Medsurg Final 1 Flashcards by Richard smith

A deficiency of ADH causes

diabetes insipidus

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Excessive secretion of ADH causes

SIADH

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In SIADH the kidneys

retain water

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In SIADH urine becomes

concentrated

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In SIADH extracellular fluid volume is

increased

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Diagnostic tests for the posterior pituitary gland include the water ___ test

water deprivation test

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The water deprivation test measures the kidneys’ ability to

concentrate urine

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The water deprivation test is performed for clients who have a diagnosis of

diabetes insipidus

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Water deprivation test: The test is positive for diabetes insipidus if the kidneys are unable to concentrate urine despite

increased plasma osmolality.

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Water deprivation test: Begin test by withholding fluids for 8 to 12 hr, or until

3% to 5% of body weight is lost.

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Water deprivation test: Ensure that someone

remains with client during test

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Water deprivation test: obtain __ access

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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

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Water deprivation test: Repeat the three steps – weigh, measure urine, obtain serum – ___ and record any findings

hourly

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Water deprivation test: Continue the steps until the serum sodium concentration or osmolality

rises above the upper limit of the expected reference range.

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TESTS TO DIAGNOSE SIADH: Blood is obtained and transported to the laboratory within

10 min

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Low ___ sodium is expected with SIADH

serum

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High ___ sodium is expected with SIADH

urine

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Cushing’s disease and Cushing’s syndrome (hypercortisolism) are characterized by a ____ adrenal cortex

hyperfunctioning

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Cushing’s disease and Cushing’s syndrome (hypercortisolism) are characterized by an excess production of

cortisol

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Addison’s disease is characterized by ____ of the adrenal cortex

hypofunctioning

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Addison’s disease is characterized by low serum _____.

cortisol

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A CT scan and/or an MRI may be performed to determine if there is ____ of the adrenal glands causing hypofunction

atrophy

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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

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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

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

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

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