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Emergency Care: Addisonian Crisis & Adrenal Insufficiency

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Emergency Care: Addisonian Crisis & Adrenal Insufficiency Addisonian Crisis Addisonian Crisis is an acute exacerbation of symptoms in someone with Addison s disease ... – PowerPoint PPT presentation

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Title: Emergency Care: Addisonian Crisis & Adrenal Insufficiency


1
Emergency Care Addisonian Crisis Adrenal
Insufficiency
2
Addisonian Crisis
  • Addisonian Crisis is an acute exacerbation of
    symptoms in someone with Addisons disease
    (namely adrenal insufficiency)
  • Whereas Cushings syndrome is seen in patients
    with excess corticosteroids, Addisons disease is
    seen in someone with a deficiency in
    corticosteroids.

3
Addisons Disease
  • Much like Thyroid disease, Addisons disease is
    failure of some aspect the complex system of
    hormones and feedback loops
  • Also, like Thyroid disease, there may be
    dysfunction as these hormones and messengers
    interact with the hypothalamus, pituitary and the
    site of hormone release (in this case the adrenal
    glands)

4
Adrenal Function Summary
The Adrenal Gland releases
Androgens (sex hormones)
Mineralocorticoids
Glucocorticoids
Glucocortoicoids (most potent is
cortisol) Action anti-inflammatory, growth
suppressing, affects sleep patterns awareness,
stress response
Mineralcorticoids (Aldosterone) Action
Manages sodium/potassium balance
5
Connecting the dots
6
Addisons Disease
  • Addisons disease can be a lack of all three
    hormones or just glucocorticoids and androgren
  • Caused by
  • Destruction of the adrenal glands by infection
  • Autoimmune attack
  • Mutation in the ACTH receptor on adrenal cells

7
Addisonian Crisis
  • Triggered by anything that increases the persons
    normal stress level surgery, infection,
    emotional trauma, physical trauma as well as
    sudden withdrawal from sterioids or
    post-adrenalectomy
  • The body is unable to release sufficient cortisol
    to respond appropriately
  • Result is Hypotension, tachycardia, dehydration,
    hypoglycemia, hyponatremia, hyperkalemia, fever,
    weakness confusion
  • May lead to shock vascular collapse

8
Worksheet
  • Review the provided education sheet from the
    Addisons Disease Self-Help Group
  • http//www.adshg.org.uk/info/manual/crisismanageme
    nt.pdf
  • Review the last three slides
  • Fill in your worksheet

9
Addisonian Crisis Education/Nursing Care
  • Prevention through careful titration of steroids
  • Steroid coverage for stressful events (i.e.
    preoperatively, hot weather, flu, etc.)
  • Patient, family, friends aware of signs/symptoms
    of crisis
  • Wallet card/med alert bracelet explaining
    condition, medications, and how to respond in an
    emergency

10
Addisonian Crisis Education/Nursing Care
  • Treatment focuses on getting patient the cortisol
    they need to have their body respond
    appropriately (PO, IV, IM routes)
  • Patient should always carry emergency dose,
    usually 100mg IM hydrocortisone
  • Return demonstration with normal saline before
    discharge

11
Highly Recommended !!!
  • Review Corticosteroid Therapy on pp. 1332-1334
  • Probably dont remember the information from when
    you were in Pharm
  • Will help you on test and on NCLEX
  • Key information in caring for patients who are
    taking corticosteroids
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