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
- 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.
- 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.
- Symptomatic control. Medications for the symptoms of Addison’s disease such as diarrhea, pain, or mood problems can be prescribed as supportive treatment.
Nursing Diagnosis for Addison’s Disease
Nursing Care Plan 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.
| Addison’s Disease Nursing Interventions | Rationales |
| 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. |
Nursing Care Plan for Addison’s Disease 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.
| Addison’s Disease Nursing Interventions | Rationales |
| 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. |
Nursing Care Plan for Addison’s Disease 3
Risk for Decreased Cardiac Output
Nursing Diagnosis: Risk for Decreased Cardiac Output related to reduced work of the left ventricle of the heart secondary to Addison’s disease.
Desired Outcomes:
- The patient’s blood pressure, pulse rate, and heart rhythm will stabilize and be maintained within the normal or target range.
- The patient will be able to tolerate activities without signs of difficulty of breathing.
- The patient will remain free from the side effects of the medications used to medication side effects.
- The patient will verbalize understanding of the precautions for cardiac disease patients.
| Addison’s Disease Nursing Interventions | Rationale |
| 1. Obtain baseline vital signs of the patient especially the heart rate, and blood pressure, and check for the presence of orthostatic hypotension. | Patients with reduced blood cardiac output and low blood pressure are common responses to compensatory tachycardia that the patient may experience. Compensatory tachycardia has a positive effect that may be harmful when it becomes persistent. The nurse should monitor for long episodes of orthostatic hypotension because it may indicate more serious health problems. |
| 2. Check for the patient’s level of consciousness and the patient’s level of anxiety. | Anxiety and restlessness may cause agitation and confusion which is an early sign of cerebral hypoxia. Cerebral hypoxia happens when there is insufficient oxygen in the brain. |
| 3. Check for the patient’s peripheral pulses by doing a capillary refill test (CRT). | Pale, cool, and diaphoretic skin may indicate peripheral vasoconstriction. The nurse should do a capillary refill test (CRT) because when there is reduced stroke volume and decreased cardiac output this may cause a weak pulse. |
| 4. Note the respiratory rate, rhythm, and breath sounds. Assess for the presence of orthopnea or paroxysmal nocturnal dyspnea. | Decreased cardiac output is characterized by shallow and rapid breathing which may be present in patients with Addison’s disease. The nurse should also monitor for shortness of breath when lying down also known as orthopnea and the presence of paroxysmal nocturnal dyspnea(PND) which happens when the patient has episodes of shortness of breath when sleeping, these symptoms are common among patients with cardiac disease. |
| 5. Check for the presence of chest pain, and identify location, severity, and duration. | Myocardial ischemia means there is an inadequate blood supply to the heart that may affect the cardiac output and may cause chest pain and discomfort. |
| 6. Check if there is an increase in the patient’s weight, check the patient regularly and check for the presence of edema. | Fluid retention and elevated fluid volume may be due to compromised regulatory mechanisms of the body. Checking the bodyweight is a good indicator of fluid retention and an increase in fluid volume because edema may indicate heart failure. |
| 7. Check for the patient’s urine output and note the decrease in output. | The nurse should take note of the urine output every hour, because decreased cardiac output may cause perfusion of the kidneys which results in decreased urine output. |
| 8. Provide a comfortable and silent environment and advise frequent rest periods and avoid stress. | Stress may result in a life-threatening situation for patients with Addison’s disease. Providing comfort to the patient may reduce stress. Providing frequent rest periods may prevent overexertion. |
| 9. Check for the patient’s electrocardiogram (ECG). Check for the rate rhythm and ectopy. | Electrocardiogram (ECG) is used to evaluate the electrical signals in the heart. ECG may help to see how the heart is working. Abnormal heart rhythms and heart rate can further compromise cardiac output. |
| 10. Administer medications and oxygen as prescribed by the physician. Check and monitor the vital signs and the condition of the patient before giving the medication. | The patient’s oxygen saturation must be greater than 90%. Medications such as diuretics, vasodilators, anti-dysrhythmias, angiotensin-converting enzyme inhibitors, and inotropic agents as prescribed by the physician may be given to patients with decreased cardiac output. |
| 11. Teach the patient, family, and significant others about the disease and instruct them when to call a primary provider. | Early identification of the symptoms may help to prevent problems and aid in prompt treatment. Stress management should be included in health education because this may reduce the recurrence of myocardial infarction. |
Nursing Care Plan for Addison’s Disease 4
Risk for Imbalanced Nutrition: Less Than Body Requirements
Nursing Diagnosis: Risk for Imbalanced Nutrition Less Than Body Requirements related to loss of appetite, low tolerance to fluids, and decreased gastrointestinal enzymes secondary to Addison’s disease as evidenced by decreased weight, nausea, vomiting, and diarrhea.
Desired Outcomes:
- The patient’s nutritional status will be maintained within the desired level in terms of body mass index (BMI).
- The patient will verbalize understanding of options to support supplements for nutrition.
- The patient will verbalize an increase in tolerance of food and an increased desire to eat.
- The patient will demonstrate healthy eating arrangements.
| Addison’s Disease Nursing Interventions | Rationale |
| 1. Determine the patient’s weight, and appetite and check for the presence of nausea, vomiting, and diarrhea. | It is important to check the patient’s weight daily in the morning, loss of weight can be measured correctly with the patient’s actual weight every day. Document the weight regularly. The weight of the patient is an ideal tool to assess the patient’s nutritional status. Deficient cortisol can impair the function of the GI, which may cause anorexia, nausea, and vomiting. |
| 2. Determine which food the patients can eat and drink. Let the patient choose what to eat. Take note of the barriers that may affect the patient’s nutrition. | The patient’s appetite may increase with chosen foods that the patient can tolerate. Proving food that the patient likes may increase appetite. Appetite is very important to satisfy the needs of the body for food. Knowing the barriers that affect patients from eating will help in addressing and formulating goals. |
| 3. Check for the patient’s serum glucose levels and check for hypoglycemia. | Hypoglycemia happens when your blood sugar level is decreased. Glucose is very important for the body because it is the main energy source. |
| 4. Recommend food options and refer the patient to a dietician or nutritionist. | Dieticians and Nutritionists may help develop nutritional programs for the patient and may recommend food options that will supplement the patient’s nutritional problems. |
| 5. Recommend frequent small meals and encourage the patient to rest after eating. | To maintain adequate proper nutrition small frequent meals are advised because they may increase blood sugar levels and may promote weight gain. Frequent meals can also improve the caloric intake of the patient and may prevent dehydration. Resting after eating may help facilitate digestion. |
| 6. Encourage the patient to eat with family and significant others if possible. | The patient’s focus on food may reduce through socialization with others which may encourage the patient to eat more without noticing. Families and significant other plays an important role in encouraging the patient and they may also help to reach the nutritional goals. |
| 7. Generate a daily weight monitoring chart as well as the food and fluid chart. Discuss with the patient as well as the family and the significant others the goals for nutrition. | A weight and food chart may monitor the patient’s daily progress towards nutritional goals. |
| 8. Provide as-needed (PRN) medication for diarrhea or vomiting as prescribed by the physician. | Medications such as antidiarrheal can help to slow down diarrhea and antiemetic to decrease vomiting medications may also be given which may help to prevent dehydration. |
| 9. Check for signs of dehydration. Assess the patient’s mucus membrane for dryness and the turgor of the skin, | Dehydration is very common in patients with anorexia and vomiting. Dehydration is caused by too much loss of fluid from the body. It happens when the patient losses too much liquids than he or she is taking, which then causes the body not to function properly. |
| 10. Promote patient safety at all times. Provide assistive devices if needed. | The patient may show signs of weakness due to decreasing patient strength because of imbalance nutrition which may decrease the their overall safety. The assistive device may also be provided as needed assistance. |
| 11. Encourage the patient to good oral habits. | Oral hygiene may help increase the patient’s appetite. |
| 12. Provide enteral feeding as needed and as ordered by the physician. | In a critical care setting giving enteral feeding may be necessary to meet the body’s nutritional needs. |
Nursing Care Plan for Addison’s Disease 5
Nursing Diagnosis: Fatigue related to a decreased capacity for physical and mental work secondary to Addison’s disease as evidenced by verbal reports of lethargy and exhaustion.
Desired Outcomes:
- The patient’s fatigue will be reduced.
- The patient will express understanding about energy management.
- The patient will gain emotional support.
- The patient will participate in coping enhancement activities.
| Addison’s Disease Nursing Interventions | Rationale |
| 1. Encourage the patient to describe the severity of fatigue and the factors that alleviate and aggravate fatigue. Check the patient’s level of movement physically. | Allow the patient to rate fatigue through a quantitative score scale of 1 to 10 or use another scoring scale by showing pictures. The nurse should assess fatigue that varies over time and constantly. |
| 2. Evaluate the causes of fatigue such as depression, medication side effects, emotional stress, and illness. | A collaborative plan of care is important when the factors that cause fatigue are identified. Evaluation of the causes helps to develop plans that may help to reduce fatigue. |
| 3. Evaluate the patient’s ability to perform the task or activity of daily living. | Activities of the patient may be restricted including self-care and continuing the patient’s role in his family and work. Activities of daily living of the patients are important to meet the individual’s physical needs like eating, dressing by himself, bathing, and going to the toilet. It is also important to assess the level of assistance from the family the patient needs. |
| 4. Evaluate the patient’s nutritional status, and assess if energy source and metabolic elements are adequate. Refer to the dietitian service as needed. | Inadequate nutrition may cause fatigue. Nutrition is essential to achieve physical and mental growth, lifelong health, and well-being. |
| 5. Encourage the patient to participate in the strategies that may reduce fatigue. Evaluate the patient’s emotional support level from the patient’s family and significant others. | Active participation from the patient as well as his family and significant others is important in developing and implementing plans and strategies for reducing fatigue. |
| 6. Assess the diagnostic results of the patient. Check for the patient’s blood glucose level, BUN, Hemoglobin, hematocrit, and oxygen saturation. | Possible changes in the level of laboratory results may cause fatigue in the patient. Decreased levels in the laboratory especially the decrease in glucose level may cause fatigue. A decrease in BUN level may indicate that the patient’s liver is not functioning properly. Assessing the laboratory levels may prevent life-threatening emergencies. |
| 7. Assess the patient about his sleeping patterns, sleep quantity, and quality. | Changes in the sleeping pattern may contribute to developing fatigue in the patient. Sleeping helps your body and mind to recharge, the brain will not properly function if you the patient don’t have enough sleep. |
| 8. Ask the patient about his/her current medications. Conduct a medication review by asking the patient if he/she is currently taking beta-blockers, calcium channel blockers, tranquilizers, muscle relaxants, and sedatives. | Medications such as beta-blockers, calcium channel blockers, tranquilizers, muscle relaxants, and sedatives may cause fatigue as a common side effect. |
| 9. Provide a relaxed environment. Restrict noises during the time the patient sleeps. Family and significant others should also be advised about the restrictions needed to help the patient. | Limit noise, visitors, and distractions to the patient’s surroundings because these may affect the patient’s time to sleep and relax. |
| 10. Advise the patient to use the devices that may assist the patient in doing activities. | These devices may help in assisting the patient to continue activities of daily living, assistive devices prevent injury and lessen the expenditure of energy. |
| 11. Encourage the patient to make a schedule for activities and rest. | Balance activity periods will reduce fatigue and reduce the risk of injury for the patient. Balance activity is important to help provide the patient the opportunity to be prepared mentally for the upcoming activities. |
| 12. Instruct the patient about the energy conservation methods, the nurse may also seek help from the occupational therapist as needed. | Time management, task organization, setting priorities, clustering care, and learning skills to delegate a task to others may help complete activities and conserve energy. An occupational therapist can help people with physical, sensory, and/or cognitive problems to cope with activities of daily living. |
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. (2022). 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. (2020). 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
