Transcript for:
Understanding Addison's and Cushing's Diseases

Hey guys, Nurse Mike here and welcome to SimpleNursing.com. Now before we get today's lecture started, please remember to access your free quiz and preview our cool nifty new study guides not here on YouTube. Click the link right up here at any time during this video. All right guys, let's begin.

Now Addison and Cushing is all about the steroids. Typically when we think of someone on steroids, you think of some big hairy weight lifter, right? Well, we're the same way and Addison's think we have an absence of steroids we have too little we need to add some in Addison's so clients typically present small and skinny and very frail and weak with a very odd tan and with Cushing it's the exact opposite big round and hairy so think a big cushion of steroids with Cushing's basically too much cortisol we can call him cushy Carl kind of like a big round hairy airbag So think cushing as more cushion for the push-in.

Now pump those NCLEX breaks. Guys, the majority of the NCLEX questions come from this section. So we took over 10,000 questions while creating the script.

And I can almost guarantee you, this part will be on your exam in the form of a SATA question. So again, Addison's, we have an absence of steroids. We need to add some steroids, guys, so everything will be low. We'll have low blood pressure, which is the most critical.

We'll have low weight from that water loss. Key words here, very skinny and very weak. We'll have low temperature from that cold intolerance. Low hair, known as hair loss or alopecia. Low mood or depression or irritable.

Low energy, low sodium guys, big one here. Hyponatremia, 135 or less. And this comes with a big salt craving.

Also slow or irregular periods or menstrual cycles. Now big ones here. Two highs, the two double P's here, pigmentation and potassium.

So remember, double P's for the double D's and add to sins. So guys, write this part down, the NCLEX loves this, big key words. High pigmentation or hyperpigmentation, also called bronze pigmentation.

And high potassium over 5.0, aka hyperkalemia. And since potassium pumps those muscles. We get muscle spasms and EKG changes.

So high potassium is high heart pumps, with peak T waves and ST elevations. And for Cushing's, it's the exact opposite. So just think big, huge cushion of steroids. Big, round, and hairy.

We get big blood pressure with big sugars and big sodium. Big on-clicks tip right there. And a big, round, hairy body with big weight or weight gain from that water gain.

And this leads to our NCLEX favorites guys. Big belly or Truncal obesity. Big keyword right there. Now three more big words for the NCLEX here.

Big face called a moon face, a big buffalo hump called a fat pad, or big hair called hirsutism, which I call a hairy suit-ism. And also big stretch marks known as purple striae on the face and abdomen. And big red face or rosy cheeks.

And lastly, Big infections or slow wound healing and a big risk for fractures from brittle bones or osteoporosis. Now I know what you're going to be thinking guys. You're going to be thinking, oh my gosh, that is a lot to remember, right?

But guys, it's very simple. Just think big and just think low. So to help you remember the biggest test topics for the NCLEX, just use your memory tricks, add and kush. So ads for Addison, A for added tan and added potassium.

Again, think the double P's here. Pigmentation and potassium over 5.0. D is for decreased weight.

Water loss usually means weight loss. So we'll get skinny patients and not truncal obesity. And not the moon face or buffalo hump.

Guys, that's Cushing's. Also D for decreased blood pressure, which again is the most critical. Guys, that low blood pressure can kill the patient in Addisonian crisis, which we'll be covering very soon. But also decreased hair sugar and energy keywords here are fatigue alopecia and hypoglycemia Lastly s for sodium loss or below 135 and s for salt craving again Not hairy body or thin skin guys That's Cushing's and for Cushing simply remember Cush see for cushion of fat So truncal obesity and two more keywords here write these down moon face and buffalo hump U for unusual hair growth, also called hirsutism.

Remember that hairy suit. And S for skin that has stretch marks, called purple striae. And lastly, H is for high sugar, high BP, and even high weight. Again, guys, the NCLEX will try and trick you. It's weight gain, not weight loss.

So just think big, round, and hairy. Now let's break down that pathophysiology for those nursing exams. And a little side note here, guys.

The majority of the NCLEX questions come from priority signs and symptoms and the treatments. Not specifically from this patho section. FYI.

So as you know the hypothalamus in the base of the brain starts the steroid domino chain Now that should be a rap song. secreting CRH which tells the pituitary to squeeze out ACTH Which eventually stimulates the adrenal cortex to produce steroids which controls the three S's Sugar, salt, and sex. So cortisol, our stress hormone, increases the sugar during times of stress aldosterone adds the salt and water to the body and lets go of potassium.

And androgens control hair and sex. But our main key player here is cortisol, the stress hormone. The synthetic version ending in zone like prednisone or hydrocortisone. Guys normally these steroids shield and protect us from stressful situations. So remember the four S's.

Surgery, which is a really big one on tests, but also stress from work and school like during. In finals week, we produce more cortisol, or even emotional stress from a bad breakup or even some baby mama drama. And lastly guys, key words here, sepsis or sickness or aka infection and even strenuous activity can increase this cortisol. So steroids help to suppress the inflammation and swelling caused by those stressors, pretty much protecting us from the harshness of reality.

Sort of like a big fat airbag, it deploys during times of trauma. So it's a little easier to understand the signs and symptoms, right? So in Cushing's, we have too much steroids, guys.

We end up looking like a big fat cushion, right? Big sugars and slower immune response with slower wound healing. Big salt means big swelling, leading to a big round body with big blood pressure and big sodium or hypernatremia. And big sex and hair, leading to a big hairy body called hirsutism, aka that hairy suit. And Addison's, we have the exact opposite guys, absence of steroids, which again, any added stress can kill our patient, called our antisodium crisis, which we'll cover pretty soon.

Now typically, absence of sugar will have hypoglycemia. Absence of salt means absence of swelling, low BP and very skinny, with salt cravings and low sodium, below 135. And absence of sex and hair, basically we see it as alopecia. Now normally the body turns these hormones on and off like a light switch called our negative feedback loop. Too much the body turns it off and too little like during times of stress the body turns it on. But you guys already know the problem here.

Cushing is stuck on high and Addison is stuck on dry with absent hormone so production is off. Okay so what's causing our adrenals to mess up? Yeah why though? Now Addison is usually caused by our memory trick ADD. So A for autoimmune disease, where the body basically kills the adrenals or pituitary.

This is called a primary cause. Or secondary causes from DND, like diseases like cancer or infection like TB, and even just trauma to the adrenals, like from a car accident or falling off a roof. Now on the other side, Cushing is either caused by drugs from outside the body called an exogenous cause, Usually coming from high steroid medication ending in zone like prednisone Often we see this when giving high doses over time with inflammatory conditions like asthma COPD and even rheumatoid arthritis Patients this makes the adrenals think they can stop producing steroids They sort of close up shop and go on vacation But high cortisol can also come from inside the body called an endogenous cause like tumors on the adrenal or pituitary and even small cell lung cancer.

Guys, big NCLEX tip right there. Write that one down. Small cell lung cancer. Now, the treatments are pretty simple. For Addison's, we just add some steroids, ending in zone like prednisone and hydrocortisone.

Now, we can also add IV maintenance fluid to bring that blood pressure up. And in Cushing's, we control the causes by cutting out the tumor or slowly decreasing those steroids causing the problem. Now we always slowly decrease those steroids to prevent that low blood pressure crisis.

So for Addison, we use the acronym ADDIE like Addison's disease. We add some guys those steroids during times of stress to avoid that Addisonian crisis. So big test tip right here guys, write this down.

Teach patients to tell their doctor about increased stress from work, school, or emotions. We have to increase their steroid doses guys. Always stressful times.

increased the steroids. Huge NCLEX favorite. Now D is for a diet high in protein, carbs, and sodium.

Cortisol helps convert proteins, carbs, and fat to energy, so keep these high in the diet. Also, don't stop taking steroids abruptly. Guys, we never abruptly stop hormones. In this case, it leads to Addisonian crisis.

BP so low, it will cause death, aka shock. And D, don't believe this medication will cure you, guys. It will not cure you.

Always more education is needed for any patients thinking hormones will cure them. And I, indefinitely on this medication. This is a lifelong hormone replacement therapy guys. No cure. You're always on hormones.

What's known as a forever drug. And lastly, we can always wear a medical alert bracelet. Now lifelong or long term steroids come with a few precautions.

So here are the top 7 most tested steroid side effects. and nursing considerations. Now I can guarantee you at least three or four will be on your exam.

So remember the seven S's of steroids ending in zone like prednisone. S for swollen. Steroids swell the body so weight gain means water gain.

We see a big moon face with big blood pressure. Big key words here. Sudden excessive or rapid weight gain.

Teach patients to report one pound in one day or even two to three pounds in a few days. S for sepsis or infection from low WBCs. Guys, this leads to slow wound healing, which is a huge risk for a fever and infection.

Always priority on the NCLEX. Any low-grade fever, even 100 or 37.8 degrees Celsius, can be very serious. Now, sugar will be increased.

Hyperglycemia, over 115. So guys, for diabetics on steroids, steroids increase the sugar. So we... increase the insulin write that one down big key word for the NCLEX now skinny muscles and bones or osteoporosis big risk for fractures and sites specifically risk for cataracts so we're referring these patients to optometrists another NCLEX tip guys everyone always misses that one on SATA questions and lastly to prevent Addisonian crisis we always teach patients to slowly taper off Never an abrupt stop. And again, for stress and surgery, we always increase the dose with increased stress.

Write that one down. I saw that one like three times on the NCLEX review. Okay, now how do you treat Cushing? Well, we simply cut it out, right?

The tumors or the steroids causing the problem. Pretty simple, right? Wrong!

Guys, cutting off an adrenal or pituitary, or even suddenly stopping steroids... can lead to an Addisonian crisis. We're talking blood pressure so low it can kill the patient.

Now this is called shock. So remember, we always slowly decrease or taper off steroids ending in zone, and if we cut off tumors. So remember, if we remove any endocrine gland, we have to replace these hormones. And a key word here, lifelong hormone replacement therapy. With no cure, we're just managing it with meds.

So when a question comes up along the NCLEX or even your exam stating what statement made by the patient requires additional teaching after that adrenalectomy. Guys, keyword here, lifelong hormone replacement therapy and never stop those hormones. It will lead to Addisonian adrenal crisis.

So think ADD for Addisonian or adrenal crisis. A for added stress like a broken leg or car accident. Or if Addison disease patients go into surgery and don't increase their dose.

Guys, they're like a ticking time bomb. Stress will kill. The second A is for abrupt stop. Patients forget to take their prednisone steroids or they go on vacation and don't refill their prescription. And boom, Addisonian crisis.

Now this leads to our low blood pressure, which is shock and then death. So what's your first priority action as the nurse? Well guys, what do you do in low blood pressure?

No, you don't go clock out or cry to your mommy. Our first priority is to get that blood pressure up. So our very first nursing action is to add zone steroids, IV push.

Write this down guys, again, hydrocortisone or prednisone IV push. That's the NCLEX number one for Addisonian adrenal crisis. And after we can always treat the low fluids and low sugar with either IV normal saline or IV normal saline.

and even dextrose iv solution all right guys that wraps it up don't forget to download your cheat sheet study guides in the download section Thanks for watching. For our full video and new quiz bank, click right up here to access your free trial. And please consider subscribing to our YouTube channel. Last but not least, a big thanks to our team of experts helping us make these great videos. Alright guys, see you next time.