Exam 4 Medsurg Notes

A patient has been admitted who is suspected of having thyrotoxicosis. Which laboratory findings would confirm this diagnosis? A. very low thyroid-stimulating hormone (TSH) B. decreased T3 uptake ration C. increased serum osmolality D. decreased urine osmolality

A. very low thyroid-stimulating hormone (TSH) Hypothyroidism ↑TSH & ↓Thyroxine (T4) Hyperthyroidism (thyrotoxicosis): ↓TSH, ↑T4, & ↑T3:T4 ratio > 20 (normal T3/T4 Ratio: < 20) Medications affecting thyroid Glucocorticoids ↓Serum T3 & inhibit TSH secretion, hypothyroidism Dopamine (> 1mcg/kg/min), blocks TSH release, hypothyroidism Amiodarone iodine-rich compound, structurally similar to T3 & T4, Too much dose, possible thyroid dysfunction (hypo or hyperthyroidism) Aspirin, Furosemide, Heparin Displace T4 from binding site (protein), ↑ free T4 à hyperthyroidism

A patient has been admitted with a brain mass. The practitioner suspects it might be a pituitary tumor and orders a computed tomography (CT) scan. What area of brain should be scanned to confirm this diagnosis? a. frontal lobe b. base of skull c. temporal lobe d. anterior fossa

b. base of skull •CT of the base of the skull identifies pituitary tumors, blood clots, cysts, nodules, or other soft tissue masses. CT studies can be performed with or without radiopaque contrast. This dye may cause allergic reactions in iodine-sensitive people, and the patient must be carefully questioned about iodine allergy before the test. .•radiographic examination of the inferior skull views the sella turcica and surrounding bone formation. Bone fractures or tissue swelling at the base of the brain suggest interference with the vascular supply and nerve impulses to the hypothalamic-pituitary system. .•MRI enables the radiologist to visualize internal organs and cellular characteristics of specific tissues. MRI uses a magnetic field rather than radiation to produce high-resolution, cross-sectional images. The soft brain tissue and surrounding cerebrospinal fluid (CSF) make the brain especially suited to MRI, especially in cases of DI or SIADH.

A patient has been admitted with uncontrolled atrial fibrillation and muscle wasting. The practitioner suspects the patient may have a thyroid disorder. The nurse auscultates a bruit over the thyroid. What does this finding indicate? a. normal function b. enlargement of the thyroid c. hypoplasia of the the thyroid d. tumor of the thyroid

b. enlargement of the thyroid Auscultation of the thyroid is accomplished by use of the bell portion of the stethoscope to identify a bruit or blowing noise from the circulation through the thyroid gland. The presence of a bruit indicates enlargement of the thyroid, as evidenced by increased blood flow through the glandular tissue.

The nurse is caring for a patient with type 1 diabetes who was admitted with complaints of increased lethargy. Serum laboratory values validate the diagnosis of diabetic ketoacidosis (DKA). Which symptom is most suggestive of DKA? a. irritability b. excessive thirst c. rapid weight gain d. peripheral edema

b. excessive thirst •Malaise, headache, polyuria, polydipsia (extreme thirst), polyphagia, nausea, vomiting, extreme fatigue, dehydration, & weight loss •CNS Depression: ALOC (e.g., Coma, stupor) r/t fluid imbalance •Dehydration: flushed dry skin, dry buccal membranes, ↓ skin turgor, Sunken eyeballs, tachycardia, hypotension, Kussmaul respirations, fruity odor of acetone

A patient is admitted with hyponatremia. The practitioner suspects the patient may have syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and orders a serum ADH level for the next morning. Which medications must be stopped or withheld at least 8 hours prior to the test? a. insulin and furosemide b. morphine and carbamezepine c. digoxin and potassium d. heparin and lopressor

b. morphine and carbamezepine These medications mimic and/or increase the ADH level

The nurse has admitted a patient with hyperglycemic hyperosmolar state (HHS). Which findings would the nurse expect to observe in this patient? a. hyperglycemia with low serum osmolality b. severe hyperglycemia with minimal or absent ketosis c. little or no ketosis in serum with rapidly escalating ketouria d. hyperglycemia and ketosis

b. sever hyperglycemia with minimal or absent ketosis Epidemiology and etiology -Complication in Type 2 DM -Extremely high BG w/ hyperosmolality (àosmotic diuresis) -Ketosis: absent or mild -Diagnostic criteria: BG >600, pH > 7.3, HCO3 > 18, S-Osm >320, absent or mild ketonuria (cf. DKA: BG > 250 mg/dL, pH < 7.3, Serum HCO3 < 18 mEq/L, & moderate or severe Ketonemia) -Manifestations: visual changes, mental status changes, potentially hypovolemic shock -Causes: infection, stroke, myocardial infarction, trauma, major surgery, & stress of critical illness -Differences from DKA: Extremely ↑↑ serum glucose, profound dehydration, & minimal or absent ketosis.

A patient has been admitted with abdominal pain. The patient's fasting blood glucose is 120 mg/dL.Which statement regarding this finding is accurate? a. this is a normal finding in critically patients b. this finding is indicative of prediabetes. c. this finding is indicative of diabetes this finding is indicative of diabetic ketoacidosis

b. this finding is indicative of prediabetes. Fasting: 70-100 normal 100-125 pre > 126 diabetes >180 hyperglycemia <70 hypoglycemia <40 medical emergency 140-180 target blood glucose range Glycated Hemoglobin: <5.4% WNL, <6.5% targeted for diabetic patients, >6.5% bad

A patient is admitted with diabetic ketoacidosis (DKA). The patient's arterial blood gas indicates the patient has an uncompensated metabolic acidosis. The patient has rapid, regular respirations. Which medical intervention would the nurse expect to initiate to correct the acidosis? a. Initiate oxygen therapy via a face mask. b. Administer sodium bicarbonate. c. Administer insulin and fluids intravenously. d. Prepare for intubation.

c. Administer insulin and fluids intravenously. •The regular insulin drip is not discontinued until the ketoacidosis subsides. Insulin is given subcutaneously after glucose levels, dehydration, hypotension, and acid-base balance are normalized, and the patient is in stable condition and taking an oral diet.

A patient is admitted with hypernatremia secondary to neurogenic diabetes insipidus. The patient's serum osmolality is 350 mOsm/kg. What does this finding indicate? a. the patient is overhydrated b. the patient's serum osmolality is normal c. the patient is dehydrated d. the patient is hypothyroid

c. the patient is dehydrated Serum antidiuretic hormone (ADH) •ADH: 1 ~ 5 pg/ml (WNL) •↑Serum Osm > Release ADH à hold fluid à ↓U/O •↓Serum Osm > inhibit ADH à fluid release à ↑U/O Serum and urine osmolality •Serum Osmolality: 275 ~ 295 mOsm/kg H2O (≈ 2times of Na) •Urine Osmolality: 50-1400 depending on fluid intake

A patient is admitted with diabetic ketoacidosis (DKA). The nurse knows that the lack of insulin results in which process? a. Decreased glucagon release b. Decreased glycogenolysis c. Decreased ketone production d. Increased gluconeogenesis

d. Increased gluconeogenesis Pathophysiology Insulin deficiency >Glucagon stimulates the liver to release glucose >↑ Blood Glucose via glycogenolysis & gluconeogenesis

A patient is admitted with severe hyperglycemia. The patient is very lethargic and has a "fruity" odor to his breath. The nurse knows the odor on the patient's breath is indicative of which situation? a. Alcohol intoxication b. Lack of sodium bicarbonate c. Hypokalemia d. Presence of acetone

d. Presence of acetone DKA

A patient is reporting a headache, fatigue, abdominal pain, and blurred vision. The nurse knows that these signs may indicate the patient has what problem? a. hypothyroidism b. pituitary tumor c. cushing syndrome d. hyperglycemia

d. hyperglycemia s/s blurred vision, headache, weakness, fatigue, drowsiness, anorexia, nausea, and abdominal pain, flushed skin, polyuria, polydipsia, vomiting, and evidence of dehydration. Progressive deterioration in the level of consciousness

The nurse is caring for a patient who has been newly diagnosed with type 1 diabetes. The nurse observes that the patient is extremely dehydrated. To make this assessment, what did the nurse evaluate? A. Skin turgor B. Nail bed color C. Capillary refill D. Skin temperature

A. Skin turgor Hydration status assessment: Skin integrity, skin turgor, buccal membrane moisture. skin turgor and buccal membrane moisture. Moist, shiny buccal membranes indicate satisfactory fluid balance. Skin turgor that is resilient and returns to its original position in less than 3 seconds after being pinched or lifted indicates adequate skin elasticity. In older patients, these typical assessment findings may be absent.

A patient is admitted with diabetic ketoacidosis. The nurse requests the practitioner to order a glycosylated hemoglobin (HbA1c). What information does this test provide to the health care team? A. it is an indicator of the patients average blood glucose level over the previous 3 to 4 months. B. it compares blood glucose levels withserum hemoglobin over the previous 3 to 4 weeks. C. it is an indicator of the patient's highest blood ketone level over the past month. D. it associates the serum and urine glucose levels and is an indicator of kidney involvement.

A. it is an indicator of the patients average blood glucose level over the previous 3 to 4 months. The glycated hemoglobin test, also known as glycosylated hemoglobin (HbA1c or A1c) provides information about the average amount of glucose that has been present in the patient's bloodstream over the previous 3 to 4 months

A fasting blood glucose between 100 and 125 indicates which condition? A. A Normal Fasting Glucose B. Prediabetes/impaired fasting glucose (IFG) C. Diabetes D. Ketonemia

B. Prediabetes/impaired fasting glucose (IFG) An FPG level between 100 and 125 mg/dL (5.6 and 6.9 mmol/L) denotes IFG. An FPG level 70 to 100 mg/dL (5.6 mmol/L) signifies normal fasting glucose. An FPG level greater than 126 mg/dL (7 mmol/L) provides a diagnosis of diabetes (result is verified by testing more than once). Ketonemia refers to excessive ketones in the blood.

Low TSH and high T4 values indicate which condition? A. Diabetes B. Prediabetes C. Hyperthyroidism D. Hypothyroidism

C. Hyperthyroidism is identified by low TSH and high T4 values. Diabetes and prediabetes are indicated through fasting blood glucose. Hypothyroidism is identified by high TSH and low T4 values.

A fruity, sweet-smelling odor on the exhaled breath may indicate which condition? A. Diabetes B. Glycosylation C. Ketonemia D. Pheochromacytoma

C. Ketonemia Elevated levels of ketones (ketonemia) may be detected by a fruity, sweet-smelling odor on the exhaled breath. The odor derives from the elimination of acetone as part of the compensatory response to maintain a normal pH. B. Glycosylation: process by which the hemoglobin within each cell binds to the available blood glucose. D. Pheochromocytomas: rare tumors tha arise

Clinical signs of a rapid metabolic rate, such as high fever, tachycardia, hypertension, and tremor, are evidence of which condition? A. DKA B. SIADH C. Thyroid Storm D. Myxedema coma

C. Thyroid Storm Thyroid storm is identified by clinical signs such as high fever, tachycardia, hypertension, and tremor, as evidence of the rapid metabolic rate. The diagnostic criteria for DKA include a blood glucose concentration greater than 250 mg/dL, an arterial pH value of less than 7.3, a serum bicarbonate level lower than 18 mEq/L, and moderate or severe ketonemia or ketonuria. SIADH occurs when excess ADH (vasopressin) is released from the posterior pituitary gland. This stimulates the kidney tubules to retain water, resulting in fluid overload and hyponatremia. Myxedema coma is characterized by hypothermia, hypoventilation, bradycardia, depression, and decreased mental acuity, reflecting a slowed metabolic rate

The nurse is caring for a patient who has been newly diagnosed with type 1 diabetes. Which laboratory results would the nurse not confirming this diagnosis? A. glycated hemoglobin A1C of 3% B. absence of ketones in the urine C. presence of ketones in the blood D. Fasting glucose of 105 mg/dL

C. presence of ketones in the blood Blood Ketones (Ketonemia) Ketones: a by-product from rapid fat breakdown. High ketones in acute illness, fasting, & sustained high blood glucose in DM type 1 in the absence of insulin A. Glycated hemoglobin of 3% is WNL B. absence of ketones in the urine WNL C. Fasting glucose of 105 (prediabetes) Fasting: 70-100 normal 100-125 pre > 126 diabetes >180 hyperglycemia <70 hypoglycemia <40 medical emergency 140-180 target blood glucose range Glycated Hemoglobin: <5.4% WNL, <6.5% targeted for diabetic patients, >6.5% bad

The nurse is caring for a patient with a traumatic brain injury. The nurse suspects the patient is developing diabetes insipidus. Which test or procedures would confirm this diagnosis? A. skull radiographs B. serum glucose level C. water deprivation test D. Antidiuretic hormone (ADH) stimulation test

D. Antidiuretic hormone (ADH) stimulation test The ADH test is used to differentiate neurogenic (central) DI from nephrogenic (kidney) DI. Test results in which urine osmolality remains unchanged indicate nephrogenic DI, suggesting kidney dysfunction, because the kidneys are no longer responsive to ADH. ADH range is 1 to 5 picograms per milliliter (pg/mL). Prior to ADH measurement, all medications that may alter the release of ADH are withheld for a minimum of 8 hours. Serum ADH levels are then compared with the blood and urine osmolality to differentiate syndrome of inappropriate antidiuretic hormone (SIADH) from central diabetes insipidus (DI). Neurogenic DI: Injection of ADH then there will be a decrease in U/O and an increase in Urine Osm. Neuphrogenic DI: No change of Urine osm. due to no response from kidney. High Serum Osm will release ADH, will hold fluid and decrease U/O. Low Serum Osm will inhibit ADH, will release fluid and increase U/O.

A patient has been admitted who is suspected of having thyrotoxicosis. Which sign or symptom would support this diagnosis? A. moist, shiny buccal membranes B. presence of a headache with fatigue and weakness C. lack of visibility of the thyroid gland in the anterior neck D. presence of a bruit upon auscultation of the thyroid.

D. presence of a bruit upon auscultation of the thyroid. Bruit is an indication of an enlargement of a thyroid as evidence by increased blood flow through the glandular tissue. Auscultation of the thyroid is accomplished by the use of the bell portion of the stethoscope. A. Good hydration B. DM C. Normal size thyroid

A patient is admitted in diabetic ketoacidosis (DKA). The patient presents with dry, cracked lips and is begging for something to drink. Which reply would be the nurse's best response? a. "We can't give you anything to drink until we get your blood sugar under control." b. "You can have one cup of coffee without sugar." c. "You drink anything you want as long as its sugar free." d. "You can drink as much water has you can handle."

a. "We can't give you anything to drink until we get your blood sugar under control." •Rapid intravenous fluid replacement requires the use of a volumetric pump. Insulin is administered intravenously to patients who are severely dehydrated or have poor peripheral perfusion, to ensure effective absorption. Patients with DKA are kept on nothing-by-mouth (NPO) status until the hyperglycemia is under control.

The neuroendocrine stress response produces which findings? (Select all that apply.) a. Elevated blood pressure b. Decreased gastric motility c. Tachycardia d. Heightened pain awareness e. Increased glucose

a. Elevated blood pressure b. Decreased gastric motility c. Tachycardia e. Increased glucose The fight-or-flight response, or sympathetic nervous response, releases catecholamine that causes an increased heart rate and blood pressure. Blood is shunted form nonessential organs such as the stomach, glucose is made available to the brain cells, and pain awareness is decreased.

The nurse is managing a patient with hyperglycemia. Which findings would the nurse expect to note to support this diagnosis? (Select all that apply.) a. anorexia b. abdominal pain c. bradycardia d. fluidoverload e. change in level of consciousness f. kussmaul respirations

a. anorexia b. abdominal pain e. change in level of consciousness f. kussmaul respirations more than likely the patient with hyperglycemia will be fluid volume depleted and tachycardic s/s blurred vision, headache, weakness, fatigue, drowsiness, anorexia, nausea, and abdominal pain, flushed skin, polyuria, polydipsia, vomiting, and evidence of dehydration. Progressive deterioration in the level of consciousness

The nurse is caring for a patient with type 1 diabetes who was admitted with complaints of increasedlethargy. Serum laboratory values validate the diagnosis of diabetic ketoacidosis (DKA). Which medical intervention would the nurse expect to be ordered for this patient? a. extensive hydration b. oral hypoglycemic agents c. large doses of IV insulin d. limiting food and fluids

a. extensive hydration •Rapid intravenous fluid replacement requires the use of a volumetric pump. Insulin is administered intravenously to patients who are severely dehydrated or have poor peripheral perfusion, to ensure effective absorption. Patients with DKA are kept on nothing-by-mouth (NPO) status until the hyperglycemia is under control. Nursing management Administer fluids, insulin, and electrolytes •Rapid IV fluid replacement •Insulin administration •Add dextrose to solution when glucose falls below 200 mg/dL Monitor response to therapy •Hourly BG, I/O, V/S (BP&HR), Hemodynamic value monitoring Surveillance for complications •Fluid volume overload •Hypoglycemia (BG<70) •Hypokalemia and hyperkalemia: ECG changes •Hyponatremia •Risk for cerebral edema: LOC, Pupil reaction, Motor function •Risk for infection: repositioning, oral hygiene, Sterile technique Patient Education •Target glucose levels, Hyperglycemia, Managing insulin, DKA Collaborative management

The nurse has admitted a patient with hyperglycemic hyperosmolar state (HHS). Which medical intervention would the nurse expect to see ordered for this patient? a. rapid rehydration with intravenous fluids b. insertion of a pulmonary artery catheter c. administration of high dose intravenous insulin d. hourly monitoring of uring glucose and ketones levels

a. rapid rehydration with intravenous fluids •rapid rehydration, insulin replacement, and correction of electrolyte abnormalities, specifically potassium replacement. The underlying stimulus of HHS must be discovered and treated. The same basic principles used to treat DKA are used for the patient with HHS. •rapid rehydration to restore the intravascular volume. Physiologic saline solution (0.9%) is infused at 1 L/h, especially for the patient in hypovolemic shock if there is no cardiovascular contraindication. Infusion volumes are adjusted according to the patient's hydration state and sodium level.

A patient is admitted after surgery with a history of hyperthyroidism. The nurse suspects the patient may be developing thyroid storm. Which finding would confirm this suspicion? a. tachycardia b. hypotension c. decreased appetite d. hypothermia

a. tachycardia Excessive endogenous Life-threatening exacerbation of hyperthyroidism (thyrotoxicosis) thyroid hormone Impaired Thermoregulation: fever Heart: atrial fibrillation, supraventricular tachycardia, acute heart failure CNS: agitation, restlessness, delirium Gastrointestinal impairment: nausea, vomiting, diarrhea, unexplained jaundice, stupor, coma >Hyperactivity of cardiac tissue, nervous tissue, smooth muscle tissue, & tremendous heat production.

A patient is admitted in thyrotoxicosis. Which laboratory tests would the nurse expect to be ordered for this patient? (Select all that apply.) a. total serum triiodothyronine (TT3) b. total serum thyroxine (TT4) c. free urine thyroid-stimulating hormone d. total urine thyroxine e. thyroglobulin (Tg) f. Free thyroxine (T4)

a. total serum triiodothyronine (TT3) b. total serum thyroxine (TT4) e. thyroglobulin (Tg) f. Free thyroxine (T4) Thyroid tests include total serum thyroxine, free thyroxine, total serum triiodothyronine, free triiodothyronine, thyroid-stimulating hormone (thyrotropin), and thyroglobulin.

The nurse is caring for a patient with a head injury who has developed diabetes insipidus (DI). What medication would the nurse expect to be prescribed for the patient? a. vasopressin b. insulin c. glucagon d. propylthiouracil

a. vasopressin •Patients with central DI who are unable to synthesize ADH require replacement with ADH or an ADH analogue. The most commonly prescribed medication is the synthetic analogue of ADH, desmopressin (DDAVP). It is preferred over vasopressin (Pitressin) because it has a stronger antidiuretic action with little effect on BP. •The mainstay of therapy is to stop any medications that are inducing the ADH resistance. Nephrogenic DI is not a diagnosis encountered in critical care unless the patient is admitted with this condition. It is treated with the diuretic hydrochlorothiazide, with the dosage titration based upon the patient's antidiuretic response.

A patient has thyroid storm. The nurse is providing medication instruction for home. The patient asks"If I have a fever, should I take Tylenol or aspirin?" Which response would be the most appropriate? a. "Either one is fine because they do not affect the antithyroid medication." b. "Tylenol rather than aspirin because aspirin increases the amount of free thyroid hormone in circulation." c. "Aspirin rather than Tylenol because Tylenol increases the amount of free thyroid hormone in circulation." d. "They both prevent the antithyroid medication from working correctly. I would recommend anNSAID"

b. "Tylenol rather than aspirin because aspirin increases the amount of free thyroid hormone in circulation." •Reduction in body temperature is achieved by use of a cooling blanket and the antipyretic agent acetaminophen. Salicylates (aspirin) are contraindicated because they inhibit protein binding of T3 to T4, increasing the level of free, metabolically active thyroid hormone. Medical Management Prevent cardiovascular collapse. Reduce hyperthermia •Cooling blanket, antipyretics •No ASA use: ASA à ↑ free T3 &T4 Reverse dehydration •Glucose and isotonic solutions Pharmacologic management (Tb 23.10) •Beta-blockers: propranolol, Esmolol •Antithyroid medications: Propylthiouracil, Methimazole, Iodine, Hydrocortisone Severe cases: Plasmapheresis to remove thyroid hormone Nursing Management Medication Administration Normalize body temperature Rehydration and correction of metabolic derangements Patient education: Disease, management, not taking ASA for fever

The nurse is caring for a patient with a traumatic brain injury. Yesterday the patient weighed 62 kg and today the patient weighs 60 kg. How much fluid loss does this change in weight reflect? a. 1L b. 2L c. 4L d. 10L

b. 2L 2 kg x 2.2 lbs = 4.4 lbs •Sudden weight change (1Liter ≈ 2.2lbs)

A patient has been admitted with diabetic ketoacidosis. The nurse knows that the top priority in the initial treatment of diabetic ketoacidosis (DKA) which intervention? a. Lowering the blood sugar as quickly as possible b. Administering intravenous fluids c. Administering sodium bicarbonate d. Determining the precipitating cause

b. Administering intravenous fluids

A nurse is teaching a patient with diabetes mellitus. The patient asks the nurse what is an acceptableHbA1c level for him. What should the nurse tell the patient? a. an acceptable level is < 5.4% b. an acceptable level is < 6.5% c. an acceptable level is determined by your practitioner. d. it is depending on your age

b. an acceptable level is < 6.5% Fasting: 70-100 normal 100-125 pre > 126 diabetes >180 hyperglycemia <70 hypoglycemia <40 medical emergency 140-180 target blood glucose range Glycated Hemoglobin: <5.4% WNL, <6.5% targeted for diabetic patients, >6.5% bad

Which pathophysiologic mechanism occurs in the syndrome of inappropriate antidiuretic hormone(SIADH)? a. hemoconcentration b. dilutional hyponatremia c. massive diuresis d. hypermetabolism

b. dilutional hyponatremia >Fluid and electrolyte disturbances: Overhydration >Altered sodium balance: dilutional hyponatremia •The patient with SIADH has an excess of ADH secreted into the bloodstream, more than the amount needed to maintain normal blood volume and serum osmolality. Excessive water is resorbed at the kidney tubule, leading to dilutional hyponatremia.

Which pathophysiologic mechanism occurs in the patient with type 2 diabetes? a. lack of insulin production and excessive glucose intake b. insulin resistance and decreased insulin secretion c. overproduction of glucose and decreased metabolism d. increased uptake and decreased relase of glucose in the cells.

b. insulin resistance and decreased insulin secretion Type 2 diabetes results from a progressive insulin secretory defect in addition to insulin resistance.

A patient is admitted with severe hyperglycemia due to new-onset type 1 diabetes mellitus. The nurse notes a sweet-smelling odor on the patient's exhaled breath. What causes this phenomenon? a. metabolic alkalosis b. ketoacidosis c. glycosylation d. dehydration

b. ketoacidosis If ketoacidosis occurs, the patient's breathing becomes deep and rapid (Kussmaul respirations), and the breath may have a fruity odor. Elevated levels of ketones (ketonemia) may be detected by a fruity, sweet-smelling odor on the exhaled breath. This distinctive breath odor derives from the elimination of acetone as part of the compensatory response to maintain a normal pH.

Which nursing intervention should be initiated on all patients with the syndrome of inappropriate antidiuretic hormone (SIADH)? a. placing the patient on an air mattress b. encouraging oral fluids c. initiating seizures precautions d. applying soft restraints

c. initiating seizures precautions •Symptoms of severe hyponatremia include inability to concentrate, mental confusion, apprehension, seizures, decreased level of consciousness, coma, and death. Remove causes of SIADH Fluid restriction: 0.5-1L a day Sodium replacement: •Hypertonic solution (3% saline) over 24 hours slowly while monitoring electrolytes (Na: no more than ↑10mEq/24hrs) Medications: when water restriction does not work •Vasopressin receptor antagonistsConivaptan (Vaprisol®) Monitor side effects: e.g., hypotension Nursing management Restriction of fluids: I/O, Weight Patient education: SIADH, I/O, S/Sx to report •nursing assessments are required for care of the patient with SIADH while an attempt is made to correct the fluid and sodium imbalance; the systemic effects of hyponatremia occur rapidly and can be lethal. Fluids are restricted. Accurate measurement of I&O is required. Frequent assessment of the patient's hydration status and weight are needed. Frequent mouth care may provide patient comfort.

A patient has been admitted after surgery for removal of a brain tumor. The nurse suspects the patient may be developing diabetes insipidus (DI). Which findings would confirm the nurse's suspicion? a. hyperglycemia and hyperosmolarity b. hyperglycemia and peripheral edema c. intense thirst and passage of excessively large quantities of dilute urine d. peripheral edema and pulmonary crackles

c. intense thirst and passage of excessively large quantities of dilute urine -very dilute urination -Clinical manifestations •Increased dilute UO, Severe thirst, restlessness, agitation, ↓ reflexes, seizures, bladder distention, tachycardia, hypotension -Laboratory studies •Serum sodium > 145 mEq/L (reference: 134~145) •Serum osmolality > 295 mOsm/kg H2O (reference 275~295) •Urine osmolality < 300 mOsm/kg H2O (Reference: 300~1400) •Urine SG < 1.005 (Reference: 1.005~1.030) •Measurement of ADH (reference: 1~5 pg/mL) •Urine output: 1~1.5L/hr (reference: 1~1.5L/day)

The nursing management plan for a patient with thyrotoxicosis would include which intervention? a. providing diversional stimuli b. restricting fluids c. maintaining a quiet, restful environment d. administering thyroid supplements at the same time each day

c. maintaining a quiet, restful environment r/t agitaiton, restlessness and delirium B. they are dehydrated and need to reverse r/t fever and GI loss C. is for hypothyroidism

A patient is admitted with hypernatremia secondary to diabetes insipidus (DI). Which test would help the practitioner differentiate between central and nephrogenic DI? a. water deprivation test b. serum osmalality c. thyroid-stimulating hormone test d. antidiuretic hormone (ADH) test

d. antidiuretic hormone (ADH) test ADH test •Differentiate neurogenic DI & Nephrogenic DI with U/Osmo change Neurogenic DI: Injection of ADH > ↓ U/O > ↑ Urine Osm Nephrogenic DI: No change of Urine osmolality due to no response from kidney Serum and urine osmolality •Serum Osmolality: 275 ~ 295 mOsm/kg H2O (≈ 2times of Na) •Urine Osmolality: 50-1400 depending on fluid intake •DI (Diabetes Insipidus): ↑Urination > ↑Na, Hyperosmolar •SIADH (Syndrome of Inappropriate ADH): Oliguria >↓Na, Hypoosmolar

A patient is admitted with severe hyperglycemia due to new-onset type 1 diabetes mellitus. Which signs and symptoms obtained as part of the patient's history might indicate the presence of hyperglycemia? a. recent episodes of tachycardia and missed heart beat b. decreased urine output accompanied by peripheral edema c. periods of hyperactivity with weight gain d. increased thirst and increased urinary output

d. increased thirst and increased urinary output s/s blurred vision, headache, weakness, fatigue, drowsiness, anorexia, nausea, and abdominal pain, flushed skin, polyuria, polydipsia, vomiting, and evidence of dehydration. Progressive deterioration in the level of consciousness

The nurse is caring for a patient with type 1 diabetes who was admitted with complaints of increased lethargy. Serum laboratory values validate the diagnosis of diabetic ketoacidosis (DKA). Which statement best describes the rationale for administrating potassium supplements with the patient's insulin therapy? a. potassium replaces losses incurred with diuresis. b. the patient has been in a long term malnourished state c. IV potassium renders the infused solution isotonic d. insulin drives the potassium back into the cells.

d. insulin drives the potassium back into the cells. Low serum potassium (hypokalemia) occurs as insulin promotes the return of potassium into the cell and metabolic acidosis is reversed. Replacement of potassium by administration of potassium chloride (KCl) begins as soon as the serum potassium falls below normal. Frequent verification of the serum potassium concentration is required. The serum phosphate level is sometimes low in DKA. Insulin treatment may make this more obvious as phosphate is returned to the interior of the cell. If the serum phosphate level is less than 1 mg/dL, phosphate replacement is recommended Medical management Reverse dehydration •Immediate N/S 1L IV infusion, then Continuous infuse (200ml/hr) à D5 w/1/2N/S (0.45% NaCl) after BG of 200 Replace insulin •Initial regular insulin IV Bolus 0.1unit for kg of weight or Protocol i.e. 6 units IV Push for 60kg •Continuous drip @ 0.1 unit/kg/hr with BG Check q1hr or Protocol Reverse ketoacidosis •Via hydration & insulin Tx, glucose into cells, fat no longer converts to glucose •Bicarb is not routine Tx unless pH is < 7.0 Replace electrolytes •K replacement to be done as insulin infusion is provided Monitor electrolytes when insulin drip is on. •Phosphate replacement if needed (when < 1mg/dL)

A patient is admitted with hypernatremia secondary to diabetes insipidus (DI). The practitioner suspects the patient has nephrogenic DI. Which finding would confirm this diagnosis? a. a slight increase in urine osmolality b. a decrease in urine output c. a decrease in serum osmolality d. no change in urine osmolality

d. no change in urine osmolality ADH test •Differentiate neurogenic DI & Nephrogenic DI with U/Osmo change Neurogenic DI: Injection of ADH > ↓ U/O > ↑ Urine Osm Nephrogenic DI: No change of Urine osmolality due to no response from kidney Serum and urine osmolality •Serum Osmolality: 275 ~ 295 mOsm/kg H2O (≈ 2times of Na) •Urine Osmolality: 50-1400 depending on fluid intake •DI (Diabetes Insipidus): ↑Urination > ↑Na, Hyperosmolar •SIADH (Syndrome of Inappropriate ADH): Oliguria >↓Na, Hypoosmolar

A patient with a history of type 2 diabetes was admitted after aneurysm repair. The patient's serum glucose levels have been elevated for the past 2 days and the patient is concerned about becoming dependent on insulin. Which statement is the nurse's best response to the patient's concerns? a. this surgery may have damaged your pancreas. we will have to do more evaluation b. perhaps your diabetes was more serious from the beginning c. you will need to discuss this with your physician d. the stress on your body has temporarily increased your blood sugar levels

d. the stress on your body has temporarily increased your blood sugar levels •Major neurologic and endocrine changes occur when an individual is confronted with physiologic stress caused by any critical illness, sepsis, trauma, major surgery, or underlying cardiovascular disease.1 The normal "fight-or-flight" response that is initiated in times of physiologic or psychological stress is exacerbated in critical illness through activation of the neuroendocrine system, specifically the hypothalamic-pituitary-adrenal (HPA) axis