Addison’s Disease, also known as primary adrenal insufficiency, is a rare endocrine disorder where the adrenal glands fail to produce sufficient amounts of vital hormones, particularly cortisol and aldosterone. This nursing diagnosis focuses on identifying symptoms, managing hormone replacement, and preventing life-threatening adrenal crisis.
Causes (Related to)
Addison’s Disease can develop due to various factors affecting adrenal gland function:
- Autoimmune disorders (most common cause)
- Infections affecting the adrenal glands:
- Tuberculosis
- HIV
- Fungal infections
- Genetic factors
- Medications such as:
- Sudden stopping of corticosteroids
- Certain immunotherapy drugs
- Other conditions:
- Surgical removal of adrenal glands
- Hemorrhage of adrenal glands
- Cancer metastasis to adrenal glands
Signs and Symptoms (As evidenced by)
The symptoms of Addison’s Disease develop gradually and may go unnoticed until a stressful event triggers an adrenal crisis.
Subjective: (Patient reports)
- Severe fatigue and weakness
- Salt cravings
- Muscle and joint pain
- Gastrointestinal symptoms (nausea, vomiting)
- Dizziness upon standing
- Depression and irritability
- Loss of appetite
- Decreased libido
Objective: (Nurse assesses)
- Hyperpigmentation of skin and mucous membranes
- Postural hypotension
- Weight loss
- Low blood pressure
- Hypoglycemia
- Electrolyte imbalances
- Dehydration
- Weakness
Expected Outcomes
Successful management of Addison’s Disease includes:
- The patient maintains stable vital signs
- The patient demonstrates proper medication management
- The patient maintains electrolyte balance
- The patient avoids adrenal crisis
- The patient maintains adequate nutrition and hydration
- Patient verbalizes understanding of stress dose management
- Patient identifies early signs of complications
Nursing Assessment
1. Monitor Vital Signs
- Check blood pressure in lying and standing positions
- Monitor heart rate and rhythm
- Assess respiratory rate
- Check temperature
2. Evaluate Endocrine Function
- Monitor for signs of adrenal insufficiency
- Assess medication compliance
- Check blood glucose levels
- Monitor electrolyte levels
3. Assess Fluid Status
- Monitor intake and output
- Check skin turgor
- Assess mucous membranes
- Monitor for dehydration signs
- Track weight changes
4. Monitor for Complications
- Watch for signs of adrenal crisis
- Assess for infection
- Monitor stress levels
- Check for medication side effects
- Evaluate emotional status
5. Review Risk Factors
- Assess knowledge of disease management
- Review stress management techniques
- Evaluate support system
- Check emergency preparedness
- Review medication history
Nursing Care Plans
Nursing Care Plan 1: Risk for Adrenal Crisis
Nursing Diagnosis Statement:
Risk for Adrenal Crisis related to primary adrenal insufficiency and potential stressors as evidenced by a history of Addison’s Disease and current illness.
Related Factors:
- Inadequate cortisol production
- Stress (physical or emotional)
- Infection or illness
- Medication non-compliance
- Trauma or surgery
Nursing Interventions and Rationales:
- Monitor vital signs frequently
Rationale: Early detection of adrenal crisis symptoms - Administer corticosteroids as prescribed
Rationale: Maintains adequate hormone levels - Teach stress dose management
Rationale: Prevents crisis during periods of stress - Monitor for signs of infection
Rationale: Infection can trigger an adrenal crisis
Desired Outcomes:
- The patient will remain free of adrenal crisis
- The patient will demonstrate proper stress dose management
- The patient will identify early warning signs of crisis
Nursing Care Plan 2: Fluid Volume Deficit
Nursing Diagnosis Statement:
Risk for Fluid Volume Deficit related to inadequate aldosterone production as evidenced by hypotension and electrolyte imbalance.
Related Factors:
- Decreased aldosterone production
- Sodium and water loss
- Gastrointestinal symptoms
- Poor oral intake
Nursing Interventions and Rationales:
- Monitor fluid balance
Rationale: Ensures adequate hydration - Administer IV fluids as ordered
Rationale: Corrects fluid and electrolyte imbalances - Monitor electrolyte levels
Rationale: Identifies imbalances requiring intervention
Desired Outcomes:
- The patient will maintain adequate hydration
- The patient will demonstrate stable electrolyte levels
- The patient will maintain blood pressure within normal range
Nursing Care Plan 3: Fatigue
Nursing Diagnosis Statement:
Fatigue related to endocrine imbalance as evidenced by decreased energy and activity intolerance.
Related Factors:
- Hormone deficiency
- Electrolyte imbalance
- Poor nutrition
- Sleep disturbance
Nursing Interventions and Rationales:
- Plan activities during peak energy periods
Rationale: Maximizes energy utilization - Assist with ADLs as needed
Rationale: Conserves energy while maintaining function - Monitor activity tolerance
Rationale: Prevents exhaustion
Desired Outcomes:
- The patient will report improved energy levels
- The patient will demonstrate increased activity tolerance
- The patient will maintain a balance between rest and activity
Nursing Care Plan 4: Risk for Ineffective Therapeutic Regimen Management
Nursing Diagnosis Statement:
Risk for Ineffective Therapeutic Regimen Management related to complex medication schedule as evidenced by verbalized confusion about medication timing.
Related Factors:
- Complex medication regimen
- Knowledge deficit
- Lack of support system
- Financial constraints
Nursing Interventions and Rationales:
- Provide medication education
Rationale: Ensures proper medication administration - Develop medication schedule
Rationale: Promotes adherence to regimen - Teach signs of under/over-replacement
Rationale: Enables early recognition of problems
Desired Outcomes:
- The patient will demonstrate proper medication management.
- The patient will maintain a medication schedule
- The patient will identify signs of dosing problems
Nursing Care Plan 5: Imbalanced Nutrition
Nursing Diagnosis Statement:
Risk for Imbalanced Nutrition: Less than Body Requirements related to gastrointestinal symptoms as evidenced by weight loss and decreased appetite.
Related Factors:
- Nausea and vomiting
- Decreased appetite
- Metabolic changes
- Fatigue
Nursing Interventions and Rationales:
- Monitor nutritional intake
Rationale: Ensures adequate nutrition - Provide small, frequent meals
Rationale: Improves tolerance to food - Monitor weight regularly
Rationale: Tracks nutritional status
Desired Outcomes:
- The patient will maintain a stable weight
- The patient will demonstrate an improved appetite
- The patient will maintain adequate nutritional intake
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
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- Chidiac, R., El Samad, S., & El Ghoul, B. (2024). Addison’s disease: A rare condition not to be missed. Clinica Chimica Acta, 558, 118151. https://doi.org/10.1016/j.cca.2024.118151
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- Silvestri, L. A. (2023). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
