Endocrine

Question 1

Arginine Vasopressin Deficiency

Answer 1

• ADH deficiency or low response
• Polyurea and increased thirst
• Dilute urine and high blood osmolality, hypernatremia

Question 2

Arginine Vasopressin Resistance

Answer 2

• Failure to produce properly diluted urine despite adequate ADH levels
• Requires diuretics to create mild hypovolemia, enhancing proximal Na and water reabsorption
• Also treated with NSAIDs which reduce prostaglandin synthesis to enhance renal ADH response

Question 3

Arginine Vasopressin Deficiency Nursing Management

Answer 3

• Strict I&O and daily weight
• Monitor serum Na
• Monitor specific gravity and osmolality

Question 4

SIADH Interventions

Answer 4

• Fluid restriction
• Address underlying cause (meds, malignancy)
• Vasopressin receptor antagonists
• IV hypertonic saline if hyponatremic, infuse slowly
• Diuretics

Question 5

Hypothyroidism

Answer 5

• Levothyroxine (synthetic T4)
• Monitor TSH and free T4 levels
• Bradycardia and hypotension, weight gain, constipation = undertreatment
• Tachycardia and palpitations = overtreatment
• Take on empty stomach, avoid taking with Ca or Fe, treatment is lifelong, report overtreatment symptoms

Question 6

Hyperthyroidism

Answer 6

• Thionamides (methimazole, PTU) - bloch thyroid hormone synthesis
• Bet blockers (propranolol, atenolol) to manage anxiety, tremors, tachycardia
• Additional management with iodine therapy to destroy overactive thyroid tissue, thyroidectomy for severe cases
• Avoid iodine rich foods

Question 7

Hyperthyroidism Monitoring

Answer 7

• Decreased WBCs = agranulocytosis risk
• Decreased LFTs = hepatotoxicity risk