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

                                Name: __________________________                 Date: ________________

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

ADRENAL INSUFFICIENCY

1primary adrenal insufficiency :-also known as Addison's disease,hyposecretion of glucocorticoid,mineralocorticoid and androgen. autoimmune destruction is the common cause  

2secondary adrenal insufficiency:-hyposecretion of ACTH from anterior pituitary gland,mineralocorticoid release is spared.

What are four characteristics associated with Adrenal Insufficiency?

1. Hyperpigmentation of skin
2. lethargy
3. hyperkalemia
4. postural hypotension

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:

1. weight loss and decrease appetite
2. hypoglycemia
3. muscle and joint pain
4. irritability

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

Addisonian crisis:-A life threatening disorder caused by acute adrenal insufficiency,presipitated by stress,infection,trauma,surgery or abrupt withdrawal of exogenous corticosteroid use

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

insulin induced hypoglycaemia test:-test involves checking your blood sugar and cortisol level after an injection of insulin in healthy people glucose level fall and cortisol level increase.

imaging tests:-computerized tomography scan of your abdomen to check size of the adrenal gland and look for other abnormalities,magnetic resonance imaging also helps to identify it may be due to secondary adrenal insufficiency

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

• ​​​​​​​J.s have hyperkalemia potassium:-5.5meq/ltr
• j.a have hyponatremia sodium:-130 new/ltr
• her cortisol level is lower 4mcg/dl

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

Sudden stoppage of medication as she was taking prednisone 10mg

What would you do as the nurse in providing prioritized care to J.S.

• monitor vital signs

• correct hyperkalemia as per prescription

• correct hyponatremia

• monitor blood parameters

• Administer glucocorticoid or mineralocorticoid medication as prescribed

• observe for addisonian crisis cause