chapter 39 exam 1 endocrine soukup

<p>Fatigue, weakness  Excess body fat  Hyperlipidemia  Headaches  Decreased muscle and bone mass  Sexual dysfunction  Risk for cardiovascular disease  Risk for cerebrovascular disease  Decreased quality of life</p> Signup and view all the answers

<p>GH level  GH stimulation test  MRI  X-rays  Therapeutic interventions  Synthetic GH  Somatropin (humatrope)  Surgery</p> Signup and view all the answers

<p>Signs and symptoms/Complications:  Nose, jaw, brow, hands, and feet enlarge  Change in ring or shoe size  Teeth become displaced  Tongue becomes thick  Skin changes  Thickened, oily, severe acne, excessive sweating  Hoarse voice  Sleep apnea  Weight gain  Visual disturbances  Headaches  Diabetes  HTN  In women:  Galactorrhea, irregular menstrual cycles  In men:  Impotence</p> Signup and view all the answers

<p>Thickened, oily, and severe acne</p> Signup and view all the answers

<p>GH level  Bone x-rays  CT scan or MRI  History and physical exam  Treatment:  Treat cause  Surgery  Hypophysectomy  Radiation  Drug therapy- block GH</p> Signup and view all the answers

<p>Prepare patient for location of surgery &amp; what they should expect after surgery  Baseline neurological assessment  Preoperative care teaching  Teach to avoid actions that increase pressure on surgical site (example, coughing, sneezing, straining).  Teach deep-breathing exercises, incentive spirometry.  Nasal packing and mustache dressing</p> Signup and view all the answers

<p>Neurological assessment  HOB elevated at 30-degree angle- decreases ICP  Avoid vigorous coughing, sneezing, bending, straining with BM  Avoid brushing teeth for 10 days if upper lip incision  Urine for specific gravity (risk for DI)  Monitor urine output  Nasal packing and mustache dressing- (48-72 hrs. postop)  Report cerebrospinal fluid drainage  Monitor for clear leakage from nose, postnasal drip  Hormone replacement therapy with target hormones</p> Signup and view all the answers

<p>Antidiuretic Hormone (ADH)</p> Signup and view all the answers

<p>Osmolality of blood increases with dehydration and decreases with over-hydration</p> Signup and view all the answers

<p>Underproduction or inability to respond to ADH</p> Signup and view all the answers

<p>Excessive water excreted • Dehydration, decreased BP • Blood is concentrated, sodium levels high • High blood osmolality • Increased urine output, low urine osmolality, low specific gravity Hypo-Secretion: Diabetes Insipidus  Osmolality of blood increases with dehydration and decreases with over-hydration  Normal urine specific gravity- 1.005-1.03</p> Signup and view all the answers

<p>Excessive water retention • Blood diluted, sodium levels low • Low blood osmolality • Decreased urine output, high urine osmolality and high specific gravity</p> Signup and view all the answers

<p>Increased urine volume with low specific gravity............................................Deficiency of production or secretion of ADH or inability of kidneys to respond to ADH  Excretion of large volumes of dilute urine  Renal tubules are unable to reabsorb water  Polyuria, increased serum osmolality (increased serum Na+ levels)</p> Signup and view all the answers

<p>Pituitary tumor  Head trauma  Surgery  Drugs(Underproduction of antidiuretic hormone (ADH)  Unable to conserve fluids)</p> Signup and view all the answers

<p>Increased serum sodium levels</p> Signup and view all the answers

<p>Polyuria  Excretion of large quantities of urine w/ low specific gravity  Dilute urine  Polydipsia  Nocturia  Elevated serum osmolality- Hypernatremia  Dehydration  Hypovolemic shock  Decreased level of consciousness  Death</p> Signup and view all the answers

<p>riority nursing issue: Dehydration, promote fluids!  Body is putting out way too much fluid via the urine  Can cause weight loss  Lots of urine, not concentrated at all  Low specific gravity (&lt; 1.005)  Watch for decrease in BP and increase in HR</p> Signup and view all the answers

<p>Urine specific gravity &lt;1.005  Plasma osmolality (increased)  Urine osmolality  Serum sodium levels  CT or MRI  Fluid deprivation test  Glucose level</p> Signup and view all the answers

<p>Manage hydration- Free access to fluids!  Monitor pts. BP, HR, skin turgor, urine output, specific gravity, LOC  Daily weights</p> Signup and view all the answers

<p>Control w/ drug therapy (synthetic vasopressin- DDAVP)  Vasopressin should decrease the urine output  Vasopressin should concentrate urine  Therapeutic goal is maintenance of fluid and electrolyte balance  Hypotonic IV fluids  Replaces volume without extra sodium  Teach pt. about long term management  Monitor weight at home  Dietary measures  Signs/symptoms of dehydration</p> Signup and view all the answers

<p>Overproduction of Antidiuretic Hormone (ADH)  Conserve way too much fluid  Priority nursing issue: Fluid Overload-restrict fluids!  Body isn’t making nearly enough urine  Not a lot of urine, extremely concentrated  High specific Gravity (&gt; 1.030)</p> Signup and view all the answers

<p>Occurs in nervous system disorders, malignancies, pulmonary disorders, specific drugs  Most common cause is a hormone-secreting tumor (lung cancer)  Fluid retention, low serum hypoosmolality, hyponatremia, concentrated urine (specific gravity, urine osmolality increased)</p> Signup and view all the answers

<p>Signs and symptoms  Weight gain without edema  Dilutional hyponatremia (&lt;135)  Low serum osmolality  Decreased urine output  Concentrated urine &gt;1.03  Muscle cramps and weakness  High blood pressure  Headache  Brain swelling, seizures, coma, death</p> Signup and view all the answers

<p>Diagnostic tests  Serum osmolality  Urine osmolality  Urine specific gravity  Serum sodium  ADH levels  CT scan or MRI for underlying cause</p> Signup and view all the answers

<p>Therapeutic interventions  Eliminate cause  Surgical removal of tumor  Fluid restriction  Hypertonic saline IV or sodium supplements  Furosemide (Lasix)  Conivaptan (Vaprisol)- vasopressin receptor antagonist to block ADH</p> Signup and view all the answers

<p>Implement fluid restriction</p> Signup and view all the answers

<p>Nursing Management  Physical assessment- Fluid overload  Assessing changes in mental status  Protect the patient from injury- seizure precautions  Restricting fluid intake  Frequent oral care, hard candies  Obtain daily weights  Measure I&amp;O  Teaching pt. self management – do they need to restrict salt? NO – already hyponatremic!</p> Signup and view all the answers