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NURS 3512 - Class 1-6 > Week 1 - Pituitary Disorders > Flashcards

Week 1 - Pituitary Disorders Flashcards

1
Q

what hormone does the posterior pituitary store and secrete

A
  • ADH
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2
Q

what is the fnxn of ADH

A
  • plays major role in regulation of water balance and osmolarity
  • plays major role in how the body retains water thru the kidneys
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3
Q

what are the two primary disorders of the pituitary gland

A
  • syndrome of inappropriate antidiuretic hormone (SIADH)

- diabetes insipidus

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4
Q

what is SIADH

A
  • condition caused by too much ADH

* think: Syndrome of Increased ADH*

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5
Q

what effect does increased ADH have on the kidneys? how does this effect intravascular fluid volume?

A

= increased water reabsorption in renal tubules

= increased intravascular fluid volume

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6
Q

how does increased ADH effect sodium and serum osmolality in SIADH

A

= dilutional hyponatremia & decreased serum osmolality

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7
Q

how would SIADH effect a pt’s BP? urine output? body weight?

A
  • hypertension
  • cause low urinary output with high specific gravity (very concentrated)
  • increased body weight
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8
Q

what symptoms could the dilutional hyponatremia during SIADH cause? (9)

A
  • muscle & abdominal cramps
  • weakness
  • vomiting
  • seizures
  • muscle twitching
  • lethargy
  • decreased LOC & confusion
  • headaches
  • coma if severe
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9
Q

1 kg of weight = ____ fluid

A

1kg = 1L of fluid

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10
Q

what should nurses monitor for a pt with, or possibly with, SIADH (10)

A
  • LOC
  • VS
  • I&O
  • low urine output w high specific gravity
  • increased daily weight
  • low K and Na lvls
  • heart and lung sounds
  • neurological assessments for decreased LOC
  • observe for signs of hyponatremia
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11
Q

why should a nurse monitor heart and lung sounds for a pt with SIADH

A
  • due to fluid overload which could cause pulmonary edema, etc.
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12
Q

what is the treatment goal for a pt with SIADH

A
  • restore fluid volume & electrolyte balance
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13
Q

what is considered mild hyponatremia

A
  • > 125 mmol/L
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14
Q

what would be the treatment for a pt with mild hyponatremia with SIADH? what should this cause (2)?

A
  • fluid restriction of 800 - 1000 mL/day

- should result in gradual weight & increase Na

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15
Q

what is considered severe hyponatremia

A

< 120 mmol/L

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16
Q

what type of IV solution would be given to a pt with severe SIADH? how should it be given & why?

A
  • IV hypertonic saline (3-5%)

- must be infused slowly to prevent fluid overload & to avoid too rapid of a rise in Na

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17
Q

why would a nurse give hypertonic saline to a pt with severe SIADH

A
  • to remove fluid from the cells back into the vascular system so it can be urinated out
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18
Q

what would be the treatment for a pt with severe hyponatremia & SIADH? (4)

A
  • fluid restriction of 500 mL/day
  • IV hypertonic saline
  • IV Lasix
  • Tolvaptan (Samsca)
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19
Q

what is important to monitor with Lasix for a pt with SIADH

A
  • monitor electrolytes carefully (may lose K+ and Na+)

- may need to supplement

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20
Q

what is tolvaptan (Samsca)

A
  • a med that blocks ADH effect on renal tubules = decreased water reabsorption
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21
Q

why is close monitoring required with tolvaptan

A
  • to prevent rapid correction of serum sodium lvl
22
Q

what position should a pt’s head be in if they have SIADH & why

A
  • HOB flat

- enhance venous return, increase left atrial filling pressure = reduced ADH release

23
Q

what kind of diet should a pt with SIADH have

A
  • diet high in Na and K
24
Q

how can we help prevent patients with SIADH from injury (2)? why is this important?

A
  • fluid overload and hyponatremia can cause confusion, changes in LOC, seizures, etc.

actions can include:

  • padding the rails
  • helping w ambulation
25
Q

what is an important nursing care responsibility for a pt with SIADH r/t the fluid restrictions?

A
  • oral care & ice chips

- can help relieve the thirst r/t fluid restriction

26
Q

what should be included in discharge planning for someone w chronic SIADH (5)

A
  • symptoms of fluid imbalances
  • symptoms of electrolyte (especially Na and K) imbalances
  • that ice chips and sugarless gum can help relieve thirst
  • how to plan fluid intake
  • if on diuretics, diet should be supplemented w Na and K+
27
Q

what is diabetes insipidus

A
  • conditions associated w low ADH
28
Q

what are the 3 types of causes of DI

A
  1. central
  2. nephrogenic
  3. primary
29
Q

what is central DI

A
  • DI causes by interference w ADH synthesis, transport, or release
  • such as a brain tumour, pituiatry tumour, head injury
30
Q

what is nephrogenic DI

A
  • DI caused by an inadequate response to ADH despite adequate lvls ( renal damage)
31
Q

what is a primary DI

A
  • DI caused by excessive water intake, due to a psych problem or lesion in the thirst center
32
Q

what effect does DI have on BP? urine output & how much? water intake

A
  • cause hypotension
  • polyuria –> lots of urine (5-20 L/day) with low specific gravity & is often clear
  • causes polydipsia
33
Q

what effect does DI have on Na

A
  • will cause hypernatremia
34
Q

what symptoms should nurses monitor for with DI (12)

A
  • polyuria & low specific gravity
  • high Na
  • weight loss
  • polydipsia
  • hypotension
  • tachycardia
  • dry mucous membranes and skin
  • weakness
  • NV
  • muscle cramps
  • confusion
  • hypovolemic shock
35
Q

what assessments can be used to confirm DI (3)

A
  • history
  • physical exam
  • water deprivation test (read more on in textbook)
36
Q

what is the treatment goal for pts with DI

A
  • restore fluid volume and electrolyte balance
37
Q

what does the treatment of DI depend on

A
  • the type of cause
38
Q

what is the treatment for central DI (2)

A
  • acute: give hypotonic saline to replace fluid loss

- give DDAVP (desmopressin acetate

39
Q

what is DDAVP

A
  • an analog of ADH used as a hormone replacement f/t lack of ADH
40
Q

what is the treatment for nephrogenic DI(3)

A
  • diet low in sodium
  • thiazide diuretics
  • indomethacin (a type of NSAID)
41
Q

how much sodium should a pt with nephrogenic DI have? why?

A

<3g daily

- thought to help retain water & decrease urine output

42
Q

why are thiazide diuretics given for a pt with nephorgenic DI

A
  • leads to lower GFR = increased water reabsorption
43
Q

why is indomethacin used for nephrogenic DI

A
  • increases renal response to ADH
44
Q

what should you monitor for with a pt on DDAVP (2)

A
  • waterintoxication

- hyponatremia

45
Q

what is the treatment for a pt with primary DI (2)

A
  • limit fluid intake

- treat psych disorder

46
Q

describe nursing care for someone with DI (5)

A
  • monitor I&O
  • monitor daily weights
  • monitor VS
  • ensure adequate fluid at bedside & encourage drinking (unless primary)
  • monitor effects of DDAVP
47
Q

why is it important to monitor the effects of DDAVP for a pt with DI

A
  • want to make sure its working but not too much

- monitor for under or over hydration and adjust accordingly

48
Q

what would indicate a need for increasing the dosage of DDAVP

A
  • increased urine volume with low specific gravity
49
Q

what should you monitor for with a pt on DDAVP (7)

A
  • water intoxication
  • hyponatremia
  • weight gain
  • restlessness
  • headache
  • fluid input and output
  • urine specific gravity
50
Q

what would be included in discharge teaching for a pt with chronic DI (4)

A

need instructions w self management

  • how to take DDAVP
  • signs of hyponatremia, headache, etc. could indicate overdosage
  • failure of improvement = underdosage
  • must monitor weight daily & increase in weight could = fluid retention

NURS 3512 - Class 1-6 (47 decks)

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