Page 1383 - Saunders Comprehensive Review For NCLEX-RN

f. Monitor intake and output and obtain
weight daily.
g. Monitor fluid and electrolyte balance.
h. Monitor serum and urine osmolality.
i. Restrict fluid intake as prescribed.
j. Administer IV fluids (usually normal
saline [NS] or hypertonic saline) as
prescribed; monitor IV fluids carefully
because of the risk for fluid volume
overload.
k. Loop diuretics may be prescribed to
promote diuresis, but only if serum
sodium is at least 125 mEq/L
(125 mmol/L); potassium replacement
may be necessary if loop diuretics are
prescribed.
l. Vasopressin antagonists may be
prescribed to decrease the renal
response to ADH.
IV. Adrenal Gland Problems (Box 46-7)
A. Adrenal cortex insufficiency (Addison’s disease)
1. Primary adrenal insufficiency
a. Also known as Addison’s disease,
refers to hyposecretion of adrenal
cortex hormones (glucocorticoids,
mineralocorticoids, and androgen);
autoimmune destruction is a common
cause.
b. Requires lifelong replacement of
glucocorticoids and possibly of
mineralocorticoids if significant
hyposecretion occurs; the condition is
fatal if left untreated.
2. Secondary adrenal insufficiency is caused by
hyposecretion of ACTH from the anterior pituitary
gland; mineralocorticoid release is spared.
3. Loss of glucocorticoids in Addison’s disease leads to
decreased vascular tone, decreased vascular response
to the catecholamines epinephrine and
norepinephrine, and decreased gluconeogenesis.
4. In Addison’s disease, loss of the mineralocorticoid
aldosterone leads to dehydration, hypotension,
hyponatremia, and hyperkalemia.

5. Assessment (Table 46-1)

6. Interventions

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