Complex Exam 2 Review PDF

Complex Exam 2 Review DASH DIET ★ Dietary approaches to stopping HTN ★ Low sodium, High K+, High Ca+ diet to lower BP and Cholesterol ○ Low Sodium: NO canned soups, chips, smoked meats, seasoning, processed foods ○ High K: apricots, bananas, potat...

Complex Exam 2 Review DASH DIET ★ Dietary approaches to stopping HTN ★ Low sodium, High K+, High Ca+ diet to lower BP and Cholesterol ○ Low Sodium: NO canned soups, chips, smoked meats, seasoning, processed foods ○ High K: apricots, bananas, potatoes and tomatoes ★ < 2,300 milligrams of sodium recommended Sexuality MALES Erectile Dysfunction ED is inability to achieve or maintain an erection organically or functionally. Dysfunction must be present for more than 3 months for medical diagnosis. Organic ED: Gradual reduction in function resulting from diabetes, medications, vascular disease, hyperlipidemia,atherosclerosis, direct injury to penis, and hypertension. Functional ED: Result of physiological causes - high stress, guilt, and low self-esteem. ★ Risk Factors ○ Inflammation of seminal vesicles, urethra, and prostate ○ Prostatectomy, spinal surgery, bladder surgery ○ Damage to smooth muscles, nerves, ect ○ Pelvic fracture ○ Vascular disease/HTN ○ Chronic neurologic conditions ○ Endocrine disorders Diabetes, thyroid disorders, low testosterone ○ Smoking/alcohol consumption ○ Antihypertensives ○ Poor overall health that prevents sexual intercourse ★ Pharmacological Interventions  Fil had along erection blow BP ○ PDE-5 Inhibitors: Sildenafil and Vardenafil Relax smooth muscle to increase penile blood flow compressing veins to prevent blood loss Take 1 hour before sex More than 1 per day can cause leg/back cramps and N/V Avoid alcohol Adverse Effects: Dyspepsia Headache, facial flushing, stuffy nose Leg/back cramps from more than 1 dose/day Priapism and hypotension No Nitrates Seek medical attention if erection lasts over 4 hours ○ Vasodilators: Alprostadil, papaverine, Phentaphentolamine Injected into penis to cause erection ○ Hormone replacement Testosterone injections, creams ★ Management of Care ○ Prior to giving medication, cardiovascular workup is recommended ○ Vacuum Constriction Device (VCD): Draws blood into penis and rubber ring placed at base to maintain erection ○ Penile Implants: Three piece inflatable device implanted into penis to achieve erection Squeeze pump in scrotum to fill penis with fluid and release button to deflate Education: observe surgical site for bleeding and infection following insertion ○ Penile Suppository  Relaxes smooth muscle to increase blood flow Inserted 10 min before intercourse; erection can last up to 1 hour; can use twice a day ★ Health Promotion ○ Educate patient that erections achieved after treatment may not be the same as it was before ★ Complications ○ Priapism or severe hypotension From medication therapy Benign Prostatic Hyperplasia When the prostate gland enlarges and causes urinary dysfunction. Very common in older adult males, non cancerous. ★ Health Promotion ○ Watch with age ○ Smoking cessation ○ Obesity control, Exercise! ○ Avoid decongestants, antihistamines, and anticholinergics Decrease bladder contractility, restriction and impairment of urethra ○ Avoid Western diet (high fat, protein, carbs and low fiber) ○ Risk from diabetes and heart disease ○ Don’t hold pee in, pee when felt ○ Decrease stress ★ Medications ○ DHT Lowering medications: Finasteride Decrease production of testosterone in prostate gland Takes 6 mos for effects Decreases libido and impotence Report breast enlargement to provider  Pregnancy Cat X, can absorb through skin, pregnant women shouldnt touch ○ Alpha-blocking agents: Tamsulosin Causes relaxation of the prostate gland and bladder to relieve obstructions Tammy SHORS ri re y og t d n Establishes strong urine flow gn n onuc oc u ru n t p ri e Education: ne I n Causes high HR, syncope, ortho hypotension ★ Management of Care ○ Transurethral ablation (TUNA) Low level radiation used to shrink prostate ○ Transurethral microwave therapy Heat used to shrink prostate ○ **Both TUNA and TMT used before TURP** ○ TURP - transurethral resection of the prostate Resectoscope inserted through urethra and trims away excess prostatic tissue, a 3 way indwelling catheter Continuous or intermittent bladder irrigation (CBI) Education/Management of Care: If bladder becomes obstructed, turn off CBI and irrigate with 50 mL irrigation solution, using large piston syringe ○ Output should be pink or light colored ○ If output is bright red = clots (increases flow rate) ○ High flow rate flushes out clots Catheter has a large balloon (30-45 ml) that is taped to the leg ○ Avoid kinks ○ Instruct client to not void around the catheter Causes bladder spasms/bladder obstruction Control pain with analgesics, decrease activity in first 24 hours  Monitor V/S, I&O (decreased output), infections, overhydration, ★ Nutrition ○ Consume high-fiber diet and laxatives to avoid straining ○ Drink 12 or more 8 oz glasses of water each day ○ Avoid caffeine and alcohol ○ Avoid drinking large amounts of fluid at one time FEMALES Menopause Permanent (normal physiologic process) cessation of menses, menses has not occurred for 12 months. First: perimenopausal, which can last for years due to decreased estrogen production. Second: postmenopausal, is 1 year after final menstrual period. ★ Health Promotion ○ Weight bearing exercise ○ Proper nutrition ○ Discuss feelings on sex life ○ Improve self esteem and body image ○ Take supplements ○ NO smoking ★ Clinical Manifestations ○ Hot flashes ○ Atrophy of the vagina ○ Vaginal dryness ○ Osteoporosis risk ○ Coronary artery disease risk ○ Decreased HDL and LDL ○ Decreased skin elasticity and hair loss ○ Mood swings  ★ Diagnostics ○ FSH: Follicle Stimulating Hormone Done 1 year after cessation of menses, increased (>30) during menopause ○ Pelvic exam or pap smear Rules out cancer in cases of abnormal bleeding ○ Breast mammogram Rule out cancer in cases of fatty tissue change ○ Uterine lining biopsy Diagnose abnormal uterine bleeding for clients over 40 yrs ○ DXA (bone mineral density measurement): Determine risk for osteoporosis Baseline needed ★ Nutrition ○ Increase intake of high protein and high calcium food ○ Decrease intake of fats ○ Avoid Alcohol, caffeine and tobacco ○ Take Ca, Vitamin D and Phosphorus supplements Vit D: Fish, fortified dairy products, egg yolks and sunlight ○ Vitamin E and B6 = decrease hot flashes Vitamin E: vegetable oils, grains, nuts, dark green veggies B6: meats, grains, legumes (beans), Fibrocystic Breast Disease Painful, tender lumps in breast tissue, common in the upper outer quadrant of the breast. Does not increase risk for breast cancer. Common in younger women and is not cancerous. ★ Risk Factors ○ Premenopausal status ○ Postmenopausal hormone replacement therapy  ★ Diagnostic Procedures ○ Breast ultrasound (confirmation/rules out cancer) ○ Fine needle aspiration (confirmation and reduction in pain from fluid build up) ★ Medications ○ OTC Analgesics Acetaminophen or ibuprofen ○ Oral contraceptives Suppress estrogen or progesterone secretion ○ Diuretics Decrease breast engorgement ★ Management of Care ○ Suggest client reduce intake of salt before menses Reduces breast enlargement ○ Wear supportive bra ○ Apply local heat or cold to temporarily reduce pain ○ Discuss risk of hormone medications (liver disease and stroke) ○ Encourage client to journal effectiveness Cystocele Protrusion of bladder into anterior vaginal wall. Weak pelvic muscles and/or structures. ★ Health promotion ○ Lose weight if obese and at risk ○ Eat high fiber diet and drink adequate fluids to prevent constipation ○ Watch increased risk from aging and post menopause ★ Management of care ○ Anterior Colporrhaphy Pelvic muscles are shortened and tightened to increased bladder support ○ Intravaginal estrogen  Prevents atrophy of vagina ○ Bladder training Kegel exercises: help with urinary incontinence ○ Vaginal pessary Silicone device inserted to provide support and block profusion of other organs into vagina Insure client does not have latex ALLERGY ○ Transvaginal repair Vaginal mesh/tape used to create a sling that supports pelvic floor ★ Education ○ Notify provider = signs of infection Elevated temp, HR, and RR Foul smelling or purulent discharge and pain ○ Avoid straining at defecation ○ Avoid Sneezing, coughing, lifting, sitting, walking or standing for long periods of time Tighten and support pelvic muscles when coughing or sneezing ○ Adhere to post-op restrictions Avoidance of strenuous activity Take analgesics, antibiotics, and stool softeners No sex for 6 weeks Sutures absorb, don't need removal Sexually Transmitted Infections (STI) Syphilis Bacterial infection usually spread by sex contact that starts as painless sore. ★ Clinical Manifestations ○ Primary: Canker sore with little or no pain (6 weeks)  ○ Secondary: Skin rash, mucous patches, sore throat, flat broad papule on labia, flu like S&S (2-6 weeks) ○ Latent: No S&S but still spreads (1 year) ○ Tertiary: infiltrating tumors and inflammatory response ★ Diagnostics ○ Venereal Disease Research Laboratory (VDRL) Oldest blood series used for screening ○ Rapid Plasma Reagin (RPR) Blood test: (+) 4-6 weeks after infection ○ **If either of these are (false) positive** = FTA ABS test (antibody test) ★ Treatment ○ Penicillin G Genital Herpes Caused by herpes simplex virus, can be transmitted when ptnt does not have S&S. ★ Clinical Manifestations ○ Pain, itching, small red bumps ○ White blisters, ulcers and scabs ★ Diagnostics ○ Viral culture Swab fluid from lesion ○ PCR Test Identifies genetic material from the virus through: Lesion, blood or body fluids Recognize HSV 1 & 2 ○ Antibody test Blood test ○ Immunoblot and enzyme-linked immunosorbent assay (ELISA) test Differentiate between HSV 1 & 2  ★ Complications ○ Other STI’s ○ Meningitis ○ Bronchitis ★ Treatment ○ Antivirals: “-vir” Decrease risk of transmission HPV - Human Papillomavirus Virus that can cause genital warts and asymptomatic infection. Vaccines are available. ★ Clinical Manifestations ○ Genital warts/plantar warts ★ Complications ○ Cervical cancer ○ Oral and upper respiratory lesions or cancer ★ Diagnostics ○ Pap test Abstain from sex until discharge has stopped Notify if heavy vaginal bleeding, fever or foul discharge ○ DNA test L if youhavedischarge HPV Report ★ Treatment ○ Salicylic Acid ○ Freezing warts with liquid nitrogen ○ Surgical removal of warts Chlamydia Bacterial infection that affects the reproductive organs of both males and females. ★ Clinical Manifestations ○ Females = often asymptomatic  Can have pain urinating, lower abdomen pain, vaginal discharge Painful sex ★ Complications ○ Other STI’s ○ Pelvic inflammatory disease ○ Testicle and prostate gland infections ○ Infertility ★ Diagnostics ○ Urine test ○ Culture Swab ★ Treatment ○ Azithromycin - Single dose ○ Doxycycline - 2x daily for 7 days Education: No sex for 7 days, retest in 3 months Gonorrhea Bacterial STD that usually affects mucous membranes of male urethra or female cervix. ★ Clinical Manifestations ○ Dysuria Foul smelling discharge ○ Pus-like discharge from M E ○ Swelling in testicles ○ Dyspareunia (painful sex) ○ Abnormal menses ○ Vaginal bleeding b/w periods ★ Diagnostics ○ Urine test ○ Culture sab of infected area ★ Complications ○ Infertility ○ Infection spreading to other parts of body  Increased risk for: HIV/AIDS ○ Atopic pregnancy ○ Blindness in infants ★ Treatment ○ Antibiotics r Cillin Ingrain Perfusion Coronary Artery Disease and Angina Angina: chest pain from decreased coronary blood flow. Stable Angina: (most common & predictable) increased by physical exertion, relieved by rest and nitrates. Variant Angina; usually at night, from coronary spasm, with or without plaque (unpredictable and mechanism unknown). ★ Risk Factors Troponin 5 long term ○ CAD: Modifiable check MI Lifestyle and high cholesterol Smoking Myoglobin short term Obesity Inactivity MI Birth control and hormone replacement therapy Stress ○ Non-modifiable Age, gender, genetics and race (diagnosis HTN/DM) ★ Clinical Manifestations CAD ○ Men: typically chest pain w activity, rest = relief Dyspnea Pallor Increased HR Anxiety ○ Women:  Ingestions nausea/vomiting Upper back pain NOT chest pain ★ Diagnostics ○ History/Physical Screen for risk factors and related diseases ○ Serum Cholesterol Levels: Check for hyperlipidemia ○ C-reactive Protein (CRP): Increased indicates inflammation ○ Ankle-Brachial Index (ABI): BP in arms and legs 3 seconds in toes ○ Decreased pulses ○ Loss of hair, dry scaly mottled skin ○ Pallor with elevation, redness when dangling  ○ Dry, necrotic ulcers and gangrene to toes ★ Diagnostics ○ Begin with client history and physical examination Check for CAD ○ Arteriography: Invasive procedure using contrast dye that is injected to visualize areas of decreased blood flow on x-ray Education: must have consent, NPO past midnight, check for shellfish/iodine allergy Hold Metformin 24-48 hours b4 and after procedure Assess pedal pulses, possible occlusion, and bleeding Monitor BUN and creatinine ○ Stress test: Requires consent With or without treadmill (adenosine chemical version of stress test) Pulse volume and BP taken before and after 5 minutes of exercise Delays in return to normal BP and HR = arterial disease ○ Doppler ultrasound: Used if cant feel pulse Pressures in thigh, calf and ankle are lower than in upper extremities = arterial disease ○ Ankle, Brachial BP Index (ABI): Ankle BP compared to brachial BP 30 yrs old, obesity ★ Clinical Manifestations: ○ VTE: blood clot due to venous stasis, endothelial injury or hypercoagulability that can lead to PE Asymptomatic Dull or aching calf/groin pain Unilateral leg swelling Warm edema and redness ○ VI: Incompetent valves in deeper veins of legs leading to pooling and dilation of veins Stasis dermatitis (brown discoloration on ankles, spread to calf, relative to the level of insufficiency)  Edema Venous Stasis Ulcers Heavily draining wounds ○ VV: enlarged, twisted and superficial veins in any part of body Distended superficial veins visible just below the skin Muscle cramp, aches, pain after sitting and pruritus ★ Diagnostics ○ D-Dimer Test (first step diagnosis) Measures fibrin degradation products present in blood from fibrinolysis Positive test = clot somewhere (not where it is) ○ Venous Duplex Ultrasonography (Second step diagnosis) Shows real time picture of blood flow ○ Venogram (last step for diagnosis) Contrast (allergy) injected using contrast/imaging to visualize blood flow Shows locations of DVT ○ Varicose Veins: Trendelenburg Test Supine position with legs elevated Veins will fill will blood revealing varicose veins (flow upwards) ★ Education ○ VTE: Bed rest with legs elevated above the heart Do not use pillow under knees Do not massage or use SCD (leg compressions) Only ambulate if already on anticoagulants Thigh high compression or anti embolism stockings Contraindicated for KNOWN DVT Use warm, moist compress ○ VI: Y As Elevate for 20 min 4-5x daily ABOVE HEART at night, in bed  Avoid crossing legs and wearing constrictive clothes/ stockings Wear elastic compression stockings After they've been elevated and minimal swelling ○ VV: Wear elastic stockings Elevate legs when sitting AVOID dangling over side of bed Engage in ROM exercises of the legs ★ Health Promotion ○ VTE: Prophylaxis treatment: Enoxaparin 30 - 40 mg with ambulation Hypertension Pre Hin 213 Readings No known cause. Elevated BP: Systolic 12-129, Diastolic /= 130, Diastolic >/= 90. ★ Risk Factors ○ Race (African American Males) ○ Increased sodium or alcohol intake silent killer ○ Smoking and stress ○ K+ and Vitamin D decreased cerebrospinal acciden ○ Family history ○ Advanced age ○ Cholesterol increased ○ Too much caffeine ○ Obesity ○ Restricting activity ○ Sleep apnea ★ Clinical Manifestations  ○ Frequently asymptomatic until it becomes severe (nicknamed silent killer) ○ Headaches (mainly morning) ○ Facial flushing and fainting ○ Dizziness and retinal changes (blurry) ○ Nocturia ★ Medications ○ Diuretics (FIRST LINE); thiazide (hydrochlorothiazide), Loop (furosemide), y fluid DKP Potassium sparing (spironolactone) WATCH hypokalemia Muscle weakness, irregular pulse, dehydration Increase K+ rich foods Monitor BP, HR, and ECG ○ Calcium Channel Blockers; amlodipine, verapamil, and diltiazem antdipineis vert ditzy AVOID grapefruit juice Hypotension loves ○ ACE Inhibitors; lisinopril, enalapril cat Monitor BP, HR Ace's give the thrill 31cough Report dry cough, angioedema, increased K+ PK cough angioedema STOP if cough and angioedema present, then report ○ ARBs; “-SARTANS” Satan loves Arby's Give if patient has cough on ACEs or hyperkalemia Can cause angioedema Ingioedema AVOID high K+ foods ○ Beta Blockers; “-LOL” Monitor BP and HR (withhold 2 high digoxin levels, low K+ levels = concern meds don't Report fatigue, muscle weakness, confusion and loss of work appetite, yellow/green halos, N/V (digoxin toxicity) ★ Nutrition ○ Low sodium; < 2,300 mg daily ○ Fluid restrictions; 1.5-2 L daily ○ Consume normal amounts of food with K+  ○ Small frequent meals to conserve energy Soft and easy to chew foods ○ No smoking, limit alcohol ○ Increase protein to 1.12g/kg Life-Threatening Dysrhythmias Sinus Bradycardia ★ Interpretation ○ #1: R-wave regularity Regular ○ #2: HR Less than 60 bpm, more than 5 BIG squares ○ #3: P-Wave WITH QRS Normal, P-wave is present before QRS ○ #4: PR Interval Normal, 3-5 small squares ○ #5: QRS Interval Narrow, no more than 3 small squares ★ Management of Care ○ Find out if ptnt is stable/unstable Treat underlying cause ○ Unstable: atropine to increase HR  S&S: lethargic, low BP (40 ○ Non-alcoholic Fatty Liver Disease ○ Polycystic Ovarian Syndrome ○ GERD ○ Stroke ○ Cataracts ○ Pulmonary disease ○ Osteoporosis Osteoporosis Chronic metabolic bone disorder resulting in low bone density. Leading to fragile bone tissue and bone fractures. ★ Risk Factors ○ Family hx ○ Lean, thin, body build ○ Females (primary) Decreased estrogen after menopause ○ Males (secondary) Decreased testosterone ○ Hx of low Ca and Vitamin D ○ Tobacco smoke and high alcohol intake ○ Excess caffeine consumption ○ Lack of physical activity or immobility ○ High Phosphorus intake >40oz of carbonated drinks ○ Older adults  Risk of falls ★ Clinical Manifestations ○ Reduced HT 2-3 inches ○ Acute back pain after lifting or bending ○ Restriction in movement ○ Kyphosis ○ Hx of fractures ★ Health Promotion ○ Consume adequate amounts of Ca and Vitamin D from food or supplements Ca: milk products, green leafy veggies, fortified orange juice and cereals, figs Vitamin D: fish, egg yolks, fortified milk/cereal ○ Spend time outdoors, increase vitamin d and wear sunscreen ○ Engage in WT bearing exercise (walking and lifting weights) To promote bone rebuilding and maintenance ★ Medications ○ Thyroid hormone: Salmon Calcitonin Decrease bone reabsorption ○ Teriparatide Contraindicated for hypercalcemia, bone cancer, radiation, and pagets disease Adverse: Nausea Back pain Leg cramp Only can be used for 2 years ortho hypotension can last up to 4 hours ○ Estrogen Hormone Supplements: estrogen, medroxyprogesterone Cause breast and endometrial cancers  DVT Perform monthly breast exams ○ Selective estrogen receptor modulators: Raloxifene Prevents and treats post menopausal osteoperosis Avoid if Hx of DVT Discontinue use 72hrs before prolonged bed rest ○ Calcium Supplements: Calcium Carbonate & Calcium Saturate Take with food 6-8 oz of water ○ Vitamin D Supplements Increase amounts of calcium absorption ○ Bisphosphonates: Alendronate Al done Ate Esophagitis ulcers, remain upright for 30 min after taking, take with 8 oz water in morning b4 eating ○ Monoclonal Antibody: Denosumab Contraindicated in hypocalcemia Dental exams SQ upper arm, thigh or abdomen ★ Education ○ Avoid slippery surfaces Wear river bottom shoes ○ Exercise under guidance from provider to reduce risk of vertebral fractures Isometric exercise to strengthen core Avoid activities that increase body stres Strenuous weight lifting WT bearing 3-5x weekly ○ Remove throw rugs ○ Adequate lighting  ○ Clear walkways ○ Mark thresholds and steps ★ Nutrition ○ Limit excess caffeine, alcohol and carbonated drinks ○ Consume adequate amounts of protein, Mg, Vitamin K, Ca, and Vitamin D DAD Mg: green leafy veggies, nuits, whole grains, tuna, chocolate Vitamin K: carrots, eggs, spinach, broccoli, asparagus ai Calcium: daily, broccoli, kale and fortified greens Thyroid Disease (HYPO/HYPER) ★ Clinical Manifestations ○ Hypo: Hashimoto LOW 31 Slow s Cold intolerance Hair loss AWTWHR KBP U metabolism Dry skin Constipation Extreme fatigue: sleep upto 16 hours a day Pallor WT gain Constipation Thick skin, nails Decreased LOC Bradycardia, hypotension, and dysrhythmias Swelling in face, tongue, hands and feet (myxedema) ○ Hyper: Grove's Grapes Heat intolerance High 3 Hot WT loss eyes Golf ball Bulging eyes: exophthalmos y tturning more energy Finger clubbing  Warm sweaty, flushed skin Hair thinning Tremor Goiter and bruit over thyroid gland Hyperkinesia and -flexia mm Diarrhea HTN Tachycardia, palpitations, dysrhythmias Pretibial myxedema Dry waxy swelling on legs ★ Complications ○ Hypo: Myxedema Coma Life threatening: bradycardia, hypo-BP, Na, BG, thermia, RR failure, coma Monitor ECG, ABGs, LOC, body temp Ventilatory support and ECG monitoring on site can bringeverything IT so then SIS Administer corticosteroids and replace fluid with 0.9% NS Administer levothyroxine via IV bolus of hyperthyroidism ○ Hyper: L levo thyroxine Po given in Hemorrhage the stomach Leading to RR distress morning empty Early Thyroid storm/crisis Sign agitation Surge of large amounts of thyroid hormones in blood ○ Leads to hyperthermia, HTN, delirium, angina 31confusion Administer Beta-Blocker Administer acetaminophen for hyperthermia instead of aspirin due to release of thyroxine Airway obstruction  Hypocalcemia and tetany if damaged to parathyroid ★ Management of Care ○ Hypo: Monitor cardiovascular changes and peripheral edema Increase activity level gradually w frequent rest periods Apply anti embolism stockings, ELEVATE Provide low cal-high bulk diet Encourage fluids Provide meticulous skin care Use alcohol free products before and after baths Give extra clothing and blankets NO electric blankets or heating devices (burns) Reassure client that physical manifestations are reversible ○ Hyper: Provide calm environment Minimize clients energy by helping Provide eye protection Reduce room temp Provide cool shower and sponge bath Monitor ECG for dysrhythmias Report temp increase of 1 degree or more to provider ○ Thyroid crisis Assure family that abrupt changes in behavior ARE disease related Avoid excess palpation of thyroid Cushing’s Over secretion of hormones by adrenal cortex. ★ Clinical Manifestations ○ Moon face, truncal obesity and buffalo hump  Bp Rolycemia ○ Hyperglycemia ○ Increased susceptibility to infection, weakness and fatigue ○ HTN, tachycardia ○ Muscle wasting ○ Hirsutism in women ○ Osteoporosis ○ Purple lines/striae on body, bruising and petechiae ○ Thin, fragile skin and thinning balding hair ○ Man boobs and irregular menses ★ Management of Care ○ Maintain safe environment to reduce fractures and skin trauma ○ Frequent hand hygiene ○ Encourage exercise ○ Change position q 2 hours ○ Surgical asepsis for dressing changes ○ Monitor WT daily, report excess WT gain ○ Monitor WBC and skin breakdown ADD ★ Nutrition apps skinpbd peggy ○ Decreased sodium intake and Increased K, protein, calcium and vitamin D K: oranges, dried fruits, tomatoes, avocados, broccoli, meats, whole grains and potatoes Addison’s Decreased aldosterone and cortisol in the body due to no adrenal insufficiency. ★ Clinical Manifestations ○ ○ Craving salt Hyperpigmentation Addison Absent ○ Weak, fatigue ○ Nausea, anorexia, vomit steroids small weak tanned  b b b Electrolytes dehydrated ○ Dizzy with ortho HTN ○ Dehydration ○ Diarrhea ○ Abdominal pain ○ HYPO: K, Na, Glucose and Ca same diet as Cushing's P