Hypofunction (Additions disease)

Subject: Medical and Surgical Nursing I (Theory)

Overview

Lack of ACTH, inadequate mineralocorticoid and glucocorticoid production, and hypofunction of the adrenal cortex. Its causes include CRH deficit, ACTH deficiency, adrenalectomy, etc. Its symptoms include weight loss, irritability, anorexia, anemia, etc. Depending on the patient's health or the degree of adrenal dysfunction. Exercises like ROM and isometrics ought to be promoted. Activities should be gradually increased while enough rest should be encouraged. A component of an emergency medication kit should be described to a patient and used by the nurse. The surgical procedure used includes bilateral adrenalectomy, subtotal adrenalectomy, resection of adrenocortical tumor, etc.

Lack of ACTH, inadequate mineralocorticoid and glucocorticoid production, and hypofunction of the adrenal cortex.

Addison’s crisis

When the client has been under stress without receiving the proper hormone replacement, Addison's crisis or acute adrenal insufficiency may ensue.

Chronic adrenal insufficiency

Etiology

Cortisol deficiency results from hypothalamic-pituitary axis infiltration of the adrenal gland with cancer.
CRH deficiency
ACTH deficiency
Adrenalectomy
Hemorrhage

Clinical feature

Loss of weight
Irritability
Anorexia
Anemia
Postural hypotension
Diarrhea
Mild fatigue
Nausea

Diagnostic evaluations

History
Serum electrolyte
CT scan
MRI
Total blood count
Blood glucose
X-ray studies

Medical management:

There are three phase of medical management:

Acute Addison crisis: Hormone replacement.
Chronic adrenal insufficiency: It is gradual onset which found out from serum electrolyte and serum hormone.
Stress steroid dose: Due to a double amount of hormone introducing into the patient.
- Dietary management
- Balance diet.
- Monitor fluid and electrolyte.

Active management

Depending on the patient's health or the degree of adrenal dysfunction.
Exercises like ROM and isometrics ought to be promoted.
Activities should be gradually increased while enough rest should be encouraged.

Nursing management

A component of an emergency medication kit should be described to a patient and used by the nurse.
Tell the patient about the body's current and potential effects of adrenal insufficiency.
The patient's need for a high-carb, high-protein diet should be explained, along with the patient's needs, activity restrictions, and lifestyle.
Describe the significance of continuing to receive medical care.
Describe the intended use, administration method, dosage, location, adverse effects, and safety measures of the medicine.
The nurse should record any changes to bowel habits, routines, and urine output.
Examine the amount of mental and emotional activity.
Verify past menstruation changes, physical changes, hyperpigmentation, hair distribution, and other things.
Check your heart health by monitoring your blood pressure, pulse, and any changes in your posture.
Weight and GI status should be checked, and a 24-hour intake and output chart should be kept.

Surgical management

Bilateral adrenalectomy
Subtotal adrenalectomy
Adrenocortical tumor resection
Adrenal medullary tumor resection
Trans – sphenoidal resection.

References

Mandal, G. (August 2013). A Textbook of Adult Health Nursing (2nd ed.). Dilllibazar kathmandu: Makalu publication house. Retrieved August 2013
mayoclinic.org/diseases-conditions/addisons-disease/home/ovc-20155636
medlineplus.gov › Medical Encyclopedia

Things to remember

Hypofunction of the adrenal cortex and an insufficiency of secretion of both mineralocorticoids and glucocorticoids and lack of ACTH.
Cortisol deficiency results from hypothalamic-pituitary axis infiltration of the adrenal gland with cancer.
Monitor fluid and electrolyte.
Check the emotional and mental status activity level.
Check the menstrual changes history and changes in the body, hyperpigmentation , hair distribution etc.

Questions and Answers

What is hypofunctio? List its causes.

Adrenal cortex hypofunction, insufficient mineralocorticoid and glucocorticoid production, and a lack of ACTH.

Etiology:

Cortisol insufficiency is caused by malignancy infiltrating the hypothalamic-pituitary axis and infiltrating the adrenal gland.
Insufficiency of CRH
A lack of ACTH
Adrenalectomy
Hemorrhage

List the symptoms of hypofunction.

Clinical feature:

Weight reduction
Irritability
Anorexia
Anemia
Hypotension caused by posture
Diarrhea
Mild exhaustion
Nausea

How additions disease can be managed?

Active management:

Depending on the severity of the adrenal failure or the patient's condition.
Exercises such as ROM and isometrics should be promoted.
Rest should be encouraged, and activities should be gradually increased.

Nursing management:

The nurse should explain and demonstrate how to utilize each component of an emergency medication kit to the patient.
Explain the current and potential effects of adrenal insufficiency on the body to the patient.
Explain to the patient why a high carbohydrate, high protein diet is necessary for identifying needs, activity limitations, and lifestyle.
Explain the significance of regular check-ins with health-care providers.
Explain the medication's purpose, route, dose, place, adverse effects, and precautions.
The nurse should record any changes in bowel habits or urine output.
Examine your emotional and mental state, as well as your degree of activity.
Examine the history of menstruation changes as well as changes in the body, such as hyperpigmentation and hair distribution.
Examine the cardiovascular states, such as blood pressure, pulse, and posture.
Examine your GI status and weight.
A 24-hour intake and output chart should be kept.

Surgical management:

Adrenalectomy on both sides
Adrenalectomy with partial adrenalectomy
Resection of an adrenocortical tumor
Resection of an adrenal medullary tumor
Transsphenoidal resection