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TL DI & SIADH
Disorders of the Pituitary Gland
| Question | Answer |
|---|---|
| Name two disorders that result from dysfunction of the posterior pituitary gland, the tissues it acts on, or the hormones it produces. | DI and SIADH |
| What is the normal function of ADH? | to cause the kidneys to reabsorb water in response to increased serum osmolality (osmoreceptors) or decreased volume (baroreceptors) in order to maintain adequate blood volume and pressure. |
| Define SIADH. | excessive amount of serum ADH causing water intoxication and hyponatremia (water – Stays In, Aint Draining H20, Syndrome of INCREASED ADH) |
| What’s happening in SIADH? | Excessive ADH in the blood activates the kidneys to retain water , excessive volume suppresses Renin release so no Aldoseterone so sodium loss resulting in water overload, cellular edema, and dilutional hyponatremia |
| Name 4 potential causes of SIADH. | Malignant tumors like oat cell cancer of the lung can secrete ADH, Damaged hypothalamus – head injury, trauma, surgery, tumor etc; Positive pressure ventilation tricks aortic baroreceptors into thinking blood volume is low, limbic system stimulation |
| What would the nurse find on assessment of the client with SIADH? | general manifestations of fluid volume excess: increased BP, crackles to auscultation, JVD, taut skin, greater intake than output |
| What are the clinical manifestations of SIADH? | headache, fatigue, anorexia, nausea, muscle aches, abdominal cramps, weight gain without edema, progressive altered LOC, seizure, coma, small amounts of concentrated urine |
| What kind of results would we expect for our client with SIADH for the following labs: urine osmolality, urine specific gravity, serum osmolality, hematocrit, BUN, and serum NA+ | Urine osmolality - increased >1,200 mOsm/kg H2O, Urine specific gravity- increased >1.032, serum osmolality – decreased <275mOsm/kg, decreased HCT, BUN, and serum sodium <135mEq/L |
| Give 8 applicable nursing diagnoses for the patient with SIADH. | Excess fluid volume; Interrupted thought processes; Acute pain; Risk for injury; Imbalanced nutrition less than; Fatigue; Deficient knowledge |
| While caring for the client with SIADH what lab values will we watch? | urine osmolality, electrolytes, hematocrit, BUN, sodium, and serum osmolality |
| What are some priority assessments of the client with SIADH? | changes in LOC, mentation, cognition, nutrition, muscle twitching, comfort, weight – daily same scale, report gain of 2 lbs in a day, I&O |
| How much fluid does 2 lbs lost or gained represent? | 1 liter |
| What will we do about fluid volume excess? | Limit fluid intake including ice chips to 800mL/day; flush enteral or gastric tubes with NS not water; monitor I&O; weigh daily |
| What interventions will address the hyponatremia associated with SIADH? | supplement sodium intake orally or by hypertonic 3% saline IV infusion (slowly), monitor serum sodium |
| What medications might the client with SIADH receive? | IV hypertonic saline (3%), Demeclocyclien (Declomycin), diuretics |
| What are some things the client with SIADH should know and do? | They should know all about SIADH and symptoms to report, that medication therapy may be lifelong depending on the cause, how to avoid excessive intake of water, weigh daily on same scale and report gain of 2lbs in a day. |
| Define Diabetes Insipidus. | excessive loss of water caused by hyposecretion of ADH or the kidney’s inability to respond to ADH resulting in polyuria and possible severe dehydration |
| Name some possible causes of Diabetes Insipidus. | Neurogenic, nephrogenic, caused by drugs (lithium carbonate or demeclocycline/Declomycin, primary -idiopathic/inherited, secondary - damage to the pituitary gland (tumors, head trauma, surgery, aneurysm, hemorrhage or cancer of the lungs or breast) |
| What happens in neurogenic DI? | because the posterior pituitary does not produce enough ADH the renal tubules excrete excessive amounts of water (DI = Draining Incessantly) |
| What happens in nephrogenic DI? | There’s plenty of ADH but the kidneys don’t respond to it. |
| What causes primary DI? | results from an inherited or idiopathic malfunction of the posterior pituitary gland |
| Name 2 drugs that alter the kidney’s response to ADH. | demeclocycline (Declomycin), Lithium carbonate |
| What are the clinical manifestations of DI? | polyuria, excessive thirst, dry tented skin, dry mucous membranes, severe hypotension leading cardiovascular collapse if water is not replaced |
| What lab results will we expect with DI for the following: urine specific gravity, urine osmolality, water deprivation test, Serum ADH if primary cause, serum sodium? | urine specific gravity – decreased <1.005, urine osmolality – decreased <300mOsm/kg, water deprivation test - positive, Serum ADH if primary cause- reduced, serum sodium – increased >145mEq |
| How is fluid volume deficit treated for the patient with DI? | oral or IV fluid replacement (D5W) |
| What is the treatment for neurogenic DI? | hormone replacement with desmopressin (DDAVP) and adjunctive chlorpropamide (Diabinese) or carbamzepine (Tegretol) |
| What are the therapeutic effects of Diabinese or Tegretol? | may act to increase ADH release or enhance the effect of ADH on the renal collecting duct |
| What is the course of treatment for nephrogenic DI? | correct the underlying disease, or stop the causative medication; begin a low-salt, low-protein diet to decrease net excretion of solute. |
| Give five applicable nursing diagnoses for the patient with DI. | fluid volume deficit; decreased cardiac output; risk for impaired skin integrity; risk for constipation; deficient knowledge |
| How often should we monitor I&O for the paitent with DI and what values should be reported? | hourly; report urine output >200mL/hr for 2 consecutive hours or 500mL over 2 hours |
| How is the amount of IV fluid delivered to the patient with DI determined? | if IV is running at 100mg/hr and client put out 300mL last hour, add 300mL to next hour input |
| What nursing interventions, other than I&0, are important to the care of a client with DI? 3 | weigh dialy, report weight loss, monitor urine specific gravity report decrease; monitor serum osmolality and sodium for increases, encourage fluid intake, use skin barriers with incontinence; administer prescribed medications |
| What medications are likely to be prescribed for DI? | desmopressin (DDAVP), chlorpropamide (Diabinese), or carbamazepine (Tegretol) |
| What does the client with DI need to know about self care? | about the disorder, how to take medications, may need life long, wear medic alert bracelet, weigh daily, consult HCP b4 OTC meds |
| What outcomes indicate that the client with DI is okay and ready to manage on their own? | intake within 500mL of output, return to client baseline weight, lab values WNL, Client wears medic alert bracelet and is informed, skin is intact, bowel habits normal, client understand medication and administration, records I&O, and weights |
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Perseverandovercome
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