514 Endocrine questions and answers graded A+.

514 Endocrine questions and answers graded A+. Classifications of the endocrine disorders? - correct answers.Primary involves gland involvment Secondary involves anterior pituitary Tertiary involves the hypothalamus Target call dysfunction - bone for PTH, kidneys for ADH, etc What is your endocrine assessment? - correct answers.1. History; Use systems approach, Usual demographic data 2. Personal and family History of endocrine problems, hospitalizations, meds such as steroids, oral contraceptives 3. Socioeconomic status; Need to know if client has the $$$ for special diet, meds, Rx that might be required 4. Energy See decrease esp in thyroid probs, Effect of ADL, 5. Elimination pattern; nocturia or dysuria 6. Sexual and reproductive; menstrual problems, impotence, change in libido 7. Physical appearance and assessment 8. ADLs/activity patterns ANTIDIURETIC HORMONE Produced where? Stored and released from? What does it do? Why is it released? - correct answers.Produced by the hypothalamus Stored/ released from the posterior pituitary gland Conserves water to maintain blood pressure Acts on collecting ducts and tubules of kidney Secreted in response to: ----Increased serum osmolarity ----Decreased plasma volume ----Decreased blood pressure What hormone is deficient in DI? Why? Lack of this hormone causes? - correct answers.Decrease in ADH synthesis Inability of kidneys to respond to ADH Increased urine output Specific gravity 1.005 Serum Na+ 145 Increased serum osmolarity Decreased urine osmolarity Dehydration. Must keep hydrated Thirst Diagnostic evaluation of DI - correct answers.1. Measure 24hr fluid I&O w/o restricting food or fluids. +=UO 4L and ingestion value 2. Water deprivation test 3. Chemistries - serum and urine 4. CT medical management of DI? - correct answers.Increase ADH drug: Diabinese Desmopressin (DDAVP)- parenteral form is 10x stronger than oral and intranasal Pitressin drugs will induce H2O retention. Watch for fluid overload. Weigh daily.. Increase fluid intake Orally if alert and awake IV - fluid type based upon serum sodium levels Case study 1: DIABETES INSIPIDUS Ms. Allen is admitted to the Neuro Step-Down Unit after undergoing a transsphenoidal hypophysectomy for removal of a pituitary adenoma. She arrives with the following equipment and orders Oxygen 60 % via face tent Peripheral IV of LR at 100 cc/hour Nasal drip pad under nose Foley catheter to drain Vital signs every hour Serum electrolytes with osmo Q6hrs Urine electrolytes and osmo Q6hrs Intake and output Q1hr Urine specific gravity Q4 hrs Notify physician for UO greater than 200 cc/hr for 2 consecutive hours Clear fluids once awake and alert with intact gag reflex - correct answers. Case study 1: What is your interpretation of her first set of lab results? Serum Na 150 mEq/L Serum K 4.2 mEq/L Serum Osmolality 312 mOsm/kg Urine specific gravity 1.008 - correct ased sodium serum K ok high serum osmolarity specific gravity low Case study 1: DIABETES INSIPIDUS Several hours later, you note a large amount of water on the floor near Ms. Allen's bed. On closer observation, you note that her foley bag is totally full and the water is coming from a hole in the drainage bag. Priority Assessments? Stat Lab Results: Urine SG 1.002 Serum Na 155 mEq/L Serum K 4.8 mEq/L Serum Os 325 mOsm/kg - correct answers.Vital Signs Tachycardia with hypotension Changes in LOC Pupillary reactions; sluggish Urine output Nasal discharge... Case study 1: The physician diagnoses Ms. Allen with Diabetes Insipidus and orders a Pitressin infusion to be started. What is the usual dose? What is the rationale? Fluid management? Pitressin therapy How administered? Expected results of Pitressin? How could these F&E changes impact her neuro status? - correct answers.D5 Water only with hypernatremia! 5Units is adequate, or 10Units (0.5mL) in adults IM 3-4 hr intervals helps prevent loss of water from the body by reducing urine output and helping the kidneys reabsorb water into the body. Vasopressin also raises blood pressure by narrowing blood vessels. Can increase ICP NURSING MANAGEMENT for DI? - correct answers.FLUID MANAGEMENT Monitor I&O Daily weights Increase fluid intake- drink same amount as UO Mouth care Monitor labs and specific gravity PROTECT FROM INJURY associated with changes in Na+ Visual Disturbances MONITOR FOR INCREASED ICP: HA, blurry vision, N/V, dizzy Syndrome of Inappropriate ADH (SIADH) occurs as a result of? What can cause this? - correct sive release of ADH (vasopressin) resulting in fluid and electrolyte imbalance Malignancies Pulmonary Disorders CNS Disorders (trauma, stroke) Drugs SIADH: manifestations? - correct answers.Decreased urine output Specific gravity 1.020 Serum Na+ 130 mEq/L: dilution hyponatremia Weight gain Decreased serum osmolality Increased urine osmolality Increased urine Na+ GI changes (N&V) Changes in level of consciousness Headache The increase in blood volume increases kidney filtration and inhibits renin and aldosterone, which increases urine and Na+ loss. Case Study 2: SIADH Harry James, age 63, has advanced lung cancer, and has been admitted to the medical unit with SIADH. The physician orders a fluid restriction of 800 cc/day. What is rationale for Fluid Restriction? Lab Values: Serum Na+ 130 mEq/L BUN 8 mg/dL Urine SG 1.046 Priority Interventions? - correct answers.Hyponatremia has significant neurological problems. Seizure Precautions Oral care Pt/family teaching- don't give a drink to patient. VS, I&O, F&E, LOC, Safe environment, weight, serum Osms, Specific gravity urine, administer diuretics as rx. SIADH Management? - correct answers.Monitor serum sodium Assess for seizure activity Fluid restriction- 500-1000mL/24hr Closely monitor I&O dilute all feedings and irrigation w/ saline. Vasopressin antagonists (inpatient only) Diuretics Demeclocycline- decreases diuretic effect 3% saline solutions- hypertonic solution Keep mouth moist by offering frequent oral rinsing. SIADH early manifestations CNS problems? - correct answers.R/t H2O retention: GI, loss of appetite, N/V, and increased weight Free H2O is retained not Na+, dependent edema not present. CNS problem w/ decreased Na+- Lethargy, HA, hostility, disoriented, LOC, decreased DTreflexes, seizure, and coma Vasopressin antagonists (inpatient only) name some, and the warnings. Diuretics: when is it appropriate to give them? - correct ptan (Samsca) oral, black box warning can increase Na+ rapidly, Conivaptan (Vaprisol) IV, promote H2O excretion without loss of Na+ When Na+ levels normal and if HF present. Hypo/Hyperpituitarism: What causes this? Clinical manifestations? Assessment? Treatment? - correct answers.Deficiency or excess of one or more anterior pituitary hormones Vary according to specific hormone involved Age, gender, family hx, changes in hat, glove, ring size, or shoe size, fatigue, increase in GH, may have backache or joint pain, HA, vision problem. Labs CT/MRI Replacement of deficient hormones Growth Hormone Deficiency Etiology? Clinical manifestations? - correct answers.Decreased GH production Lack of somatomedins by the liver Lack of target cell response Pituitary adenoma or damage Dwarfism in children Osteoporosis in adults mild-moderate obesity reduced CO fatigue and low BP HA Growth Hormone Deficiency Diagnosis? Treatment? - correct answers.Measurement of growth hormone Stimulation testing; Insulin increases GH release Hormone replacement Growth Hormone Excess Etiology? Clinical manifestations ? Diagnosis? - correct answers.Overproduction of growth hormone Typically caused by pituitary adenoma (most common) Gigantism in children Acromegaly in adults- airway is a big problem b/c enlarged tongue and lips elongated jaw. Labs Physical exam CT/MRI scan angiography can rule out aneurysm and vascular malformations Acromegaly symptoms - correct answers.Thickened lips, coarse facial features, increased head size, lower jaw protrusion, enlarged hand or feet, joint pain, barrel-shaped chest, hyperglycemia, sleep apnea, enlarged heart, lungs, liver. Suppression testing can help dx GH excess because High_________ suppresses GH. Giving 100g of oral glucose or 0.5g/kg is followed by serial GH level measurements. Levels that fall below_____________ mean abnormal result. - correct answers.BG 5ng/mL