as stress or infection (Nurselabs, 2020)
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Monitor client vital signs with frequent monitoring of BP, HR, and Sp02
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Medications
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Nutrition supplements from GI issues, weight loss, and decreased appetite
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Antiemetics, antinauseants, and antidiarrheals for GI issues
Etiology
Caused by the body's inability to produce enough cortisol and aldosterone (Mayo Clinic, 2020)
Cortisol
Suppresses inflammation, short term immunity boost (Cleveland Clinic, 2021)
Regulates blood pressure, high cortisol leads to high blood pressure and vice versa (Cleveland Clinic, 2021)
Helps control body's metabolism (Cleveland Clinic, 2021)
Regulates blood sugar by releasing stored glucose into the bloodstream (Cleveland Clinic, 2021)
Regulates body's stress response (Cleveland Clinic, 2021)
Helps control sleep cycle and wakefulness (Cleveland Clinic, 2021)
Aldosterone
Increase excretion of potassium (Encyclopedia Britannica, n.d.)
Has a small effect on metabolism of fats, carbohydrates, and proteins (Encyclopedia Britannica, n.d.)
Increases retention of sodium and water in the kidneys (Encyclopedia Britannica, n.d.)
Pathophysiology
Autoimmune reaction (Lilley et at., 2018)
Adrenal gland damaged via infection (Lilley et al., 2018)
Adrenal tumor (Lilley et al., 2018)
Secondary adrenal insufficiency via too little ACTH (adrenocorticotropic hormone) or usage of corticosteroid medications (Mayo Clinic, 2020)
Affects all genders and ages (Mayo Clinic, 2020)