After a shift handoff about four patients, which patient would the nurse attend to first?

After a shift handoff about four patients, which patient would the nurse attend to first?

• A. Patient with acute adrenal insufficiency who has a blood glucose of 36.
• B. Patient with moonface and hypertension.
• C. Patient with Conn syndrome with hypertension.
• D. Patient with Addison's disease with mild hyponatremia.

Answer: (A)

The most urgent issue is acute adrenal crisis presenting with severe hypoglycemia. A blood glucose of 36 mg/dL is a life-threatening condition requiring immediate intervention (rapid IV dextrose and supportive care) to prevent brain injury and shock. In adrenal crisis, lack of cortisol and aldosterone can lead to profound hypotension, electrolyte disturbances, and volume depletion, making it the priority. The other patients have significant adrenal-related conditions but not an immediate life-threatening crisis. Moonface with hypertension points to Cushing syndrome; Conn syndrome (primary hyperaldosteronism) causes hypertension and electrolyte changes but is not an acute emergency. Addison’s disease with mild hyponatremia is important to address, but the hyponatremia is mild and not acutely destabilizing. Therefore, addressing the severe hypoglycemia first is the correct priority.

The most urgent issue is acute adrenal crisis presenting with severe hypoglycemia. A blood glucose of 36 mg/dL is a life-threatening condition requiring immediate intervention (rapid IV dextrose and supportive care) to prevent brain injury and shock. In adrenal crisis, lack of cortisol and aldosterone can lead to profound hypotension, electrolyte disturbances, and volume depletion, making it the priority.

The other patients have significant adrenal-related conditions but not an immediate life-threatening crisis. Moonface with hypertension points to Cushing syndrome; Conn syndrome (primary hyperaldosteronism) causes hypertension and electrolyte changes but is not an acute emergency. Addison’s disease with mild hyponatremia is important to address, but the hyponatremia is mild and not acutely destabilizing. Therefore, addressing the severe hypoglycemia first is the correct priority.