Complex Exam 4 - metabolism: posterior pituitary Flashcards
What type of respirations occur with SIADH?
cheyne-stokes
What can decreased sodium cause with SIADH?
- personality changes (hostility)
- decreased DTR’s
- N/V/D
- oliguria with dark yellow concentrated urine
- S/C/D
What does FVE look like with SIADH?
- tachycardia
- bounding pulses
- HTN
- crackles
- JVD
- taut skin
- weight gain w/o edema
What is the urine chemistry result of SIADH?
- concentrated
- increased Na
- increased osmolarity
What is the blood chemistry result of SIADH?
- dilute
- decreased Na
- decreased osmolarity
When should SIADH medication demeclocycline be avoided?
- with impaired kidney function
- calcium
- iron
- magnesium
- antacids
- milk products
What should you monitor for with SIADH medication demeclocycline?
- yeast infection
- diarrhea
What is the purpose of giving tolvaptan or conivaptan for SIADH?
promotes excretion without sodium loss
What should be monitored with SIADH medications tolvaptan and conivaptan?
- glucose
- sodium
- I&O’s
- bowel patterns
- dehydration
What should be done frequently with SIADH medications tolvaptan and conivaptan?
oral care
What should be monitored with loop diuretics used for SIADH?
hyponatremia: N/V, decreased appetite
What rate should hypertonic sodium chloride be given for SIADH?
no faster than 1 mEq/hr for a total of 200-300 mL
What should be monitored with hypertonic sodium chloride for SIADH?
- hypervolemia: weight gain, difficulty breathing
- neuro changes, tremors, disorientation
- central pontine demyelination: permanent parkinson’s-like state
What is the priority intervention for SIADH?
restricting oral fluids to 500-1000 mL/day
What comfort measures can be given for thirst with SIADH?
- mouth care
- lozenges
- ice chips
- staggered water intake
What vital sign changes occur with SIADH?
- increased BP
- increased HR
- decreased temp
What should be reported for SIADH?
weight gain of 2.2 lbs/1 kg
What precautions are needed for SIADH?
seizure precautions
What should enteral and gastric tubes be flushed with for SIADH?
NS
Do the 3 P’s occur with DI?
yes
How much output usually occurs per day with DI?
4-30 L of dilute urine
What dehydration symptoms occur with DI?
- loss/absence of skin turgor
- dry mucous membranes
- weak/fatigue
- poor peripheral pulses
- decreased cognition (confusion)
- weight loss
- dry, cracked lips
What happens to BP and HR with DI?
- tachycardia
- hypotension
What type of diet should be promoted with DI?
a diet that restricts diuresis (NO caffeine, coffee)
What safety considerations should be used with DI?
- side rails up while in bed
- assistance with ambulation
- easy access to bedpan and bathroom
Why is IV therapy used with DI?
- F&E replacement
- ADH replacement
What labs should be monitored with DI?
- K
- Na
- BUN/creatinine
- specific gravity
- osmolarity
What should be done if a DI patient experiences constipation?
add bulk foods and fruit juices to their diet
What can happen with DI medication desmopressin?
- HA
- confusion
- water toxicity
What should a DI patient be educated on with desmopressin?
it is a lifelong medication
What should be increased in the diet of someone with DI?
fiber
What should be restricted with DI?
- fluids
- alcohol
What causes decreased ADH with primary DI?
defects in the hypothalamus or pituitary gland
What causes secondary DI?
- head injury
- infection (meningitis)
- tumor @/near the hypothalamus or pituitary gland
- brain surgery
What causes nephrogenic DI?
ADH is produced but not responded to
What medications can cause drug-induced DI?
- lithium carbonate
- demeclocycline
