DI
This hormone is deficient or ineffective in diabetes insipidus.
ADH (Antidiabetic Hormone)
ADH is secreted by the posterior pituitary gland and
ADH is released in excess due to hyperfunctioning of which gland?
Posterior pituitary gland
Insufficient production of which glucocorticoid and mineralocorticoid?
glucocorticoid = cortisol
mineralcorticoid = aldosterone
both secreted from adrenal cortex
Metabolic disorder resulting in excess secretion of what?
Cortisol
*can also be caused by large doses of glucocorticoids x weeks or longer
Which thyroid hormone is low, and which is elevated?
T4 (thyroxine) is LOW
TSH is ELEVATED
Which hormones are hyper secreted?
Is total or subtotal preferred?
Subtotal
Common cause of HYPOparathyroidism is...
Thyroidectomy involving removal of parathyroid gland
Onset?
HHS = gradual
DKA = sudden
Assessment findings in DI
Excretion of large amounts of DILUTE urine, polydipsia, LOW urine specific gravity
What are common causes of SIADH?
trauma, stroke, malignancies, meds, stress
Which electrolyte imbalance is associated with deficient aldosterone?
HYPOnatremia and HYPERkalemia
Other causes of Cushing's disease related to pituitary gland?
Which medication is most commonly prescribed for this disorder?
levothyroxine
Common cause of HYPERthyroidism is...
Grave's disease
What should be kept at the bedside postop?
O2, suction, emergency trach set
Controlled by parathyroid gland; signals bones to release Ca, intestines to absorb more Ca from foods, and kidneys to prevent Ca from being lost in urine
DKA = Ketosis, Kussmaul's, 3 Ps
If ADH deficiency is SEVERE or CHRONIC, which medication will be adminsitered?
Vasopressin or desmopressin (DDAVP)
Common electrolyte imbalance associated with SIADH?
HYPOnatremia (dilutional)
Patient education related to pharmacological interventions to treat Addison's?
Never stop abruptly
Expected assessment findings?
truncal obesity, moon face, buffalo hump, thin arms/legs
Symptoms of hypothyroidism include...
fatigue, weakness, cold intolerance, weight gain, dry skin, brittle hair, myxedema (general puffiness around eyes/face)
Symptoms of HYPERthyroidism include...
nervousness, fine tremors, heat intolerance, weight loss, dysrhythmias, exophthalmos, goiter
Signs of laryngeal nerve damage?
airway obstruction, high pitched voice, stridor, dysphagia, restlessness
Key electrolyte imbalance with HYPOparathyroidism?
HYPOcalcemia and HYPERphosphatemia
*sx = Chvostek's, Trousseau's, tetany
Serum glucose lab value? Ketones present?
HHS = > 800 mg/dL; NO KETONES
DKA = > 300 mg/dL; YES KETONES
Priority complication of untreated DI?
Severe dehydration/Hypovolemic shock
Why is environmental safety important in SIADH patients?
Risk for AMS and seizures
Symptoms of Addison's crisis?
Severe HA, abdominal/leg/back pain, irritability, confusion, severe HYPOtension, shock
What post-op complication should the nurse monitor for if the patient has an adrenalectomy?
OR hemorrhage due to the vascularity of adrenal glands
If left untreated, which complication can occur?
myxedema coma
Life-threatening complication associated with uncontrolled hyperthyroidism?
Thyroid storm
*can be caused by manipulation of thyroid gland during surgery
Which electrolyte imbalance can occur?
HYPOcalcemia (due to damage to parathyroid gland)
HYPERcalcemia and HYPOphosphatemia
*sx may include pathological fx, skeletal muscle pain, cardiac dysrhythmias
Bicarb (HCO3-) level?
HHS = > 20
DKA = < 15
A client taking desmopressin reports headache, weight gain, and decreased urine output. What should the nurse suspect?
Which type of IV solution may be prescribed and nursing implications for infusion?
HYPERtonic (3% NaCl)
Infuse SLOWLY and monitor neuro status and Na levels
How will steroids be administered during Addison's crisis?
Parenteral - mainly Intravenously
If patient has bilateral adrenalectomy, which medications will they be on life-long?
HYPOtension, BRADYcardia, HYPOthermia, HYPOglycemia, COMA
*maintain airway, administer levothyroxine intravenously,
Medications prescribed during thyroid storm?
antithyroids (methimazole, propylthiouracil)
iodides (inhibit release of thyroid hormone)
beta blockers
glucocorticoids
Which medication will be prescribed for tetany (if it occurs)?
Calcium gluconate
*tetany = involuntary muscle spasms/twitching r/t nerve hyperexcitability
Treatment for HYPOparathyroidism and HYPERparathyroidism?
HYPOparathyroidism = Ca + Vit D, phosphate binders to lower Ph levels
HYPERparathyroidism = calcitonin (decreases skeletal muscle Ca release and increases renal excretion of Ca); parathyroidectomy (same precautions as thyroidectomy)
Which insulin is used in the treatment of both?
Short-acting, Regular insulin