Adrenal Crisis (Addisonian Crisis) Review Notes for NCLEX

Below are review notes for Adrenal Crisis, which is also called Addisonian Crisis, to help you study for the NCLEX exam or your nursing lecture exams.

As the nurse taking care of the patient with Adrenal Crisis, you must know how to properly care for them.

In addition to these notes, don’t forget to review the NCLEX notes on Addison’s Disease vs Cushing’s.

 

These NCLEX review notes will cover:

• Key players in Adrenal Crisis
• Causes of Adrenal Crisis
• Signs & Symptoms of Adrenal Crisis
• Nursing Management

After reviewing these notes, don’t forget to take the Adrenal Crisis NCLEX quiz.

Adrenal Crisis (Addisonian Crisis)

Adrenal crisis in a nutshell is extremely low CORTISOL levels.

Key Players in Adrenal Crisis:

• Adrenal Cortex: produces CORTISOL
• Pituitary Gland (anterior): regulates CORTISOL production by releasing ACTH (adrenocorticotropic hormone)…when this is released it causes the adrenal cortex to release cortisol.
• CORTISOL:  a steroid hormone which is a glucocorticoid know as the “STRESS Hormone” . This helps the body deal with stress such as illness or injury by increasing blood glucose though glucose metabolism, breaking down fats, proteins, and carbs, and regulating electrolytes.

Lecture on Adrenal Crisis

Causes of Adrenal Crisis

• Damage to the adrenal cortex:
  • Addison’s Disease which is under treated (not taking medication properly or they are taking it properly, but there is extra stress on the body and the medication needs to be increased…surgery, illness, emotional stress)
• Adrenalectomy:
  • A treatment for Cushing’s (removal of the adrenal gland) and patient must take oral cortisol because body isn’t producing it. If the patient fails to take the medication or the medication isn’t enough they could enter into adrenal crisis.
• Pituitary gland is damaged and isn’t producing enough ACTH. Remember the negative feedback loop (watch the video for details on it)

Signs and Symptoms of Addisonian Crisis

Remember the 5’S & 3 H’s

1. Super low blood pressure (nothing will bring it up)
2. Sudden pain in stomach, back, and legs
3. Syncope (going unconscious)
4. Shock
5. Severe vomiting, diarrhea and headache

1. Hyponatremia
2. Hyperkalemia
3. Hypoglycemia

Nursing management of Adrenal Crisis

• Administer some cortisol STAT via fastest route which is IV!!
  • Most commonly prescribed is Solu-Cortef “hydrocortisone”, along with IV fluids which will help replenish sodium and glucose (D5NS).
• Start on PO glucocorticoids and mineralocorticoid:
  • For replacing cortisol: ex: prednisone, hydrocortisone
    • Education: patient to report if they are having stress such as illness, surgery, or extra stress in life…… will need to increase dosage, take medication exactly as prescribed….don’t stop abruptly without consulting with md.
• For replacing aldosterone: Fludrocortisone aka Florinef
  • Education: consuming enough salt..may need extra salt
• Watch sodium, potassium and glucose levels and ensure clean environment to prevent infection

Quiz on Adrenal Crisis