Question

Mrs. Ramirez was admitted to the hospital for wrist surgery secondary to rheumatoid arthritis. Postoperatively, she is stabilized and transferred to the general surgery unit. Mrs. Gonzalaez’s medications include digoxin, Lasix, captopril, Synthyroid, aspirin, Protonix, and prednisone. When administering morning medications, Mrs. Ramirez refuses her aspirin and prednisone, and the nurse holds the medications. Over the next 3 days, Mrs. Gonzalez continues to refuse the prednisone, and the medication is not administered. On the third postoperative day, Mrs. Ramirez becomes hypotensive, tachycardic, and has a decrease in level of consciousness. STAT labs are sent for a complete blood cell count and chemistry panel, and the physician is notified of the change in patient status. On review of the patient’s record, the physician notes that Mrs. Ramirez has not received her prednisone for 4 days. Mrs. Ramirez has been on Prednisone for the past 5 years for her rheumatoid arthritis, and the physician begins to treat the patient for acute adrenal insufficiency?

a.What other clinical manifestation should the nurse monitor for with suspected adrenal Insufficiency?

Adrenal insufficiency -: monitor hypoglycemia, hyponatremia, hyperkalemia and hypercalcemia.

Muscle weakness, anorexia, GI symptoms, emaciation, dark pigmentation of the mucous membrane. Hypotension.

b. The physician orders a stat dose of IV hydrocortisone. What is the rational for this medication in this situation

Answer 1

a. The adrenal gland produces cortisol, which affects various function in the body.

• it helps to maintain blood pressure and functions of the cardiovascular system.
• slow down the inflammatory response of the immune system
• maintains blood sugar level
• regulate the metabolism of carbohydrates protein and fat

symptoms should be noted :

• fatigue and muscle weakness
• loss of appetite
• weight loss
• nausea and vomiting
• hyperkalemia
• diarrhoea
• hypotension
• hyperpigmentation(elbows, knees, toes lips and mucous membrane)
• depression
• hypoglycemia
• irregular menstruation
• loss of consciousness ( in severe stage)

b.the treatment of adrenal insufficiency is substituting hormones(cortisol) by hydrocortisone.

Addison's disease is mainly treated with hydrocortisone, normal saline and dextrose and if patients show any insufficiency in aldosterone, it should be treated with fludrocortisone acetate.

intravenous administration of hydrocortisone is an emergency basis, later converted to hydrocortisone tablets. treating with hydrocortisone ease the symptoms and help them to live a normal active life and follow normal diet and exercise.