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 weightlifter right so in the same way in 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 Cushings 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 pushing now pump those enlex breaks guys the majority of the enlex 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 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 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 PS here pigmentation and potassium so remember double P's for the Double D's and Addison so guys write this part down the enlex loves this big key words High pigmentation or hyperpigmentation also called bronze pigmentation and high potassium over 5.0 AKA hyper calmia 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 STL elevations and for cushions 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 enlex tip right there and a big round hairy body with big weight or weight gain from that water gain and this leads to our enlex favorites guys big belly or trunkal obesity big key word right there now three more big words for the dlex here big face called a moon face a big buffalo hump called a fat pad or big hair called he suit ISM which I call a hairy suit ISM and also big stretch marks known as Purple stri 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 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 enlex just use your memory tricks add and cush so ads for Addison a for added tan and added potassium again think the double P's here pigmentation and pottassium over 5.0 D is for decreased weight water loss usually means weight loss so get skinny patients and not truncal obesity and not the moon face or buffalo hump guys that's Cushings 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 key words 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 Cushings and for Cushing simply remember cush C for cushion of fat so trunkle obesity and two more key words here write these down moonface and buffalo hump you for unusual hair growth also called hairism remember that hairy suit an S4 skin that has stretch marks called Purple strier and lastly H is for high sugar high BP and even high weight again guys the enlex 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 enlex questions come from Priority signs and symptoms and the treatments not specifically from this pathos section FYI so as know the hypothalamus in the base of the brain starts the steroid Domino Chain man that should be a rap song huh secreting crh which tells the pituitary to squeeze out act 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 elderone adds the salt and water to the body and lets go of pottassium and androgens control hair and sex but our main key player here is cortisol the stress hormone the synthetic version ending in zone like prazone 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 in school like during finals week we produce more qu or even emotional stress from like 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 Cushings 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 hypernia and big sex and hair leading to a big hairy body called H suismon we have the exact opposite guys absence of steroids which again and 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 ad 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 prednizone often we see this when giving high doses over time with inflammatory conditions like asthma coop OPD and even rheumatoid arthritis patients this makes the adrenals think they can stop producing steroids they sort of closeup 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 en clix tip right there write that one down small cell lung cancer now the treatments are pretty simple for Addison we just add some steroids and in zone like prazone and hydrocortisone now we can also add IV maintenance fluid to bring that blood pressure up and in Cushings 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 sewn 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 we increase the steroids huge enlex 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 longterm steroids come with a few precautions so here are the top seven 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 PR a Zone 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 2 to three pounds in a few days s for sepsis or infection from low wbc's guys this leads to slow wound healing which is a huge risk for a fever and infection always priority on the en click any low-grade fever even even 100 or 37.8 de C 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 enlex now skinny muscles and bones or osteoporosis big risk for fractures and SES specifically risk for cataracts so we're referring these patients to optometrist another enlex tip guys everyone always misses that one on stic 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 enle 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 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 enlex or even your exam stating what statement made by the patient requires additional teaching after that adrenalectomy guys key word 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 prednizone 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 guys 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 prednizone IV push that's the enlex number one for addisonian adrenal crisis and and after we can always treat the low fluids and low sugar with either IV normal sailing and even dextrose IV solution all right guys that wraps it up don't forget to download your cheat sheet steady 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 all right guys see you next time [Music] [Music]