The patient is returning to the unit after undergoing a bilateral adrenalectomy. Which clinical manifestation would indicate that the client is experiencing an Addisonian crisis?
Pain 7/10 at the surgical site
Hyperglycemia
Blood pressure 92/50
Sodium 152 mEq/L
The Correct Answer is C
A. Pain 7/10 at the surgical site: This level of pain is expected following major surgery, such as a bilateral adrenalectomy, and does not specifically indicate an Addisonian crisis.
B. Hyperglycemia: Although hyperglycemia can be associated with stress or corticosteroid treatment, it is not a hallmark of Addisonian crisis. Addisonian crisis is more related to adrenal insufficiency rather than hyperglycemia.
C. Blood pressure 92/50: Low blood pressure is a critical sign of an Addisonian crisis. This condition results from severe adrenal insufficiency where the body cannot maintain adequate blood pressure.
D. Sodium 152 mEq/L: High sodium levels are not characteristic of an Addisonian crisis. Addisonian crisis typically leads to hyponatremia (low sodium levels) due to inadequate aldosterone production.
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Related Questions
Correct Answer is B
Explanation
A. It is important that you taper off of the corticosteroids you are taking which have caused this disorder: This statement is not applicable because the client has a pituitary adenoma causing Cushing disease, not iatrogenic Cushing syndrome from corticosteroid use.
B. You will need to have your adrenal glands removed to reverse your symptoms: For Cushing disease caused by a pituitary adenoma, treatment typically involves surgical removal of the pituitary tumor, not the adrenal glands.
C. You will need to begin taking hydrocortisone, and increase your dose during times of stress: This is incorrect as hydrocortisone replacement is used for Addison's disease, not for managing Cushing disease.
D. You will receive glucose checks and sliding-scale insulin until your hormone levels are corrected: While glucose monitoring might be necessary due to hyperglycemia, the primary treatment for Cushing disease involves addressing the source of excess cortisol, which is the pituitary adenoma.
Correct Answer is C
Explanation
A. Limit your intake of high sodium foods for several days after the procedure to prevent hypernatremia: This is not typically recommended for clients with Addison's disease. In fact, they often need more sodium.
B. Limit fluid intake to 1,500 mL per day for the next five days after the surgery to prevent fluid retention: This is not appropriate for clients with Addison's disease. They generally need to maintain adequate hydration.
C. You will need to increase your dose of corticosteroids due to the stress of surgery: Stress, including surgery, increases the body’s need for corticosteroids in clients with Addison's disease. Therefore, increasing the dose is crucial to prevent adrenal crisis.
D. Avoid taking hydrocortisone after the procedure due to the risk of surgical-site infection: Hydrocortisone should not be avoided. It is essential for managing Addison's disease and preventing an adrenal crisis, especially under stress.
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