Medical Surgical Addisons vs Cushing #5

Question

A client who has had Addison’s disease for 20 years and has been in the ICU following an event where he was found unconscious due to Addisonian crisis is being discharged home. Which discharge teaching is priority for the client?

Answers

  1. Showing the client how to daily check his blood pressure
    • Rationale:

      This answer is not correct because showing the client how to check his blood pressure is not a priority over explaining the importance of wearing medical alert jewelry. The client was found unconscious in an Addisonian crisis. This reiterates the importance of having or continuing to wear medical alert jewelry.

  2. Explaining importance of wearing medical alert necklace
    • Rationale:

      This answer is correct because the priority nursing discharge teaching for a client being discharged following an addisonian crisis is explaining the importance of wearing medical alert jewelry. This helps emergency personnel be able to treat the client immediately if found unable to communicate.

  3. Explaining the side effects of taking hydrocortisone
    • Rationale:

      This answer is not correct because if the client has had Addison’s disease for 20 years, he has been taking hydrocortisone for a long time. The client should know the side effects. It is always important to review those with clients but is not a priority over explaining the importance of wearing medical alert jewelry. This helps emergency personnel be able to treat the client immediately if found unable to communicate.

  4. Helping the client understand what Addison's disease is
    • Rationale:

      This answer is not correct because if the client has had Addison’s disease for 20 years, they have known about Addison’s disease for a long time. It is always important to review information with clients but is not a priority over explaining the importance of wearing medical alert jewelry. This helps emergency personnel be able to treat the client immediately if found unable to communicate.

Overview

A client who has had Addison’s disease for 10 years and was recently found unconscious from Addisonian crisis should be reminded about the importance of wearing medical alert jewelry. This helps emergency personnel be able to treat him immediately if found unable to communicate.

Explanation

Learning Outcomes

Addison’s disease is a rare, yet serious disorder of the adrenal gland. Dysfunction of the adrenal glands causes decreased production of cortisol and aldosterone in the body. Electrolyte imbalance may occur and be triggered from stress, trauma, or surgery. Assessment findings consist of generalized muscular weakness, hypotension, irritability, and hyperpigmentation of skin. If Addison’s disease goes untreated, or the client experiences an injury, sickness, or infection, Addisonian crisis can occur. This occurs because the body is unable to produce cortisol. For example, during a physical stressor, such as injury, sickness, or infection, the body produces two to three times the normal cortisol level in the body. With Addison’s disease, the client does not have enough and it can cause a life-threatening situation where the blood pressure is extremely low, the blood glucose is low, and there is high levels of potassium. This client needs immediate medical treatment. Sometimes the client is unable to communicate or are unconscious due to the crisis. Therefore, the client with Addison’s disease should wear medic alert jewelry to notify emergency personnel.

Test Taking Tip

Read the questions and ascertain information it gives you, such as how long the client has had the disease. Although the nurse never assumes the client knows about a disease, the client has had the disease for 20 years or the medication he has been taking at home, it is not a priority over making sure the client can communicate his medical history to emergency personnel.

Video Rationale