Replaces deficient cortisol in primary (Addison) or secondary adrenal insufficiency; therapy is lifelong.
Before you read
Test yourself first: 5 questions
Question 1 of 5
A nurse is teaching a client about hydrocortisone replacement therapy for adrenal insufficiency. Which information should the nurse emphasize?
Answer: B. Clients on glucocorticoid replacement for adrenal insufficiency need a higher (stress) dose during illness, infection, surgery, or other physical stress to prevent adrenal crisis, and they should never abruptly stop the medication. Taking it only when feeling unwell or stopping when feeling better can be life threatening.
Question 2 of 5
Which medication is the priority treatment for a client in adrenal crisis?
Answer: A. Adrenal crisis is treated with immediate IV glucocorticoid replacement, most commonly hydrocortisone, along with IV fluids (normal saline with dextrose). Replacing cortisol corrects the hypotension, hypoglycemia, and electrolyte abnormalities.
Question 3 of 5
A client newly diagnosed with Addison disease will take lifelong hydrocortisone. Which statement indicates the teaching was effective?
Answer: B. Clients on long-term glucocorticoid replacement must increase the dose during physical or emotional stress (illness, surgery, trauma) to mimic the body's normal stress response and prevent adrenal crisis. They must never abruptly stop the drug. Taking the dose on an empty stomach or skipping it when feeling well is incorrect and dangerous.
Question 4 of 5
A child with cystic fibrosis takes pancreatic enzyme replacement. When should the nurse instruct the parent to administer the enzymes?
Answer: B. Pancreatic enzymes must be given with every meal and snack so they are present in the gut to digest fats and proteins as food is eaten. Giving them at any other time would not aid digestion of that meal.
Question 5 of 5
A client receiving enoxaparin for DVT prophylaxis after hip replacement asks how to take it correctly. Which teaching point about subcutaneous enoxaparin is accurate?
Answer: B. Enoxaparin is given subcutaneously into the abdominal fat pad, and the air bubble in the prefilled syringe should not be expelled because it ensures the full dose is delivered and seals the medication in the tissue. The site is not aspirated or massaged after injection, as massage increases bruising.
Keep the streak going with more questions like these, each with a full rationale.
What is hydrocortisone replacement?
Unlike high-dose anti-inflammatory steroid use, this is lifelong replacement that must never be stopped abruptly to avoid adrenal crisis. Doses must be increased ('stress dosing') during illness, surgery, or major stress because the body cannot mount its own cortisol response.
Key points to remember
- Replaces deficient cortisol in primary (Addison) or secondary adrenal insufficiency; therapy is lifelong.
- Must never be stopped abruptly because sudden withdrawal precipitates life-threatening adrenal (Addisonian) crisis.
- Stress dosing: the dose must be increased during illness, infection, trauma, or surgery.
- Often given to mimic the body's rhythm (larger dose in the morning, smaller in the afternoon).
- Long-term or excess dosing causes Cushingoid effects: hyperglycemia, weight gain, infection risk, osteoporosis, and GI ulcers.
Nursing priorities
- Teach the patient never to stop the drug suddenly and to taper only under provider direction.
- Educate on stress dosing (sick-day rules) and ensure access to an emergency injectable hydrocortisone kit.
- Monitor for signs of adrenal crisis: hypotension, weakness, nausea, and hyperkalemia.
- Monitor blood glucose, weight, blood pressure, and signs of infection.
Labs & values
Patient teaching
- Take steroids exactly as prescribed and never stop them abruptly.
- Follow sick-day rules: increase the dose during illness, fever, or surgery as instructed.
- Carry medical alert identification and an emergency hydrocortisone injection kit.
- Take oral doses with food to reduce stomach upset and ulcer risk.
- Report signs of infection, severe fatigue, dizziness, vomiting, or rapid weight change.
Red flags: report now
- Adrenal crisis — severe hypotension, profound weakness, vomiting, and confusion; emergency, give IV hydrocortisone and fluids.
- Abrupt discontinuation — never stop replacement steroids suddenly.
- Signs of infection may be masked by steroids; fever or wound changes must be reported promptly.
References
Clinical references for this topic
