Addison's Disease

Addison’s Disease Nursing Diagnosis Interventions and Care Plans

Addison’s Disease Nursing Diagnosis NCLEX Review Care Plans

Nursing Study Guide for Addison’s Disease

Addison’s disease is a condition wherein there is a decreased production of adrenal hormones; it is also known as adrenal insufficiency

The adrenal glands are situated just above the kidneys and they are part of the endocrine system. In Addison’s disease, the adrenal glands produce very low levels of cortisol and aldosterone.

If left untreated, Addison’s disease may result to acute adrenal failure, also called Addisonian crisis.

Signs and Symptoms of Addison’s disease

  • Weight loss
  • Decreased or loss of appetite
  • Extreme fatigue
  • Hyperpigmentation or darkening of skin
  • Hypotension or low blood pressure
  • Hypoglycemia or low blood glucose level
  • Nausea and vomiting
  • Abdominal pain
  • Muscle or joint pains
  • Irritability
  • Depression or other mood/behavioral symptoms
  • Body hair loss
  • Sexual dysfunction in women

In Addisonian crisis, the patient may also have:

  • Confusion or decreased level of consciousness, even delirium
  • Lower back or lower limb pain
  • Hyperkalemia (high potassium) and hyponatremia (low sodium)

Causes and Risk Factors of Addison’s Disease

Addison’s disease features a low production of adrenal hormones, which results to the poor regulation of important body functions, such as the conversion of food to energy by the glucocorticoids (e.g. cortisol), imbalance of sodium and potassium due to low levels of its regulator, the mineralocorticoids (e.g. aldosterone), and reduced sex drive (libido) and male sexual development problems due to small amounts of sex hormones.

Some risk factors that are related to the development of Addison’s disease include history of tuberculosis, adrenal gland infection or cancer, or bleeding.

Complications of Addison’s Disease

Infection, injury, or other forms of physical stress may trigger Addisonian crisis in patients with untreated Addison’s disease.

In response to physical stress, the adrenal glands usually secrete 2-3 times more cortisol than normal.

However, Addison’s disease patients are unable to do this kind of response, causing a fatal adrenal gland failure, which includes hypotension, hypoglycemia, and hyperkalemia.

Diagnosis of Addison’s Disease

  • Physical exam and history taking – to check for the symptoms of Addison’s disease and any history of other autoimmune diseases
  • Blood tests – to check for electrolyte levels, cortisol, and ACTH levels
  • ACTH stimulation test – to measure the cortisol level before injection of synthetic ACTH, and after administering it
  • Insulin-induced test for hypoglycaemia – to check if cortisol levels increase when glucose level decrease (normal or healthy people). If it does not, then adrenal insufficiency is suspected
  • Imaging – MRI or CT scan to visualize the adrenal glands

Treatment for Addison’s Disease

  1. Oral corticosteroids. To raise the adrenal hormone levels, oral corticosteroids are given. These include methylprednisolone, hydrocortisone, or prednisone to boost cortisol levels. Fludrocortisone is used to improve aldosterone levels.
  2. High sodium, high caloric, low potassium diet. The dietitian will recommend appropriate food and fluids to increase the water, salt and calories in the diet to combat hyponatremia, excessive water excretion, weight loss, hyperkalemia, and fatigue.
  3. Symptomatic control. Medications for the symptoms of Addison’s disease such as diarrhea, pain, or mood problems can be prescribed as supportive treatment.

Nursing Care Plans for Addison’s Disease

  1. Nursing Diagnosis: Risk for Deficient Fluid Volume related to increased water and sodium secretion and potassium retention

Desired Outcome: The patient will have adequate fluid balance as evidenced by urinary output of more than 30 mL/hr, normal skin turgor, and stable vital signs.

InterventionsRationales
Commence a fluid balance chart, monitoring the input and output of the patient.To monitor patient’s fluid volume accurately and effectiveness of actions to prevent fluid volume deficit and dehydration.
Start intravenous therapy as prescribed. Encourage oral fluid intake.To replenish the fluids lost, usually starting with a saline drip, and to promote better blood circulation around the body.
Educate the patient (or guardian) on how to fill out a fluid balance chart at bedside.To help the patient or the guardian take ownership of the patient’s care, encouraging them to drink more fluids as needed, or report any changes to the nursing team. 
Administer Kayexalate (orally or rectally through an enema) as prescribed.To decrease potassium levels in the body by using Kayexalate, an ion exchange resin.
Administer cortisone, hydrocortisone, or fludrocortisone as prescribed.To promote resorption of sodium using cortisone or prednisone. Fludrocortisone is useful for aldosterone replacement, promoting water and sodium resorption.
Monitor patient’s serum electrolytes and recommend electrolyte replacement therapy (oral or IV) to the physician as needed.Sodium is an important electrolyte that is lost in Addison’s disease. Hyponatremia or low serum sodium level may cause brain swelling.
Addison’s Disease Nursing Care Plan

2. Nursing Diagnosis: Deficient Knowledge related to new diagnosis of Addison’s disease as evidenced by patient’s verbalization of “I want to know more about my new diagnosis and care”

Desired Outcome: At the end of the health teaching session, the patient will be able to demonstrate sufficient knowledge of Addison’s disease and its management.

InterventionsRationales
Assess the patient’s readiness to learn, misconceptions, and blocks to learning (e.g. denial of diagnosis or poor lifestyle habits)To address the patient’s cognition and mental status towards the new diagnosis of Addison’s disease and to help the patient overcome blocks to learning.
Explain what Addison’s disease is, and how it affects the body. Avoid using medical jargons and explain in layman’s terms.To provide information on Addison’s disease and its pathophysiology in the simplest way possible.
Educate the patient about adrenal insufficiency, its symptoms, and management.To give the patient enough information on adrenal insufficiency and its diagnosis and treatment.  
Inform the patient the details about the prescribed medications (e.g. drug class, use, benefits, side effects, and risks) to promote sodium and water resorption, to reduce potassium levels, and to manage symptoms of Addison’s disease, and explain how to properly self-administer each of them. Ask the patient to repeat or demonstrate the self-administration details to you.To inform the patient of each prescribed drug and to ensure that the patient fully understands the purpose, possible side effects, adverse events, and self-administration details.
Use open-ended questions to explore the patient’s lifestyle choices and behaviors that can help in the management of Addison’s disease.To assist the patient managing nutrition, diet, and exercise as related to the care and management of Addison’s disease.
Addison’s Disease Nursing Care Plan

Other Nursing Diagnoses:

  • Risk for Imbalanced Nutrition: Less than Body Requirements
  • Risk for Decreased Cardiac Output

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines and policies and procedures. The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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