addison's disease

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addison disease for nurse

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ASUHAN KEPERAWATAN PADA PASIEN DENGAN ADDISONS DISEASE

ASUHAN KEPERAWATAN PADA PASIEN DENGAN ADDISONS DISEASEFasilitator: Kunty Utami Dewi, S.Kep.,NsL/O/G/ODEFINISI hipofungsi dari korteks adrenalMerupakan gangguan endokrin yg juga dikenal dg insufisiensi adrenokortikalPenurunan adrenal steroid : glucocorticoid, mineralocorticoid, androgenAddisons disease terjadi ketika 90% korteks adrenal telah rusak

What is function of Cortisol ??Maintain blood presure and cardiovascular functionHelp slow the immune systems inflamatory responeHelp balance the effect of insulin in breaking down for sugarRegulate the metabolism of proteins, carbohydrate and fats4Maintain blood pressure Maintain the balace of sodium anf potassium

If low aldosteron decrease reabsorbtion of sodium n excretion of pottasium Decreased sodium drop in blood volume drop blood pressure. increasing potassium in body disturbance of heart contractility irreguler heartbeatWhats function of Aldosteron ??Dehidroepiandrosterone (DHEA)Use to make androgen and estrogenIn adrenal insufficiency the adrenal gland may not make enough DHEA

Etiologi Primary adrenal insufficiencyAutoimun or idiopathic atrophy of adrenal glands (80%-90%)Surgical removal of both adrenal glandsInfection of adrenal glands tuberculosis

Secondary adrenal insufficiencyInadequate secretion of ACTH from pituitaryTherapeutic use of corticosteroidsPrimary Adrenal InsufficiencyIdiopathic adrenal insufficiency: caused by autoimun, if only adrenal gland is affectedPolyendocrine deficiency syndrome: caused by autoimun, if other gland also are affected type I and Type IIType I accurs in children, may be accompanied by under active parathyroid glands, slow sexual development, pernicious anemia (type of severe anemia, which have bigger red blood cell than most type of anemia) , chronic candida infection, chronic hepatitis, hair lossType II ~ Schmidts Syndrome accurs in adult, under active thyroid gland, slow sexual developmentInfection, Autoimun, surgical removal, Inadequate secretion of ACTH from pituitary, corticosteroidadrenal glands not function

Glucocorticoid very low mineralocorticoid (aldosteron)Or absentvery low or absent

Severe insulin penurunan HCl, Kidney:heart Sensitivity, aktivitas pepsin, enzym water n irreguler nglukoneogenesis vomite,diare,kram sodium loss output menurun decreasedhypoglucemia brain: coma n death Syock Low BP androgen n estrogen very low or absentin women: loss of pubic hair, dry skin, reduced interest in sex, menstruation disturbance, depressionin men: reduced libido

Manifestasi Klinis Ealy signs:TirednessLoss of appetiteWeight lossNauseaVomittingdiarrheaDizziness when standingHiperpigmentasiHipoglikemiadepression

Late signs (addison Crisis)Severe pain in lower back, abdomen or legsLoss of too much fluid from body (dehydration)HipotensionLoss of consciousness

Hiperpigmentation in neck and chest

Hiperpigmentation in palate

Hiperpigmentation intongueHow Is it Diagnosed ???Early stages difficult to diagnoseACTH stimulation test cortisol level measurd before n after ACTH is given by injection (IM/IV) normal respone: rise cortisol level in blood n urine, addison: no increaseCRH stimulation test cortisol level measured before n after (30,60,90,120 minutes) CRH is given by injection Addison: high level ACTH but no cortisolsecondary adrenal insufficiency: absent ACTH responeOther testX-ray be taken to see if adrenal have calsium deposits may indicate TB, tuberculin skin test also be usedTreatment Hormone replacement therapyDepending on which hormon is lowGlukocorticoid twice a dayMineralocorticoid once a dayAldosteron adviced to increase salt intakeaddison crisis injection hidrocortison, salin (salt water), dextrose (sugar)

NURSING ASSESMENTComplete health historyBaseline weightMuscle weakness/ fatigueHistory of illnessStress responseAssess glucose levelsBaseline vitalsSkin pigmentationSkin turgorAssess moodAssess knowledge of diseaseDIAGNOSISKekurangan volume cairan b.d muntah dan diareResiko injuri b.d kelemahanDefisit perawatan diri b.d kelemahan, kelelahan ototGangguan citra tubuh b.d perubahan pigmenIntoleransi aktivitas b.d kelemahan,kelelahan ototResiko bunuh diri b.d depresi iritabilitasPlanning Manage/ monitor Addison crisisRestore fluid balanceIncrease activity toleranceProvide home and community based care.Prevent stressors that trigger Addison crisis.ImplementationMonitor wieghtLabs- Fluid/electrolyte balance q daily.Administer meds as ordered.Monitor mood changesGlucose test Increase salt intakeEvaluasi Maintain weightStable vitalsGlucose controlledBehaviorNeurological changesLabs (Evaluate)Thank You!www.themegallery.comL/O/G/O