Fluid and Electrolyte Imbalance - Endocrine Flashcards
Check for method of handling hormone test samples
note tube type, timing, drugs to be administered as part of the test, etc
Patient education about test
explain procedure and any restrictions to the patient
If you are drawing blood sample from a line
clear the IV line thoroughly; do not use a double- or triple-lumen line to obtain samples
If drug is prescribed for the test
Emphasize the importance of taking drug on time; tell pt to set alarm if the drug is to be taken at night
Urine collection
instruct pt to begin the urine collection by first emptying his or her bladder; do not save this urine; note time and plan to collect all urine from this time until the end of the collection period
To end urine collection
empty his or her bladder at the end of the timed period and add that to the collection
Storage and handling
is preservative needed (add to beginning), does sample need to be kept cold (place the container in cooler with ice)
Hormone replacement for acute adrenal insufficiency
Start rapid infusion of NS or D5NS; hydrocortisone sodium succinate 100-300 mg or dexamethasone 4-12 mg as IV bolus; 100 mg hydrocortisone sodium succinate via IV over next 8 hrs; hydrocortisone 50 mg IM every 12 hrs; H2 histamine blocker IV for ulcer prevention
Hyperkalemia management for acute adrenal insufficiency
administer insulin with dextrose in NS to shift K+ into cells; admin K+ binding and excreting resin; give loop or thiazide diuretics; avoid K+-sparing diuretics; initiate K+ restriction; monitor input/output; monitor HR, rhythm, and ECG for manifestations of hyperkalemia
Hypoglycemia management for acute adrenal insufficiency
administer IV glucose; administer glucagon; maintain IV access; monitor blood glucose hourly
Causes of primary adrenal insufficiency
autoimmune disease, TB, metastatic cancer, fungal lesions, AIDS, hemorrhage, gram-negative sepsis, adrenalectomy, abdominal radiation therapy, drugs and toxins
Causes of secondary adrenal insufficiency
pituitary tumors, postpartum pituitary necrosis, hypophysectomy, high-dose pituitary radiation, high-dose whole-brain radiation
Adrenal gland hypofunction history
changes in activity level, salt intake, anorexia, N/V, diarrhea, abdominal pain, weight loss, radiation to abdomen or head, and past and current drugs
Neuromuscular manifestations of adrenal insufficiency
muscle weakness, fatigue, joint/muscle pain
GI manifestations of adrenal insufficiency
anorexia, N/V, abdominal pain, bowel changes, weight loss, salt craving
Skin manifestations of adrenal insufficiency
vitiligo, hyperpigmentation
Cardiovascular manifestations of adrenal insufficiency
anemia, hypotension, hyponatremia, hyperkalemia, hypercalcemia
Psychosocial manifestations of adrenal insufficiency
lethargy, depression, confusion, psychotic, fearful
Increased lab values in adrenal insufficiency
potassium, calcium, bicarbonate, BUN, eosinophil, ATCH
Decreased lab values in adrenal insufficiency
sodium, glucose, cortisol, urinary 17-hydroxycorticosteroids, 17-ketosteroids
Nursing interventions for adrenal insufficiency
daily weight, intake/output, VS every 1-4 hrs, monitor lab values
Correction of cortisol and aldosterone deficiencies
hydrocortisone corrects glucocorticoid deficiency; mineralcorticoid hormone may be needed to maintain electrolyte balance
Hypersecretion by the adrenal cortex results in
hypercortisolism, Hyperaldosteronism, or excessive androgen production
Hypercortisolism (Cushing’s Disease)
exaggerated secretion of cortisol from the adrenal cortex; caused by problem in adrenal cortex, anterior pituitary gland, or hypothalamus; glucocorticoid therapy can also lead to hypercortisolism