Serquina, Johniza Hope G.

April 15,
2021
BSN 3A NCM 116
Critical Thinking Exercise 13
Study the situation. Describe the manifestations that would indicate an effective response to
treatment and the nursing interventions needed to prevent or detect signs of complications.
Mrs. A is wearing a medic-alert bracelet indicating a history of Addison’s disease. She has
been admitted to the emergency room where you work after being found at the side of a
deserted street in her wrecked automobile. The environmental temperature is 38C and she
was unresponsive at the accident site. Her pulse is 130 and thready, her blood pressure is
78/48 mmHg, and skin and mucus membranes are dry. The physician orders the rapid
infusion of 1,000 ml of normal saline and intravenous hydrocortisone succinate.
Indications that Mrs. A is responding effectively:

 Regained normal peripheral perfusion with blood pressure within normal range
 Her heart rate (HR) is less than 100 beats/min.
 Mrs. A have a normal skin turgor.
 She is alert and oriented and able to verbalize knowledge of the causes and effects of her hx
of having an Addison’s disease.
 Have a normal fluid balance after the rapid infusion of 1,000 ml of normal saline and
intravenous hydrocortisone succinate.
Nursing Interventions performed to prevent or detect complications:

 Monitor intake and output closely.

 Monitor blood pressure, pulses, and skin turgor every 2 hours until stable, then 4 times a
day.
 Monitor electrolytes, and report abnormal results.
 Assist during activity to prevent falls.
 Provide verbal and written instructions, and encourage verbal feedback about the causes
and effects of the disease, the effects of medications, the effects of not taking long-term
cortisone drugs, the diet, and self-care at home.
 Because of the negative effect of physical and emotional stress on the patient with adrenal
insufficiency, promote strategies that reduce stress.
 Teach the patient to rest between activities to conserve energy and to wear warm clothing
to increase comfort and limit heat loss.
 To limit the risk of infection, encourage the patient to use good hand-washing techniques
and to limit exposure to people with infections.
 To prevent complications, teach the patient to avoid using lotions that contain alcohol to
prevent skin dryness and breakdown and to eat a nutritious diet that has adequate proteins,
fats, and carbohydrates to maintain sodium and potassium balance.
 Discuss with the patient the presence of support systems and coping patterns. Provide
emotional support by encouraging the patient to verbalize feelings about an altered body
image and anxieties about the disease process.