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34 Cards in this Set

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Diabetes insipidus
A disorder of water metabolism caused bey def ADH either a decrease in ADH synthesis or an inability of kidneys to respond appropriately to ADH.
ADH deficiency results in?
the excretion of lg amts dilute urine. Due to without ADH the distal tubules and collecting ducts of kidney are impermeable to water. The water is excreted as urine rather than being absorbed.
Polyuria
excessive urination with loss of free water.
How is dehydration caused?
the massive diuresis results in an increase plasma osmolarity which stimulate the osmoreceptors to relay the sensation of thirst to cerebral cortex.
Nephrogenic diabetes insipidus
an inherited disorder. the renal tubules do not respond to the action of ADH which causes inadequate water reabsorption by the kidneys. the actual amount of hormone produced is no deficient.
primary diabetes insipidus
caused by a defect in the hypothal or pit gland resulting in lack of ADH production or release.
Secondary diabetes insipidus
result from tumors within or adjacent to the hypothal or pit gland, head trauma,infectious process, surgical proceduresor metastatic tumors
Drug related diabetes insipidus
is caused by admin of lith caronate and Declomycin. these drug interefere with kidneys response to ADH.
Name the key features of Diabetes insipidus for Cardio.
Hypotension
Decreased pulse pressure
tachycardia
perph pulse weakness
increase hgb hct.
key renal features of Diabetes insipidus
increase urine output
dilute, low spec gravity
Hypo-osmolar
Key integ features of Diabetes insipidus
poor turgor

dry mucous membranes
Key neuro features of Diabetes Insipidus
Increase thirst
irritability
decreased cognition
hyperthermia
lethargy to coma
ataxia
Name nursing interventions for Diabetes Insipidus
aimed at early detection of dehydration and the maintenece of adequate hydration. accurately measure I&O urine spec gravity and daily wts.
encourage pt to take in fluids equal to urine output. if IV check patency of cath and watch how much infused each hour.
What med is given to clients with permanent Diabetes insipidus?
vasopression
Clients should know polyuria and polydipsia are signals for what?
need for another dose of medication.
What do clients taking vasopressin need to do daily?
weigh self on same scale same time of day wearing similar clothing. if weight gain notify Dr. also should wear a medical bracelt to Id problem.
What is the syndrome of inapproppriate antidiurectic hormone? (SIADH)
when vassopressin (ADH) is secreted even when plasma osmolality is low or normal.
in SIADH the feedback mech that regulate ADH do not function properly.
Name symptoms of SIADH
Water Retention
Gi disturbances loss of appetite N& V.
Change of level of consciousness is an early sign of SIADH. letargy ha disorientation seizure and coma. deep tendon reflexes may be sluggish. tachycardia(caused by increased fluid vol) hypothermia caused by cns disturbance.
What are the interventions for SIADH?
Resrict fluid intake
promote sectretion of water, replace lost sodium
Diuecrics are sometimes given.
Hypertonic saline 3% NaCl is given.
watch closely for fluid vol overload..
How will nurse provide safe enviroment for pt with SIADH?
watch for change in neuro status

assess for subtle changes such as muscle twitchingbefore progress to seizure or coma.

orientation to time,place, person checked q2hrs.

noise and lights reduced to prevent overstimulation.
Name the primary causes of Adrenal Insufficiency
idiopathic disease
TB
Metastatic ca
fungal lesions
AIDS
Hemorrhage
gram neg sepsis
adrenalectomy
abdomial radiation therapy
drugs and toxins
Name the sec causes of Adrenal insufficiency.
Pit tumors
Postpartum pit necrosis
Hypophysectomy
high dose pit radiation
high dose whole brain radiation
What is the nursing care for the client with acute adrenal insuff?
Before tx obtain cbc,electrolyte,blood urea nitrogen and plasma cortisol levels as ordered by the dr.
give an initial dose of hydocortisone sodium 100-300mg Ivto infuse over 8 hrs.
after resolution of crisis adjust dosage ordered by dr.
What are the key neuromuscular features of adrenal insuff?
muscle weakness
fatigue
joint/muscle pain
key Gi features of Adrenal Insuff?
Anorexia
N&V
ab pain
bowel changes
wt loss
salt cravings
Key Integ features of Adrenal insuff
Vitiligo

hyperpigmentation
key cardio features of adrenal insuff
anemia
hypotension
hyponatremia
hyperkalemia
hypercalcemia
nurse interventions for adrenal insufficency
promote fluid balance and monitor for fluid deficit.weigh pt daily. I&O,vital signs every 1-4 hrs.
what is the normal sodium range?
136-145 meq/ml
what is he normal potassium range?
3.4-4.5 meq/L
Glucose range
74-106 mg/Dl
normal calcium
8.6-10.0 mg/dl total

4.6-5.08mg/dL ionized
Leukocytes normal range
20-40%
bun normal range
6-20mg/L