Mrs. ramirez was admitted to the hospital for wrist surgery secondary to rheumatoid arthritis. postoperatively, she is stabilize
d and transferred to the general surgery unit. mrs. ramirez's medications include digoxin, lasix, captopril, synthroid, aspirin, protonix, and prednisone. when administering morning medications, mrs. ramirez refuses her aspirin and prednisone, and the nurse holds the medications. over the next 3 days, mrs. ramirez continues to refuse the prednisone, and the medication is not administered. on the third postoperative day, mrs. ramirez becomes hypotensive, tachycardic, and has a decrease in level of consciousness. stat labs are sent for a complete blood cell count and chemistry panel, and the physician is notified of the change in patient status. on review of the patient's record, the physician notes that mrs. ramirez has not received her prednisone for 4 days. mrs. ramirez has been on prednisone for the past 5 years for her rheumatoid arthritis, and the physician begins to treat the patient for acute adrenal insufficiency. a. what other clinical manifestations should the nurse monitor for with suspected adrenal insufficiency?
b. the physician orders a stat dose of iv hydrocortisone. what is the rationale for this medication in this situation?
(a) This is a case of iatrogenic cause of acute adrenal insufficiency and can present will signs and symptoms related to glucocorticoid insufficiency. Other clinical manifestations to be monitored are fatigue, weight loss, myalgia, fever, anemia, lymphocytosis, hypotension, and hyponatremia.
(b) The first step in managing a case of acute adrenal insufficiency is immediate rehydration therapy with PNSS. The doctor gave a stat dose of IV hydrocortisone for replacing the lack of glucocorticoids to achieve physiologic levels of glucocorticoids in the body.
