Summary NUR 445 Exam 1 Study Guide

Emphasized in ppts (* or bolded)
Subjects (no significance)
Meds
In Quizlet/Study guide from Cohort 2
FS on Exam


Endocrine Respiratory

Diabetes insipidus Prioritization

SIADH Ethical considerations

Thyroid Storm/Thyrotoxicosis Medications

Myxedema Coma Pain/Sedation/Delirium

Thyroid Surgery Ventilator management and care

Thyroid Medications Pulmonary embolism

Adrenal insufficiency/ Addisonian crisis Acute respiratory distress syndrome (ARDS)

Cushing’s syndrome Chest trauma

DKA Pneumothorax

HHS Chest tube

Arterial Blood Gases (ABG)

Intubation




Module 1 (Ch. 41 42, 44)
Module 2 ( Ch. 27)


Module 1 - Endocrine Disorders
● Endocrine function
○ Pituitary gland
- Regulates growth, metabolism and reproduction
- Hypothalamus synthesizes hormones posterior pituitary gland releases:
- Oxytocin
- Vasopressin (ADH)- Makes concentrated urine
- Released with decreased BP, dehydration and increased
serum osmolality
- Increases water reabsorption in the kidneys
●Diabetes insipidus (in”SIP”idus)

, ○ “Dry inside”
○ Pathophysiology
-Central DI - decreased ADH secretion from PPG (Posterior Pituitary
Gland)
- Dysfunction of the posterior pituitary gland
- Causes: idiopathic, brain tumors, intracranial surgery, trauma
○ S/S:
- Polyuria - significant water loss
- Polydipsia - excessive thirst
- Nocturia
- Hypovolemia
- Dehydration
- Weakness
- Fatigue
- Hemoconcentration> elevated H & H
- Primary signs:
- Significant water loss
- Decreased BP (HYPOTENSION)
- Increased HR (TACHYCARDIA)
○ Diagnosis
- Urine specific gravity = below <1.005
- Urine osmolality = below <200 mOsm/kg
*monitor hourly urine output, it is used to determine Dx of DI*
- Serum osmolality
-Hypernatremia = >145 sodium
- Hematocrit = elevated
- CT scan and MRI
- Water deprivation test
- Monitor weight and urine osmolality q1hr
- Elevated serum osmolality confirms Dx
- Determine the cause
○ Medical Management
- Maintain fluid status, d/t fluid balance deficit
- Encourage PO fluids
- IV fluids (if emergent, unconscious)
-Hypotonic D5 ½ NS, (0.45% sodium chloride, 5% dextrose in
water)
*you will INCREASE hypotonic fluids*
- Electrolyte balance
- Monitor for fluid overload
- Correct hypernatremia
- Monitor for hypernatremia
- TREAT CAUSE
○ Medications

, - Give these medications in the MORNING
-Desmopressin (DDAVP) - a synthetic analog of ADH, is the drug of
choice in patients with DI !
- Routes: Subq, intranasal or oral
- N.I: Teaching - overcorrection w/ DDAVP or Pitressin can lead to
fluid overload
* monitor pts for fluid status, electrolytes and UO*
- Vasopressin (Pitressin) - used to treat DI that is less expensive than
desmopressin
- ^Therapeutic effect = decreased UO
○ Complications
- The patient with DI may develop dehydration and hypovolemia,
progressing to circulatory collapse without adequate fluid administration
- Hemoconcentration leading to hypernatremia
○ Assessment (from book)
- Because DI is directly related to the lack of ADH, there is loss of free
water
- Assessment findings include:
- Polyuria
- Urine specific gravity less than 1.005
- Low urine osmolality (especially in relation to serum osmolality)
○ Assessment (from slides)
- Vital signs: decreased BP, increase HR
- I & O’s
- Daily weight: Increased output of dilute urine, secondary to lack of ADH,
leads to decrease in weight
- Same time, same scale
- Must report 2 lbs gain/loss !
- Visual Acuity
- CN II & III compressed
- Serum sodium and osmolality
- Urine specific gravity
- Dilute urine specific below 1.005
○ N.I
- Priority = monitor serum sodium and fluid replacement
- Maintain IV access
- Obtain access early
- Admin IV Fluids (hypotonic)
- Admin Desmopressin (DDAVP) or Vasopressin (Pitressin)
- Synthetic ADH is administered to cause water reabsorption in the
kidney
- Monitor I & O’s, serum electrolytes, fluid status
- Provide adequate oral fluids
- Provide mouth care

, - Weigh daily
- Osmolality
- Visual acuity
○ Teaching
- Teach pts to weigh daily
- Report weight gain of 2 lbs or more in a day
- Weigh at the same time everyday
- Keep track of I & O’s in a logbook
- Report swelling or cough to MD
●SIADH (Syndrome of inappropriate antidiuretic hormone secretion)
○ “Soaked Inside”
○ Pathophysiology
-Increase in ADH (hypersecretion)
- Water retention (overload)
- Excessive secretion of ADH from PPG despite normal or increased
plasma volume
- Water reabsorbed in the kidneys
-Hyponatremia & Hypoosmolality
-d/t hemodilution
○ Causes
- CNS disorders
- Head or neck tumors
- Brain/neck tumors, SE NSAIDs, psychotic meds
○ Clinical manifestations
- Hyponatremia
- Low sodium levels cause headaches and confusion
- Nausea
- Malaise
- Anorexia
- Irritability
- Weakness
- Scant amount of concentrated urine
○ Diagnosis
- Serum osmolality
- Urine specific gravity
- Urine osmolality
- CT scan and MRI
○ Treatment
- Fluid restrictions = < 1,000 mL/day
- Usually fluid restrictions are indicated, except in the case of severe
hyponatremia
- Tx for Hyponatremia:
- IV fluids
- 100mL/day fluid restriction