The CJMM Coach
Adrenal · Addison's Disease
Stop and think

Mrs. Chen, 45

Mrs. Chen has a known history of Addison's disease, managed on daily oral hydrocortisone. She was admitted overnight with two days of vomiting and diarrhea from a viral illness and has not been able to keep her morning dose down. She now reports abdominal pain and looks lethargic.

BP84/52 mmHg (baseline 118/74)
HR118 bpm
Temp100.9°F
Mental statusLethargic, slow to answer questions

Before you move on, notice:

Known Addison's disease with two days of vomiting and diarrhea
Unable to keep her oral hydrocortisone dose down
New abdominal pain and lethargy
BP significantly below her documented baseline, with tachycardia
Your turn

What should the nurse do?

What is the priority nursing action?

A
Give her the oral hydrocortisone dose again now that some time has passed
B
Notify the provider and prepare for IV hydrocortisone administration
C
Encourage oral fluids to bring the blood pressure back up
D
Apply a warming blanket to address the low-grade fever
CJMM debrief

Let's break it down

AWhy not: Option A

She is actively vomiting and cannot reliably absorb an oral dose, and oral replacement is too slow for what this picture is becoming anyway.

BCorrect: Option B

A patient with known Addison's disease who is vomiting, hypotensive, tachycardic, and lethargic is heading into an Addisonian crisis. She needs IV hydrocortisone urgently, and getting the provider notified now is what makes that happen.

CWhy not: Option C

Oral fluids won't stay down given the vomiting, and fluids alone don't correct the underlying cortisol deficit driving this crisis.

DWhy not: Option D

100.9°F is a mild fever, not a temperature requiring active warming, and treating it does nothing for the falling blood pressure and cortisol deficit that are the real emergency here.

Keep asking why. · thecjmmcoach.com