When providing care for a female client with Addison disease, the nurse should be alert for which of the following laboratory values?
A. Potassium level of 3.2 mEq/L.
B. Calcium level of 3.3 mEq/L.
C. Sodium level of 150 mg/dL.
D. Hematocrit level of 25%.
Correct Answer: D. Hematocrit level of 25%.
A client with Addison’s disease is at risk for anemia. The normal hematocrit level of a female adult is 35% to 45%. A client with anemia has a low hematocrit level. Addison anemia, better known today as pernicious anemia (PA), is characterized by the presence in the blood of large, immature, nucleated cells (megaloblasts) that are forerunners of red blood cells. (Red blood cells, when mature, have no nucleus). It is thus a type of megaloblastic anemia.
Option A: The client with Addison’s disease has increased potassium. A deficiency of aldosterone, in particular, causes the body to excrete large amounts of sodium and retain potassium, leading to low levels of sodium and high levels of potassium in the blood.
Option B: The client with Addison’s disease has an increased calcium level. As not all cases of adrenal insufficiency present with hypercalcemia, adrenal insufficiency is not easily considered an etiology of hypercalcemia. The prevalence of hypercalcemia at the time of diagnosis of Addison’s disease is reported to be ~5.5%–6.0%.
Option C: The client with Addison’s disease has a low sodium level. The kidneys are not able to retain sodium easily, so when a person with Addison disease loses too much sodium, the level of sodium in the blood falls, and the person becomes dehydrated. Severe dehydration and a low sodium level reduce blood volume and can lead to shock.