Posterior Pituitary Gland Disorders

SIADH early, mid, and late s/s?

- Early: thirst, dyspnea on exertion, fatigue - Mild hyponatremia: muscle cramping, irritability, headache - Late (<120 mmol/L): vomiting, abdominal cramps, muscle twitching - Later: cerebral edema, lethargy, confusion, seizure, coma

Causes of SIADH

- cancer (colorectal, lymphoid, small cell lung) - CNS disorders (brain tumors, meningitis) - drug therapy (chemotherapy, opioids) - miscellaneous conditions

DI nursing care

- early detection - maintaining adequate hydration - pt teaching for long term management

Features of SIADH are?

- fluid retention - serum hypoosmolarity - dilutional hyponatremia - hypochloremia - concentrated urine

How to monitor SIADH patient?

- intake and output - vital signs - heart and lung sounds - daily weights - monitor for signs of hyponatremia (seizures, headache, vomiting, and decrease neuro function

Manifestations of SIADH

- low urine output - increased body weight

Key features of diabetes insipidus?

- polydipsia (abnormally thirsty) - polyuria

PATHO of SIADH

1. Increased antidiuretic hormone Causing 2. Increased water reabsorption in renal tubules Causing 3. Increased intravascular fluid volume Causing 4. Dilutional hyponatremia and decreased serum osmolarity

The nurse is providing discharge instructions to a patient with diabetes insipidus. Which instruction about desmopressin acetate would be most appropriate? A. Expect to have some nasal irritation while using this drug. B. Monitor for symptoms of hypernatremia as a drug side effect. C. Report any decrease in urinary output to the health care provider. D. Drink at least 3000 mL of water per day while taking this medication.

A Desmopressin acetate is used to treat diabetes insipidus by replacing the antidiuretic hormone that the pt is lacking. Diuresis will be decreased and is expected. Inhaled desmopressin can cause nasal irritation, headache, nausea, and other signs of hyponatremia, not hypernatremia. Drinking too much water or other fluids increases the risk of hyponatremia. The patient should follow the provider's directions for limiting fluids and be taught to seek medical attention if they have severe nausea; vomiting; severe headache; muscle weakness, spasms, or cramps; sudden weight gain; unusual tiredness; mental/mood changes; seizures; and slow or shallow breathing.

The nurse is teaching a pt with acromegaly from an unresectable benign pituitary tumor about octreotide therapy. The nurse should provide further teaching if the pt makes which statement? A. "The provider will infuse this medication through an IV." B. "I will inject the medication in the subcutaneous layer of the skin." C. "The medication should decrease the growth hormone production to normal." D. "I will have my growth hormone level measured every 2 weeks for several weeks."

A Drug therapy is an option for patients whose tumors are not surgically resectable. The primary drug used is octreotide, a somatostatin analog. It reduces growth hormone (GH) levels to normal in many patients. Octreotide is given by subcutaneous injection three times a week. GH levels are measured every 2 weeks to K guide drug dosing, and then every 6 months until the desired response is obtained.

The pt with systemic lupus erythematosus is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). What interventions should be included in the plan of care? (Select all that apply.) A. Obtain daily weights. B. Limit fluids to 1000 mL/day. C. Administer diuretics as ordered. D. Monitor for signs of hypernatremia. E. Minimize turning and range of motion. F. Elevate the head of the bed at 10 degrees or less.

A, B, C, F The care for the pt with SIADH will include limiting fluids to 1000 mL/day or less to decrease weight, increase osmolality, and improve symptoms and keeping the head of the bed elevated at 10 degrees or less to enhance venous return to the heart and increase left atrial filling pressure, thereby reducing the release of ADH. Measure weights daily and maintain accurate intake and output. Monitor for signs of hyponatremia. Frequent turning, positioning, and range-of-motion exercises are important to maintain skin integrity and joint mobility.

Hormones secreted by posterior pituitary gland?

ADH and oxytocin - ADH has a key role of water balance and serum osmolarity

A patient with a head injury develops SIADH. Manifestations the nurse would expect to find include a. Hypernatremia and edema b. Muscle spasticity and hypertension c. Low urine output and hyponatremia d. Weight gain and decreased glomerular filtration rate

C

A nurse is monitoring a client who has SIADH. Which of the following findings should the nurse expect? a. Polyuria b. Dehydration c. Hyponatremia d. Hyperthermia

C Hyponatremia caused by excessive release of antidiuretic hormone (ADH). As a result of the excess ADH, the client retains water, which causes dilutional hyponatremia

A nurse is planning care for a client who has SIADH with mild manifestations. The nurse should expect the provider to prescribe which of the following medications? a. Chlorpropamide b. Tolvaptan c. Vasopressin d. Desmopressin

C Tolvaptan is a vasopressin antagonist which promotes the excretion

A nurse is caring for a client who has DI. Which of the following lab values should the nurse identify as reflecting a contraindication to receiving vasopressin to treat this disorder? a. Sodium 152 b. Potassium 6.0 c. Creatinine clearance 50 mL/min d. Aspartate aminotransferase (AST) 52 units/L

C creatinine clearance should be above 87 mL.min for female and above 107 ml/mom for male clients a clearance of 50ml.min indicates renal impairment and is a contraindication to recovering this

A nurse is caring for a client who has DI. For which of the following findings should the nurse monitor? a. Proteinuria b. Oliguria c. Polyuria d. Glycosuria

C increase urination and increased thirst are findings

Most common cause of SIADH

Cancer especially small cell lung cancer

A nurse is assessing a client who is postoperative following a craniotomy and has a urine output of 600 mL/hr. The nurse suspects the client has manifestations of diabetes insipidus (DI). Which of the following lab values should the nurse plan to obtain to assess for DI? a. BUN b. Blood glucose c. Urine ketones d. Specific gravity

D DI is caused by damage to hypothalamus or pituitary gland as a result of cranial surgery, infection, or tumor. Inadequate amount of ADH is released and results in polyuria. A low specific gravity (1.001 to 1.003 is a manifestions of DI

Hormone replacement of choice for central DI?

DDAVP - can be given orally, IV, subQ, or nasal spray

What is caused by a deficiency of production or secretion of ADH?

Diabetes insipidus (DI)

SIADH If symptoms are mild and serum sodium is greater than 125 mmol/L the only treatment is __________________?

Fluid restriction of 800 - 1000 mL/day

Provide pt with fluid restrictions with what?

Frequent oral care and distractions Ice chips Sugarless chewing gum

What may be used to promote diuresis for an SIADH pt?

Furosemide (Lasix) - serum sodium must be at least 125 because it may promote further sodium loss

A patient with diabetes insipidus excretes large or low quantities of urine?

High (2-20L/day) very low specific gravity (1.005) urine osmolarity less than 100 mmol/kg

Glands make and release chemical messengers called

Hormones

Endocrine glands include

Hypothalamus Pituitary Thyroid Parathyroid Adrenals Pancreas Ovaries Testes Pineal Gland

With sever hyponatremia (less that 125 mEq/L) small amounts of what may be given slowly?

IV hypertonic saline solution

Care for SIADH pt with altered sensorium or seizures?

Indicate seizure or fall precautions - position bed flat or no more than 10 degrees Frequent turning, positioning and range of motion exercise for skin integrity

dilutional hyponatremia (water intoxication)

Indicated by; serum sodium less than 135 serum osmolarity less than 280 mmol/kg serum specific gravity greater than 1.030

Why might a DI patient be tired?

Nocturia (trouble sleeping because voiding at night)

Syndrome of Inappropriate Antidiuretic Hormone (SIADH) results from what?

Overproduction of ADH

It is important to correct hyponatremia quickly or slowly?

SLOWLY - level should not increase by more than 8-12 mEq/L in first 24 hours. - quickly can cause osmotic demyelination syndrome with permanent damage to brain drive cells

Diagnosis of SIADH is based on what?

Simultaneous measurements of urine and serum osmolarity

What is caused by an overproduction of ADH?

Syndrome of inappropriate antidiuretic hormone (SIADH)