Addisons vs Cushing's Disease for NCLEX RN

hey guys nurse Mike here and welcome to simple nursing comm now before we get today's lecture started please remember to access your free quiz and preview our cool nifty new study guides not here on YouTube click the link right up here at any time during this video all right guys let's begin now Addison and cushing is all about the steroids typically when we think of someone on steroids you think of some big hairy weightlifter right so in the same way in Addison's think we have an absence of steroids we have too little we need to add some in Addison's so clients typically present small and skinny and very frail and weak with a very odd tan and with Cushing it's the exact opposite big round and hairy so think a big cushion of steroids with Cushing's basically too much cortisol we can call them cushy Carl kind of like a big round hairy air bag so think Cushing has more cushion for the pushin now pump those NCLEX breaks guys the majority the NCLEX questions come from this section so we took over 10,000 questions while creating the script and I can almost guarantee you this part will be on your exam in the form of a static question so again Addison's we have an absence of steroids we need to add some steroids guys so everything will be low we'll have low blood pressure which is the most critical will have low weight from that water loss key words here very skinny and very weak will have low temperature from that cold intolerance low hair known as hair loss or alopecia low mood or depression or irritable low energy low sodium guys big one here hyponatremia 135 or less and this comes with a big salt craving also slow or irregular periods or menstrual cycles now big ones here - highs the - double peas here pigmentation and potassium so remember double peas for the double D's and AD descends so guys right this part down the NCLEX loves this big keywords high pigmentation or hyper pigmentation also called bronze pigmentation and high potassium / 5.0 aka hyperkalemia and since potassium pumps those muscles we get muscle spasms and EKG changes so high potassium is high heart pumps with peaked t-waves and st elevations and for Cushing's it's the exact opposite so just think big huge cushion of steroids big round and hairy we get big blood pressure with big sugars and big sodium they can click step right there and a big round hairy body with big weight or weight gain from that water game and this leads to our NCLEX favorites guys big belly or truncal obesity big key word right there now three more big words for the NCLEX here big face called a moon face a big Buffalo Hump called a fat pad or big hair called hirsutism which I call a hairy suit isn't and also big stretch marks known as purple striae on the face and abdomen and big red face or rosy cheeks and lastly big infections or slow wound healing and a big risk for fractures from brittle bones or osteoporosis now I know what you're gonna be thinking guys you're gonna be thinking oh my gosh that is a lot to remember right but guys it's very simple just think big and just think low so to help you remember the biggest test topics for the NCLEX just use your memory tricks add and cook so ads for Addison a for added tan and added potassium again think the double Peas here pigmentation and potassium / 5.0 D is for decreased weight water loss usually means weight loss so we'll get skinny patients and not truncal obesity and not the moon face or Buffalo Hump guys that's Cushing's also D for decreased blood pressure which again is the most critical guys that low blood pressure can kill the patient in a de Sounion crisis which will be covering very soon but also decreased hair sugar and energy key words here are fatigue alopecia and hypoglycemia last yes for sodium loss or below 135 and s for salt craving again not hairy body or thin skin guys that's Cushing's and for Cushing simply remember cush see for cushion of fat so truncal obesity and two more key words here write these down moon-faced and Buffalo Hump you for unusual hair growth also called hirsutism remember that hairy suit an S for skin that has stretch marks called purple striae and lastly H is for high sugar high BP and even high weight again guys the NCLEX will try and trick you it's weight gain not weight loss so just think big round and hairy now let's break down that pathophysiology for those nurse and exams and a little side note here guys the majority the NCLEX questions come from priority signs and symptoms and the treatments not specifically from this pathos section FYI so as you know the hypothalamus in the base of the brain starts the steroid domino chain and that should be a rap song secreting CRH which tells the pituitary to squeeze out ACTH which eventually stimulates the adrenal cortex to produce steroids which controls the 3 s's sugar salt and sex so cortisol our stress hormone increases the sugar during times of stress aldosterone adds the salt and water to the body and lets go of potassium and androgens control hair and sex but our main key player here is cortisol the stress hormone the synthetic version ending in zone like prednisone or hydrocortisone guys normally these steroids shield and protect us from stressful situations so remember the four essence surgery which is a really big one on tests but also stress from work and school like during finals week we produce more cortisol or even emotional stress from like a bad breakup or even some baby mama drama and lastly guys keywords here sepsis or sickness or aka infection and even strenuous activity can increase this cortisol so steroids help to suppress the inflammation and swelling caused by those stressors pretty much protecting us from the harshness of reality sort of like a big fat airbag it deploys during times of trauma so it's a little easier to understand the signs and symptoms right so when Cushing's we have too much steroids guys we end up looking like a big fat cushion right big sugars and slower immune response with slower wound healing big salts means big swelling leading to a big round body with big blood pressure and big sodium or hypernatremia and big sex and hair leading to a big hairy body called hirsutism aka that hairy suits and Addison's we have the exact opposite guys absence of steroids which again any added stress can kill our patient called our an Estonian crisis which we'll cover pretty soon now typically absence of sugar will have hypoglycemia absence assault means absence of swelling low BP and very skinny with salt cravings and low sodium below 135 and absence of sex and hair basically we see it as alopecia now normally the body turns these hormones on and off like a light switch called our negative feedback loop too much the body turns it off and too little like during times of stress the body turns it on but you guys already know the problem here Cushing is stuck on high and Addison is stuck on dry with absent hormone so production is off ok so what's causing our adrenals to mess up yeah why though now Addison is usually caused by our memory trick ad so a for autoimmune disease where the body basically kills the adrenals or pituitary this is called a primary cause or secondary causes from D&D like diseases like cancer or infection like TB and even just trauma to the adrenals like from a car accident or falling off a roof now on the other side Cushing is either caused by drugs from outside the body called an egg so Janice cause usually coming from high steroid medication ending in zone like prednisone often we see this when giving high doses over time with inflammatory conditions like asthma COPD and even rheumatoid arthritis patients this makes the adrenals think they can stop producing steroids they sort of close up shop and go on vacation but high cortisol can also come from inside the body called an endogenous cause like tumors on the adrenal or pituitary and even small cell lung cancer guys big NCLEX tips right there write that one down small cell lung cancer now the treatments are pretty simple for Addison's we just add some steroids ending in zone like prednisone and hydrocortisone now we can also add IV maintenance fluid to bring that blood pressure up and in Cushing's we control the causes by cutting out the tumor or slowly decreasing those steroids causing the problem now we always slowly decrease those steroids to prevent that low blood pressure crisis so for Addison we use the acronym Addie like Addison's disease we add sone guys those steroids during times of stress to avoid that edisonian crisis so big test tip right here guys write this down teach patients to tell their doctor about increased stress from work school or emotions we have to increase their steroid doses guys always stressful times we increase the steroids huge NCLEX favorite now D is for a diet high in protein carbs and sodium cortisol helps convert proteins carbs and fat to energy so keep these high in the diet also don't stop taking steroids abruptly guys we never abruptly stop hormones in this case it leads to a de Sounion crisis BP so low it will cause death aka shock and II don't believe this medication will cure you guys it will not cure you always more education is needed for any patients thinking hormones will cure them and I indefinitely on this medication this is a lifelong hormone replacement therapy guys no cure you're always on hormones what's known as a forever drug and lastly we can always wear a medical alert bracelet now lifelong or long-term steroids come with a few precautions so here are the top seven most tested steroid side-effects and nursing considerations now I can guarantee you at least three or four will be on your exam so remember the seven s's of steroids ending in zone like prednisone s for swollen steroids swell the body so weight gain means water gain we see a big moon face with big blood pressure big key words here sudden excessive or rapid weight gain teach patients to report one pound in one day or even two to three pounds in a few days s for sepsis or infection from low WBC's guys this leads to slow wound healing which is a huge risk for a fever and infection always priority on the NCLEX any low-grade fever even a hundred or thirty seven point eight degrees Celsius can be very serious now sugar will be increased hyperglycemia over 115 so guys for diabetics on steroids steroids increase the sugar so we increase the insulin write that one down big keyword for the NCLEX now skinny muscles and bones or osteoporosis big risk for fractures and sites specifically risk for cataracts so we're referring these patients to optometrist another NCLEX tip guys everyone always misses that one on Satta questions and lastly to prevent edisonian crisis we always teach patients to slowly taper off never an abrupt stop and again for stress and surgery we always increase the dose with increased stress write that one down I saw that one like three times on the NCLEX review okay now how do you treat Cushing well we simply cut it out right the tumors or the steroids causing the problem pretty simple right wrong guys cutting off an adrenal or pituitary or even suddenly stopping steroids can lead to an edisonian crisis we're talking blood pressures so low it can kill the patient now this is called shock so remember we always slow decrease or taper off steroids ending in zone and if we cut off tumors so remember if we remove any endocrine gland we have to replace these hormones and a key word here lifelong hormone replacement therapy with no cure we're just managing it with meds so when a question comes up along the NCLEX or even your exam stating what statement made by the patient requires additional teaching after that adrenalectomy guys key word here lifelong hormone replacement therapy and never stop those hormones it will lead to edisonian adrenal crisis so think ad D for an Estonian or adrenal crisis a for added stress like a broken leg or car accident or if Addison's disease patients go into surgery and don't increase their dose guys they're like a ticking time bomb stress will kill the second day is for abrupt stop patients forget to take their prednisone steroids or they go on vacation and don't refill their prescription and boom add a Sounion crisis now this leads to our low blood pressure which is shock and then death so what's your first priority action as the nurse well guys what do you do in low blood pressure no you don't go clock out or cry to your mommy guys our first priority is to get that blood pressure up so our very first nursing action is to add sown steroids IV push write this down guys again hydrocortisone or prednisone IV push that's the NCLEX number one for edisonian adrenal crisis and after we can always treat the low fluids and low sugar with either IV normal saline and even dextrose IV solution alright guys that wraps it up don't forget to download your cheat sheet study guides in the download section thanks for 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Channel: Simple Nursing

Views: 649,087

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Keywords: Cushing’s, Addison’s, endocrine, Addison disease, Cushing syndrome, Cortisol, hypercortisolism, Hypocortisolism, addisonian crisis, adrenal crisis, adrenal insufficiency, adrenal glands, pituitary glands, hydrocortisone, prednisone, fludrocortisone, dexamethasone suppression test, Registered nurse RN, RN, Osmosis, Pharmacology, NCLEX, ATI exit, HESI exit, Kaplan, student nurse, nursing student, simplenursing, simple nursing

Id: mNJdZt3Z08I

Length: 15min 40sec (940 seconds)

Published: Wed Aug 21 2019