An adult client underwent a short plasma corticotropin (ACTH) stimulation test this morning. What subsequent assessment finding would rule out a diagnosis of adrenal insufficiency?

Metformin is an oral medication used to lower blood sugar levels in clients with type 2 diabetes. It works by decreasing the production and absorption of glucose in the liver and intestines, respectively. However, metformin is contraindicated in clients with severe infections, as the drug can increase the risk of developing lactic acidosis, a rare but serious complication characterized by the buildup of lactic acid in the bloodstream.

During a severe infection, the body may experience a state of inflammation and stress, which can cause metabolic changes that increase the risk of developing lactic acidosis. Therefore, metformin should be temporarily discontinued in clients with severe infections and resumed only after the infection has been successfully treated and resolved.

In the meantime, the client's diabetic regimen may need to be adjusted to maintain appropriate blood sugar levels. This may include the use of alternative medications such as insulin, which can be used to control blood sugar levels during times of illness or infection. The healthcare provider will determine the appropriate management plan based on the individual client's needs and medical history.

Hydrocortisone is a synthetic form of the hormone cortisol, which is produced by the adrenal glands. Addison's disease is a condition in which the adrenal glands do not produce enough cortisol and other hormones. Treatment with hydrocortisone is a lifelong therapy that replaces the missing hormones.

One of the potential adverse effects of long-term treatment with hydrocortisone is the development of sodium depletion or hyponatremia. This occurs because hydrocortisone can increase the excretion of sodium in the urine, leading to low levels of sodium in the blood.

To mitigate this potential adverse effect, the nurse should encourage the client to increase their intake of sodium. This can be done through dietary sources such as adding more salt to their food or drinking sports drinks that contain electrolytes. The client should also be monitored closely for signs of sodium depletion, such as weakness, fatigue, and confusion.

It is also important to note that long-term treatment with hydrocortisone can increase the risk of other adverse effects, such as osteoporosis, hyperglycemia, and infection. The nurse should educate the client on these potential adverse effects and encourage them to follow their healthcare provider's instructions for monitoring and management.