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Other Therapies: Cortisone acetate (Cortone); fludrocortisone acetate (Florinef)

Independent

During the initial hours of managing a patient with acute adrenal crisis, the first priority is to maintain airway, breathing, and circulation. Patients who receive large amounts of room-temperature fluids are at risk for hypothermia. Keep the temperature of the room warm and the bed linens dry. If possible, keep the patient fully covered. During massive fluid replacement, administer warmed (body-temperature) fluids if possible.

Teach the patient on corticosteroids about the medication and the need to continue to take it until the physician tapers the dose and then finally discontinues it. Explain the symptoms of adrenal crisis to any patient who is undergoing anticoagulant therapy. Explain the effects of stress on the disease and the need for adjustment of medications during times of stress.

Patients with altered tissue perfusion require frequent skin care. If the patient is immobile, perform active and passive range-of-motion exercises at least every 8 hours. Encourage coughing and deep breathing to limit the complications from immobility. Provide small, frequent meals and make referrals to the dietitian early in the hospitalization.

• Physical findings: Vital signs; pulmonary artery catheter pressure readings; monitoring of airway, breathing, circulation; urine output; mental status

• Important changes in laboratory values: Plasma cortisol, serum glucose, serum sodium and potassium, pH, oxygen saturation

• Presence of complications: Infection, cardiac dysrhythmias, fluid and electrolyte imbalance, weight loss

• Response to therapy: Daily weights, appetite, level of hydration

PATIENT TEACHING. Teach the patient and significant others about the disease and the factors that aggravate it. Provide suggestions about rest and activity and stress reduction. Explain the signs and symptoms that may lead to crisis.

PREVENTION. Identify the stressors and the need to increase medication during times of stress. Teach the patient and family when the physician needs to be notified.

MEDICATIONS. Teach the patient the name, dosage, action, and side effects of drugs and the need to continue using them for life. Provide written instruction about medications and follow-up physician's appointments.

^Acute alcohol intoxication occurs when a person consumes large quantities of alcohol. In most states, legal intoxication is 80 mg/dL, or 0.08 g/dL. Acute alcohol intoxication leads to complex physiological interactions. Alcohol is a primary and continuous depressant of the central nervous system (CNS). The patient may seem stimulated initially because alcohol depresses inhibitory control mechanisms. Effects on the CNS include loss of memory, concentration, insight, and motor control. Advanced intoxication can produce general anesthesia, while chronic intoxication may lead to brain damage, memory loss, sleep disturbances, and psychoses. Respiratory effects also include apnea, decreased diaphragmatic excursion, diminished respiratory drive, impaired glottal reflexes, and vascular shunts in lung tissue. The risk of aspiration and pulmonary infection increases while respiratory depression and apnea occur.

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