Addison's Disease was first discovered by Addison in 1885 was caused by a malfunction of the adrenal tissue. The disease is usually autoimmune and adrenal autoantibodies in plasma was found in 75-80% of patients. Addison's disease is very rare. From the results of research in the UK showed a million people just happen only 8 cases. Most cases occur between the ages of 20 to 50 years, but it can occur at any age. This disease can first appear as Addison crisis with fever, abdominal pain, hypotension, collapse, and pigmentation of the skin and mucous membranes due to the very high concentration of ACTH in the circulation.
The disease is associated with a slow decay of the adrenal gland, with a deficiency of cortisol, aldosterone, and adrenal androgens and excess of ACTH and CRH are associated with loss of negative feedback (adhiarta, 1996)
Etiology
Autoimmune (approximately 70-90 cases.
Infections (tuberculosis, histoplasmosis, HIV, Syphilis).
Malignancy (metastases from lung, mammary, colon carcinoma, melanoma, lymphoma).
Clinical manifestations
Symptoms associated with cortisol deficiency
body weak, tired, anorexia, nausea, vomiting, diarrhea, hypoglycemia, mild orthostatic hypertension, hyponatremia, eosinophilia.
Symptoms associated with a deficiency of aldosterone
Orthostatic hypertension, hyperkalemia, hyponatremia
Symptoms associated with androgen deficiency
Losing feathers axilla and pubis.
Symptoms associated with excess ACTH.
Hyperpigmentation of the skin and mucosal surfaces.
Complication
Diabetes mellitus.
Shock.
Lung Cancer.
Sepsis.
Hypoglycemia.
Dehydration.
Circulation collapse.
Physical Examination (Review Of System)
B1: Chest symmetrical, rapid chest movement, absence of respiratory muscle contraction (dyspnoea), there is a movement of the nostrils, resonant, there is the sound crackles, crackles on the state of infection.
B2: ICTUS cordis does not appear, ICTUS cordis palpable on ICS 5-6 clavikula mid line of the left, dim, weak heart sounds, Increased heart rate / pulse at minimal activity.
B3: Dizziness, syncope, trembling, weakness, numbness, disorientation to time, place, space (due to low sodium levels), lethargy, mental fatigue, sensitive to stimuli, anxiety, coma (in a crisis)
B4: diuresis followed by oliguria, changes in the frequency and characteristics of urine.
B5: Mouth and throat: decreased appetite, dry mouth, intestinal bisung ↑, tenderness because there is abdominal cramps.
B6: Decreased muscle tone, fatigue, pain / weakness in the muscles occurs worsening every day), not able to move / work. decrease in strength and range of motion.
Nursing Diagnosis for Addison's Disease
1. Fluid and Electrolyte Imbalances
related to:
lack of sodium and fluid loss through the kidneys, sweat glands, GI tract (for lack of aldosteron)
2. Imbalanced Nutrition Less than Body Requirement
related to:
intake not adekuat (nausea, vomiting, anorexia) glukontikord deficiency.
3. Activity intolerance
relating to:
production decrease metabolism, fluid imbalance of electrolytes and glucose.
4. The Self-concept disturbance
relating to changes in the ability of the function, change the characteristics of the body.
5. Self-care Deficit
relation to muscle weakness.
6. Impaired Urinary Elimination
related to:
disturbance in tubular reabsorption.
The disease is associated with a slow decay of the adrenal gland, with a deficiency of cortisol, aldosterone, and adrenal androgens and excess of ACTH and CRH are associated with loss of negative feedback (adhiarta, 1996)
Etiology
Autoimmune (approximately 70-90 cases.
Infections (tuberculosis, histoplasmosis, HIV, Syphilis).
Malignancy (metastases from lung, mammary, colon carcinoma, melanoma, lymphoma).
Clinical manifestations
Symptoms associated with cortisol deficiency
body weak, tired, anorexia, nausea, vomiting, diarrhea, hypoglycemia, mild orthostatic hypertension, hyponatremia, eosinophilia.
Symptoms associated with a deficiency of aldosterone
Orthostatic hypertension, hyperkalemia, hyponatremia
Symptoms associated with androgen deficiency
Losing feathers axilla and pubis.
Symptoms associated with excess ACTH.
Hyperpigmentation of the skin and mucosal surfaces.
Complication
Diabetes mellitus.
Shock.
Lung Cancer.
Sepsis.
Hypoglycemia.
Dehydration.
Circulation collapse.
Physical Examination (Review Of System)
B1: Chest symmetrical, rapid chest movement, absence of respiratory muscle contraction (dyspnoea), there is a movement of the nostrils, resonant, there is the sound crackles, crackles on the state of infection.
B2: ICTUS cordis does not appear, ICTUS cordis palpable on ICS 5-6 clavikula mid line of the left, dim, weak heart sounds, Increased heart rate / pulse at minimal activity.
B3: Dizziness, syncope, trembling, weakness, numbness, disorientation to time, place, space (due to low sodium levels), lethargy, mental fatigue, sensitive to stimuli, anxiety, coma (in a crisis)
B4: diuresis followed by oliguria, changes in the frequency and characteristics of urine.
B5: Mouth and throat: decreased appetite, dry mouth, intestinal bisung ↑, tenderness because there is abdominal cramps.
B6: Decreased muscle tone, fatigue, pain / weakness in the muscles occurs worsening every day), not able to move / work. decrease in strength and range of motion.
Nursing Diagnosis for Addison's Disease
1. Fluid and Electrolyte Imbalances
related to:
lack of sodium and fluid loss through the kidneys, sweat glands, GI tract (for lack of aldosteron)
2. Imbalanced Nutrition Less than Body Requirement
related to:
intake not adekuat (nausea, vomiting, anorexia) glukontikord deficiency.
3. Activity intolerance
relating to:
production decrease metabolism, fluid imbalance of electrolytes and glucose.
4. The Self-concept disturbance
relating to changes in the ability of the function, change the characteristics of the body.
5. Self-care Deficit
relation to muscle weakness.
6. Impaired Urinary Elimination
related to:
disturbance in tubular reabsorption.
