Question

Chapter 49 Endocrine Problems

Adrenal Insufficiency or Adrenocortical Insufficiency

Patient Profile

J.S. is a 58-year-old woman brought to the emergency department (ED) at 7:00 am by her husband because when she got up this morning, she was light-headed, confused, and so weak that she could not dress herself. J.S.’s husband immediately drove her to the ED in her pajamas. She has a history of rheumatoid arthritis and had been taking prednisone 10 mg daily.

Subjective Data

• Husband states that J.S. has not been feeling good, has been tired, and has had very little appetite
• Husband states he lost his job a couple of months ago, and J.S. stopped taking her medication a couple of weeks ago because they could not afford it because they no longer had health insurance
• J.S. denies a headache or blurred vision

Objective Data

Physical Examination

• Temperature 98.7°F, pulse 94, respirations 20, blood pressure 100/60
• No difficulty speaking
• Oriented to name only
• Poor skin turgor
• Dry mucous membranes
• Weakness in bilateral upper and lower extremities

Diagnostic Studies

• Lab values

*	Calcium	9.2 mg/dL
*	Sodium	130.0 mEq/L
*	Potassium	5.5 mEq/L
*	HCO3	25.4 mEq/L
*	Chloride	93.5 mEq/L
*	Cortisol	4 mcg/dL (normal 8:00 am level is 5-23 mcg/dL)

Case Study Questions

  

1. What are four characteristics associated with Adrenal Insufficiency?

a.

b.

c.

d.

2. What other symptoms is J.S experiencing that is not included in the list above, but yet linked to the disease process? Student must list four:

3. What is one major complication associated with adrenal insufficiency or adrenocortical insufficiency and describe it? Additionally, what might trigger this complication in a patient?

a.

4. What diagnostics will be used in diagnosing J.S.?

• 5. What is your critical thinking significance of J.S.’s labs; relate all her labs to the disease process of adrenal insufficiency?
•   
•   
•   

6. What major factor do you believe triggered J.S.’s symptoms?

a.

7. What would you do as the nurse in providing prioritized care to J.S.? Student must list four:

Reference(s):

Harding, M. M., Kwong, J., Roberts, D., Hagler, D., and Reinisch, C. (2020). Lewis’s

     Medical-Surgical Nursing: Assessment and Management of Clinical Problems (11^th Edition),

     St. Louis Missouri: Elsevier.

Answer 1

Addison's disease can also be called as adrenal insufficiency it is an uncommon condition when the body is unable to produce certain amount of hormones. It can be considered as an endocrine emergency precipitated by an internal or external process which may result in the lack of production of cortisol

The adrenal glands are known to produce too little cortisol and Aldosteron.

The main characteristics may include

1) Hyperpigmentation.

Hypoglycemia

Weight loss

Decreased appetite

Abdominal pain

Muscle pain

Joint pain

Depression.

2) J. S is known to experience light headed, confused and weak., poor skin turgor, dry mucous membrane.

3) the main complications may include

Hyponatremia - which causes muscle twitching, fatigue, seizures.

Hyperkalemia can lead to changes in heart rhythms.

Hypoglycemia due to decreased gluconeogenesis, glycogenolysis)

Hypercalcemia due to increased absorption and decreased excretion.

4) the diagnostic test to detect adrenal insufficiency may include -

ACTH test - which may help determine the cortisol level.

2) insulin tolerance test- to assess for involvement of pituitary gland.

3) crh stimulation test can be done if acth test results aren't enough.

4) antibody blood test - to detect for autoimmune conditions.

5) computed tomography scan - can help detect any changes in the gland.

6) serum electrolytes to detect for any presence of hyponatremia, hypokalemia.