Drink more water
Decreased urinary output, specific gravity greater than 1.025, weight gain without edema, serum osmolality less than 280 mOsm/kg or mmol/kg, dilutional hyponatremia
What are symptoms of SIADH?
Truncal obesity, moon face, striae, osteoporosis, delayed wound healing, bronze skin.
What are the symptoms of Cushing's Disease?
Hashimoto’s thyroiditis
What is another name for primary hypothyroidism?
High blood pressure, Weight loss, Sleeping difficulty, exophthalmos, Confusion, Irregular menstrual cycle, Fatigue, Goiter, Sweating, Nervousness, Irritability, Shaky hands, Fast heartbeat
What are the symptoms of hyperthyroidism?
Demeclocycline (Declomycin) may be prescribed for patients with this disorder.
What is SIADH?
500 ml
What is the recommended daily fluid restriction for patients with SIADH who have a serum sodium of 120 mmol/L or less (severe hyponatremia)?
Muscle weakness, fatigue, weight loss, low blood pressure, hyponatremia, hyperpigmentation, hyperkalemia, orthostatic hypotension
What are the clinical manifestations of Addison's Disease?
Fatigue, Increased sensitivity to cold, Constipation, Dry skin, Weight gain, Puffy face, Hoarseness, Impaired memory, Slowed heart rate, Depression
What are the symptoms of hypothyroidism?
Too much thyroid hormone circulating in the body
Thyrotoxicosis
Benign pituitary adenoma, ectopic hormonal syndrome associated with malignancy (especially small cell lung cancer)
What are risk factors for developing SIADH?
Excrete large quantities of dilute urine with specific gravity less than 1.005.
What is symptoms of patients with Diabetes insipidus?
Lifelong exogenous replacement of glucocorticoid and possibly lifelong replacement of mineral corticoid
What is the treatment for Addison’s Disease?
What is the crisis state of hypothyroidism?
Myxedema coma
circumoral paresthesias, paresthesias of the fingers and toes, dysphagia, a constricted feeling in the throat, laryngospasms, muscle twitching, feelings of apprehension
What are the signs of tetany?
EKG changes seen in the crisis state of this condition include peaked T waves, widening QRS complex, prolonged PR interval
What is Addison’s Disease?
What is nursing care for the patient with SIADH (or at risk for SIADH)?
Monitor serum sodium and urine specific gravity, careful monitoring of vital signs, I and O, daily weights. Heart and lung sounds assessed, watch for headache, vomiting, seizures, and decreased neurologic functioning.
Important patient teaching for the patient with Addison’s disease.
What is control stress and increase glucocorticoids during times of stress? Monitor BP and weight; report hypotension and weight loss greater than 2 pounds/week. Avoid infection and report any signs of infection. Wear a medic alert bracelet. Keep regularly scheduled health care appointments. Report signs of Cushing's Disease.
Imprecise kill with radioactive iodine therapy, subtotal thyroidectomy. (Overtreatment of hyperthyroidism)
What are the common causes of hypothyroidism?
What are the three primary means of decreasing circulating thyroid hormone levels in the patient with hyperthyroidism?
(1) Use of antithyroid drugs like methimazole (Tapazole) or propylthiouracil (PTU); (2) radioactive iodine treatment (RAI); or (3) thyroid surgery (subtotal thyroidectomy is most common).
Home management for individuals with this disorder includes maintaining a prescribed fluid restriction and monitoring daily weights, diet may be supplemented with sodium, and foods that are high in potassium may also be recommended.
What is SIADH?
List 3 strategies to help the patient tolerate the discomfort of fluid restriction?
use of ice chips sparingly - must calculate into fluid restriction, chewing gum, sucking on hard candies, frequent oral cares, diversional activities.
What are ongoing assessments the nurse makes in caring for the patient with Cushing’s syndrome and what is the rationale for these assessments?
(1) Vital signs, particularly BP (because of mineral corticoid excess, may need antihypertensives) (2) Daily weights (mineral corticoid excess Na and water retention) (3) S/S infection (glucocorticoid effect, depressed immune response) (4) pain assessment (glucocorticoid effect, osteoporosis risk of pathologic fracture) (5) S/S thromboemboli (glucocorticoid effect, hypercoagulable state) (6) Glucose monitoring (glucocorticoid effect, hyperglycemia) (7) changes in mental ststus (glucocorticoid effect, psychosis, mood disturbances) (8) S/S hypokalemia (mineral corticoid effect, excess in the mineral corticoid aldosterone; aldosterone causes a patient to hold Na and Water and excrete K+).
What teaching should the nurse provide to the patient who is newly prescribed levothyroxine?
Levothyroxine should be taken first thing in the morning on an empty stomach; report the following: chest pain, weight loss, nervousness, tremors, and/or insomnia and palpitations or rapid or irregular heart rate/rhythm.
What is the best diet for the person with thyrotoxicosis?
high calorie, high CHO, high PRO, low fiber, and low caffeine
For the patient with this disorder who can’t consume an adequate amount of oral fluids to keep up with urinary losses, hypotonic saline is given IV.
What is diabetes insipidus?