Physiological Integrity Q 45
A client with Addison’s disease has been admitted with a history of nausea and vomiting for the past 3 days. The client is receiving IV glucocorticoids (Solu-Medrol). Which of the following interventions would the nurse implement?
A. Daily weights
B. Intake/output measurements
C. Sodium and potassium levels monitored
D. Glucometer readings as ordered
Correct Answer: D. Glucometer readings as ordered
IV glucocorticoids raise the glucose levels and often require coverage with insulin. Cortisone and prednisone replace cortisol deficits, which will promote sodium reabsorption. 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.
Option A: Daily weights are unnecessary. Monitor trends in weight. This provides documentation of weight loss trends. Weight loss is a common manifestation of adrenal insufficiency.
Option B: Intake/output measurements are not necessary at this time. Assess vital signs, especially noting BP and HR for orthostatic changes. A BP drop of more than 15 mm Hg when changing from supine to sitting position, with a concurrent elevation of 15 beats per min in HR, indicates reduced circulating fluids.
Option C: Sodium and potassium levels would be monitored when the client is receiving mineralocorticoids. Abnormal laboratory findings include hyperkalemia (related to aldosterone deficiency and decreased renal perfusion), hyponatremia (related to decreased aldosterone and impaired free water clearance), and increase in blood urea nitrogen (related to decreased glomerular filtration from ).