Addisons disease PPT for nursing students

Introduction:The adrenal glands are developed from two separate embryological tissue.
The nerve crest ectoderm and the intermediate mesoderm.
The medulla originate from neural crest cells.
The Two adrenal glands are situated on the upper pole of each kidney enclosed with in the renal fascia.
Definition: A disease characterized by progressive anemic, low blood pressure, great weakness and bronze discoloration of the skin.
It is caused by inadequate secretion of hormones by the adrenal gland ( glucocorticoids, mineralocorticoids).
Incidence: 80 – 90 % of all cases are auto immune or ideopathic in nature.
1 in 100,000 people in US have addison’s disease
Prevalence is estimated to be between 40 and 60 million people of the general poppulation.
All age groups are affected.
Can be life threatening.
Both sex are affected equally
Risk factors: Cancer
Anticoagulants ( resulting in adrenal hemorrhage)
Have chronic infections like tuberculosis with antibiotics
Had surgical removal of adrenal glands.
Auto immune disease like type- 1 diabetes or grave’s disease.
Signs and symptoms: Fatique
Muscle weakness, Muscle / joint pain
Increased insulin sensitivity
Nausea, vomitting
Anorexia ( decreased appetite)
Irritability, Depression
Dehydration, hypotension
Hyperpigmentaion
Abdominal pain
Hyponatremia, hypoglycemia
Hyperkalemia, hypovolemia
Treatment medical: Hormone replacement is used to correct the insufficient levels of steroids the adrenal glands cannot produce.
Increase sodium intake
Life long drug maintenance is required.
Pharmacological mgt: Hydrocortisone pills to replace cortisol.
If patient also lacking aldosterone, fludrocortisone acetate pills will be provided.
If the patient is taking fludrocortisone, need to increase salt intake, especially in hot and humid whether and after exercise.
In emergencies and during surgery, the medicine is given intravenously.
Patient education: Advise the patient to take more salt during hot whether and heavy exercise.
Never skip a dose- this could lead to addison’s crisis.
Learns to recogise the symptoms of an addison’s disease. Eg- pain in the lower back, severe vomitting,extreme weakness, fainting, contact physician immediately.
Wear medic allert card.
Frequently monitor weight.
Reframe from stressful activities.
education about self care of patient: Advice the patient for regular medications.
1oo mg- hydrocortisone
4 mg dexamethasone
Availability of medications should be known by the patient.
Always wear the medic allert card and carry medic bag.
Nursing magt: ASSESSMENT OF THE PATIENT
Health history & physical examination focus on the presence of fluid imbalance and patients level of stress.
Monitor vital signs ( blood pressure)
Patient is assessed for changes in weight, muscle weakness, fatique and any illness or stress
Monitoring and managing crisis:Monitoring vital signs include, shock, hypotension, rapid weak pulse, rapid respiratory rate, pallor & extreme weakness.
Patient with crisis requires immediate

1. ‘s se ase

2. TEACHING PRACTICE ON ADDISON’s DISEASE

3. INTRODUCTION The adrenal glands are developed from two separate embryological tissue. The nerve crest ectoderm and the intermediate mesoderm. The medulla originate from neural crest cells. The Two adrenal glands are situated on the upper pole of each kidney enclosed with in the renal fascia.

4. STRUCTURE Its is situated in upper part of the both side kidneys. They are 4 cm long and 3 cm thick. The arterial blood supply is by branches from the abdominal aorta and renal cortex. The venous return is by supra renal veins, the right gland drains into the inferior venacava , and the left into the left renal vein. Glands are composed of two separate parts which have different structure and function, the outer part is cortex and inner part is medulla.

5. ANATOMICAL IMAGE

6. THE ADRENAL CORTEX It is red to brown in color and is composed of three zones from the outer to inner . The layers are - zonaglomerulosa - zonafasiculata - zonareticularis The adrenal cortex represents 80 – 90 % of the adrenal gland. The adrenal medulla represents only 10 – 12 % of the adrenal gland.

7. The adren al glands are firm, and the capsule is easily fractured on flexion. The cortex on appearance is yellow and radially straited , whilst the medulla is darker with a more uniform appearance. The zonaglamerulosa is narrow and the cells are in a wholred pattern. The zonafasiculata is wide and the cells lie in columns and the zina reticularis more randomly organized.

8. VASCULAR SUPPLY The oxygenated blood from - Aorta - Renal arteries - lumbar artery, pherenicoabdominal artery and the cranial mecenteric arteries. After perfusion of the gland, the blood pools a central vein and then exits the gland through the hilus . Then this vein joins up with the cauda venacava or one of its tributaris .

9. BLOOD SUPPLY

10. PHYSIOLOGY Main function is to produce hormones. Adrenal cortex- it is made up of inner, middle and outer layres . Aldosterone produced by outer layer. The adrenal cortex produces several hormones - Aldosterone ( A Mineralocorticoids ) - Cortisol ( A Glucocorticoid ) - Androgen and estrogen ( sex hormones)

11. ALDOSTERONE Helps the kidneys control the amount of salt in the blood and the tissue of the body. It stimulates the kidney to absorb of sodium by the kidneys and regulates water and salt balance

12. RENIN-ANGIOTENSIN-ALDOSTRONE SYSTEM

13. GLUCOCORTICOIDS CORTISOL Hydrocortisone Helps the body manage and use carbohydrates, protein and fat. It include breaking down food and transforming into energy, eliminating waste and toxins, breathing, circulating, blood and regulating temperature. To help the body to manage the stress Supresses the immune system

14. GLUCOCORTICOIDS Metabolic effects generally concerned with cataabolism ( break down) of protein, fat that makes glucose and other substances. HYPERGLYCEMIA - Breakdown of glycogen and glyconeogenesis . LIPOLYSIS - Breakdown of triglycerides into fattyacids and glycerol for energy production. STIMULATING BREAKDOWN OF PROTEIN- releasing aminoacids . PROMOTING ABSORPTION OF – sodium and water from renal tubules.

15. OTHER EFFECTS INCLUDES , Anti- inflammatory action. Suppression of immune response. Delayed wound healing.

16. ANDROGEN Male sex hormone and estrogen ( female ). More common for excess androgen to be produced than excess estrogen. Afterperfusion of the gland, the blood pools in a central vein and then exists the gland through the hilus . This then joins up with the cauda venacava or one of tis tributeries .

17. ADRENAL MEDULLA The hormone produced by the medulla are catacholamines . They act as hormones and as neurotransmittor , they manage the body response to stress. The two more important catacholamines are, - Epinephrine ( adrenaline) - Norepinephrine (nor adrenaline.)

18. EPINEPHRINE Released during times of short term stress, ( sudden shock or fear). Increases heart rate, blood pressure and blood sugar levels.

19. NOREPINEPHRINE Constricts blood vessels. Like epinephrine, it increases HR, BP and Blood sugar levels. The adrenal medulla also produces the protein chromogranin A, which is stored and secreated with epinephrine and norepinephrine . CAPSULE- surrounds and protects the adrenal glands.

20. ADDISON’S DISEASE

21. DEFINITION A disease characterised by progressive anaemic , low blood pressure, great weakness and bronze discolourisation of the skin. It is caused by inadequate secreation of hormones by the adrena gland ( glucocorticoids , mineralocorticoids ).

22. INCIDENCE 80 – 90 % of all cases are auto immune or ideopathic in nature. 1 in 100,000 people in US have addison’s disease Prevalence is estimated to be between 40 and 60 million people of the general poppulation . All age groups are affected. Can be life threatening. Both sex are affected equally . Causes……leaflet

23. RISK FACTORS Cancer Anticoagulants ( resulting in adrenal hemorrhage) Have chronic infections like tuberculosis with antibiotics Had surgical removal of adrenal glands. Auto immune disease like type- 1 diabetes or grave’s disease. p/p…..chart

24. SIGNS AND SYMPTOMS Fatique Muscle weakness, Muscle / joint pain Increased insulin sensitivity Nausea, vomitting Anorexia ( decreased appetite) Irritability, Depression Dehydration, hypotension Hyperpigmentaion Abdominal pain Hyponatremia , hypoglycemia Hyperkalemia , hypovolemia Adrenal crisis…………….hand out

25. flannel board TREATMENT- MEDICAL Hormone replacement is used to correct the insufficient levels of steroids the adrenal glands cannot produce. Increase sodium intake Life long drug maintenance is required.

26. PHARMACOLOGICAL MGT Hydrocortisone pills to replace cortisol . If patient also lacking aldosterone , fludrocortisone acetate pills will be provided. If the patient is taking fludrocortisone , need to increase salt intake, especially in hot and humid whether and after exercise. In emergencies and during surgery, the medicine is given intravenously.

27. PATIENT EDUCATION Advise the patient to take more salt during hot whether and heavy exercise. Never skip a dose- this could lead to addison’s crisis. Learns to recogise the symptoms of an addison’s disease. Eg - pain in the lower back, severe vomitting,extreme weakness, fainting, contact physician immediately. Wear medic allert card. Frequently monitor weight. Reframe from stressful activities.

28. EDUCATING THE PATIENT ABOUT SELF CARE Advice the patient for regular medications. 1oo mg- hydrocortisone 4 mg dexamethasone Availability of medications should be known by the patient. Always wear the medic allert card and carry medic bag.

29. NURSING MANAGEMENT ASSESSMENT OF THE PATIENT Health history & physical examination focus on the presence of fluid imbalance and patients level of stress. Monitor vital signs ( blood pressure) Patient is assessed for changes in weight, muscle weakness, fatique and any illness or stress

30. MONITORING AND MANAGING CRISIS Monitoring vital signs include, shock, hypotension, rapid weak pulse, rapid respiratory rate, pallor & extreme weakness. Patient with crisis requires immediate treatment with IV administration of fluid, glucose and electrolytes IMPROVING ACTIVITY INTOLERENCE Untill the patient condition is stabilized, the nurse takes precautions to avoid unnecessary activities. Promoting home, community based and traditional care.

31. RESTORING THE FLUID BALANCE Encourage the patient to consume foods and fluids that assist in restoring maintain fluid and electrolyte balance. Taking high sodium intake and it creates GI disturbances. Advice the patient and family to administer hormone replacement as prescribed.

32. NURSING DIAGNOSIS Electrolyte imbalance related to vomiting, diarrhea, hyperkalemia and hyponatremia . Imbalanced nutrition less than body requirement related to anorexia, decrease in eight and inadequate food intake. Fluid volume deficit related to decreased cortisol production and fatique , loss sodium in the urine. Activity intolerance related to decreased cortisol production and fatique .

33. COMPLICATIONS Hypotension Nausea , vomitting Coma Weakness Psychological stress