SIADH
The patient is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). What manifestation does the nurse expect to find?
Decreased urinary output
The client is admitted to rule out Cushing’s syndrome. Which laboratory tests should the nurse anticipate being ordered?
Plasma levels of ACTH and Cortisol
The nurse is admitting a client diagnosed with primary adrenal cortex insufficiency (Addison’s disease). Which clinical manifestations should the nurse expect to assess?
Bronze pigmentation of the skin, Hypotension, Anorexia, Muscle weakness, Lethargy, etc.
In diabetes insipidus, what hormone and organ is mostly affected?
Deficiency of ADH + kidney and hypothalamus/pituitary gland
Name 2 important reminders about steroid use.
--Need to be tapered off
-- Increased risk of bone fractures/osteoporosis
-- Increased blood glucose
-- Increased risk of infection (low WBC)
-- Stress/surgery needs to increase dose
-- Sight is affected, risk of cataracts = Recommend frequent optometrist visits
-- Increase in swelling = increase weight
What is the most common cause of SIADH?
Small Cell Carcinoma of the Lung
The nurse writes a problem of “altered body image” for a 34-year-old client diagnosed with Cushing’s disease. Which intervention should be implemented?
Use of therapeutic communication to allow the client to discuss feelings.
The nurse is planning the care of a client diagnosed with Addison’s disease. What education regarding medications should be included?
Do not stop abruptly, increase amount during times of high stress, lifelong medication (not a cure)
Select the following correct signs and symptoms related to diabetes insipidus:
Glucose in the urine
Polyuria
Extreme sweating
Polydipsia
Polyuria
Polydipsia
The nurse is caring for clients on a medical floor. Which client should be assessed first?
*Muscle twitching is an early warning sign of electrolyte imbalance, this increases the patients risk of seizure activity occuring
What are 3 expected findings when completing an assessment on a patient with SIADH?
A 37-year-old patient is being admitted with a diagnosis of Cushing syndrome. Name 4 findings the nurse can expect to find during the assessment.
Striae (on the abdomen), moon face, trunkal obesity, weight gain, increased oiliness of the face, buffalo hump
Why is it important for a patient to disclose signs and symptoms of complications such as under replacement of corticosteroid hormones?
Risk of Addisonian crisis
A patient recently came into the clinic with extreme thirst and urine output. Urinalysis testing was completed and the USG came back as 1.025. The patient has consumed more than 5 L of liquids. Name 2 assessments in your head to toe assessment you would complete for this patient
Check skin turgor
Check mucus membranes
Complete neuro assessment
Assess pedal/radial pulses
A patient is admitted to the community health clinic with the following signs/symptoms:
sudden pain in the stomach, back and legs, recent vomiting and diarrhea multiple times a day for the last 2-3 days. She stated she had to leave the country suddenly last week due to a death in the family and has not felt ‘right’ since. Upon further probing, she stated she had severe weakness and fatigue, as well as slurred speech and confusion. State 3 priority assessments you would perform on this patient
Blood sugar check
Blood pressure check
Cardiac assessment
Neuro assessment
Skin turgor check
In the condition of SIADH, is ADH released in excessive amounts, or insufficient amounts?
SIADH is a condition of hyperfunctioning of the posterior pituitary gland in which EXCESS ADH is released, but not in response to the bodies need for it.
Describe one of the common causes of Cushing’s syndrome.
Use of corticosteroid medications, Excessive glucocorticoid production, Tumor of the pituitary gland (bronchogenic carcinoma)
What would the recommended diet be for a patient with Addison’s Disease?
High in protein and carbohydrates
Take calcium and Vitamin D supplements to aid in corticosteroid induced osteoporosis
Explain how the water deprivation test is performed
Withholding fluids for 8-12 hours or until 3-5% of the body weight is lost. The patient is weighed frequently throughout the test, and plasma + urine osmolality studies are performed at the beginning and the end of the test.
After your assessment is performed, you begin to ask the patient about prior medical history. The patient states they have been prescribed corticosteroid therapy and had a hypophysectomy 3 months ago. Patient stated when she left she only took “the clothes on her back”. Based on your previous knowledge of steroid use, what ques are recognized based off this patients statement that could pertain to this patients plan of care?
A: Abrupt stop of steroid use due to forgetting to take meds when leaving town
During nursing care of the SIADH patient, what nursing interventions should be implemented in the patient's care plan? Name at least 4.
The client diagnosed with Cushing’s disease has developed 1++ peripheral edema. The client has received intravenous fluids at 100 mL/hr via IV pump for the past 79 hours. The client received intravenous piggyback (IVPB) medication in 50 mL of fluid every six (6) hours for 15 doses. How many mL of fluid did the client receive?
The client has received 8,650 mL of intravenous fluid.
List lab values that indicate a patient may have acute adrenal insufficiency
Decrease in serum sodium levels (<135), Decrease in blood glucose., Increase in serum potassium levels (>5.0), Leukocytosis, Increased morning plasma ACTH (>60 pg/mL), Decreased Morning Cortisol (<5 mcg)
What is the main goal of treatment in a patient with DI? Name one medication used to achieve this goal
ADH replacement.
[Desmopressin, Vasopressin{DDAVP}, Chlorpropamide/Diabinese]
The patient has confirmed Addisonian Crisis. What orders would you expect the patient to be put on for efficient treatment?
Corticosteroids (IV push)
IV fluids
Dextrose fluids if hypoglycemic