Endocrine 2

Question 1

Hyposecretion of Posterior Pituitary gland

Answer 1

• *Diabetes Insipidus = ADH deficiency (KNOW IT VERY WELL)**
• ADH: also called vasopressin
• deficiency of production or secretion of _ADH which is the inability to conserve water and increased thirst and increased urination _

-or with a decreased renal response to ADH cause by injury

Causes

**Central DI: **Interference with ADH synthesis and release by brain tumor, head injury, brain surgery and CNS infections

**Nephrogenic DI: **inadequate renal response to ADH despite adequate ADH

ADH disruption may be transient or permanent (IMPORTANT KNOW DIFFRENCE)
Transient: 24-48 hours after surgery

Permanent: for life

Question 2

DI Assessment

Answer 2

• Skin: poor tissue turgor, dry mucous membranes
• CVS: hypotension, tachycardia, shock
• Hypernatremia with severe dehydration, elevated serum osmolality (>295 mmol/kg)
• Irritability, mental dullness, coma
• Fatigue d/t noctuira, generalized weakness
• Polyuria: 5-20 L /day*
• Low urine specific gravity (less than 1.005) 2nd to polyuria*

> THIS IS CAUSE BY DI rather than DM
Weight loss, ++ thirst (polydipsia)*

Question 3

DI Management 1

Answer 3

Hypohysectomy (surgery): to remove posterior pituitary tumor
Medical:
- IV fluids,
- ADH replacement with Desmopressin,
> can be IV, SQ or intranasal, onset in 1 hour
Prognosis good if compliance with vasopressin (Pitressin) therapy
> d/t brain being swelling up
> once the swelling goes away and with therapy it improve

Question 4

DI Management Nursing Interventions

Answer 4

• Anticipate clients at risk
• Monitor I & O, daily weight, urine specific gravity** (IMPORTANT fluid volume status)
• Maintain fluid & electrolyte balance

            \> 5-20L

• Provide adequate amount of fluids 1.5-2lL (prevents dehydration)
• If IV glucose are use

            \> monitor for serum glucose (hyperglycemia, glucosuria = osmotic diuresis

• Observe for effects of drug: (desmopressin)
• Assess for wt gain, headache, restlessness, and chest pain
• Client teaching: monitor daily weight
• Wt gain may indicate fluid retention, close f/u
• Administration fo DDAVP

            \> assess i/o, urine specific gravity to assess adequacy of treatment
  
            \> notify HC for increase u/o and low specific gravity to increase dose

Question 5

SIADH- _Syndrome of Inappropriate Antidiuretic Hormone _

Answer 5

Hyperssecretion of Posterior Pituitary Gland

• Malignancy
• Head trauma
• Risk Factors: vasopressin overuse
• **Drugs: **Thiazide diuretics, oxytocin, opioids, tryclic antidepresants

Question 6

SIADH Signs and Symptoms

Answer 6

• Low Na causes muscle cramps & weakness
• Low urinary output & increased body weight (accumulation of water)
• As serum Na levels fall, less than 120 mEq/L:

            \> **vomiting, abdominal cramps, muscle twitching, seizures**

• As Na level continues to decline: cerebral edema, lethargy, anorexia, confusion, headache, seizures, & coma
• urine specific gravity greater than 1.005 (INCREASE)

Question 7

Management SIADH

Answer 7

• Goal: restore normal fluid volume & osmolality
• If symptoms are mild: fluid restriction 800 – 1000 ml /day
• Gradual daily reduction of weight (fluid loss)
• Progressive rise in Na concentration & osmolality

In severe cases

• **To Correct Hyponatremia: **Very slow infusion of hypertonic solutions (2N saline (1.8%) contains Na 300 mmol/L) (N saline 0.9%, 150 mmol/L)
• **To correct low plasma osmolality: **Diuretics (Lasix)
• K supplements may be needed
• Fluid restriction, 500 ml/day

Monitor and replace electrolyte loss (K supplements)

• **Assessing hyponatremia: **Neurostatus
• Daily weights/ accurate I & O
• Anticipate patients at risk**
• Watch for:
• low urinary output,
• high urine specific gravity,
• sudden weight gain,
• decline in serum Na (MUST BE CHECK!!)

Question 8

SIADH Management 2

Answer 8

• VS q1h
• I & O q1h
• Measure urine specific gravity q1h
• Daily weights
• Monitor LOC** KEY FACTOR IN SIADH > DI
• Observe of signs of hyponatremia

            \> decreased neurological function,
            \> seizures,
            \> N & V,
            \>muscle cramping Monitor heart and lung sounds
            \> d/t fluid overload

_____________________________________________________________________________________

Nursing Management

• Restrict fluid intake to 1000 ml/day (incl IV meds) (NOT GOING TO ASK)
• HOB flat or 10% to enhance venous return to heart and increase L atrial filling pressure,
• > reducing ADH release
• Protect from injury (assist with ambulation, side rails up)

            \> R/T alteration in mental status

• Seizure precautions
• Frequent turning and positioning (q2h) & ROM exercises

            \> Risk for skin breakdown d/t moist/wet skin **_2nd to fluid overload_**

• Frequent oral hygiene
• Provide distractions to decrease discomfort of thirst related to fluid restrictions (DON’T USE)