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66 Cards in this Set

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Diabetes Insipidus
-what causes this??
Caused by undersecretion (deficiency) of ADH (Anti-Diuretic Hormone, aka: Vasopressin)

OR




an inability of the kidneys to respond to ADH.
Diabetes Insipidus

major symptom resulting from ADH deficiency??



without ADH, kidney tubules and collecting ducts:
EXCESSIVE dilute urine production(peeing up a storm).

Without ADH, kidney tubules and collecting ducts do not reabsorb water, leading to polyuria (excessive water loss through urination) and dehydration. (instead of kidneys putting it back into blood, it becomes urine and is urinated out
Diabetes Insipidus
-can be caused by?? 4
tumors,

strokes,

certain drugs such as Dilantin, alcohol, Lithium Carbonate which interfere with the response of the kidneys to ADH,

surgical hypothalamic damage
Assessment of a Patient with Diabetes Insipidus

-most manifestations are related to _________. The key s/s are: (2)
dehydration



increase in the frequency of urination and excessive thirst.
Assessment of a Patient with Diabetes Insipidus

key s/s
-Polyuria of 4-24 Liters a day!! Chronic dehydration
-Polydipsia (excessive thirst)
-Dehydration as evidenced by: poor skin turgor, dry mucous membranes, cracked mucous membranes or skin
-Nocturia
Assessment of a Patient with Diabetes Insipidus


3 other s/s
Weight Loss,
fatigue,
muscle weakness
Assessment of a Patient with Diabetes Insipidus

HR?

Hypotension / Hypertension?
tachycardia






-Postural hypotension,
Assessment of a Patient with Diabetes Insipidus

Complication:
electrolyte imbalances
Interventions for Diabetes Insipidus

-Diagnosis:
CT, PET
Interventions for Diabetes Insipidus

If only partial deficit of ADH is present, control can be achieved thru:
oral chlorpropamide (Diabinese, Novo-Propramide) or clofibrate (Atromid S, Claripex)


WHAT DO THESE DRUGS DO??????????


this drug increases the action of existing ADH and possibly has a stimulating effect on the production of ADH in the hypothalamus
Interventions for Diabetes Insipidus


When ADH deficiency is severe, we need ADH to be replaced in amounts sufficient to maintain water balance. Use what to help with that?
Desmopressin Acetate (DDAVP) given orally or intranasally in a metered inhaled dose is the drug of choice. DDAVP is a synthetic form of vasopressin (ADH)
Interventions for Diabetes Insipidus

-Drugs for DI induce 2 things:



what do you need to tell pts to do?
water retention and can cause fluid overload and water toxicity








(teach all pts who take these drugs to weigh themselves daily to identify weight gain)
Interventions for Diabetes Insipidus

monitor:
-Monitor VS ,
neuro (confusion can occur),
cardio status

-Monitor I & O* (24 i&o is important. Shows fluid deficit. How much of a deficit do I have which helps understand treatment,

-check weight daily

-Lytes,
Interventions for Diabetes Insipidus


what is the urine specific gravity

RBC??




H&H???
urine Specific Gravity (low – specific gravity (less than 1.005) , is about particular gravity, because urine is so dilute)



-Rbc and h&h will be high

RBC will be greater than 5.6
-Hematocrit will be greater than 54%
-Hemoglobin wil be greater than 18
Interventions for Diabetes Insipidus


what should they avoid in their diet??
-Avoid foods that cause diuresis! (tea, beer, wine, coffee) –high sodium diet will retain fluids
Administration of corticosteroids: replace the ________ hormones that aren't being produced because of _____________ deficiency
adrenal





an adrenocorticotropic hormone (ACTH)
Thyroid supplement example:
Levothyroxine
Desmopressin (DDAVP)
-what is it used for?
In a patient with diabetes insipidus to replace ADH (reduces body's loss of water).


Desmopressin is taken as a nasal spray, oral tablet or by injection.
Sex hormones. These include testosterone in men and estrogen or a combination of estrogen and progesterone in women.


Testosterone is administered how?



Female hormone replacement can be administered with (2)
through the skin with either a patch, a gel or by injection.









either pills or patches
Growth hormone
-example of drug?



-what is the SE?
Somatropin












-GH is an insulin antagonist; hyperglycemia is common!
Hyperpituitarism

hormone over secretion that occurs with (2)
pituitary tumors or hyperplasia (tissue overgrowth) which cause an increase in GH, ACTH, and PRL
Hyperpituitarism


Overproduction of _________Hormone, results in Gigantism or Acromegaly:
Growth
Hyperpituitarism

Gigantism, the onset of GH hypersecretion occurs when?
before puberty, which causes rapid proportional growth in the length of all bones.


Secretion of GH in childhood BEFORE epiphyseal closure of the long bones.
Hyperpituitarism

Acromegaly -Excessive GH secretion occurs when?
after closure of the growth plates in bone during puberty and produces increased skeletal thickness, hypertrophy of the skin, and enlargement of many organs, such as the liver and heart
Hyperpituitarism

-Gigantism
can cause problems with what 2 other diseases??
Can cause problems with diabetes and kidney insufficiency.
Gigantism
-tell me about the bones and cell growth??




-what does the growth hormone have an effect on?
-bone thinning and bone cell overgrowth occur slowly.



-because GH blocks the action of insulin, hyperglycemia is common
Hyperpituitarism : Assessment
-Large hands and feet
-Protruding jaw
-Arthritic changes (arthralgias: joint pain)
-Visual disturbances
Hyperpituitarism : Assessment

-Fatigue and lethargy are common
-Diaphoresis
-Oily, rough skin
-Organomegaly (still functioning at the age of the individual)
-Fatigue and lethargy are common
-Diaphoresis
-Oily, rough skin
-Organomegaly (still functioning at the age of the individual)
Hyperpituitarism : Assessment

-Hypertension leads to kidney. Always connect hypertension to kidney problems
-Dysphagia
-Deepening voice
Hyperpituitarism – Interventions

-Provide emotional support related to altered body image


-Interventions for what kind of pain?
joint pain
Hyperpituitarism – Interventions


prepare for what if there is a tumor??
-Prepare the patient for radiation therapy (for tumor)
Hyperpituitarism – Interventions

look for what electrolyte problem
hypocalcemia
what is the most common treatment for hyperpituitarism
“hypophysectomy” (removal of the pituitary gland and tumor)
Hyperpituitarism – Interventions

What does drug therapy consist of?
most common drugs used are dopamine agonists which stimulate dopamine receptors in the brain and inhibit the release of many pituitary hormones, specifically GH and PRL.
Hypophysectomy
--The surgical removal of what???


through the Transsphenoidal approach (through nose) for the treatment of ________________-
pituitary gland,





hyperpituitarism
Hypophysectomy

-the surgeon makes an incision where?
just above the upper lip and reaches the pituitary gland through the sphenoid sinus.

After the gland is removed, a muscle graft is taken, often from the thigh, to support the area and prevent leakage of cerebrospinal fluid (CSF). Nasal packing is inserted after the incision is closed.
Hypophysectomy

Complications include: 3
increased intracranial pressure,


bleeding,


meningitis
Hypophysectomy - Teaching
Explain that nasal packing is present for 2-3 days after surgery.


It will be necessary to breathe through the mouth and a drip pad will be placed under the nose.


Instruct the patient not to brush teeth, cough, sneeze, blow the nose, or bend forward after surgery. These activities can open the muscle graft, increase ICP, and delay healing of the incision.
Post-Op Care: Hypophysectomy


what should you monitor?
Monitor VS,

Monitor LOC, if it is altered, think swelling in brain,

neuro status,


changes in vision,


-Monitor I & O..especially output greater than intake because transient diabetes insipidus can occur
Post-Op Care: Hypophysectomy

keep the head of the bed elevated how many degrees?
-30 degrees minimum!
Post-Op Care: Hypophysectomy

-teach patient to avoid doing what???
-teach the patient to avoid coughing early after surgery because it increases pressure in the incision area and may lead to a CSF leak but remind the patient to perform deep breathing exercises hourly while awake to prevent pulmonary problems



-teach patient to use dental floss and oral mouth rinses because brushing the teeth is not permitted until the incision heals



-instruct the patient to avoid bending at the waist for any reason because this position increases ICP
Post-Op Care: Hypophysectomy

-Monitor for postnasal drip which may indicate CSF leak!



Assess nasal drainage for quantity, quality, and the presence of:
glucose (which indicates that the fluid is CSF)
Post-Op Care: Hypophysectomy


the “Halo Sign” is what??? and indicates what???
-A light yellow color at the edge of clear drainage








CSF;
Post-Op Care: Hypophysectomy

Headaches??
Assess for persistent headache –CSF may have leaked into the sinus area.
Post-Op Care: Hypophysectomy


Assess for nuchal rigidity, why?
tell you if the meninges are being inflamed. They cog down like trying to pull chin down - its like a wheel cog.


nuchal rigidity = neck stiffness
Post-Op Care: Hypophysectomy

give what 3 drugs?
analgesics,
antibiotics,

hormones/gluccocorticoids (IV injection, dexamethazone ---secondary reaction to that drug is hyperglycemia)
Post-Op Care: Hypophysectomy


-If the entire pituitary gland has been removed, the patient requires lifelong replacement of what 2 categories of drugs?
thyroid hormones and glucocorticoid replacement is lifelong
Syndrome of Inappropriate Anti-Diuretic Hormone (SIADH)


results from what??
-An oversecretion of ADH (vasopressin) (conserving water -- water intoxication)..
Syndrome of Inappropriate Anti-Diuretic Hormone (SIADH)


what is a major complication
-Major complication is seizure , results in excessive water conservation (fluid retention)
Syndrome of Inappropriate Anti-Diuretic Hormone (SIADH)


sodium level?
-Results in water intoxication which causes hyponatremia and expansion of the extracellular fluid volume.
Syndrome of Inappropriate Anti-Diuretic Hormone (SIADH)


Signs of fluid volume overload –
-nonpitting edema
-Weight gain
-Decreased urine output
-Altered mental status (headache, confusion, lethargy, seizures and coma if severe)
Syndrome of Inappropriate Anti-Diuretic Hormone (SIADH)


BP?



HR?
-Hypertension –BP goes up








-Tachycardia (caused by increased fluid volume)


-Anorexia, nausea, vomiting
Syndrome of Inappropriate Anti-Diuretic Hormone (SIADH)


sodium???






potassium?
-Anorexia, nausea, vomiting


-Hyponatremia

-hyperkalemia.

Caused by central nervous system disturbance
-
Syndrome of Inappropriate Anti-Diuretic Hormone (SIADH)



what is the edema like?
Dependent edema
Syndrome of Inappropriate Anti-Diuretic Hormone (SIADH)


monitor VS, neuro status, cardio status

-watch for indications of incresed fluid overload, such as?
(bounding pulse, increasing neck vein distention, presence o crackles in lungs, increasing peripheral edema, reduced urine output) every 2 hours.


Pulmonary edema can happen fast and can lead to death
Syndrome of Inappropriate Anti-Diuretic Hormone (SIADH)


daily weight

monitor input and output

assess lytes
yes!!
Syndrome of Inappropriate Anti-Diuretic Hormone (SIADH)


medical treatment focuses on: 4
on restricting fluid intake,

promoting the excretion of water,

replacing any lost sodium,

interfering with the action of ADH.
Syndrome of Inappropriate Anti-Diuretic Hormone (SIADH)


administer what to help with excess volume of fluid
-Administer IV diuretics (to pull fluid out) as ordered
Syndrome of Inappropriate Anti-Diuretic Hormone (SIADH)


-Administer what oral antibiotic





















– this does what?
Declomycin


inhibits ADH-induced water reabsorption & produces water diuresis
Syndrome of Inappropriate Anti-Diuretic Hormone (SIADH)


-what is used when serum sodium is very low?
-IV hypertonic saline (3%NaCl) may be used to tread SIADH when serum sodium is very low.
The adrenal glands are vascular, tent shaped organs located where?


what's the anatomy?
on top of each kidney.








The adrenal gland has an outer portion (cortex) and an inner portion (medulla) each area has independent functions.
Adrenal gland cortex secretes
-Mineralocorticoids which are the hormones produced that help control what??
the body’s sodium and potassium content. They also help control body fluids and electrolytes
Aldosterone, the chief mineralocorticoid, maintains what??



what does it do in the kidney tubules?
extracellular fluid volume







It promotes sodium and water reabsorption and potassium excretion.
What adrenal gland hormone causes the kidney to reabsorb sodium and water to bring the plasma volume and osmolarity back to normal?
Aldosterone (mineralcorticoid) produced by the adrenal cortex
Glucocorticoids are produced by the __________



what is the main Glucocorticoid produced by the adrenal cortex ?
adrenal cortex.










Cortisol
-what does it affect???












affects (carbs, protein, and fat metabolism, the body's response to stress, emotional stability, immune function). They also maintain blood glucose levels
The adrenal medulla secretes:
The medulla secretes:
-Catecholamines (including epinephrine and norepiniephrine) play a role in the physiologic stress response (fight or flight)