Addison's Disease | Complete Nursing School Lecture

In this video, we are going to walk through Addison's disease. We will go over the pathophysiology of Addison's disease, the signs and symptoms, and the nursing assessments and the nursing interventions for it so you can pass your nursing school exams. Let's dive in. So Addison's disease is also known as adrenal cortex insufficiency, meaning that the adrenal glands are insufficient at making certain hormones, specifically aldosterone, correct, cortisol and androgens. So let's talk about these hormones so that we can get a really good idea and understanding of all of them. Let's start with aldosterone. It is a mineralocorticoid. It's just a big fancy word for a steroid that impacts salt and water balance in the body. So aldosterone has three main jobs to do. The first is to tell the kidneys to hold on to water. The second is to tell the kidneys to hold on to sodium. And the third is to tell the kidneys to get rid of potassium. Now let's move on to cortisol, which is a glucocorticoid. Again, big fancy word. All it means is that it is a corticosteroid. So it's one of our flight, fight or flight hormones. Now, cortisol has a lot of responsibilities, and the four main things it does are reduce inflammation and suppress suppress the immune system. It causes the body to break down protein and fat, causes the blood glucose levels in the body to rise, and it helps regulate mood. And finally, androgens are hormones that help regulate the reproductive system and the sex hormones. I know that sounds like a lot right now, but don't worry, we're going to make it all come together for you in a minute. We just had to get all of those kind of general definitions out of the way first. And of course, if you're a nursing SS member, make sure to download the Addison's Disease study guide that we have for you inside the nmc. That way you have everything that you need to pass your exam. All the information is all laid out there for you, and if you're not a member yet, you're going to absolutely love it. Okay, I'll put the link in the description down below, so be sure to check that out and join next time. Enrollment is open. So now that we have a basic understanding of the different hormones the adrenal glands are responsible for, now we can really break down into the pathophysiology of Addison's disease. Now, what's happening during Addison's disease is that the body isn't making enough of those hormones. So Addison's disease is also called adrenal cortex insufficiency, like we said, because aldosterone, cortisol, and androgens are released by the adrenal cortex. So it makes sense that it would be called adrenal cortex insufficiency because the adrenal cortex is. Is insufficient at making aldosterone. It's not making enough aldosterone, cortisol, and androgens. So there's less of those hormones in the body. And this can lead to many, many problems. So let's put this whole process into simple steps for you to follow. Now, you know, I love putting pathophysiology into simple steps for you to follow. Just. I just think it makes it way easier to help you learn it faster because our brains are really wired to understand steps. So let's put this complex patho into a simple step by step process for you follow so you can really understand it easier. The first step is that there is a breakdown of the adrenal cortex tissue, so it can't release aldosterone and cortisol. This can be caused by autoimmune disorders that maybe attack the adrenal cortex, maybe infections or tumors or even certain medications. So step number one, the adrenal cortex breaks down. This is really bad because the adrenal cortex is responsible for releasing all. All those hormones. And they're important, right? Aldosterone, cortisol, androgen, they do a lot of things. So I am going to say I'm sure those three hormones over and over and over again in this video so that they'll really stick in your mind, okay? So don't get upset if I'm saying them over and over again. It'll help it stick. Okay? Now step number two. Aldosterone, cortisol, and androgens, they can't be released. This is because that tissue breakdown in the adrenal cortex is happening. Those. The adrenal glands, they simply just can't release those hormones. Hormones, as usual. So say them with me, okay? Aldosterone, cortisol, and androgen. And remember what those three hormones do. This is key to understanding Addison's disease. And now step number three, There's a decreased blood pressure and impaired metabolism. There just isn't enough aldosterone. And of course, aldosterone's job is to tell the kidneys to hold on to water and sodium, get rid of potassium, right? But without enough aldosterone, the kidneys can't hold on to Water, it just gets urinated out more often, causing dehydration, low blood volume, low blood pressure. And because cortisol is required to regulate protein, fat and glucose metabolism, without enough cortisol, those processes are also impaired and the body has a hard time getting those nutrients that it needs. And then next, during step number four, electrolytes and glucose levels are now affected. The sodium level may drop and the potassium level may rise, right? Because there isn't enough of aldosterone to regulate them properly. And there just isn't enough glucose in the blood for the cells to use because there isn't enough cortisol to help increase glucose levels. So all goes back to those hormones right? Now this leads us to step number five, which is metabolic acidosis possible and blood vessel collapse possible. So because the body can't use glucose for energy, there isn't enough blood and oxygen going to the tissues. Then anaerobic metabolism begins to try and get energy to cells to keep them functioning. But anaerobic metabolism can cause acids to be produced and this can lead to that metabolic acidosis. And eventually, if the low blood volume continues and there just isn't like, still isn't enough aldosterone and cortisol to regulate the fluid volume, then the blood vessels can collapse. Now, when you think about the signs and symptoms of Addison's disease, I really want you to be thinking about those three key hormones that we keep talking about over and over and over again. Aldosterone, cortis and androgen, and what happens without them. So let's keep these three in mind as we go through the signs and symptoms, because once you know those roles, once you've got those down solid of what aldosterone does, what cortisol does and what androgens do, like we just outlined, you will more easily be able to critically think through these signs and symptoms to figure out what happens when someone doesn't have enough of them. That's what you're going to see here in these signs and symptoms. So the main signs and symptoms that you'll be looking for are low sodium level, low blood pressure and dehydration, an increased potassium level, low glucose level, high calcium level, weight loss, weakness of fatigue, GI symptoms, things like nausea, vomiting and diarrhea, changes in menstruation for women, or erectile dysfunction for men, and hyperpigmentation. Now, if you've been around for a while, you know that I do not recommend that you just memorize a list of signs and symptoms like this, right? Instead, we are going to connect them back to the pathophysiology. So you actually understand them and can critically think about them for your exams, right? Because your nursing exams, they are not going to test you on how well you just memorize a list of things, right? Of course not. That's not what they're going to test you on. They're going to test you on how well you understand it and can critically think about everything that you're learning. And don't forget the Addison's Disease study guide that I have for you inside the nursing SOS membership community, right? Along with loads of other study guides and step by step videos for all of them. I'll put that link to the NMC down in the description below for you to check that out if you are interested. So let's dive in to some of these and do some critical thinking around them and why they occur. So low sodium, low blood pressure and dehydration and an increased potassium level, those are all directly related to a lack of aldosterone release, right? Remember, the aldosterone's job is to tell the kidneys to hold onto water, hold on to sodium and get rid of potassium. So without enough aldosterone, the kidneys are actually doing the opposite, right? The kidneys get rid of sodium, they get rid of water and they keep potassium. So without enough aldosterone, the sodium and the water levels will decrease and the potassium level will increase. Kind of funny how that works, right? It makes sense. Now this can lead to low blood pressure and dehydration because there isn't enough water to keep that blood pressure up, to keep the body hydrated. The kidneys are getting rid of just too much water. Now the next set of symptoms are related to the lack of cortisol in the body. Cortisol's job is to reduce inflammation and suppress the immune system. It helps to break down protein and fat, right? Helps to raise blood glucose levels and it helps to regulate mood. Those are its four primary jobs. So without enough cortisol to help raise the blood glucose level, the blood glucose level will fall. Now cortisol also helps to regulate calcium levels along with protein and fat metabolism. So without cortisol, the body takes up too much calcium and it can't break down fat and protein for the body to use and store. So without cortisol, weight loss can happen because there just isn't as much fat and protein in the body. Because the body just simply can't break it down and store it, weight loss can occur. It has that lack of water in the body as well. Then weakness Fatigue and GI symptoms also have to do with that fluid balance in the body, as well as the sodium balance. Water is necessary to help keep the blood flowing and the muscles and the organs perfused. So without enough fluid volume, right, the organs and the muscles, they just can't do their job as effectively, which can lead to that weakness and that fatigue and the GI symptoms, things like nausea and vomiting and diarrhea. There just simply isn't enough water to keep the GI tract happy and functioning. Now, that decreased sodium level can also be an issue here because sodium is vital to neurological function and muscle function, including the muscles in the GI system. So without enough sodium to keep the neurons firing optimally and to keep the muscles contracting well, then weakness and fatigue and those GI symptoms, those can all occur. Now, the next ones we'll talk about relate to those androgen hormones. With a decrease in androgen hormones such as testosterone. Testosterone, it can cause changes in menstruation for women and erectile dysfunction for men. And last but not least, another sign that you might see is hyperpigmentation. This one has to do with the hormone acth, or adrenal corticotropic hormone acth. So ACTH is what stimulates the adrenal cortex to release the hormones that we've talked about, right? The aldosterone, the cortisol and the androgen hormones. But because the adrenal cortex isn't releasing those hormones, there is a buildup of ACTH in the body because the adrenal glands, they're just not responding to it. And ACTH also binds to melanocytes on the skin, which produces a darker skin color. So with all of that ACTH buildup in the body, that skin pigment can become darker. So now let's switch gears a bit. We'll talk about the nursing assessment and the nursing interventions that you might do for patient with Addison's disease. The main things that you'll need to assess for are blood pressure, their heart rate, do daily weight checks, track their intake and output, right fluid status, monitor their heart rhythm through an ecg. Ask about and monitor for GI symptoms, things like nausea, vomiting and diarrhea. Ask about their energy level, how are they feeling, are they fatigued, are they weak? Assess their lab values, especially glucose and white blood cell count, their sodium, potassium and their calcium. Ask about reproductive changes such as erectile dysfunction in men and menstrual cycle changes for women. And then take a look at their skin color, their skin to check for those skin color changes. And that hyperpigmentation is what we're looking for. You'll also need to be on the lookout for an Addisonian crisis. We're going to talk about what that is here in a little bit, but that one's really important to know for your nursing school exam, so. As well, like we talked about earlier, aldosterone's job is to tell the kidneys to hold on to water and sodium and get rid of potassium, right? So without aldosterone, there is a decrease in that sodium and that water and an increase in potassium. And the first set of things to assess revolve around those things. So, of course, you will want to assess their vital signs. Especially you're going to look for their blood pressure and their heart rate when it comes to that fluid volume, right? Looking for their fluid status. Now, with the lowered fluid volume because of that decrease in aldosterone, the blood pressure might be decreased, specifically because there just isn't enough water in the blood to keep that blood pressure up. And the heart rate may try to increase to try to compensate for that low blood pressure, because the heart just tries to keep the blood circulating, right? That's its job, so it's going to try to compensate. And then daily weight checks and tracking intake and output will also help you to assess for those fluid imbalances. Aldosterone helps the kidneys get rid of potassium, too, right? If there's not enough aldosterone, the kidneys are going to hold on to potassium. And high levels of potassium can cause many problems with the heart and really disrupt the cardiac rhythm. So you will need to make sure that your patient is on an ECG monitor and that you are really tracking their heart rhythm to make sure that nothing really wonky is going on. You'll assess them for any GI symptoms like nausea, vomiting, and diarrhea, along with weakness and fatigue and a lack of energy because the fluid volume and that sodium level may be lowered in the body. That GI tract and the muscles, they just won't be getting the hydration and the sodium that they need to function, which can then lead to those GI symptoms, right? Along with that fatigue and the weakness and the lack of energy. And of course, you should assess their electrolyte levels specifically looking for their sodium and potassium, because the sodium level may be low and the potassium level may be high with that decrease in aldosterone hormone. And you'll definitely need to be monitoring their white blood cell count and their glucose levels to make sure that they aren't getting too low. Cortisol can also mess with calcium balance in the body, like we talked about. So you'll need to check their calcium level just to make sure that it's not getting too high. You'll also need to ask about their reproductive health because one set of those hormones that's low here, remember, are those androgen hormones which help to regulate the reproductive system, like we talked about earlier. So when those are low, you might see changes in menstruation. Those can happen. Changes in menstruation for women and erectile dysfunction in men. Those things can occur. And then, of course, another thing you should assess for, like we talked about, hyperpigmentation, because like we just mentioned a little bit earlier, ACTH is what, what stimulates that adrenal cortex to release aldosterone, that cortisol and the androgen hormones right from the adrenal cortex. But just because the adrenal cortex isn't responding to that, it's not releasing those hormones. There's a buildup of ACTH in the body because the adrenal glands just simply aren't responding to it. And ACTH also binds to melanocytes on the skin, which produces that darker skin color. So with all of that ACTH buildup in the body, it can cause hyperpigmentation. So along with assessing your patient, you will need to give medications as prescribed. Maybe things like KX late, which will help get rid of excess potassium, prednisone or hydrocortisone to increase those cortisol levels, and fludrocortisone to replace aldosterone. Then make sure that you keep assessing your patient before, during and after giving medications to make sure that it's working and that there are no complications. So we're always going to give those medications as prescribed. Prescribed by a doctor's order, of course. And because Addison's disease is a lifelong condition, you will need to do a lot of patient education to make sure that they know how to manage it at home and take all of their medications properly as prescribed. So whatever medications they're receiving, make sure that you walk them through what it is, what it's for, and how to take it properly as prescribed. And then make sure to mention that they might must take their medications as the doctor wrote them. Right, as prescribed. It's really important that they know that if they suddenly stop their stirring medications, they could have an Addisonian crisis. This is where the adrenal hormones drop too much in the body and it is life threatening. So there's a really key point for you to know for your nursing school exams, they love to test you on this. You will need to encourage them to reduce stress as much as possible and eat a high protein and a high carb diet. And one of the most important things that you'll need to educate them on, along with taking those medications exactly as prescribed, is when to call the doctor. So they should contact their doctor if they feel weak, if they feel fatigued, have severe headache, are passing out or fainting or feeling faint, if they're vomiting or having diarrhea or stomach or leg or back pain. These are all possible symptoms of an Addisonian crisis, so they should be seen right away. Now, if you want a quick for how to learn pathophysiology easier in nursing school, I know that it can be a lot. Be sure to check out this video here and I'm going to show you how to do that for all the disorders you're studying in nursing school. And if you liked this video, write love in the comments below because that is exactly how we do it around here. It's kind of our thing. And as always, my friend, go become the nurse that God created only you to be. And I will see you over there in that next video.