An insufficient supply of cortisol signals the pituitary gland to secrete more ACTH, which has the effect of increasing the coloration of scars, skin folds, pressure areas, and the areolae of the nipples. Replacement therapy usually brings about a rapid recovery. Nursing care is concerned with intensive support of the patient during addisonian crisis , prevention of problems related to hypoglycemia and orthostatic hypotension, alleviation of gastrointestinal problems, and instruction of the patient in self-care. It includes providing regular feedings throughout the day and providing for adequate rest. When fasting is required for diagnostic studies or surgery, the patient probably will need intravenous feedings of glucose to avoid profound hypoglycemia.
Maintenance doses of exogenous glucocorticoids are especially important during fasting.
Gastrointestinal problems require attention to adequate nutrition and avoidance of foods that are irritating to the gastrointestinal mucosa and difficult to digest. The patient's intake and output are measured regularly, and postural blood pressure is checked periodically. The apical-radial pulse is taken along with other vital signs to identify early symptoms of hyperkalemia. Cardiac monitoring may be indicated if cardiac arrhythmias develop. Safety measures must be taken to prevent falls during spells of weakness and fainting that may occur.