The nurse is providing care to a patient recovering from a bilateral adrenalectomy. What should the nurse do to assess for the onset of adrenal insufficiency?
1. monitor strict intake and output
2. change the dressing using clean technique
3. question the order for cortisol administration
4. place the patient on fluid restriction
Correct Answer: 1
Removal of an adrenal gland, especially a bilateral adrenalectomy, results in adrenal insufficiency. Addisonian crisis and hypovolemic shock may occur. The nurse should monitor intake and output. While care should be taken during dressing changes to avoid infection, this will not prevent adrenal insufficiency. Cortisol is often given on the day of surgery and in the postoperative period to replenish inadequate hormone levels. Intravenous fluids are also administered postoperatively.
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