Addison Crisis Priority Nsg Intervention

[souleater11]

Hi everyone,

I would like clarify my confusion about Addison Crisis Nursing Priority Nursing Intervention.

Major complications are Vascular Collapse and Shock.

1. Should RN administer first Oxygen or Cortisol meds ?

2. Also is Addison Crisis, an airway/respiratory problem or a circulatory problem ?

3. Is the client's need for oxygen administration, a respiratory problem or circulatory problem ?

thanks

[nurseprnRN, BSN, RN]

What do you think? Where have you looked for the background on this condition? We are always happy to help students (and spend a great deal of time doing it to the occasional detriment of our other responsibilities :) ), but first we need to know what you think and why, so we can point you in the right direction without just giving you the answer!

Nursing involves life-long learning; we want to help you learn how to do that better. SO... what do you think?

[souleater11]

What do you think? Where have you looked for the background on this condition? We are always happy to help students (and spend a great deal of time doing it to the occasional detriment of our other responsibilities :) ), but first we need to know what you think and why, so we can point you in the right direction without just giving you the answer!

Nursing involves life-long learning; we want to help you learn how to do that better. SO... what do you think?

Thanks GrnTea,

Here's my own answers:

1. oxygen first because patient is hypoxic due to vascular collapse then followed by cortisol administration

2. Hypoxia is a circulatory problem that needs oxygen for the hypoxic tissues. Though airway problems are focus more on oxygen gas exchange obstruction (correct me if i am wrong)

3. i think the need for Addison Crisis of oxygen is due to poor tissue perfusion.

3.

[nurseprnRN, BSN, RN]

The most striking feature of adrenal crisis (which is what this is) is a collapse in blood pressure (what does this tells you about deciding whether it's an airway or circulatory problem?), with vomiting and diarrhea, and electrolyte disturbances which can also be life-threatening (low sodium, high potassium and high calcium).

What do those derangements do to what normal phyisological mechanisms?

The decreased tissue oxygen from shock is a later result of the shock, not a cause; giving oxygen may help the patient, but it's not the first thing we'd think of.

The cause of all this havoc is ............... , so the first line of therapy is .............

What did you learn that causes adrenal crisis?

[souleater11]

thanks GrnTea,

Cause is low cortisol in the patient's body and the first line of treatment is cortisol Meds.

correct me if im wrong

btw, i just to clarify something my friend emphasize that low cortisol cause a low blood sugar which makes a patient difficult to breath so an RN should administer cortisol because its a sugar hormone.

Do you think my friend is wrong because she thinks that hypoglycemia is more life threatening than low BP in low cortisol patients ?

[nurseprnRN, BSN, RN]

"A sugar hormone"?? What the heck is that? It is true that glucocorticoids raise blood sugar an can make diabetics get a bit out of control. Low blood sugar doesn't make it harder to breathe...it makes it harder to stay awake and alive, though. :) She might be getting totally confused about the idea that when people have very high blood sugars and ketoacidosis they do very heavy deep breathing as a respiratory compensation for the metabolic acidosis, but she sounds pretty muddled to me and I couldn't be sure that's where she's getting her mix-up from. I couldn't begin to speculate what she's thinking.

You got the idea that the first line of treatment is to stabilize the internal milieu by giving the steroid, though.

Shock will kill you faster than low blood sugar, generally.

[BrooklynRN11201]

I wouldn't think of glucocorticoids as sugar - they raise BG by blocking the absorption of insulin, not by directly contributing to blood glucose.

Also, as a nursing intervention, as far as NCLEX is concerned, it's almost always a safety answer or something NOT medicine related. I would imagine a priority nursing action is to monitor pt's BP, instruct pt to change positions slowly, etc.

[souleater11]

I wouldn't think of glucocorticoids as sugar - they raise BG by blocking the absorption of insulin, not by directly contributing to blood glucose.

Also, as a nursing intervention, as far as NCLEX is concerned, it's almost always a safety answer or something NOT medicine related. I would imagine a priority nursing action is to monitor pt's BP, instruct pt to change positions slowly, etc.

hitype1nurse,

thanks for your input.

btw, wont it be approriate for an RN to prioritize in adminster cortisol since Addision Crisis's symptoms are life threatening ?

[Nimble]

Here is a hint about Addison's Disease. They are always Hypovolemic, Hyponatremic, Hypoglycemic, and Hyperkalemic

[BrooklynRN11201]

hitype1nurse,

thanks for your input.

btw, wont it be approriate for an RN to prioritize in adminster cortisol since Addision Crisis's symptoms are life threatening ?

yes, absolutely, but that is not an independent nursing action - it's collaborative, so for me, I think the independent nursing actions surrounding patient safety and ABCs would probably be the best answers - but that's just me and my experience with the NCLEX - it's not necessarily testing your knowledge but your critical thinking and nursing judgment. just my .02 :)