ADRENOCORTICOTR

OPIC HORMONE
DISORDER
Maria Teresa Añonuevo
Monica Malaluan
Relah Peninsula
Jevanette Velacruz
WHAT IS ACTH?
ACTH is a hormone made by the pituitary gland, a
small gland at the base of the brain. ACTH controls the
production of another hormone called cortisol.
Cortisol is made by the adrenal glands, two small
glands located above the kidneys. Cortisol plays an
important role in helping you to:

● Respond to stress
● Fight infection
● Regulate blood sugar
● Maintain blood pressure
● Regulate metabolism, the process of how your
body uses food and energy
ADDISON
DISEASE
 WHAT IS ADDISION DISEASE

• Addison's disease, also called adrenal insufficiency, is an uncommon

disorder that occurs when your body doesn't produce enough of
certain hormones. In Addison's disease, your adrenal glands, located
just above your kidneys, produce too little cortisol and, often, too little
aldosterone.

• Addison's disease occurs when the adrenal glands are damaged and
can't make enough of the hormone cortisol and sometimes the
hormone aldosterone.
 SIGN OF SYMPTOMS

• lack of energy or motivation (fatigue)

• muscle weakness.
• low mood.
• loss of appetite and unintentional weight
loss.
• increased thirst.
Risk factors for the autoimmune type of Addison's
disease include other autoimmune diseases:

• Type I diabetes.
• Hypoparathyroidism.
• Hypopituitarism.
• Pernicious anemia.
• Testicular dysfunction.
• Graves' disease.
• Chronic thyroiditis.
• Candidiasis.
 NURSING MANAGEMENT

• The focus of treatment of Addison's disease is

hormone therapy and the prevention of Addisonian
Crisis. Acute nursing management involves
monitoring fluid and electrolyte balance, promoting
adequate fluid volume, and monitoring for
hypoglycemia and hypotension.
 Treatment & Management
• In patients in acute adrenal crisis, IV access should be established urgently, and an
infusion of isotonic sodium chloride solution should be begun to restore volume deficit and
correct hypotension. Some patients may require glucose supplementation. The
precipitating cause should be sought and corrected where possible.
• In stress situations, the normal adrenal gland output of cortisol is approximately 250-300
mg in 24 hours. This amount of hydrocortisone in soluble form (hydrocortisone sodium
succinate or phosphate) should be given, preferably by continuous infusion. [49]
• Administer 100 mg of hydrocortisone in 100 cc of isotonic sodium chloride solution by
continuous IV infusion at a rate of 10-12 cc/h. Infusion may be initiated with 100 mg of
hydrocortisone as an IV bolus. Some hospitals mix 300-400 mg in 1 liter saline and infuse
over 24 h to avoid needing to renew the infusion every 8-10 hours.
• An alternative method of hydrocortisone administration is 100 mg as an IV bolus every 6-8
hours.
• The infusion method maintains plasma cortisol levels more adequately at steady stress
levels, especially in the small percentage of patients who are rapid metabolizers and who
may have low plasma cortisol levels between the IV boluses.
 DIAGNOSTIC PROCEDURES
• Blood test. Tests can measure your blood levels of sodium, potassium, cortisol
and adrenocorticotropic hormone (ACTH), which stimulates the adrenal cortex
to produce its hormones. A blood test can also measure antibodies associated
with autoimmune Addison's disease.
• ACTH stimulation test. ACTH signals your adrenal glands to produce cortisol.
This test measures the level of cortisol in your blood before and after an
injection of synthetic ACTH.
• Insulin-induced hypoglycemia test. You may be given this test if doctors think
you may have adrenal insufficiency as a result of pituitary disease (secondary
adrenal insufficiency). The test involves checking your blood sugar (blood
glucose) and cortisol levels after an injection of insulin. In healthy people,
glucose levels fall and cortisol levels increase.
 DIAGNOSTIC PROCEDURES

• X-rays: These may be done to look for calcium deposits on the

adrenal glands.

• Computed tomography (CT scan): Computed tomography uses

computers to combine many X-ray images into cross-sectional views.
A CT scan might be done to evaluate the adrenals and/or pituitary
gland. For example, it can show if the immune system has damaged
the adrenal glands or if the glands are infected.
 CE N A R IO
CASE S
Jack E. Robinson, a 21 year old male who lives with his parents, reports to your clinic with a chief complaint of
gradual onset of weakness and fatigue, and pain in his knees. On a 0-10 scale, he states that the pain in his knees is
at a 3/10 at best and a 6/10 at its worst.

Jack works at United Parcel Service (UPS) at night while attending the local community college during the day. His
work duties require him to lift boxes up to 60 lbs. by himself and he has been struggling to do so in recent months,
even becoming dizzy and nearly fainting a few times. He has used almost all of his sick days due to feeling nauseous
and vomiting while at work and occasionally before coming to work.  He reported a slight decrease in his weight and
not being hungry nearly as often. He used to stop by the 24 hour Subway for a sandwich every night after work, but
only goes one or two times per week in recent months.

Now when he goes the sandwiches taste bland and he has to use a lot of salt to make them taste better. He states
being nervous about eating certain foods when he is hungry due to diarrhea which he has not figured out the cause
of. When asked, he states that his tanned skin from the summer has not faded like it usually does even though it is
well into the winter months (January) and that he does not use a tanning bed. He states his parents are worried
because he is quick to become irritated with them and rarely comes out of his room when at home.
 ’ S D ATA
PATIENT
C. History of Present Illness
A. Biographical Data
Name: Jack E. Robinson, Few hours prior to admission patient
Address: Daet, Camarines Norte experience  unusual fatigue, weakness,
Age: 21 frequent diarrhea, a craving of salty foods,
Sex: Male decreased appetite, joint pain, and that his
Race: Filipino tan was lasting longer than usual, then
Marital status: Single brought to hospital for consultation, hence
Occupation: Works at United Parcel Service (UPS) at night while admission.
attending the local community college during the day)
Date of Admission: February 20, 2020 4:00 PM
Admission Diagnosis: Addison Disease

B. Chief Complaint

Gradual onset of weakness and fatigue, and pain in his knees few
hours PTA.
 ’ S D ATA
PATIENT
D. Past History

Patient has had previous physical therapy for an ACL repair after an injury playing
soccer in 2010. Jack has seen his primary care physician twice since the onset of symptoms
and last time was referred to PT with a prescription that said “evaluate and treat for
weakness and fatigue”. He has received no other care for his current condition.

E. Family History of Illness

With History Type 1 Diabetes of the family


ASSESSMENT
“Nanghihina ako at
sobrang pagod. Sumasakit
din ang aking tuhod.
Minsan nahihilo din ako at
parang mahihimatay
tuwing nagtratrabho at
bago pumasok sa trabaho”
as verbalized by the pt.
- (+)nausea and
vomiting
- (+) slightly decrease in
weight of 65 to 58 lbs.
- (+) diarrhea
- Restlessness
- Pain in the scale of
3/10 at its best to 6/10
at its worst.
Vitals:
HR: 75
BP: 106/54
RR: 16
NURSING CARE PLAN
NSG. DX. PLANNING INTERVENTION RATIONALE EVALUATION
Risk for After 8 hours of • Provide adequate • To promote relaxation and • After 8 hours of nursing
Imbalanced intervention the ventilation of comfort intervention,
Nutrition: Less patient’s nutritional rooms and quiet
Than Body status will be environment the patient demonstrate
Requirements optimized as • Assess appetite • Cortisol deficiency can impair comfort and and increase
r/t decreased evidenced by and for the GI function, causing anorexia, appetite as evidence of
gastrointestinal maintenance of presence of  nausea, and vomiting eagerness to eat foods,
(GI) enzymes, weight and nausea, vomiting, . verbalized the lessen of pain in
Nausea, adequate dietary or diarrhea. the scale of 2/10.
vomiting, intake. • Monitor trends in • This provides documentation
diarrhea weight. of weight loss trends. Weight
loss is a common
• Assess foods that manifestation of adrenal
patient can insufficiency.
tolerate. • Appetite may increase with
preferred and tolerable foods.
• Monitor serum • Patients with adrenal
glucose levels. insufficiency are likely to
experience hypoglycemia. It
• Assess for salt may require adjustment of
cravings. insulin dosage.
• Aldosterone deficiency causes
increased renal excretion of
sodium.
 NURSING CARE PLAN
ASSESSMENT NSG. DX. PLANNING INTERVENTION
• Ask the dietician to
provide high-protein,
low-carbohydrate, high-
sodium diet.
• Keep a  late-morning
snack available.
• Suggest need for
frequent small meals.
• Encourage rest periods
after eating
• Encourage for adequate
fluid intake.
• Administer medication
as prescribed by the
physician
RATIONALE EVALUATION
• The patient tires because of
inadequate production of
hepatic glucagon; the
recommended diet prevents
fatigue, hypoglycemia, and
hyponatremia. The patient with
primary Addison’s disease
needs to increase salt intake 5
g if any activity causes an
increase in diaphoresis
(activities in warm weather).
• In case the patient becomes
hypoglycemic
• Inadequate caloric intake in
meals may precipitate
hypoglycemia. Promotion of oral
intake maintains adequate
blood glucose levels and
nutrition.
• This is important to facilitate
digestion.
• Limiting fluids 1 hr prior to meal
decreases possibility of early
satiety.
• To combat the signs and
symptoms manifested by the
patient
 DRUG STUDY
DRUG ACTION INDICATION CONTRAINDICATION ADVERSE EFFECTS NSG. CONSIDERATION
Generic Name: Increases fecal Hyperkalemia. Obstructive bowel disease. Anorexia, constipation, • Monitor acid–base balance,
SODIUM potassium Neonates with reduced gut diarrhea, fecal impaction, electrolytes, and minerals in
POLYSTERENE excretion through motility. GI concretions (bezoars), patients receiving repeated doses.
SULFONATE binding of ischemic colitis, nausea, • Observe patient closely for early
Brand Name: potassium in the vomiting; intestinal clinical signs of severe hypokalemia
KAYEXELATE lumen of the necrosis, electrolyte (see Appendix F). ECGs are also
(Cation gastrointestinal disturbances. recommended.
exchange resin.) tract. • Consult physician about restricting
sodium content from dietary and
other sources since drug contains
approximately 100 mg (4.1 mEq) of
sodium per gram (1 tsp, 15 mEq
sodium).
• Check bowel function daily.
Brand Name: These drugs are adrenocortical low amount of potassium in upset stomach • Establish baseline and continuing
Hydrocort, often used to treat insufficiency; chronic the blood stomach irritation data on BP, weight, fluid and
Alphosyl, similar conditions. use in other brain injury vomiting,dizziness, electrolyte balance, and blood
Aquacort, Cortef, Hydrocortisone situations is limited high blood pressure Insomnia, Restlessness, glucose.
Cortenema, injection works by because of chronic heart failure depression, anxiety • Monitor for adverse effects. Older
SoluCortef reducing mineralocorticoid decreased kidney function Acne, increased hair adults and patients with low serum
Generic Name: inflammation activity. osteoporosis growth, easy bruising, albumin are especially susceptible
hydrocortisone (irritation and Inflammatory, Allergies: Irregular or absent to adverse effects.
Drug Class: swelling) in the Allergic, Corticosteroids menstrual periods • Monitor for persistent backache or
Corticosteroids body Hematologic, (Glucocorticoids) chest pain; Monitor for and report
Neoplastic, changes in mood and behavior,
Autoimmune emotional instability.
disorders.
 DRUG STUDY
DRUG ACTION INDICATION CONTRAINDICATION ADVERSE EFFECTS NSG. CONSIDERATION
Generic Name: Ibuprofen is a pain Pain/Fever/Dysmenorr an increased risk of bleeding, Dizziness • Monitor for therapeutic effectiveness.
reliever and fever hea alcoholism Stomach and abdominal Optimum response generally occurs
IBUPROFEN reducer used to -Inflammatory Disease high blood pressure, a heart pain within 2 wk (e.g., relief of pain, stiffness,
temporarily relieve -Osteoarthritis attack, chronic heart failure Heartburn or swelling; or improved joint flexion and
Brand Name: minor aches and -Monitor for , a blood clot, stomach or Constipation strength).
pains due to: gastrointestinal (GI) intestinal ulcer, liver problems, Nausea • Observe patients with history of cardiac
Advil, Motrin, headache, toothache, risks bleeding of the stomach or Rash decompensation closely for evidence of
backache, menstrual -Rheumatoid Arthritis intestines, kidney transplant, Ringing in the ears fluid retention and edema.
-ANALGESIC; cramps, the common -Monitor for GI risks pregnancy, a rupture in the wall • Monitor for GI distress and S&S of GI
ANTIPYRETIC cold, muscular aches, -Significantly impaired of the stomach or intestine, bleeding.
and minor pain of renal function tobacco smoking • Do not drive or engage in other
arthritis. Ibuprofen is increased cardiovascular event potentially hazardous activities until
also used to risk response to the drug is known.
temporarily reduce time immediately after coronary • Do not self-medicate with ibuprofen if
fever. bypass surgery taking prescribed drugs without
chronic kidney disease stage 4 consulting physician.
(severe) • Do not give to children younger than 3
chronic kidney disease stage 5 mo or for longer than 2 d without
(failure) consulting physician.
• Do not take aspirin concurrently with
ibuprofen.
• Avoid alcohol and NSAIDs unless
otherwise advised by physician. Do not
breast feed while taking this drug without
consulting physician.
 DISCHARGE INSTRUCTIONS:
Contact your healthcare provider if:

• You have a fever.

• You have symptoms of a cold or the flu such as a cough or congestion.
• You have 2 or more episodes of diarrhea.
• You have nausea or stomach pain, or are vomiting.
• You are vomiting so much that you cannot drink any liquids.
• You sweat more than usual.
• You have questions or concerns about your condition or care.

MEDICATION
It is very important to follow your provider's instructions when using medicines for IBS. Taking different medicines or not taking
medicines the way you have been advised can lead to more problems.

Check your blood pressure and blood sugar as directed:

Write down your blood pressure readings and blood sugar levels. Bring these numbers with you to your follow-up appointments.
Ask your healthcare provider for more information on how to check your blood pressure and blood sugar level.

Follow up with your healthcare provider as directed:

You will need ongoing blood tests to check your hormone levels. Write down your questions so you remember to ask them
during your visits.