Endocrine Disorders
Nursing Interventions for SIADH
- Monitor Na+ levels and - Watch for S/S seizures - Monitor I&O's and restrict fluids - Daily weights
Also known as vasopressin, regulates reabsorption of water by the kidneys, stored in the posterior pituitary
ADH (antidiuretic hormone)
In adults: Bone size increases leading to enlarged facial features, hands and feet. Long bones get wider but not longer
Acromegaly
S/S internal organs and glands enlarge, change in ring/shoe size, teeth may become displaced, enlarged tongue, visual disturbances (if tumor), DM may develop, increase in sub Q connective tissue
Acromegaly (giantism)
What causes DI? This then results in the body losing water
Decreased ADH
S/S polyuria, polydipsia, dehydration, urinates 3-15L a day, concentrated blood (increased serum osmolality), decreased BP, low urine osmolality ( dilute urine)
Diabetes Insipidus (DI)
Etiology: tumors/trauma to posterior pituitary gland, severe emotional stress, malnutrition
GH Imbalance
Diagnostic test for acromegaly
GH levels measured, CT/MRI to locate tumor if present
Diagnostic testing for Growth hormone imbalance
GH stimulation test, timing on test is important, MRI to detect tumor, genetic testing
S/S children: short 3-4ft, delayed sexual maturation, mental retardation adults: fatigue, muscle loss and bone loss, sexual dysfunction, high cholesterol, increased risk of MI/CVA, headaches, mental slowness and psychological disturbances
Growth Hormone Imbalance (Dwarfism)
Normally occurs in women over 50
Hypothyroidism
S/S everything slows down, HR slows, intolerant to cold, fatigue, mental slowness, confusion, decrease appetite and weight gain, elevated serum lipid, decreased sex drive, constipation
Hypothyroidism
s/s decreased urine output, weight gain w/o edema, concentrated urine, low blood osmolality, electrolyte imbalance causing muscle cramps/weakness cerebral edema, confusion, seizures, coma and death
SIADH symptoms of inappropriate antidiuretic hormone
Dilutional hyponatremia occurs in which disorder?
SIADH.Patients diagnosed with SIADH exhibit dilutional hyponatremia. They retain fluids and develop a sodium deficiency.
Dx for hypothyroidism
T3 and T4 low, TSH may be high or low, serum cholesterol and triglycerides high, antibodies if autoimmune disease
Etiology of DI
Tumors, Trauma, sometimes surgery, drugs such as glucocorticoids and alochol
Preop Care for Hypophysectomy
baseline neuro, pt teaching, no coughing/sneezing/straining/bending at the waist
Dilutional hyponatremia s/s
bounding pulse, elevated bp, muscle weakness, headache, personality changes, nausea, coma
Hashimoto's thyroiditis
chronic lymphocytic thyroiditis, autoimmune disorder that destroys thyroid tissue
myxedema coma
comatose state from severe hypothyroidism and low T3, T4 levels
Growth hormone
controls bone growth, cartilage and soft tissue. secreted by the anterior pituitary
central obesity common in
growth hormone imbalance
4 types of this disease, each with own etiology
hypothyroidism
Treatment of hyperthyroidism can lead to
hypothyroidism
Tx for DI
hypotonic saline solution, replacement of ADH/vasopressin, long term synthetic ADH which desmopressin (DDAVP), thiazide diuretic, hypophysectomy (if tumor, removes pituitary gland)
Nursing Diagnosis for growth hormone imbalance
ineffective health management, fatigue, deficient knowledge
Therapeutic measures for acromegaly
medications to block GH hypophysectomy
Nursing Interventions for DI
monitor daily weights (gain/loss greater than 2lbs call HCP), I&O, monitor restlessness/weakness, drop in bp and raise in pr may be hypovolemic shock
Post Op Care for Hypophysectomy
neuro assessment, check UA (DI may develop), monitor for CSF leaking, hormone therapy replacement
myxedema
nonpitting edema of the face, hands and feet
Acromegly
overproduction of GH in adults overproduction of GH in children=giantism
Diagnosing SIADH
serum sodium and osmolality are low, urine sodium and osmolality are high, serum ADH high
Post Op Teaching for hypophysectomy
small amount of bloody mucous, blow nose gently, stool softeners, cough suppressants
Dx testing for DI
specific gravity <1.005, sodium levels appear high, plasma osmolality (high/concentrated) , CT/MRI, check glucose to rule out DM, after hypertonic saline or fluid restriction adh should be in the blood if ADH is not elevated than positive
Therapeutic Measures for growth hormone imbalance
surgery if tumor present synthetic GH
Treatment of hypothyroidism
thyroid hormone replacement
Treatment for SIADH
underlying cause, surgical removal of tumor, restricting fluids 800-1000mL daily helps symptoms, furosemide (lasix), conivaptan (vasopril)