Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
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,Epidemiology: Disorder related to an increase in ADH. No relationships
with race, ethnicity, sex, or age.
Pathophysiology: Hyponatremia develops that is secondary to
hemodilution.
Clinical Manifestations: Primarily related to the resultant hyponatremia
(nausea, headache, confusion, and fatigue).
Management: Focused on treating the hyponatremia. Diuretics may be
administered to increase urine output.
Complication: Neck vein distention
Restrict fluids
Patho: Excessive secretion of ADH
Causes: Malignacies, CNS conditions (trauma, stroke, infections),
pdisorders, and medications (diuretics, antidepressants,
nicotine)
Clinical: Brain edema and coma is secondary to hyponatremia, ICP,
seizures. decreased urinary output, no edema
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Labs Increased urininary osmolality (500-850), decreased serum osmolality
(285-295) and hyponatremia, hypouricemia, low BUN DX Clinical and LABs
Identify and eliminate the underlying cause. Fluid restriction in asymtomatic
clients
Medical TX: Clients with severe hyponatremia.: IV 3% sodium chloride, IV
slowly with pump. Fast sodium relacement can cause demyelination and
permanent damage of the CNS(central pontine mylelonlysis( CMP))
diuretics furosemide IV to decrease intravascular fluid volume monitoring
fluid intake ( less than 800 mL/day)
Nursing Interventions: Daily weght, blood chemestries, neurologic status
(ID CMP: decreased level of consciousness) Monitor sodium levels every 6
hours Cardiopulmonary status ( signs of hypervolemia)
Low sodium, increased urine osmolality, high urine sodium, and increased
urine specific gravity.
, What manifestations are exhibited with excessive levels of antidiuretic
hormone? Hyponatremia and decreased urine output.
Hypoparathyroidism
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Patho: Lack of parathyroid hormone (PTH); calcium is not mobilized from
the bones, conserved in the
kidneys, or absorbed in the small intestines. Hypocalcemia is the primary
disorder (low calcium in the blood). Activated vitamin D leads to calcium
absorption in the intestines.
Causes: Vitamin D deficiency, hypocalcemia, hyposecretion, cancer (head
and neck), surgical removal, secondary to iodine therapy for
hyperthyroidism, and autoimmune diseases (Diabetes).
Clinical: Numbness and tingling around the mouth or in the hands and feet,
severe muscle cramps,
spasms of the hands and feet, and tetany. Positive Chvostek sign (twitching
fo facial muscles) and Trousseau sign (carpopedal spasm caused by
inflating a blood pressure cuff) are associated with an increased risk of
tetany that can result in laryngospasm and airway compromise. QT interval
prolongation and resistance to digitalis linked to loss of inotropic effect.
Hypoparathyroidism
Labs: Low serum calcium levels, high serum phosphate levels, and low
serum PTH levels. Low serum
magnesium levels inhibit synthesis of PTH, serum albumin levels are
monitored because the majority of serum calcium is plasma protein bound
(check ionized (free) calcium).
DX: Chvostek sign, Trousseau sign, xray of bones, and clinical
manifestations.
Hypoparathyroidism
Medical TX: Based on whether the presentation is acute or insidious and
focuses on raising serum calcium
levels. Calcitrol, calcium gluconate or calcium chloride, magnesium,
Vitamin D, diet high in calcium and low in phosphorus, and thiazide diuretic
, (hydrodiuril).
Nursing Interventions: Monitor for tetany (involuntary contraction of
muscles), seizures, difficulty breathing, monitor cardiac rhythm, and
administer medications as needed (Calcium and Vit D).
Vit. D is needed for calcium absorption.
Leukemia
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Give this one a try later!
,Epidemiology: Disorder related to an increase in ADH. No relationships
with race, ethnicity, sex, or age.
Pathophysiology: Hyponatremia develops that is secondary to
hemodilution.
Clinical Manifestations: Primarily related to the resultant hyponatremia
(nausea, headache, confusion, and fatigue).
Management: Focused on treating the hyponatremia. Diuretics may be
administered to increase urine output.
Complication: Neck vein distention
Restrict fluids
Patho: Excessive secretion of ADH
Causes: Malignacies, CNS conditions (trauma, stroke, infections),
pdisorders, and medications (diuretics, antidepressants,
nicotine)
Clinical: Brain edema and coma is secondary to hyponatremia, ICP,
seizures. decreased urinary output, no edema
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Labs Increased urininary osmolality (500-850), decreased serum osmolality
(285-295) and hyponatremia, hypouricemia, low BUN DX Clinical and LABs
Identify and eliminate the underlying cause. Fluid restriction in asymtomatic
clients
Medical TX: Clients with severe hyponatremia.: IV 3% sodium chloride, IV
slowly with pump. Fast sodium relacement can cause demyelination and
permanent damage of the CNS(central pontine mylelonlysis( CMP))
diuretics furosemide IV to decrease intravascular fluid volume monitoring
fluid intake ( less than 800 mL/day)
Nursing Interventions: Daily weght, blood chemestries, neurologic status
(ID CMP: decreased level of consciousness) Monitor sodium levels every 6
hours Cardiopulmonary status ( signs of hypervolemia)
Low sodium, increased urine osmolality, high urine sodium, and increased
urine specific gravity.
, What manifestations are exhibited with excessive levels of antidiuretic
hormone? Hyponatremia and decreased urine output.
Hypoparathyroidism
Give this one a try later!
Patho: Lack of parathyroid hormone (PTH); calcium is not mobilized from
the bones, conserved in the
kidneys, or absorbed in the small intestines. Hypocalcemia is the primary
disorder (low calcium in the blood). Activated vitamin D leads to calcium
absorption in the intestines.
Causes: Vitamin D deficiency, hypocalcemia, hyposecretion, cancer (head
and neck), surgical removal, secondary to iodine therapy for
hyperthyroidism, and autoimmune diseases (Diabetes).
Clinical: Numbness and tingling around the mouth or in the hands and feet,
severe muscle cramps,
spasms of the hands and feet, and tetany. Positive Chvostek sign (twitching
fo facial muscles) and Trousseau sign (carpopedal spasm caused by
inflating a blood pressure cuff) are associated with an increased risk of
tetany that can result in laryngospasm and airway compromise. QT interval
prolongation and resistance to digitalis linked to loss of inotropic effect.
Hypoparathyroidism
Labs: Low serum calcium levels, high serum phosphate levels, and low
serum PTH levels. Low serum
magnesium levels inhibit synthesis of PTH, serum albumin levels are
monitored because the majority of serum calcium is plasma protein bound
(check ionized (free) calcium).
DX: Chvostek sign, Trousseau sign, xray of bones, and clinical
manifestations.
Hypoparathyroidism
Medical TX: Based on whether the presentation is acute or insidious and
focuses on raising serum calcium
levels. Calcitrol, calcium gluconate or calcium chloride, magnesium,
Vitamin D, diet high in calcium and low in phosphorus, and thiazide diuretic
, (hydrodiuril).
Nursing Interventions: Monitor for tetany (involuntary contraction of
muscles), seizures, difficulty breathing, monitor cardiac rhythm, and
administer medications as needed (Calcium and Vit D).
Vit. D is needed for calcium absorption.
Leukemia
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