hey everyone it's Sarah register nurse rn.com and in this video we're going to be going over adrenal crisis also called ad aonian crisis what I'm going to do for you in this video is I'm going to highlight the key players in this endocrine disorder the causes the signs and symptoms and the nursing management and I want to point out the important things you need to know for the inlex exam and your nursing lecture exams and after this video be sure to go to my website register nurse rn.com and take the free quiz that we'll take test your knowledge on adrenal crisis and a card should be popping up for you to access that quiz so let's get started okay before we start getting into the causes the signs and symptoms and nursing management let's look at the background information because it'll help us understand what's going on with this endocrine problem okay the key players in adrenal crisis are the adrenal CeX the pituitary gland and cortisol if you can remember those three things all of this other stuff will make sense okay first let's talk about the role of all those three things okay the adrenal cortex what does it do it is part of the adrenal glands and your adrenal glands set on top of your kidneys it's that cone shaped area on top of the kidneys and you have the adrenal cortex inside of it and what it does is it produces cortisol the main thing with this adrenal crisis is cortisol remember that commit that to memory what is the problem with addisonian crisis also called adrenal crisis is cortisol it's way too low next your pituitary gland what does that do because it plays a role in cortisol it regulates cortisol production by releasing the hormone HCT which is short for adrenocorticotropic hormone and whenever the pituitary gland releases this it causes the adrenal glands to release cortisol okay cortisol what does Cortisol do this is a steroid hormone specifically the gluto corticoid now remember in the other endocrine videos with Addison and cushions we talked in depth about cortisol and aldosterone and all those but this is the gluco corticoid and to help you remember what cortisol is remember whenever you think of cortisol remember it's a stress hormone it helps your body deal with stress so anytime your body is undergoing an illness um a trauma or you're having some external stress going on your body starts releasing cortisol to help you deal with it and um what cortisol does is it metabolizes glucose so whenever you metabolize glucose that enters into your bloodstream and it increases your blood glucose it helps break down fats proteins and carbs um and it plays a role in regulating your electrolytes specifically what you're going to be seeing is with your sodium and with your potassium okay first let's go over this right here before we get into the causes and signs and symptoms this is the negative feedback loop and if you can remember this it'll make sense why you're having the causes okay in your brain you have your hypothalamus and then below that you have this little gland area called the pituitary gland and it plays a role in how cortisol is released so you have the hypothalamus in the brain and it releases crh which is the corticotropin releasing hormone now whenever that's released it causes the pituitary gland which is below it to release HCT which was again the adrenocortical Tropic hormone now whenever that is being release that will signal to those adrenal glands which are on top of your kidneys the cortex to release cortisol now if you have any problem in this pituitary gland area with the releasing of this a hormone this can really mess up your cortisol levels which is going to go into our causes so let's talk about our causes okay why do people go into adrenal crisis addisonian crisis well number one they either have damage to that adrenal cortex because adrenal cortex what does it do it produces your cortisol so now how does that happen well generally people who have Addison's disease remember back in the other video they have issues with aldosterone and cortisol well whenever they get Addison if it's not treated properly say they're not taking their medications or the patient is taking their medications but they started they got sick they had surgery or something crazy going on in the body that causes a lot of stress it can throw them into addisonian crisis where you get the word addisonian from Addison's disease so if a patient has Addison's disease they are definitely at risk for developing adrenal crisis just because they have that predisposition of low cortisol levels already next adrenal ectomy this is where you have removal of the adrenal glands now in Cushings this is actually one of the treatment options for Cushings because remember with Cushings the patient has excessive High cortisol levels so um they may go in there and remove the adrenal gland now whenever you have an adrenal ectomy because you have that adrenal gland gone the patient has to supplement that cortisol because the body is not producing cortisol anymore so they have to take posttop those gluco cortico cortico medications and um if the patient doesn't take them doesn't know how important they are to take them it can flip them into adrenal crisis okay next another thing that can cause this is a pituitary gland damage uh and again that goes back to that negative feedback loop that we were talking about where the pituitary gland was not producing enough act and if it's not producing enough act the cortisol is not going to be released and you're going to have low cortisol levels so that's another issue now let's look at at our signs and symptoms how is this patient going to present to you as a nurse and this is a lot of test questions um that professors like to pull or the inlex so pay attention to that and the nursing management because that's where a lot of this stuff comes from and if you can remember all this other stuff it helps make sense why they look this way or why we're going to do the certain treatment okay to help you remember the signs and symptoms of adrenal crisis let's remember the five S's and the three H's okay five s's this is how your patient is going to look to you on assessment number one very important this is why I put it as number one they will have a super low blood pressure and one of the things is that nothing will bring it up no fluids no vasopressors nothing nothing is bringing this patient's blood pressure up and it is like critically low so that is one red flag that hey we may have an endocrin problem going on specifically adrenal crisis number two patient complains of sudden pain in their stomach their back and their legs third s they have Syncopy fourth s shock literally they're on vascular um collapse their blood pressure is low they're dehydrated that this is completely life-threatening it has to be treated immediately and five the last one severe vomiting diarrhea and headache now because of this this leads into our three hes um our first H is hyponatremia so any sodium level less than 135 they're going to have low salt this could be from the vomiting and the diarrhea and just the role that cortisol and if this is being caused by Addison how aldosterone plays with those electrolytes as well uh two hypoglycemia their sugars are going to be literally bottoming out so less than 70 and why is that because cortisol increases our blood sugar it plays a role in um our body metabolizing glucose so if we don't have any cortisol we're not metabolizing glucose so our blood sugar is plummeting and then the third age is hyperemia um a potassium level greater than 5.1 and these symptoms if as well if you're studying Addison's chances are you're studying adrenal crisis as well and remember these three hes because this is present in Addison disease as well so what is nursing management what are you going to do for these patients okay your number one priority is to get this patient stable because again this is a life-threatening condition because what's going on they have extremely low cortisol levels so we need to give them some cortisol and um so we want to administer cortisol stat per doctor's order and doctors usually PR prescribe a solu Corf which is a form of Hydrocortisone and it's given intravenous route IV routes the fastest the quickest so you'll be giving that also the physician May order IV fluids to replenish from the excessive vomiting the low blood sugar help get that pressure back up after you give that IV a hydrocortisone typically it's D5 normal saline and then next after that you'll start them on some oral glucocorticoids and uh normally this is prazone or hydrocortisone also the patient may be started on the mineral corticoids which helps replace aldosterone especially if the reason that they were in adrenal crisis was Addison's disease so watch out for that now whenever they're started on cortisol some Ed education pieces you need to remember for prazone or how to cortis is that you need to educate the patient that if while they're taking this that number one they take this routinely they just don't abruptly stop it and if they are going to be having surgery they're sick or they got a lot of external factors going on that are increasing their stress level they need to let the doctor know so they can increase the dosage because they may need some more cortisol to supplement them during that stressful time um next if they are started on a minoc corticoid which is for aldosterone they may be started on florinef and an education piece with florinef remember that they need to be educated on consuming enough sodium with that and last but not least you're going to also while they're in the hospital you're going to monitor those glucose levels because they're at risk for hypoglycemia potassium due to hyperia and sodium due to hyponatremia and prevent infection because they are so at risk for infection right now because their cortisol levels are low which help them fight and deal with stress so that is about adrenal crisis now go take that quiz and see how well you grasp this material and be sure to check out my other videos on the enderr series and consider subscribing to this YouTube channel and thank you so much for watching