Nursing Plan of adrenal insufficiency or Addison's disease in the primary diagnosis of nurses Altered nutrition: less than body requirements related to anorexia, nausea and vomiting. Other possible diagnoses, including nurses Deficient fluid volume related to hypovolaemia secondary adrenal insufficiency; Ineffective tissue perfusion: peripheral associated with fluid volume deficit, anxiety associated with lack of knowledge about the effects and treatment of adrenal insufficiency.
Addison's disease, primary adrenal insufficiency is rare. Adrenal cortical bone and marrow consists of. The brains is responsible for the release of adrenaline and noradrenaline katecholamiene cerebral cortex is responsible for the introduction of glucocorticoids, mineralocorticoids and androgens. The major glucocorticoid, cortisol helps to regulate blood pressure, metabolism, anti-inflammatory reaction and emotional behavior. The main mineralocorticoid, aldosterone is important for regulating sodium levels. Adrenal insufficiency is characterized by a decreased production of cortisol, aldosterone and androgens. Cortisol deficiency causes metabolic changes that stress tolerance and reducing emotional lability. Aldosterone deficiency causes loss of urinary sodium chloride and water, leading to dehydration and electrolyte disturbance of the balance. Androgen deficiency leads to loss of secondary sexual characteristics.
Causes of adrenal insufficiency or Addison's disease
Idiopathic adrenal atrophy is the most common cause of adrenal insufficiency. It is not known exactly why it happened, but it is believed associated with immune response, leading to the slow destruction of the adrenal tissue. Tuberculosis, histoplasmosis syndrome, acquired immune deficiency (AIDS) and bleeding in the adrenal glands are related to the destruction of the adrenal glands. All patients with adrenal insufficiency or steroid-dependent diseases are at risk of acute adrenal crisis. Secondary adrenal insufficiency may occur with adrenocorticotropic hormone (ACTH)-deficiency caused by pituitary or hypothalamic disease or the effects of glucocorticoid treatment.
The plan of care for assessment and verification
Determine if the patient has a history of recent infection, use of steroids, or adrenal or pituitary surgery. Creating a history of poor tolerance of stress, weakness, fatigue and activity intolerance. Whether the patient anorexia, nausea, vomiting, diarrhea or a change in metabolism had. Get a taste of history in the salt or intolerance to cold. Detection of altered menstruation in women and impotence in men.
Assess patients symptoms of dehydration, such as tachycardia, changes in consciousness, a dry skin with poor turgor, dry mucous membranes, weight loss and poor incentives to end. Check orthostatic hypotension, ie systolic blood pressure greater than 15 mm Hg if the patient is moved from lying to sitting or standing. Look at the skin pigment changes caused by altered regulation of melanin, and underlines the surgical scars, skin folds and genitalia show distinctive bronze color. Look at the patient's gums and mouth to ascertain whether the blue-black. Take the patient's temperature, whether it is low. Note: the loss of axillary and pubic hair may cause a low androgens.
If an acute adrenal crisis can be beaten down by emotional stress, psychosocial periodic evaluation required for patients with adrenal insufficiency. Patients with adrenal insufficiency often complain of tiredness and fatigue, typical of an emotional problem. However, weakness and fatigue, emotional origin, an example of what seems worse at night and fall throughout the day, but the weakness and fatigue of adrenal insufficiency appears to be accelerated activity and less rest. Patients with adrenal insufficiency may show signs of depression and irritability to lower cortisol.