J.S. is a 58-year-old female brought to the emergency department (ED) at 7:00 AM by her husband because when she got up this morning she was light-headed, confused, and so weak that she could not dress herself. J.S.’s husband immediately drove her to the ED in her pajamas. She has a history of rheumatoid arthritis and had been taking prednisone (Deltasone) 10 mg daily.
Husband states that J.S. hasn’t been feeling good, has been tired, and has had very little appetite
Husband states he lost his job a couple of months ago and J.S. stopped taking her medication a couple of weeks ago because they could not afford it because they no longer had health insurance
J.S. denies a headache or blurred vision
Temperature 98.7° F, pulse 94, respirations 20, blood pressure 100/60
No difficulty speaking
Oriented to name only
Poor skin turgor
Dry mucous membranes
Weakness in bilateral upper and lower extremities
Glucose 68 mg/dL
Calcium 9.2 mg/dL
Sodium 130.0 mEq/L
Potassium 5.5 mEq/L
HCO3 25.4 mEq/L
Chloride 93.5 mEq/L
Cortisol 4 mcg/dL (normal 8:00 am level is 5-23 mcg/dL)
Question: Interpret J.S.’s laboratory results and describe their significance.
Question: What other assessment findings could confirm a diagnosis of adrenal insufficiency?
Question: What is the likely cause of J.S.’s adrenal insufficiency and why?
Question: Would J.S.’s adrenal insufficiency be considered to be from a primary cause (Addison’s disease) or a secondary cause? Why? How would this be confirmed?
Question: What is the treatment and nursing care for J.S.’s adrenal insufficiency?
Question: What teaching should J.S. receive regarding taking her prednisone? What else can you do to assist J.S. in being compliant with taking her medication?
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