In Addison's disease crisis, what should be the emergency department nurse's first action?

• A. Start an IV with an 18-gauge needle and infuse NS rapidly.
• B. Have the client wait in the waiting room until a bed is available.
• C. Perform a complete head-to-toe assessment.
• D. Collect urinalysis and blood samples for a CBC and calcium level.

Answer: (A)

In Addisonian crisis the immediate threat is life-threatening hypovolemia and shock from acute adrenal insufficiency. The priority is to restore circulating volume and perfusion as quickly as possible. Starting an IV with a large-bore needle and rapidly infusing normal saline directly addresses the depleted intravascular volume, helps raise blood pressure, and improves tissue perfusion to vital organs. This rapid fluid resuscitation buys time to administer steroids and obtain labs without letting the patient deteriorate. After establishing IV access and beginning fluids, the next steps would include giving hydrocortisone IV promptly and then drawing labs, but delaying fluid resuscitation would increase the risk of shock. Waiting room admission, a full head-to-toe assessment before stabilization, or collecting other tests without first addressing the shock would not meet the immediate need to restore perfusion.