ASUHAN KEPERAWATAN PADA

PASIEN DENGAN ADDISONS DISEASE

L/O/G/O
Fasilitator: Kunty Utami Dewi, S.Kep.,Ns

DEFINISI
hipofungsi dari korteks adrenal
Merupakan gangguan endokrin yg juga dikenal dg
insufisiensi adrenokortikal
Penurunan adrenal steroid : glucocorticoid,
mineralocorticoid, androgen
Addisons disease terjadi ketika 90% korteks
adrenal telah rusak

What is function of
Cortisol ??
Maintain blood presure and cardiovascular
function
Help slow the immune systems inflamatory
respone
Help balance the effect of insulin in breaking
down for sugar
Regulate the metabolism of proteins,
carbohydrate and fats

Whats function of
Aldosteron ??
Maintain 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 heartbeat

Dehidroepiandrosterone
(DHEA)
Use to make androgen and estrogen
In adrenal insufficiency the adrenal gland may
not make enough DHEA

Etiologi
Primary adrenal insufficiency
Autoimun or idiopathic atrophy of adrenal glands
(80%-90%)
Surgical removal of both adrenal glands
Infection of adrenal glands tuberculosis
Secondary adrenal insufficiency
Inadequate secretion of ACTH from pituitary
Therapeutic use of corticosteroids

Primary Adrenal
Insufficiency
Idiopathic adrenal insufficiency: caused by
autoimun, if only adrenal gland is affected
Polyendocrine deficiency syndrome: caused by
autoimun, if other gland also are affected
type I and Type II
Type 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 loss
Type II ~ Schmidts Syndrome accurs in

Infection, Autoimun, surgical removal,

Inadequate secretion of ACTH from pituitary,
corticosteroid
adrenal glands not function
Glucocorticoid very low
mineralocorticoid
(aldosteron)
Or absent
very low or absent
Severe insulin
penurunan HCl,
Kidney:
heart
Sensitivity, aktivitas pepsin, enzym
water n
irreguler n
glukoneogenesis vomite,diare,kram
sodium loss
output
menurun
decreased

androgen n estrogen very low or absent

in women: loss of pubic hair, dry skin, reduced
interest in sex, menstruation disturbance,
depression
in men: reduced libido

Manifestasi Klinis
Ealy signs:
Tiredness
Loss of appetite
Weight loss
Nausea
Vomitting
diarrhea
Dizziness when
standing
Hiperpigmentasi
Hipoglikemia
depression

Late signs (addison

Crisis)
Severe pain in lower
back, abdomen or legs
Loss of too much fluid
from body
(dehydration)
Hipotension
Loss of consciousness

Hiperpigmentation in
neck and chest

Hiperpigmentation in
palate

Hiperpigmentation in
tongue

How Is it Diagnosed ???

Early stages difficult to diagnose
ACTH 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 increase
CRH stimulation test cortisol level measured
before n after (30,60,90,120 minutes) CRH is
given by injection Addison: high level ACTH
but no cortisol
secondary adrenal insufficiency: absent ACTH
respone
Other test
X-ray be taken to see if adrenal have

Treatment
Hormone replacement therapy
Depending on which hormon is low
Glukocorticoid twice a day
Mineralocorticoid once a day
Aldosteron adviced to increase salt intake
addison crisis injection hidrocortison, salin (salt
water), dextrose (sugar)

NURSING ASSESMENT

Complete health history

Baseline weight
Muscle weakness/ fatigue
History of illness
Stress response
Assess glucose levels
Baseline vitals
Skin pigmentation
Skin turgor
Assess mood
Assess knowledge of disease

DIAGNOSIS
Kekurangan volume cairan b.d muntah dan diare
Resiko injuri b.d kelemahan
Defisit perawatan diri b.d kelemahan, kelelahan
otot
Gangguan citra tubuh b.d perubahan pigmen
Intoleransi aktivitas b.d kelemahan,kelelahan otot
Resiko bunuh diri b.d depresi iritabilitas

Planning

Manage/ monitor Addison crisis

Restore fluid balance
Increase activity tolerance
Provide home and community based care.
Prevent stressors that trigger Addison crisis.

Implementation

Monitor wieght
Labs- Fluid/electrolyte balance q daily.
Administer meds as ordered.
Monitor mood changes
Glucose test
Increase salt intake

Evaluasi

Maintain weight
Stable vitals
Glucose controlled
Behavior
Neurological changes
Labs (Evaluate)

Thank You!
L/O/G/O
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