NR 567 Week 5 Discussion; Case Scenario Discussion; Addison's Disease Medication

Trina Pullman is a 24-year old female with a history of hypothyroidism, with a 3-month history of persistent vomiting, followed by the gastroenterology service, thought to have gastritis based on the upper endoscopy report. She continued to have vomiting and weight loss, presented to the emergency department, found to be hypotensive, tachycardic and thin. Her serum labs demonstrated hyponatremia, normal potassium levels, and a random cortisol level that was very low. Thyroid stimulating hormone was normal. CBC was unremarkable, UA normal, negative pregnancy test. Serum glucose, liver function tests and renal function were normal. She was thought to have Addison's disease, with a plan to admit to the hospital for further workup and treatment. You are the hospitalist AGACNP admitting the patient. What one medication would you initiate on this admission to treat the Addison's disease? Past Medical History:  Hypothyroid  Gastritis  Social History: o Smoker 2-3 cigarettes socially on weekends o Recreational drug use-none o ETOH-none o Single, no children o Employed as hairdresser Medications  Protonix 40mg po daily  Levothyroxine 100 mcg po daily Allergies  None Physical Exam  Vitals: Pulse 104; Resp 18; BP 96/50; SpO2 98%; Temp 37 °C (98.6 °F); Wt. 65kg; Ht. 5'6".  Constitutional: Alert, no acute distress. Thin.  HEENT: Head is normocephalic and atraumatic. Eyes without icterus or injection. Mucous membranes pink and dry. Neck is supple, nontender without adenopathy. No JVD. No meningismus.  Resp: Lungs clear to auscultation bilaterally without wheezes, rales or rhonchi. No increased work of breathing.  Cardiovasc: S1S2 without murmur, rub or gallop. Regular rate and regular rhythm. Pedal pulses 2+ and equal. No edema.  Abd/GI: Soft, non-tender, nondistended. No masses. This study source was downloaded by from CourseH on :55:15 GMT -05:00 NR 567 WEEK 5 DISCUSSION ;CASE SCENARIO DISCUSSION ; ADDISON'S DISEASE MEICATION  Skin: Pink, warm, dry. No rashes or bruising.  Ext: Movement all extremities without limitation.  Back: Normal inspection. Nontender.  Psych: Affect normal. Appropriate attention, cooperation.  Neuro: Alert and oriented x 4. No focal motor or sensory deficits. Addi