Medsurg Final 1 Flashcards
A deficiency of ADH causes
diabetes insipidus
Excessive secretion of ADH causes
SIADH
In SIADH the kidneys
retain water
In SIADH urine becomes
concentrated
In SIADH extracellular fluid volume is
increased
Diagnostic tests for the posterior pituitary gland include the water ___ test
water deprivation test
The water deprivation test measures the kidneys’ ability to
concentrate urine
The water deprivation test is performed for clients who have a diagnosis of
diabetes insipidus
Water deprivation test: The test is positive for diabetes insipidus if the kidneys are unable to concentrate urine despite
increased plasma osmolality.
Water deprivation test: Begin test by withholding fluids for 8 to 12 hr, or until
3% to 5% of body weight is lost.
Water deprivation test: Ensure that someone
remains with client during test
Water deprivation test: obtain __ access
IV
Water deprivation test: Obtain 7 to 10 mL of heparinized blood in an iced tube and send to the laboratory for immediate processing to determine ___ level
sodium
Water deprivation test: Repeat the three steps – weigh, measure urine, obtain serum – ___ and record any findings
hourly
Water deprivation test: Continue the steps until the serum sodium concentration or osmolality
rises above the upper limit of the expected reference range.
TESTS TO DIAGNOSE SIADH: Blood is obtained and transported to the laboratory within
10 min
Low ___ sodium is expected with SIADH
serum
High ___ sodium is expected with SIADH
urine
Cushing’s disease and Cushing’s syndrome (hypercortisolism) are characterized by a ____ adrenal cortex
hyperfunctioning
Cushing’s disease and Cushing’s syndrome (hypercortisolism) are characterized by an excess production of
cortisol
Addison’s disease is characterized by ____ of the adrenal cortex
hypofunctioning
Addison’s disease is characterized by low serum _____.
cortisol
A CT scan and/or an MRI may be performed to determine if there is ____ of the adrenal glands causing hypofunction
atrophy
A low dose of ____ is given to screen a client for Cushing’s disease; high doses are given to determine the cause of the disease
dexamethasone
dexamethasone is given to screen a client for
Cushing’s disease
When dexamethasone is given to clients who have Cushing’s disease, there is no decrease in the
production of ACTH and cortisol (so that’s how they diagnose it)
Cortisol: higher levels are present in the early morning, and the lowest levels occur around
midnight
Cortisol: Diurnal variations are not seen in a client who has
Cushing’s syndrome
Nursing Actions: Plasma cortisol is usually collected at
midnight
ACTH may be elevated with
Addison’s disease
ACTH may be decreased with
Cushing’s disease
Serum ACTH is most accurate if performed
in the morning
If no increase in cortisol occurs after administration of ACTH, the test is
positive for Addison’s disease or hypocortisolism.
ACTH STIMULATION TEST: Two consecutive _________ are used, one prior to and one after the administration of ACTH.
collections of 24-hr urine
Disorders of the adrenal medulla may cause hypersecretion of catecholamines, resulting in
stimulation of a sympathetic response, such as tachycardia, hypertension, and diaphoresis
Adrenal Medulla disorders: VMA testing is a ________ for vanillylmandelic acid (VMA), a breakdown product of catecholamines
24-hr urine collection
Indications of VMA testing
diagnosis of pheochromocytoma
____ VMA levels at rest indicate pheochromocytoma.
Elevated
VMA testing: client may also be asked to withhold ___ and ____ medications.
aspirin and antihypertensive
VMA testing: Instruct the client to maintain a _____ level of activity.
moderate
Clonidine suppression test Indications
Pheochromocytoma
pheochromocytoma
adrenal gland tumor
Clonidine suppression test: If a client does NOT have a pheochromocytoma, _____ suppresses catecholamine release and decreases the serum level of catecholamines (decreases blood pressure)
clonidine
Clonidine suppression test: If a client does not have a pheochromocytoma, clonidine suppresses
catecholamine release (decreases blood pressure)
Clonidine suppression test: If the client does have a pheochromocytoma, the clonidine
has no effect (no decreased blood pressure)
Clonidine suppression test: monitor the patient for
hypotension
Clonidine suppression test: Inform the client that ___ may occur after the test.
fatigue
Phentolamine blocking test: Phentolamine (Regitine), an ___ ___, is administered
alpha blocker
Phentolamine blocking test: Indications
pheochromocytoma
Phentolamine blocking test: Interpretation of Findings – A rapid decrease in systolic blood pressure with the administration of phentolamine is diagnostic for
pheochromocytoma
Phentolamine blocking test: Interpretation of Findings:
A rapid decrease in systolic blood pressure with the administration of phentolamine is diagnostic for pheochromocytoma
Dysfunction of carbohydrate metabolism may be caused by insulin deficiency resulting in
hyperglycemia
Fasting blood glucose: Determines blood glucose when no foods or fluids (__ ___ ___) have been consumed for the past 8 hr.
other than water
HbA1c of __ or less indicates absence of diabetes mellitus
5%
HbA1c of ___ to ___ indicates prediabetes mellitus
5.5% to 6.5%
and HbA1c of ___ or higher indicates diabetes mellitus.
6.5%
Assists in evaluating DM treatment effectiveness and compliance with the diet plan, medication regimen, and exercise schedule
A1c
A1c: test prep
none
Hyperthyroidism and hypothyroidism are conditions in which there are
inappropriate amounts T3 and T4 circulating
inappropriate amounts of T3 and T4 cause an increase or decrease in ____ rate that affects all body systems.
metabolic
Hyposecretion of TSH may lead to ____ hypothyroidism
secondary
a high level of ___ is more diagnostic of hyperthyroidism than is ___
T3 more than T4
Posterior pituitary disorders mainly result in
fluid and electrolyte imbalance
Types of diabetes insipidus: Caused by damage to the hypothalamus or
pituitary gland from trauma, irradiation, or cranial surgery.
Neurogenic (also known as central or primary)
Types of diabetes insipidus: inherited; renal tubules do not react to ADH.
Nephrogenic
Types of diabetes insipidus: Lithium carbonate (Lithobid) or demeclocycline (Declomycin) may alter the way the kidneys respond to ADH.
Drug-induced
diabetes insipidus Urine chemistry – Think
DILUTE
diabetes insipidus Serum chemistry – Think
CONCENTRATED
desmopressin acetate (DDAVP) or aqueous vasopressin (Pitressin)
ADH replacements used to tx DI
carbamazepine
ADH stimulant (an Anticonvulsants)
carbamazepine (ADH stimulant (an Anticonvulsant)): monitor for
thrombocytopenia (sore throat, bruising, fever).
Give vasopressin cautiously to clients who have __ ___ disease because the
medication may cause vasoconstriction
coronary artery
DI tx might include life long
vasopressin injections
DI diet:
high fiber
Which electrolyte are you worried about in DI
sodium
____ losses due to diuretic use can further contribute to the problems caused by SIADH
Sodium (because you already have low sodium in the Blood with SIADH)
SIADH symptoms can include weight gain (without ___ because water, not sodium, is retained)
edema
SIADH: As the serum sodium level decreases, the client experiences
personality changes, hostility, sluggish deep tendon reflexes
SIADH Urine chemistry – Think
CONCENTRATED
SIADH Blood chemistry – Think
DILUTE
SIADH first priority
restrict fluids to 500 to 1,000 mL/day
SIADH patient that has a feeding tube
flush with NS instead of water (because you’re supposed to be restricting water)
A weight gain of 0.9 kg (2 lb) indicates a gain of
1 L of fluid
SIADH: environment
reduce stimuli
SIADH: Monitor the client for indications of ___ ___, which can occur from fluid overload.
heart failure
SIADH: Monitor the client for indications of heart failure, which can occur from fluid overload. Use of a ___ ___ may be indicated.
loop diuretic
Demeclocycline, which is a medication used for SIADH may cause
DI
Demeclocycline is a medication used for SIADH. Monitor for
yeast infection, such as a white, cheese-like film inside the mouth.
Lithium (Lithium Carbonate) can be used to
block the renal response to ADH (treats SIADH)
Lithium (Lithium Carbonate) can be used to tx SIADH, but it can cause
DI
Low serum sodium is a problem in SIADH. If it gets really bad, the IV you need is
3% sodium chloride
Treatment for SIADH may result in CPM. This most commonly occurs when a client is being treated for hyponatremia and
the sodium levels rise too fast.
Treatment for SIADH may result in CPM, a condition characterized by ___ damage
nerve
