ADH disorders (405)

Question 1

what are the two ADH disorders

Answer 1

1) SIADH (too much)
2) DI (too little)

Question 2

if hypernatremic, cells will

Answer 2

shrink

Question 3

if hyponatremic, cells will

Answer 3

swell

Question 4

hypo and hyper natremic both lead to what patient presentation

Answer 4

patient will be confused

Question 5

increased ADH secretion leads to

Answer 5

decreased water excretion which increased fluid volume

Question 6

SIADH

Answer 6

overproduction of ADH
-results in excess water reabsorption & decreased serum sodium levels
-cells swell

Question 7

most common cause of SIADH

Answer 7

ectopic hormone (ADH) production from lung cancer cells (paraneoplastic disease)

Question 8

DI

Answer 8

underproduction of ADH
-can be caused by neurogenic origins (head trauma) or nephrogenic (kidney doesn’t respond to ADH)

Question 9

what is the most common cause of drug induced nephrogenic DI

Answer 9

lithium

Question 10

SIADH pathophys map

Answer 10

inc ADH -> inc water reabsorption in renal tubules -> inc intravascular fluid volume -> dilutional hypoNa & dec serum osmolality

Question 11

SIADH clinical manifestations

Answer 11

based on severity & rate of onset of hypoNa
-muscle cramping
-dyspnea
-fatigue
-dulled sensorium, confusion, lethargy
-impaired taste & anorexia

Question 12

severe SIADH sx are associated w/ a Na+ level of

Answer 12

<100-115

Question 13

SIADH are at risk for what

Answer 13

altered mental status

Question 14

SIADH nursing interventions

Answer 14

-assess for FVO
-monitor I&O
-monitor metal status
-restrict fluids w/ an order
-IVF per order
-support
-drugs (not first line)

Question 15

immediate goal for SIADH

Answer 15

restore normal fluid volume & osmolality

Question 16

if SIADH mild (Na <125)

Answer 16

fluid restriction only (1000 ml/d)

Question 17

if SIADH severe (Na <120)

Answer 17

• 3-5% NS given slowly over days
• 500 ml/d fluid restriction

Question 18

when to use drug therapy w/ SIADH

Answer 18

only in chronic
-diuretics
-demeclocycline (blocks ADH)

Question 19

DI pathophys map

Answer 19

dec ADH -> dec water reabsorption in renal tubules -> dec intravascular fluid volume -> inc serum Na & excess urine output

Question 20

DI: neurogenic

Answer 20

-usually abrupt onset
-most severe S/s but usually self limiting
need to treat the symptoms

Question 21

DI: nephrogenic

Answer 21

-less abrupt onset
-less severe symptoms

Question 22

DI clinical manifestations

Answer 22

-polyuria & polydipsia
-urine: very low specific gravity & osmolality
-serum: high omsolality
-fatigue & weakness

Question 23

DI does not have which classic DM symptom

Answer 23

polyphagia

Question 24

high serum osmolality increases what

Answer 24

thirst

Question 25

DI goal

Answer 25

maintain fluid & electrolyte balance

Question 26

DI interventions

Answer 26

-IVF
-I&Os
-daily wts
-monitor labs (urine & serum)
-pharm

Question 27

when to notify the provider for a pt w/ DI

Answer 27

inc urine volume w/ dec specific gravity
may need to inc DDAVP

Question 28

neurogenic DI pharm therapy

Answer 28

DDAVP

Question 29

DDAVP

Answer 29

“vasopressin”
-MOA: synthetic ADH
-give small doses