Page 367 - Critical Care Nursing Demystified

352 CRITICAL CARE NURSING DeMYSTIFIED

ANSWERS

CASE STUDY

1. Management of an Addisonian crisis includes monitoring serum cortisol levels and hor-
mone replacement therapy by administering a glucocorticoid such as Solu-Cortef. Start
an intravenous infusion of 5% dextrose and sodium as fluid volume replacement and to
correct imbalances of hyponatremia and hypoglycemia. Do not anticipate giving potas-
sium because the patient is hyperkalemic. Mr. J.F.K. may require as much as 5 L of fluid
replacement in the first 12 to 24 hours of his admission due to extreme fluid volume
deficits. Especially monitor accurate intake and output. Provide close cardiac monitoring
as there is a potential for the development of dysrhythmias such as heart block, brady-
cardia, ventricular fibrillation, and sinus arrest.
2. Causes of Addison’s disease include autoimmune infections such as AIDS, tuberculosis
(TB), sarcoidosis, hemorrhage from trauma such as postpartum Sheehan’s syndrome,
cancer, radiation, developmental or congenital abnormality, barbiturate medications,
and long-term steroid use.
3. Clinical signs and symptoms of Addison’s disease appear after 90% of the adrenal gland
is destroyed.
4. Expected laboratory findings would include pH less than 7.3, BUN greater than 20 mg/dL
+
+
due to protein breakdown and hemoconcentration, Na less than 150 mEq/L, K greater Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
than 6.5 mEq/L, glucose less than 50 mg/dL, and cortisol less than 10 mg/dL.
5.
5 Nursing Diagnosis Expected Outcomes
Knowledge deficit related Patient will state the need for corticosteroid therapy
to long-term use of as a lifelong process
corticosteroids Patient will follow appropriate medication
guidelines for proper administration
Fluid volume deficits will be restored to normal
levels
Electrolyte imbalances will remain within normal
limits

Nursing Interventions
Monitor and measure fluid volume status through accurate intake and output.
Obtain and review cortisol levels, BUN, and electrolytes.
Provide patient education by teaching actions and side effects of prescribed corticos-
teroid medications.
Obtain and wear a Medical Alert bracelet identifying the disease process and emer-
gency care guidelines.