A client admitted with Addisonian crisis asks the nurse about the cause of the
condition. Which is the best response by the nurse? See what the elves have done
here? yeah, They make it sound like a client has asked you this but really they're
testing your knowledge of what causes an Addisonian crisis. Now, in real practice
you'll get to educate patients like this, but for now know that this is the topic, this
is what they're looking for. Do you recognize what is the most likely cause of an
Addisonian crisis? Now, look at that last sentence. It says what? Which is the best
response by the nurse? We know that means it's a prioritization question. Students
hate this, but the quicker you can get over your angst, questions on the NCLEX are
most often prioritization questions. That's what you're looking for; best, first, most.
Those are the types of words, the buzz words that you'll see bolded like that and be
like that on the NCLEX also so they help it jump out at you. Know that, relax,
know there's likely going to be more than 1 right answer, there's no reason to rage
against the machine because you know that's how the game is played. So, for
someone admitted with an Addisonian crisis, I'm looking for the best response as
to the cause of an Addisonian crisis. You got 4 answer choices. Write down 1, 2, 3,
4 on your sheet, just the numbers. As you're working through each answer choice,
either keep it in or throw it out but make sure you say why. Right? I want you to be
sure that you're not just going "heehee." I don't like that one. I want you to say "I'm
eliminating this answer and here's why. I'm keeping this answer in and here's why."
And you seen this strategy when I'm going through that. If you haven't yet, you
will. If I'm not sure about an answer while I'm going through it, I'll kind of leave it
in and then I know I'm comparing it to other answers and sometimes that also is a
strategy that helps me eliminate and answer because I know this is a priority
question because it says "best response by the nurse." So good luck, take the time
you need going slow now. We'll help you be more proficient and faster later, just
be slow and thorough because slow and steady wins the race. See you in a little bit.
Hey, welcome back. How'd you do? What answer choice did you pick? Okay, own
it because it only works to the best effectiveness for you if you own your own
answer and then we think through how you got there. So the best response by the
nurse, number 2, let's start with that one. The beta cells in your pancreas are
destroyed resulting in adrenal sufficiency. Wait a minute. That answer is like so
weewee. Let's stop and ask myself am I really thinking about this right? So, the beta
cells in my pancreas, I know what those are, are destroyed and that results in
adrenal insufficiency. Well, the beta cells are in my pancreas, not my adrenal gland
and those aren't really connected so an Addisonian crisis is not caused by beta cells
being messed up in my pancreas but it still says adrenal insufficiency. Okay,
do you see the kind of conversations that go on in all of our minds? Yeah, they do.
So when I get to an answer like that, I'm like I can't really focus, I'm going to leave
it alone, walk on to another answer choice, I'll come back to number 2. So, I'm
going to start the first again. First start, number 1. There are excessive amounts of
hormones produced from your adrenal gland. Well, Addisonian crisis is not
excessive hormones from your adrenal gland. It is a lack of hormones from your
adrenal gland. Now, how do you get in this state? Well, there's probably likely
some type of autoimmune disorder that has attacked the adrenal gland and it can't
produce the hormones that it used to before it was attacked by your own body. So,
excessive amounts of adrenal gland hormones is called what? Cushing's. You got
it. Cushing's disease. This is an Addisonian crisis and this happens in Addison's
disease. So I can clearly get rid of number 1. Remember, endocrine disorders are
just opposites of each other. If I have too much adrenal gland hormone, that's
Cushing's. If I have not enough, that is Addison's disease. So the symptoms are
going to be directly opposite of each other. So number 1, you're gone. Number 2,
still a little security, though I'm not going back. So hang on right now. Number 3,
usually it results from a new physical stress in your life and the extra cortisol is
not produced. Okay, so how do I answer this? First of all, I know an Addisonian
disease affects my adrenal gland. That's one way I remember. I also know with an
Addison's disease we often have to add steroids. What does my adrenal gland put
out? Oh, those are the things that help me respond to stress. So if my adrenal gland
is not working, then I'm going to need more hormones. So, usually it results from a
new physical stress. That makes sense. Because if I have Addison's disease I can't
respond to stress and extra cortisol is not produced. So, cortisol is my response to
stress too and my adrenal gland is not working so number 3 makes good sense
but I still don't rule out number 2. Okay, number 4. It results from high dose
corticosteroid therapy which suppresses the function of the adrenal gland. Okay,
Whooh, that one's not as easy either. Is it? Did you struggle with that one? Because
it says high dose corticosteroid therapy suppresses the function of the adrenal
gland. Now I know that corticosteroid therapy does suppress an adrenal gland.
Okay, so that could lead to an Addisonian crisis. The only way you could tell the
difference is Addison's disease is if it has been an autoimmune disorder. Addison's
syndrome is what happens when we have to give people excess corticosteroids, the
adrenal gland says "Hey no reason for me to do anything cause you're getting all
the steroids I make anyway so it kind of goes to sleep or suppresses itself. So,
number 4 is true but he's asking for the cause of the Addisonian crisis. So, from
high corticosteroid therapy, no that doesn't tell me what caused this crisis. I can
have Addison's because I've had high therapy so I am comfortable getting rid of
number 4 particularly when I compare it to number 3. Yeah, number 2. Okay, I can
do it this time. Alright, are you ready? Let's look at it again. Because all of you are
going to have answers that work your brain like number 2 does like we're using as
an example here. So, how do you do it? Avoid it for a minute, work through the
other answer choices, stay calm, and now say "I have a new perspective, let me go
back at number 2." The beta cells in my pancreas are destroyed. Ahh wait a
minute. That's diabetes. Diabetes doesn't cause adrenal insufficiency. So let me go
back to number 3. I was picking between 2 and 3. Usually, it results from a new
physical stress in your life and extra cortisol is not produced. This client is asking
me about what caused the Addisonian crisis. Could a crisis be caused because of an
extra physical stress and they can't produce the extra cortisol? Bingo, there is the
answer. Okay now, some of you I may be driving nuts because I'm talking you
through the process but I want you to get really familiar with, this is what you
should be doing on a test as far as you have these internal conversations with
yourself. The way you keep track and don't get confused as you use that scratch
paper and you eliminate answers or keep them in but say why you write through
those. Now, I know that that feels like ahh it's one more step. In your school, you
may not be allowed to use scratch paper. That's a conversation between you and
your nursing program. On NCLEX, you always have scratch paper in the form of a
write on wipe off board that actually you can't wipe it off, you can write on it but
you have to raise your hand, look in the camera and say "I need another board" and
they'll bring you one. But you're not allowed to wipe that board off. But this is the
strategy that no matter how stressed you get, you can use to refocus, realign, and
raise your test score. So keep at it, it's work, it's like exercise because it is exercise
for your brain and for your mind. Hang in there, you really can do this. Come back
and do more questions with us.