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MedSurg > endocrine dx > Flashcards

endocrine dx Flashcards

1
Q

SIADH

A
  • overproduction/oversecretion of ADH

- excess ADH=reabsorption of water into circulation=low Na

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2
Q

causes of SIADH

A
  • drugs
  • head trauma
  • Ca
  • metabolic dz
  • CVA
  • SLE
  • hypothyroidism
  • lung infx
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3
Q

s/s of SIADH

A
  • serum hypo osmolarity
  • dilutional low Na, low Chl,
  • fluid retention, weight gain, cerebral edema
  • increased intravascular volume
  • concentrated urine
  • normal renal function
  • muscle cramps and weakness
  • fatigue
  • thirst
  • low UOP
  • sz, coma
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4
Q

diagnostic studies for SIADH

A
  • urine osmolality
  • serum osmolality less than 280
  • low Na
  • SG greater than 1.005
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5
Q

tx for SIADH if Na > 125 mEq/L

A
  • fluid restriction 800-1000mL/24 hours
  • hypertonic saline solution 3-5%
  • diuretics
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6
Q

tx for SIADH if Na less than 120

A
  • fluid restriction 500mL/24 hour
  • demeclocycline, lithium
  • vasopressin
  • ICU or monitored bed
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7
Q

positioning for SIADH

A
  • flat

- 10 degree HOB elevation

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8
Q

diet for SIADH

A

supplement Na, K

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9
Q

diabetes insipidus

A
  • deficiency of production of ADH

- decreased renal response to ADH

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10
Q

central diabetes insipidus

A
  • most common
  • neurogenic
  • occurs when there is an organic lesion that interferes with ADH synthesis or release
  • secondary to intracranial surgery or head trauma
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11
Q

nephrogenic diabetes insipidus

A

adequate but decreased response to ADH by the kidney

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12
Q

psychogenic diabetes insipidus

A
  • dispogenic

- associated with excessive water intake

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13
Q

causes of diabetes insipidus

A
  • head trauma
  • tumors
  • surgical ablation or irradiation of pituitary
  • infx of CNS
  • drugs
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14
Q

acute phase of diabetes insipidus

A
  • abrupt onset of polyuria

- 1-5L/hour

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15
Q

interphase of diabetes insipidus

A
  • urine volume normalizes

- decrease in UOP, but still high

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16
Q

third phase of diabetes insipidus

A
  • central DI is permanent in 10-14 days
  • DI from head trauma usually improves with tx
  • DI following surgery is more likely to become permanent
17
Q

s/s of diabetes insipidus

A
  • polydipsia
  • polyuria 5-20L/day
  • low SG 295 mOsm/kg
  • hypernatremia
  • hypovolemia, hypotension, tachycardia, shock
  • weight loss, poor skin turgor
  • CNS manifestations
  • constipation
18
Q

tx of nephrogenic diabetes insipidus

A
  • low Na diet: 3g/day
  • diuretics: thiazide
  • prostaglandin inhibitors: indomethacin
19
Q

tx of central diabetes insipidus

A
  • hormone replacement
  • D5W or 0.45NS
  • titrate to replace UOP
20
Q

hyperparathyroidism

A
  • increased secretion of parathyroid hormone PTH

- oversecretion of PTH = increased Ca levels

21
Q

primary hyperparathyroidism

A

-usually there is a tumor

22
Q

secondary hyperparathyroidism

A
  • cause is outside the parathyroid gland
  • decreased vit D
  • chronic renal failure
  • increased phosphatemia
  • malabsorption of Ca in gut
23
Q

tertiary hyperparathyroidism

A

hyperplasia of parathyroid gland

24
Q

s/s of hyperparathyroidism

A
  • decreased bone density
  • hypercalciuria
  • osteoporosis
  • fx
  • cyst formation
  • general weakness
  • calculi formation
25
Q

diagnostic studies hyperparathyroidism

A

-PTH
-Ca
-phos
-electrolytes
-bone density measurements
X-rays, UTZ, MRI

26
Q

surgical tx for hyperparathyroidism

A
  • parathyroidectomy

- autotransplantation

27
Q

nonsurgical tx for hyperparathyroidism

A
  • monitor electrolytes
  • low Ca diet
  • phosphorus supplements
  • drugs
  • ambulation: put weight on bone, gain weight
28
Q

candidates for hyperparathyroidism surgery

A
  • Ca: 12+
  • urine Ca: 400+
  • decreased bone density
  • hx of renal calculi
29
Q

complications of hyperparathyroidism surgery

A
  • tetany in neck, swelling
  • hemorrhage
  • larnygospasms
  • trach tray should be bedside
30
Q

hypercalcemic crisis

A
  • Ca 15+

- results in neuro, CV, and renal s/s

31
Q

interventions for hypercalcemic crisis

A
  • tx involves rehydration with large volumes
  • diuretics to promote renal excretion of Ca
  • dialysis
  • I/O
  • IV calcium gluconate: for dysrhythmias
  • frequent monitoring for Chvostek’s and Trousseau’s signs
  • mobility to promote bone calcification
  • rebreather mask/paper bag
32
Q

hypoparathyroidism

A
  • inadequate circulating PTH
  • hypocalcemia
  • most common cause is iatrogenic
33
Q

s/s of hypoparathyroidism

A
  • numbness and tingling
  • tonic spasms
  • dysphagia
  • laryngospasm
  • decreased Ca and PTH
  • increased phos
34
Q

tx of hypoparathyroidism

A
  • IV ca chloride, gluconate, or gluceptate
  • ECG monitoring
  • rebreathing, lower pH
  • oral Ca, vit D
  • high Ca diet

MedSurg (22 decks)

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