12 terms

Addisonian Crisis

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What hormones are deficient in addison's?
glucocorticoids--cortisol and aldosterone
cortisol
helps the body respond to stress, maintains bp, balance the effects of insulin
aldosterone
helps maintain bp, water/salt balance
addisonian crisis
secondary to an illness or a stressful event; becomes life threatening
what happens in crisis?
acute deficiency in cortisol production and this results in circulatory collapse and electrolyte imbalances
adrenal crisis symptoms?
hypotension, tachycardia, dehydration, hypovolemic shock, profound hypoglycemia, confusion, altered mental status, ventricular dysrhythmias, GI (N/V, diarrhea, anorexia, cramps), hyperpigmentation of the skin

pts usually present with non specific symptoms (weakness, fatigue, sometimes a fever, lower back pain) and are often misdiagnosed, especially for a kidney infection
diagnostics
hypoglycemia, hyponatremia, hyperkalemia, hypercalcemia, azotemia (nitrogen), high creatinine
causes
sudden withdrawal of glucocorticoids, extress stress, trauma, sepsis, TB, adrenal hemorrhage, autoimmune
nursing considerations
watch VS (extreme hypotension), tele monitoring (hyperkalemia, hyponatremia), electrolytes, neuro checks (hypoperfusion, hypoglycemia, hyponatremia), daily weights, monitor for fluid overload

provide a safe environment, teamwork and communication, minimize stress, nutritional intake (need to add salt!), immobility complications, emotional support, education, pt involved in decision-making
nursing goals and diagnoses
goals: corticosteroid administration (hydrocortisone and dexamethasone), maintain BP/tissue perfusion (fluid resuscitation with isotonic fluid, vasopressors)

dx: fluid volume deficit, electrolyte imbalance, self-care deficit
treatment
combat circulatory shock! restore blood circulation, administer fluids (D5NS) and corticosteroids (high dose of hydrocortisone), monitor VS
discharge plan
educate on:
-need and importance to take daily steroid replacement
-how to increase dose at times of stress, such as fever, flu, surgery, rigorous physical activity (double dose in minor stress and triple in major stress)
-medical alert bracelet and travel kit that includes 100mg hydrocortisone/syringes

treat with cortisol equivalent, commencing at time of sx and continue for 48-72 hours after sx-taper

cortisol levels often will need to be drawn in AM (dependent on pt's sleep/waking schedule!)