A nurse is caring for a 2-week-old infant diagnosed with congenital adrenal hyperplasia (CAH). Which assessment finding requires immediate intervention?
1Weight loss of 50 grams over 24 hours
2Serum sodium level of 138 mEq/L
3Blood pressure of 85/50 mmHg
4Vomiting and lethargy with poor feeding✓ 정답
해설
Vomiting, lethargy, and poor feeding indicate adrenal crisis, a life-threatening emergency requiring immediate IV hydrocortisone and fluid resuscitation. Other findings are less urgent or expected in CAH.
Clinical Judgment
This question assesses the ability to early identify Adrenal Crisis, the most dangerous complication in infants with congenital adrenal hyperplasia (CAH). The key is to select the clinical signs indicating a life-threatening emergency. Option 4's "vomiting, lethargy, poor feeding" are the classic triad of symptoms for adrenal crisis. This signifies metabolic collapse due to hormone deficiency, dehydration, hypoglycemia, and electrolyte imbalance, requiring immediate reporting and treatment (IV hydrocortisone, fluid resuscitation). The other options are within normal limits (blood pressure, sodium) or represent a mild change (weight loss) that alone does not indicate immediate danger.
Memory Tip: The danger signals in a CAH infant are Vomiting, Lethargy, Poor feeding, i.e., VLP. Associate it with "Very Lethal Problem."
KR vs US: In Korea, newborn screening for CAH is performed, but there may be differences in the detailed execution of adrenal crisis management protocols and the intensity of home education. In the US NGN, teaching parents to recognize these VLP symptoms and to visit the emergency room immediately is emphasized as a core nursing intervention.
Clinical Practice Guide
Parent education for infants with CAH can be life-saving. Essential content includes:1. The importance of daily weight measurement and how to record it.2. How to administer oral hydrocortisone at a stress dose during stress (infection, fever, after vaccination).3.
Caution: Emphasize that if oral medication cannot be taken due to vomiting, you must go to the emergency room immediately. Do not wait at home or for the condition to improve.4. Education on how to use an emergency injection kit of hydrocortisone for emergencies (under a doctor's prescription and guidance).
Congenital Adrenal Hyperplasia — Congenital adrenal hyperplasia. A group of disorders caused by a congenital deficiency of one of the enzymes involved in the synthesis of cortisol, aldosterone, and androgens in the adrenal cortex. The most common is 21-hydroxylase deficiency.
Adrenal Crisis (Addisonian Crisis) — Adrenal crisis. A life-threatening acute condition caused by a severe deficiency of adrenal hormones (mainly cortisol). It leads to hypoglycemia, hypotension, dehydration, electrolyte imbalances (hyponatremia, hyperkalemia), and shock.
21-Hydroxylase Deficiency — 21-hydroxylase deficiency. The most common cause of CAH (over 95%). The cortisol and aldosterone synthesis pathways are blocked, causing precursors to shift toward androgen synthesis, presenting with virilization signs along with salt-wasting or non-salt-wasting forms.
Hydrocortisone — Hydrocortisone. A synthetic form of cortisol, used as lifelong replacement therapy in patients with CAH. In cases of adrenal crisis, it is administered urgently via intravenous injection.
Electrolyte Imbalance (Hyponatremia, Hyperkalemia) — Electrolyte imbalance (hyponatremia, hyperkalemia). A typical abnormal finding in salt-wasting CAH, where aldosterone deficiency leads to sodium loss and potassium accumulation. It is one of the main causes of adrenal crisis.