NUR 265 exam 2 study guide
Endocrine
Diabetes Insipidus: too little ADH
- A disease of the posterior pituitary or hypothalamus that doesn’t secrete enough anti diuretic
hormone (ADH). MAKES YOU PEE!!!!
- Primary is issue with post. Pituitary or hypothalamus and secondary is a tumor, medications,
head trauma, infections, brain surgery (things that happen near the post pituitary or
hypothalamus but not happen to the actual glands)
S/S:
- POLYURIA, POLYDIPSIA (increased thirst), HYPERNATREMIA (d/t peeing off too much water),
low specific gravity (diluted urine), dehydration signs and symptoms. Hypotension. Tachycardia.
Ataxia, decreased LOC, irritability. Weak pulses. Poor skin turgor. Dry membranes.
DX:
- 24 hour urine intake and output is measured without restricting fluids or food. DI is considered if
urine output is more than 4 L in a day. Patients vary from 4 to 30 L a day of urine output.
TX:
- give desmopressin which is a vasopressin. It replaces the ADH and decreases urination. It Is
available sublingually, orally, and intranasally.
- Teach they may need another dose If they are still peeing a lot.
- Teach about weighing daily, same scale and clothing and time etc.
- Teach about carrying a water bottle with them at all times along with their medication.
- Monitor for s/s of fluid overload if given too much desmopressin!
- Ensure that a patient with DI is not deprived of fluid for more than 4 hours because they can
deplete too much water!!
- IV desmopressin works 10 x stronger than the other forms!
- Teach pt if they take desmopressin and have persistent headache, confusion or vomiting to call
PHCP right away!! (could be signs of water toxicity!!)
, SIADH too much ADH
- Too much ADH resulting in water retention (OPPOSITE OF DIABETES INSIPIDUS)
- THEY WILL BE HYPONATREMIC!!! And have fluid overload!!
- They will have high risk for seizures and need neuro check every 2-4 hours!!
Causes: tumors, hodgkins/non hodgkins lymphoma, cancer of lungs and pancreas, head injuries,
strokes, infections, pneumothorax, PEEP ventilation, Pneumonia, medications. (Mental health meds)
S/S:
- Early on is loss of appetite, and N/V. (related to water retention causing hyponatremia)
- Fluid overload, JVD, HYPONATREMIA, lethargy, weight gain without evidence of edema,
disorientation, decreased LOC, decreased DTRs, SEIZURES!!! (due to low sodium levels) they
have flooded brain!
- Bounding pulses, hypothermia (flooded brain messes with the temperature)
- They don’t have edema!! Free water is retained not salt!!
- Sodium levels can get as low as 115.(seizure risk)
- Increased urine specific gravity!! (more concentrated)
TX:
- Restricting fluids by 500 – 1000 mls in 24 hours. (they can only have as much as 2 cans of soda
etc) (physician intervention) stop decrease of sodium and increase sodium levels.
- Nursing interventions: preventing complications, teach pt and family about fluid restrictions and
medications, and prevent injury.
- Give medications with saline and not regular water.
- DO I&O’s/ DAILY WEIGHTS! Insert urinary catheter first then measure I&Os!!
- Frequent oral with ice chips or give oral candy for dryness.
- Vital signs every 2 hours
- GIVE TOLVAPTAN!! (promotes water secretion but doesn’t affect sodium levels!)
When giving tolvaptan monitor for hypernatremia!!
- DIURETICS ARE GIVEN ONLY IF SODIUM LEVELS ARE CLOSE TO NORMAL (130 ish range).
- HYPERtonic saline (3-5%) is given only in a central line because its hard on veins.
- Monitor for fluid overload Heart failure and pulmonary edema every 2 hours (notify dr if
suspected)
Endocrine
Diabetes Insipidus: too little ADH
- A disease of the posterior pituitary or hypothalamus that doesn’t secrete enough anti diuretic
hormone (ADH). MAKES YOU PEE!!!!
- Primary is issue with post. Pituitary or hypothalamus and secondary is a tumor, medications,
head trauma, infections, brain surgery (things that happen near the post pituitary or
hypothalamus but not happen to the actual glands)
S/S:
- POLYURIA, POLYDIPSIA (increased thirst), HYPERNATREMIA (d/t peeing off too much water),
low specific gravity (diluted urine), dehydration signs and symptoms. Hypotension. Tachycardia.
Ataxia, decreased LOC, irritability. Weak pulses. Poor skin turgor. Dry membranes.
DX:
- 24 hour urine intake and output is measured without restricting fluids or food. DI is considered if
urine output is more than 4 L in a day. Patients vary from 4 to 30 L a day of urine output.
TX:
- give desmopressin which is a vasopressin. It replaces the ADH and decreases urination. It Is
available sublingually, orally, and intranasally.
- Teach they may need another dose If they are still peeing a lot.
- Teach about weighing daily, same scale and clothing and time etc.
- Teach about carrying a water bottle with them at all times along with their medication.
- Monitor for s/s of fluid overload if given too much desmopressin!
- Ensure that a patient with DI is not deprived of fluid for more than 4 hours because they can
deplete too much water!!
- IV desmopressin works 10 x stronger than the other forms!
- Teach pt if they take desmopressin and have persistent headache, confusion or vomiting to call
PHCP right away!! (could be signs of water toxicity!!)
, SIADH too much ADH
- Too much ADH resulting in water retention (OPPOSITE OF DIABETES INSIPIDUS)
- THEY WILL BE HYPONATREMIC!!! And have fluid overload!!
- They will have high risk for seizures and need neuro check every 2-4 hours!!
Causes: tumors, hodgkins/non hodgkins lymphoma, cancer of lungs and pancreas, head injuries,
strokes, infections, pneumothorax, PEEP ventilation, Pneumonia, medications. (Mental health meds)
S/S:
- Early on is loss of appetite, and N/V. (related to water retention causing hyponatremia)
- Fluid overload, JVD, HYPONATREMIA, lethargy, weight gain without evidence of edema,
disorientation, decreased LOC, decreased DTRs, SEIZURES!!! (due to low sodium levels) they
have flooded brain!
- Bounding pulses, hypothermia (flooded brain messes with the temperature)
- They don’t have edema!! Free water is retained not salt!!
- Sodium levels can get as low as 115.(seizure risk)
- Increased urine specific gravity!! (more concentrated)
TX:
- Restricting fluids by 500 – 1000 mls in 24 hours. (they can only have as much as 2 cans of soda
etc) (physician intervention) stop decrease of sodium and increase sodium levels.
- Nursing interventions: preventing complications, teach pt and family about fluid restrictions and
medications, and prevent injury.
- Give medications with saline and not regular water.
- DO I&O’s/ DAILY WEIGHTS! Insert urinary catheter first then measure I&Os!!
- Frequent oral with ice chips or give oral candy for dryness.
- Vital signs every 2 hours
- GIVE TOLVAPTAN!! (promotes water secretion but doesn’t affect sodium levels!)
When giving tolvaptan monitor for hypernatremia!!
- DIURETICS ARE GIVEN ONLY IF SODIUM LEVELS ARE CLOSE TO NORMAL (130 ish range).
- HYPERtonic saline (3-5%) is given only in a central line because its hard on veins.
- Monitor for fluid overload Heart failure and pulmonary edema every 2 hours (notify dr if
suspected)
