Addison's Disease Concept Map

Concept maps in nursing school are a big deal, but if you're struggling to make them, your grades will suffer. So in this video, we will walk through a step by step concept map for Addison's disease and I will give you the most important NCLEX key points and the key critical thinking points that you've gotta know for your exams so you can pass. This follows the same step by step breakdown process I've used to help think thousands of nursing students pass their exams in nursing school, and I want to help you, too. So hit that subscribe button and click the notification bell and let's dive in. Let's start out with one of the biggest NCLEX key points that you need to know for Addison's disease. There's three hormones that are always down in Addison's disease. These are cortisol, aldosterone, and androgens. Now, here's your first memory check, my friend. When you think Addison's disease, I want you to be thinking always down. Basically, what's happening here is that the adrenal glands, which sit on top of the kidneys, they don't produce enough of these crucial hormones, right? Primarily cortisol and often aldosterone, and sometimes those androgen hormones. Androgen production is also affected sometimes. This is why Addison's disease can also be called primary adrenal insufficiency. The adrenal glands are insufficient. They're. They're not good enough at making those hormones. So don't get tripped up on the NCLEX when they throw you that curveball. When you see primary adrenal insufficiency, think Addison's disease and those three main hormones. These are key to know about, and I'll talk about why in just a second when we get to the pathophysiology and the signs and symptoms. I have some big critical thinking points for you here, and we're going to cover a lot of ground in this video, so be sure to snag my concept map template pack so you can find, follow along and really make your nursing concept maps way easier. So let's branch off from the center of our concept map to pathophysiology. So what is actually happening in the body? What's wrong? The most common cause of Addison's is it's an autoimmune response, where the body's immune system, it mistakenly attacks the adrenal cortex, which is that outer layer of the adrenal gland. Now, this destruction, it can lead to a deficiency in those key hormones that we talked about. Now, other, less Common causes can be things like infections like TB or hiv, hemorrhage into the adrenal glands, or certain genetic factors as well. So what's actually happening here in the body? Let's talk about it. There's a breakdown of the adrenal cortex tissue. And because of this damage, the adrenal glands, they can't release those three critical hormones. Aldosterone, cortisol, and androgens. Remember, those are your three big ones. Now let's do some critical thinking about what each of these hormones does normally so that you can understand now what happens when they're low during Addison's disease. So for aldosterone, this is a huge NCLEX point for you, my friend. It has three main jobs. You can remember this as the three W's, okay? Water retention. It tells the kidneys to hold on to water with sodium. It tells the kidneys to hold on to more sodium and waste potassium. It tells the kidneys to kick out all the potassium. Just get rid of it. So when aldosterone is low, what's going to happen? The exact opposite here. The kidneys release water, which leads to dehydration. Ding, ding, ding. They release sodium, causing hyponatremia, and they keep. They retain potassium, which can result in hyperkalemia. This is why I call this a huge craving. Critical thinking point. When you see low sodium, low blood pressure, and high potassium or hyperkalemia on his. On an exam, your brain should immediately think aldosterone problem. Now, for cortisol, it has four main jobs, and you can remember them with the acronym firm. Firm Fight inflammation. So it reduces inflammation and it suppresses the immune system. It increases blood glucose, so it raises the blood glucose level. It releases energy from proteins and fats, so it breaks them down, and it helps to regulate mood. So when cortisol is low, what's going to happen? It's the opposite of firm. You get increased inflammation, low blood glucose or hypoglycemia, poor metabolism of proteins and fats, and then mood changes or irritability are things you might see. And finally, the androgens. Those are the sex hormones that help regulate the reproductive system. So when those are low, reproductive function is affected. All right, so if the body isn't producing enough of cortisol, aldosterone and androgens. Now, what might the signs and symptoms be with this patient here with Addison's disease? Now, this is where your critical thinking really comes into play. Now that we know what's going on, let's talk about it. So every symptom Leads back to one of those three key hormones. So because of that, low aldosterone, patients can present with hypotension, which is low blood pressure. And this is a big, big, big nclex point for you. Okay? You'll want to look for a blood pressure below. And they might have even orthostatic hypotension. Now, this means that they get dizzy when they stand up. You could also see hyponatremia, that's low sodium, where sodium levels less than 135 milliequivalents per liter, and then hyperkalemia as well, with a potassium level where it's more than 5 milli equivalents per liter. So these patients, they may also show signs of dehydration. They might even have some salt cravings because of those electrolytes, electrolyte abnormalities. And then because of that low cortisol, patients can experience hypoglycemia, that low blood sugar. Right. They can have pretty severe fatigue and weakness as well. Unintentional weight loss, so they're losing weight when they don't want to. Nausea and vomiting and abdominal pain. They can have poor stress responses common. And you might also see an increase in calcium levels. And because of those low androgen hormones as well, patients might have a decreased libido. And in women, this can also cause menstrual changes or amenorrhea. And in men, it can cause erectile dysfunction. Now, some patients, they can also experience a loss of body hair. Now, there's a really, really characteristic sign of Addison's disease that we have to talk about, but it's not always present. And this is hyperpigmentation. This is where the skin kind of gets darkened. This often looks like a tan, especially in sun exp areas of the skin. So skin creases, scars, and on the gums, this is a classic sign that the NCLEX loves to test on. So when the adrenal cortex doesn't respond to ACTH or adenocorticotropic hormone, the body produces more ACTH trying to stimulate those adrenal glands. Now, acth, funny enough, also affects melanocytes in the skin, and this causes hyperpigmentation. So my memory trick for this is, is when the adrenals don't respond, the skin gets bronze. Now, signs and symptoms are really important to include on your concept map, so don't forget to snag my concept map template pack so you can fill it all in and not forget any of these important things. Templates like this, super helpful in nursing school. Now, next up, on our concept map, this is diagnostic tests. So how do we confirm an Addison's diagnosis? Well, usually starts with a thorough history and a physical exam of the patient. You'll want to pay close attention, attention to those signs and symptoms that we just talked about, right? And then blood tests. Those are going to be key for diagnosing Addison's disease. So for this, you'll check electrolyte levels, specifically sodium and potassium. You'll be looking for a low sodium, that hyponatremia, right. Usually below 135mil equivalents per liter and a high potassium. So Hyperkalemia, that's usually about 4,5 milli equivalents per liter for these patients. You can also see low glucose levels, which would be below 70 milligrams per deciliter, and low cortisol levels, especially morning serum cortisol, and then high ACTH levels because the body is desperately trying to stimulate those adrenal glands here in Addison's disease. And then to confirm the diagnosis, an ACTH stimulation test is often performed. Now, this is the gold standard for this. It's the gold standard test, and it's an important NCLEX point. ACTH is a hormone that's released from that pituitary gland, and it tells the adrenal glands to release cortisol. Now, in this test, synthetic ACTH is given to the patient. And then in healthy people, cortisol levels rise dramatically. But in Addison's, there's little to no increase in cortisol, which really points to that primary adrenal insufficiency issue. And then other tests might include checking for adrenal antibodies if an autoimmune cause is suspected with that patient. And then sometimes imaging can be done, like a CT scan or an MRI of the adrenal glands or even the pituitary gland to look for damage or even possible tumors. Now, let's talk about what you will need to assess for in a patient with Addison's disease. So assessments are so, so key, my friend. For everything in nursing, you'll want to watch their blood pressure closely. Watching for hypotension. This is a key nclex point. The heart rate might increase to try to compensate for that low blood pressure. Then you should do a postural blood pressure check that assesses for that orthostatic hypotension to see if the patient's blood pressure drops when they stand up. And then when it comes to weight checks, here's a memory trick for you. T, S, C, or things that you should check time. So check Their weight at the same time of day. Scale. Use the same scale and close. Have the patient wear the same clothes each time. This will make sure that this is the most accurate daily weight that you can get for fluid status. Daily weights are the most sensitive indicator of a patient's fluid status. This is a huge NCLEX point for you. And you'll want to maintain strict INOS intake and output and check skin trigger and mucous membranes. And because that high potassium can cause cardiac arrhythmias, make sure that this patient is on an ECG monitor so that you can watch their heart rate and the heart rhythm really, really closely. And of course, you'll be monitoring their lab values, especially their sodium. Right. And their potassium, their blood glucose level and their white blood cells. We want to make sure that we're catching any electrolyte imbalances. And don't forget to assess the skin, especially looking for that bronze hyperpigmentation that we talked about. You'll also check mucous membranes and their pressure points as well. And this is really important. You need to watch for an Addisonian crisis. Huge, huge thing. This is life threatening. We'll talk about this more in just a minute when we get to the complications of Addison's disease for this concept map. But let's add another branch to our concept map here. How do we treat Addison's disease? What is the NURS interventions for this? So the cornerstone treatment, really the lifelong hormone replacement therapy for these patients. Patients will take oral corticosteroids to replace that cortisol that they don't have. Typically, hydrocortisone is really common for this and it's usually taken two to three times a day. They'll also need a medication, something like fluorocortisone, to replace aldosterone, and this can help normalize those sodium and the potassium levels and their blood pressure. We want to make sure those are all stable. And then sometimes androgen replacement might be needed as well. Now, to solve these electrolyte imbalances, IV fluids with sodium chloride, those can be given for hyponatremia. And Kxalate can also be used for hyperkalemia to get rid of that potassium. And of course, your nursing interventions, they are crucial, my friend. Make sure to always give medications exactly as prescribed. Of course, contact the doctor, though, if you think that something might be off with the order. And if you need to question it, of course, then ask. And you'll closely want to monitor their vital signs, especially their blood pressure for hypotension. Watch for that orthostatic hypotension, those orthostatic changes. Then you'll track daily weights using that TSC mnemonic that we talked about earlier. So, time scale, close and then monitor their cardiac status via an ECG, track their iOS and assess for any signs of an Addisonian crisis. We'll talk about that in a minute. Now, patient education, it's huge since Addison's disease. This is a lifelong condition. So you'll need to teach your patients to never, ever, ever abruptly stop their steroid medications because this can trigger an Addisonian crisis. So they need to know how to increase the their steroid dose during times of stress, illness, injury or surgery. Okay. This is often called the stress dose or you might hear it called sick day rules. You'll encourage them to wear a medical alert bracelet and carry an emergency kit. They'll need to have injectable hydrocortisone in that kit just in case. And they should follow a high sodium, high protein and high carb diet. The NCLEX loves nutrition and diet and they should use stress techniques to help reduce their stress and get that more under control. And the next part of our concept map is potential complications. This is a huge one, my friend. The most serious one here is, like we said, an Addisonian crisis or an adrenal crisis. Now, this is life threatening. It's an emergency that can be triggered by stress, infection or trauma or even surgery or if they suddenly stop their steroid medication. This happens when there are dangerously low cortisol levels in the body. So watch for some sudden, severe weakness, severe pain in the lower back or abdomen or legs, severe vomiting and diarrhea leading to dehydration. They could have confusion or loss of consciousness, very low blood pressure. Okay. And shock. So lab findings here, they'll show severe hyponatremia, hyperkalemia and hypoglycemia. Now your nursing priorities for an Addisonian crisis. You'll want to prepare to give hydrocortisone replacement through an IV as well as IV fluids to keep their blood pressure up. We want to keep it stable and reverse that, those electrolyte and the glucose imbalances. You'll also monitor for neurological status, their vital signs, watch their intake and their output and those electrolyte levels. And it's really important that an Addisonian crisis is treated quickly because this is a medical emergency. And this might just be one of the biggest nursing school tips I can give you. Okay, my friend, how well you critically think in nursing school depends on how well you understand the pathophysiology behind everything that you are learning. So click on this video here and I'm going to walk you through how to learn pathophysiology faster and easier in nursing school so that you can pass your exams. And if you like this video, be sure to write love in the comments below because that is what we do around here. And hit that subscribe button and click the notification bell. And as always my friend, go become the nurse that God created only you to be and I will see you over there in the next video.