Addison’s disease or adrenal hypofunction is a rare disorder characterized by inadequate production of the steroid hormones cortisol and aldosterone by the outer layer of cells of the adrenal glands (adrenal cortex).
Also called adrenal insufficiency, Addison’s disease occurs in all age groups and affects both sexes. Addison’s disease can be life-threatening.
Nursing Care Plans
Management for Addison’s disease involves taking hormones to replace the insufficient amounts being made by your adrenal glands, in order to mimic the beneficial effects produced by your naturally made hormones.
Here are three (3) Addison’s disease nursing care plans (NCP) and nursing diagnosis:
- Risk for Deficient Fluid Volume
- Risk for Imbalanced Nutrition: Less Than Body Requirements
- Risk for Decreased Cardiac Output
Risk for Deficient Fluid Volume
Addison’s disease is a condition where the adrenal glands do not produce enough hormones, including aldosterone, which regulates the body’s fluid and electrolyte balance. Without adequate aldosterone, patients may experience decreased sodium levels and increased potassium levels, leading to dehydration and electrolyte imbalances, and consequently an increased risk for deficient fluid volume. Therefore, careful monitoring of fluid and electrolyte balance is important in nursing care plans for patients with Addison’s disease.
- Risk for Deficient Fluid Volume
- Increase in sodium and water excretion with potassium retention
- GI disturbances (e.g., nausea, vomiting, diarrhea, which can be manifestations of Addison’s disease).
Possibly evidenced by
- Not applicable for risk diagnosis. A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred and nursing interventions are directed at prevention.
- The patient experiences adequate fluid volume and electrolyte balance as evidenced by urine output greater than 30 mL/hr, normotensive blood pressure (BP), heart rate (HR) less than 100 beats/min, consistent weight, and normal skin turgor.
Nursing Assessment and Rationales
1. Assess skin turgor and mucous membranes for signs of dehydration.
The patient will have dry skin and mucous membranes. Tenting of the skin will occur. The tongue may have longitudinal furrows.
2. Assess vital signs, especially noting BP and HR for orthostatic changes.
A BP drop of more than 15 mm Hg when changing from a supine to a sitting position, with a concurrent elevation of 15 beats per min in HR, indicates reduced circulating fluids.
3. Assess color, concentration, and amount of urine.
Urine volume will decrease, urine specific gravity will increase, and color will be darker.
4. Assess trends in weight.
Rapid weight loss will occur with fluid volume deficit.
5. Assess for fatigue, sensory deficits, or muscle weakness, which may progress to paralysis.
These are signs of hyperkalemia. Aldosterone deficiency leads to potassium retention by the kidneys.
6. Assess electrocardiogram rhythm, as available, for signs of hyperkalemia.
Signs of hyperkalemia are sharp-peaked T wave and widened QRS complex.
7. Assess additional indicated laboratory tests.
Abnormal laboratory findings include hyperkalemia (related to aldosterone deficiency and decreased renal perfusion), hyponatremia (related to decreased aldosterone and impaired free water clearance), and an increase in blood urea nitrogen (related to decreased glomerular filtration from hypotension).
8. Observe for petechiae.
Patient bruises easily.
Nursing Interventions and Rationales
1. Encourage oral fluids as the patient tolerates.
As sodium loss increases, extracellular fluid volume decreases. These interventions are necessary to prevent fluid volume deficit because the kidneys are unable to conserve sodium
2. Instruct the patient to ingest salt additives in conditions of excess heat or humidity.
Sweating increases sodium loss.
3. If an Addisonian crisis occurs: refer or admit the patient to an acute care setting.
Immediate hospital admission and treatment are needed because of the high mortality with the Addisonian crisis.
4. Instruct the patient to wear a medical alert bracelet and carry a wallet card.
In the event of trauma or injury, it is important to initiate appropriate therapy immediately.
5. Administer parenteral fluids as prescribed. Anticipate the need for an intravenous (IV) fluid challenge with an immediate infusion of fluids for patients with abnormal vital signs.
Normal saline is infused initially to restore fluid volume.
6. Administer Kayexalate.
This ion exchange resin can be given orally or by enema to reduce potassium levels.
7. Administer replacement medications as prescribed or indicated: oral cortisone (Cortone), hydrocortisone (Cortef), prednisone, or fludrocortisone (Florinef).
Cortisone and prednisone replace cortisol deficits, which will promote sodium resorption; Fludrocortisone is a mineralocorticoid for patients who require aldosterone replacement to promote sodium and water replacement. Acute adrenal insufficiency is a medical emergency requiring immediate fluid and corticosteroid administration. If treated for adrenal crisis, the patient requires IV hydrocortisone initially; usually by the second day, administration can be converted to an oral form of replacement.
8. Assess ECG rhythm, as available, for signs of hyperkalemia. Remember, steroids administered in the late afternoon or evening may cause stimulation of the central nervous system.
May cause insomnia in some patients
9. Explain lifelong steroid therapy is necessary
The patient will need to take daily medication to replace the lost hormones. This should ensure patient continues to lead a normal life.
Recommended nursing diagnosis and nursing care plan books and resources.
Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.
Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues and on electrolytes and acid-base balance.
NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023
The definitive guide to nursing diagnoses is reviewed and approved by the NANDA International. In this new version of a pioneering text, all introductory chapters have been rewritten to provide nurses with the essential information they need to comprehend assessment, its relationship to diagnosis and clinical reasoning, and the purpose and application of taxonomic organization at the bedside. A total of 46 new nursing diagnoses and 67 amended nursing diagnostics are presented.
Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions from NANDA-I 2021-2023 and an alphabetized listing of nursing diagnoses covering more than 400 disorders.
Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis…. subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!
All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database MUST READ!
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
- Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
Other nursing care plans related to endocrine system and metabolism disorders:
- Acid-Base Balance
- Addison’s Disease | 3 Care Plans
- Cushing’s Disease | 6 Care Plans
- Diabetes Mellitus Type 1 (Juvenile Diabetes) | 4 Care Plans
- Diabetes Mellitus Type 2 | 17 Care Plans
- Diabetic Ketoacidosis (DKA) and Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS) | 4 Care Plans
- Eating Disorders: Anorexia & Bulimia Nervosa | 7 Care Plans
- Fluid and Electrolyte Imbalances
- Gestational Diabetes Mellitus | 4 Care Plans
- Hyperthyroidism | 7 Care Plans
- Hypothyroidism | 3 Care Plans
- Obesity | 5 Care Plans
- Thyroidectomy | 5 Care Plans
4 thoughts on “3 Addison’s Disease Nursing Care Plans”
Ita really helping me out in my classes and i just love to read from Nurseslabs
Any way you could update the article’s “Published date”….we can only use articles no older than 5 years, 2014 is too old to use for assignments and projects as a reference.
Thank you in advance!!!
Appreciated. Addisonian about to have THJR.