What is the best action for a nurse when a patient with adrenocortical insufficiency begins to vomit due to stress?

In the context of a patient with adrenocortical insufficiency experiencing vomiting due to stress, administering hormonal replacement is the most critical action. Patients with this condition have impaired adrenal function, which may lead to inadequate production of glucocorticoids, particularly cortisol, especially during periods of stress. Vomiting can further exacerbate the condition, leading to dehydration, electrolyte imbalances, and potentially an adrenal crisis.

By providing the appropriate hormonal replacement therapy, typically in the form of hydrocortisone or another glucocorticoid, the nurse can help stabilize the patient's condition and mitigate the stress response. This ensures that the patient's metabolic needs are met, especially during times of physical stress when the body's demand for corticosteroids increases.

While monitoring vital signs, encouraging fluid intake, and creating a calming environment are all supportive actions that may contribute to the overall management of the patient, they do not directly address the immediate physiological deficiency caused by adrenocortical insufficiency. Therefore, administering hormonal replacement is vital in this scenario to prevent further complications and address the core issue of inadequate hormone levels.