Question

The nurse is preparing to administer cortisol (hydrocortisone) to the client with Addison's disease. Which action by the nurse indicates understanding of the correct administration of cortisol? A. The nurse checks the pulse rate prior to administering the medication. B. The nurse checks the urine specific gravity prior to giving the cortisol. C. The nurse gives the medication in the morning. D. The nurse monitors the red blood cell count while the client is receiving cortisol.

Short answer

Short Answer: The nurse should give the medication in the morning, as cortisol follows a diurnal rhythm and administering it in the morning closely mimics the body's natural cortisol pattern.

Step-by-step solution

Option A: Checking the pulse rate prior to administering the medication

Cortisol has multiple effects on the body, including its influence on heart rate, but checking the pulse rate before administering cortisol is not the primary focus when administering this medication to a client with Addison's disease.

Option B: Checking the urine specific gravity prior to giving the cortisol

Urine specific gravity can give information about the client's hydration status, which is important for clients with Addison's disease. However, it's not the primary factor to consider when administering cortisol in this situation.

Option C: Giving the medication in the morning

Cortisol is a hormone that follows a diurnal rhythm, meaning it is released in higher amounts in the morning and lower amounts in the evening. This pattern is intended to match the body's natural cortisol rhythm. Administering cortisol in the morning would closely mimic the body's own cortisol pattern, making it the optimal time to administer the medication. This option shows understanding of the correct administration of cortisol.

Option D: Monitoring the red blood cell count while the client is receiving cortisol

Cortisol can influence the production of red blood cells (RBCs), but it is not the primary concern associated with administering medication for Addison's disease. Monitoring RBC count can be beneficial in assessing overall health, but it is not directly related to the proper administration of cortisol. The correct answer is C: The nurse gives the medication in the morning.

Key concepts

Addison's Disease Treatment

Understanding Addison's disease is critical for optimal treatment and management.
Addison's disease, also known as adrenal insufficiency, is a rare endocrine disorder characterized by the body’s inability to produce sufficient steroids, including cortisol and aldosterone.

Treatment Approach

Primary treatment involves hormone replacement therapy to compensate for what the body cannot produce.

• Cortisol Replacement: Typical medications used include hydrocortisone, cortisone acetate, or prednisone. Cortisol levels are crucial for energy regulation, stress response, and immune function.
• Aldosterone Replacement: Fludrocortisone acetate is used to manage this aspect of hormone imbalance, directly impacting sodium retention and blood pressure.
• Androgen Replacement: Some patients may require dehydroepiandrosterone (DHEA) to improve mood and sexuality.

Live-saving emergency treatment for acute adrenal crises typically involves high-dose intravenous injections of hydrocortisone, saline, and dextrose.

Cortisol Administration

Correct cortisol administration is vital for mimicking the body's natural hormonal rhythms and ensuring its efficacy.

Timing and Dosage

Usually, the majority of the dose is administered in the morning, with a smaller portion in the afternoon, adhering to the natural circadian cycle of cortisol production. Cortisol levels peak in the early morning hours and gradually decrease throughout the day.

Administering Needs

It is essential for nurses to be knowledgeable about the pharmacokinetics of synthetic glucocorticoids; incorrect timing could lead to complications such as insomnia or poor adrenal cortex suppression. In situations such as surgery, illness, or stress, supplemental doses may be necessary due to increased physiological demand.

Pharmacological Nursing Interventions

Pharmacological nursing interventions encompass a variety of actions aimed at achieving optimal therapeutic outcomes for patients receiving medications.

Education and Compliance

Nurses play a pivotal role in educating patients about their medications, why they are needed, and how to take them correctly to ensure compliance and minimize adverse effects.

• Teaching about the importance of medication adherence and possible side effects.
• Providing instruction on dose timing to align with biological rhythms.

Monitoring and Assessment

Regular monitoring and assessment are integral to pharmacological interventions.

• Checking vital signs and laboratory values that could be affected by medication, such as sodium and potassium in Addison's disease patients.
• Assessing patient's overall response to therapy and making necessary adjustments.

Anticipating drug interactions and contraindications further exemplify key components of safe pharmacological nursing practice.