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- 1Nursing diagnosis for Diabetes Insipadus 1 2 3fluid vol deficit
Decreased cardiac output
impaired tissue perfusion - 2medication for diabetes insipidus isDesmopressin DDAVP a nasal spray causes increased water resabsorption
- 3diabetes insipidus 1. deficit of what hormone 2. pt becomes ___ and what electrolyte is effected and how 3 the specific gravity is1. ADH
2 dehydrated and hyPERnatremic
3. Low - 4this type of diabetes insipidus is from renal tubules are not sensitive to ADH. this is familar in renal failurenephrogenic diabetes insipidus
- 5this type of diabetes insipidus is a result from either disruption of the hypothalmus and pitutary glands from trauma irrdiation or cranial surgery or idiopathicNeurogenic diabetes insipidus
- 6Two types of Diabetes insipidus areNeurogenic and Nephrogenic
- 7Syndrome of inappropriate antidiuretic hormone secretion Nursing Diagnosis for SAIDH are 1 2 3 4Fluid vol. excess
increased cardiact out put
fluid vol. overload
fall risk - 8Some common causes of SIADH includeMeningitis
Head injury Subarachnoid hemorrhage
Cancers Lung cancer (especially small-cell lung cancer, as well as other small-cell malignancies of other organs)
Infections Brain abscess
Pneumonia
Lung abscess
Guillain-Barré syndrome
Drugs Chlorpropamide
Clofibrate
Phenothiazine
Ifosfamide
Cyclophosphamide
Carbamazepine
Selective serotonin reuptake inhibitors (SSRIs, a class of antidepressants)
Methylenedioxymethamphetamine (MDMA, commonly called Ecstasy. SIADH due to taking ecstasy was cited as a factor in the death of Leah Betts)
Oxytocin
Vincristine
Morphine
Amitriptyline
Hypothyroidism
Sarcoidosis - 9HyPERfunction of anterior pitutary gland GH during Adulthood causes GH before pubertyAcromegaly
Gigantism - 10Drugs used for SIADS areDemeclycycline (tetracycline)
- 11Treatment and nursing practices of SIADS iskeep pt safe, restrict fluids to 1 L a day for 3 - 10 days Demecloycycline a(tetracycline) antibiotic , correct underlying cause
- 12signs and symptoms brain cells, causing neurologic symptoms including headache, changes in mental status or personalit, lethargy and irriatability, weight gain from retention of fludea with no edemaSIADA
- 13Manifestation of SIADH are usually nonspecific but are related to ___ and __ __hyponatremia and water intoxication and lung cancer
- 14what is suppressed as a result of renal excretions of sodium increasesAldosterone
- 15SIADH is most often caused by Other causes may beectopic production of ADH by maligant tumor oat cell carcinoma of lung, pancreatic carcinoma, leukemia and Hodgkins.
follow a head injury, pituitary surgery or use of medications such as barbiturates, anesthetics or diuretics - 16Treatment of addisonian crisis israpid fluid and glucorcorticoids replacement
- 17Regular symptoms of addison disease + high fever, severe pain in the abdomen, lower back pain, legs, severe vomitting, diarrhea, circulatory collapse, shock, coma this isAddisonian crisis
- 18typical symptoms of addisonsMuscle weakness and fatigue
Weight loss and decreased appetite
Darkening of your skin (hyperpigmentation)
Low blood pressure, even fainting
Salt craving
Low blood sugar (hypoglycemia)
Nausea, diarrhea or vomiting
Muscle or joint pains
Irritability
Depression
Body hair loss or sexual dysfunction in women - 19results when your adrenal glands are damaged, producing insufficient amounts of the hormone cortisol and often aldosterone as well. These glands are located just above your kidneysAddison's disease
- 20addisions disease is loss of what hormonescortisol and often aldosterone
- 21Medication for acromegaly is called ? It suppresses the anterior pituitary gland and decreases the? Side effects of the medication are1. Octreotide Sandostatin
2 GH levesl
3 GI first few weeks and 25% pt develop cholesterol gallstones in a year - 22acromegaly is treated by surgical removal or irradiation of the ? the two types of surgery are called1 pituitary tumor
2 transspheonidal or transfrontal - 23The patient is admitted to the critical care unit because of uncontrolled chest pain , radiating to the shoulder. Think about what interventions will be carried on ? What medications will be administered and why ? What laboratory tests will be done and why? What is the nurses/ yours higest priority ? What nursing diagnosis will be the highest priority ?Medication administration (ASA, nitroglycerin, morphine), O2 supplementation initially. Fibrinolysis or Percutaneous Coronary Intervention via balloon angiography and stent deployment may be indicated.
In the acute phase…
ASA: to inhibit platelet activity, and thus clot formation.
Nitroglycerin: a vasodilator, to possibly reduce chest pain and determine whether the episode is an actual MI or just angina.
Morphine sulfate: for pain relief if nitro is contraindicated or ineffective. Also, relief of anxiety.
Fibrinolytics: to dissolve clots. Patients have to qualify. Recent history of bleeding is one important exclusion criteria.
Glycoprotein IIb/IIIa Antagonists: often used in conjunction with PCI to inhibit platelet aggregation.
Long-term…
Beta blockers: to decrease incidence of ventricular arrythmias, recurrent ischemia and infarction, size of infarct, and short-term mortality.
Heparin: until the ruptured plaque has resolved.
Warfarin: in certain cases only (e.g. atrial fibrillation) to reduce recurrence. Pradaxa is a newer “replacement” for Warfarin.
ACE inhibitors: decreases afterload through vasodilation.
Statins: reduces serum cholesterol to decrease progress of atherosclerosis
CBC: RBCs, H&H could be down due to hypoxia. WBC could be up due to infection.
CK/CK-MB: indicator of myocardial injury.
Troponins: most specific indicator for myocardial damage.
Myoglobin: indicator of any muscle injury, including cardiac.
Electrolytes: could be off due to MI
Immediately, relief of pain would be the highest priority.
Acute pain - 24Sodium polystyrene sulfonate also known as Kayexalate is medication treats whatHyperkalemia Sodium polystyrene sulfonate is used to treat increased amounts of potassium in the body
- 25Manifestation of acromegalyManifestations of this include peripheral nerve damage from entrapment of nerves, headache, hypertension, congestive heart failure, seizures and visual disturbances. impaired glucose tolerance and diebetes many occure. Arthritis
- 26Signs of Large forehead, maxilla lengthens ,tongue enlarges and voice deepens. Overgrowth of bone and soft tissue in the hands and feet.Acromegaly
- 27Acromegaly usually begins duringAdulthood
- 28This occurs when GH hypersecretion begins before puberty and the closure of the epephyseal plate. Height and body proportions are relatively normal. Usually tumor involvedGiantism
- 29Nursing diagnosis with addison1 fluid volume deficit
- 30Medication for Addison is 1.coticosteroid called and used for 2. Mineralocorticoids 3 diet is1. hydrocortisone (cortef) to replace cortisol
2. fludrocortisone florinef to replace mineralocorticoids
also INcrease Sodium in diet - 31blood and urine test for Addison's 1. cortisol 2. BUN 3. sodium 4. Potassium 5. glucose 6 Urine 17-5s1. decreased
2. increased
3. decreased
4 increased
5decreased
6 low or absent
**all are decreased except for Bun and Potassium - 32Manifestation of addisons are 1.Integumentary system 2.Cardiovascular 3. Central nervous system 4. Musculoskeletal 5. Gastronintestinal system 6. reporductive 7. Metabolic effects1.Delayed wound healing and Hyperigmentation
2. postural hypotension, arrhythmias and tachycardia
3. Lethargy, tremors, emotional labilty, confusion
4. weakness, muscle wasting, joint pain, muscle pain
5. anorexia, nausea and vomiting and diarrhea
6. Menstrual changes
7. HyPERKalemia, hyPOnatremia, HyPOglycemia - 33in Addison disease results in a chronic deficiency of accompanied by age is usually more common incortisol, aldosterone, and adreanl androgens
skin pigmentations
under 60
women - 34this is a disorder resulting from destruction or dysfunctino of the adrenal cortexaddisons disease
- 35Nursing diagnosis and interventions for Cushing's syndrome isFluid volume excess because of excess cortisol
Risk for injury
Risk for infection
Distrubed body image - 36Drugs used for cushing syndrom are 1. used to treat matastic adrenal cancer 2. This is used for ectopic ACTH secreting tumors that cannot be surgicall removed 3. This durgs suppresses ACTH secretions in some clinets1. Mitotane suppresses activity of the adrenal cortes
2. Aminogluthemide or Ketoconazole or both they inhibit cortisol synthesis by the adrenal cortex
3. Somatostatin analog Octreotide suppresses ACTH secretion - 37in primary Cushing syndrome ACTH levels areDecreased
- 38in secondary cushing sydrome ACTH leves areelevated
- 39other changes in cushing syndrome are electrolytes imbalances and they are 1. calcium changes cause 2. potassium is 3.sodium is 4. risk for peptic ulcers 5 cardiovascular system changes 6. Reporductive system1. osteoporosis, compression fractures, reanl calculi
2. lost
3. retained
4. increases
5. Hypertension
6 Oligomenorrhea or amenorrhea, impotence and decreased libido - 40steroid excess inhibits fibroblast resulting in loss of collagen and connective tissue results arethinning of skin, abdominal strie red purple stretch marks, easy bruising, poor wound healing and frequent skin infections
- 41cushing syndrom obesity and redistribution of body fate is in what regionsAbdominal region, fat pads under clavical, buffalow hump over upper back and round moon face
- 42this type of cushings is from long term glucocorticoid useIatrogenic Cushing syndrome
- 43this type of cushing is resulting from excessive cortisol secretion by a benign or malignant adrenal tumor. Excess secretation supresses pituitary ACTH production, resulting in atrophy of the uninvolved adrenal cortex. Thirty two percento of cushing disease is due to excessive autonomous secretion of cortisol by adrenal glandsAdrenal form
- 44type of cushing caused by ACTH secreting tumor such as small cell lung cancerEctopic form of cushing
- 45this form of cushing is is associaqted with ACTH hypersecretation by tumor of pituitary. This si most commonly causecd by a small pitutiary adenoma with persistent but disorderly and random overproduction of ACTH. Forty three persent of cushing is due to hypersecretation of ACTH by pituitaryPituitary form
- 464 types of cushing syndrome ispituitary form, ectopic form adrenal form, and iatrogenic
- 47which is the only endocrine organ that can be palpated during physical assessmentthyroid gland
- 48When conductring a health history focused on the endocrin system, which of the following questions should be includedHave you noticed any increased signs of thirst.
- 49What assessment might be made to identify low calcium levelsTrousseaus and is done by inflating a blood pressure cuff above the antecubital area, higher than the systolic blood pressure, for two to five minutes, A positive test causes carpal spasmn and the fingers and hand will contract on the arm where the blood pressure cuff is inflated
Chvostek’stroke of face and get a nose or lip twitch - 50stroke face and get a lip twitch or nose twitch on same side of faceChvostek’stroke
- 51inflating a blood pressure cuff above the anticubital area, higher than the systolic blood pressure, for two to five minutes, A positive test causes carpal spasm and the fingers and hand will contract on the arm where the blood pressure cuff is inflatedTrousseaus
- 52Trousseaus and Chvostek’stroke used to check forHypocalcaemia low calcium
- 53what physiologic response is expected if the pituitary produces and increased amount of ADHdecreased urine out put because adh antiduret hormone helps to concentrate urine, which would decrease urin output. the adh couses the distal tubules in the kidney to reablsorb water which will concentrate the urinie
- 54extreme larg bones may indicateacromegaly
- 55ultered sensation may be seen in what three endo disordersdiabetes, hypothyroidism and acromegaly
- 56increased pigmentatin of the nails is seen in what diseaseAddisons
- 57Purple striae over the abdomen and brusing may be sinn in what syndromecushing syndrome
- 58corticosteroids Glucocorticosteroids and minerocorticosteriods have effects on endocrine areasAdreal glands the cortex
- 59What gland posterior gland stimulates retention of waterADH
- 60What posterior gland stimulates uterine contractions, milk ejection reflex in the mammary glandsOxytosin
- 61What gland stimulates development of testes and ovariesLH
- 62what gland stimulates Thyroid gland to produce hormonesTSH
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- nclex endocrine 1 Fichas sobre Untitled_2, creado por sueostermeyer el 27/09/2013.
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