- Focus the health history and exam on presence of symptoms of fluid imbalance and stress.
- Monitor blood pressure and pulse rate as the patient moves from a lying, sitting, and standing position to assess for inadequate fluid volume.
- Assess skin color and turgor.
- Assess history of weight changes, muscle weakness, and fatigue.
- Ask patient and family about onset of illness or increased stress that may have precipitated crisis.
Monitoring and Managing Addisonian Crisis
- Monitor for signs and symptoms indicative of addisonian crisis, which can include shock; hypotension; rapid, weak pulse; rapid respiratory rate; pallor; and extreme weakness.
- Advise patient to avoid physical and psychological stressors such as cold exposure, overexertion, infection, and emotional distress.
- Immediately treat patient in addisonian crisis with IV administration of fluid, glucose, and electrolytes, especially sodium; with replacement of missing steroid hormones; and with vasopressors.
- Anticipate and meet patient's needs to promote return to a precrisis state.
- Encourage the patient to consume foods and fluids that assist in restoring and maintaining fluid and electrolyte balance.
- Along with the dietitian, help the patient to select foods high in sodium during GI tract disturbances and in very hot weather.
- Educate the patient and family to administer hormone replacement as prescribed and to modify the dosage during illness and other stressful situations.
- Provide written and verbal instructions about the administration of mineralocorticoid (Florinef) or corticosteroid (prednisone) as prescribed.
- Avoid unnecessary activities and stress that might precipitate a hypotensive episode.
- Detect signs of infection or presence of stressors that may have triggered the crisis.
- Explain the rationale for minimizing stress during acute crisis and increased activity.
Promoting Home, Community-Based, and Transitional Care
Educating Patients About Self-Care
- Provide patient and family explicit verbal and written instructions about the rationale for replacement therapy and proper dosage.
- Educate patient and family about how to modify drug dosage and increase salt intake in times of illness, very hot weather, and stressful situations.
- Modify diet and fluid intake to maintain fluid and electrolyte balance.
- Provide patient and family with preloaded, single-injection syringes of corticosteroid for use in emergencies and instruct them when and how to use.
- Advise patient to inform health care providers (e.g., dentists) of steroid use.
- Urge patient to wear a medical alert bracelet and to carry information at all times about the need for corticosteroids.
- Educate patient and family about the signs of excessive or insufficient hormone replacement.
Continuing and Transitional Care
- If patient cannot return to work and family responsibilities after hospital discharge, refer patient to home care to ensure a safe environment; assess patient's recovery; monitor hormone replacement; and evaluate stress in the home.
- Assess patient's and family's knowledge about medication regimen compliance; emphasize the side effects of medications and dietary modifications.
- Assess patient's plans for regular medical follow-up to clinic or health care provider's office.
- Encourage the patient to wear medical identification for Addison disease.
- Remind patient and family about the importance of health promotion activities and health screening.
Expected Patient Outcomes
- Decreases risk of injury
- Decreases risk of infection
- Increases participation in self-care activities
- Attains/maintains skin integrity
- Achieves improved body image
- Exhibits improved mental functioning
- Exhibits absence of complications
For more information, see Chapter 52 in Hinkle, J. L., & Cheever, K. H. (2018). Brunner and Suddarth's textbook of medical-surgical nursing (14th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.