A client with adrenal insufficiency has vomiting, severe weakness, blood pressure 78/42 mm Hg, and confusion. Which prescription should the nurse anticipate first?
1Administer 0.9% sodium chloride intravenously without steroids.
2Give fludrocortisone acetate orally for adrenal crisis management.
3Administer IV hydrocortisone and isotonic fluids as prescribed.✓ Correct answer
4Initiate a continuous norepinephrine infusion for hypotension.
Explanation
Hypotension, vomiting, weakness, and confusion in adrenal insufficiency suggest adrenal crisis. Treatment includes immediate glucocorticoid replacement and isotonic fluids as prescribed. Delaying steroid replacement can be life-threatening.
Clinical Judgment Adrenal crisis is a shock-risk endocrine emergency.
Memory Tip Adrenal crisis: steroids and fluids.
Clinical Practice GuideAdrenal crisis management focuses on rapid steroid replacement, fluid resuscitation, glucose and electrolyte monitoring, and treating triggers.
CautionVomiting can prevent oral steroid absorption and worsen crisis risk.
Adrenal Insufficiency — Inadequate adrenal hormone production, especially cortisol.
Hydrocortisone — A glucocorticoid used to replace cortisol in adrenal crisis.
Isotonic Fluid — IV fluid with tonicity similar to plasma, used for volume resuscitation.