FINAL EXAM STUDY GUIDE (PROFESSIONAL NURSING II )
1) Nursing assessment, clinical manifestations, treatment for a patient with
(SIADH).
SIADH: Syndrome of inappropriate antidiuretic hormone: is an excess of ADH;
results in retention of water, which dilutes the bloodstream =more hypotonic (less
concentrated than blood).
Medications that stimulate ADH release: thiazides, phenothiazines, and opioids.
Other: Severe pain and emotional stress. Endocrine diseases (adrenal
insufficiency, hypopituitarism)
- Hyponatremia = causes Cerebral Edema
- s/s: ↑ ICP and cerebral edema – this is primary cause of clinical
manifestations
- Early: headache(not relieved by analgesics), weakness, muscle cramps,
wt. gain
- Later: personality changes, hostility, sluggish reflexes. N/V/D
- Impending crisis: confusion, lethargy, change in respirations
- Na = 110: Seizures may occur, and coma
- Daily weights, restrict fluids (600-1200mL/day)
- Give sodium supplements, mannitol(osmotic diuretic ↓swelling of brain) and
loop diuretics to get rid of fluids
- Demeclocycline is abx that ↓ availability of ADH
- Fluid volume over load: FLUIDS GIVEN: NaCl 9%
- if acute symptomatic hyponatremia – NaCl 3% rate not to exceed
50mL/hr or pt will be at risk for fluid overload/HF
2) Nursing assessment and clinical manifestations for Diabetes Insipidus
DI: Occurs d/t an insufficiency of ADH (central DI), or loss of sensitivity of the
nephrons of the kidney to the circulating ADH.
Insufficient ADH = kidney cannot concentrate urine =polyuria, hypothalamus
induces polydipsia.
Central DI – common after surgery for tumors of hypothalamus or pituitary gland
(If Pt is unconscious: RISK severe dehydration and hypovolemia)
- s/s: Extreme thirst (polydipsia), Excessive urination (2.5-20L/day), wt loss,
will want to eat all the time, High HR, hypovolemia
- Urine osmolarity ↓50-100, Urine specific gravity 1.001 -1.005, serum
osmolarity ↑>300
- Hypernatremia, Hypercalcemia, and HYPOkalemia
- Monitor HR and BP
, - PRIORITY Give fluids (Volume replacement) Hypotonic Solution (NaCl
0.45%) Flow rate ordered to match urine output
- Medications (ADH replacement) – Vasopressin, Desmopressin Acetate
(Nasal spray or PO)
3) Nursing assessment/findings and medical treatment for a patient with
increasing ICP.
Decreased LOC -
Abnormal respiration patterns
Pupils asymmetrical/Dilated – compression of cranial nerve 3 – dilation of same
side (ipsilateral).
- Sluggish, OR no response
Projectile vomiting (not preceded by nausea)
Sudden increase in urinary output
Hemiplegia/decorticate or decerebrate posturing
Late sign is Cushing’s triad: changes in breathing/decreased), widening pulse
pressure (Systolic↑ – diastolic↓), Bradycardia
Medical Tx:
- Osmotic Diuretic: Mannitol, Anti-seizure: Phenytoin (Dilantin),
Corticosteroids: dexamethasone, H2 receptor blocker: Cimetidine
(Tagamet), PPI: prevent GI Bleed/ulcer
- Elevate HOB 30 degrees, low lights, low stimulation enviornment
4) Types of strokes/ manifestations/treatment/risk factors
- Hemorrhagic: blood vessel in brain bursts, leaks blood into brain tissue or
surrounding spaces
(10% strokes are hemorrhagic – more likely to die from this stroke)
- S/s: Severe headache, high BP, N/V
- Subarachnoid - bleeding between the arachnoid meninges covering the brain
and the skull, but blood does not invade the brain tissue.
- Intracerebral hemorrhage occurs when blood enters the brain tissue after a
blood vessel ruptures. This can be caused by an aneurysm
- Ischemic: damage to brain d/t clogged artery/blood vessel – brain tissue supplied
by it dies.
(87% of strokes are ischemic)
- s/s: Weakness or paralysis, Blurred vision, inability to maintain balance,
slurred speech, dizziness, memory deficits
- Thrombus: blood clot that blocks a blood vessel
- Embolus (Emboli – multiple clots) – blood clot or plaque that breaks loose
and blocks a smaller blood vessel in the brain (atherosclerosis).
1) Nursing assessment, clinical manifestations, treatment for a patient with
(SIADH).
SIADH: Syndrome of inappropriate antidiuretic hormone: is an excess of ADH;
results in retention of water, which dilutes the bloodstream =more hypotonic (less
concentrated than blood).
Medications that stimulate ADH release: thiazides, phenothiazines, and opioids.
Other: Severe pain and emotional stress. Endocrine diseases (adrenal
insufficiency, hypopituitarism)
- Hyponatremia = causes Cerebral Edema
- s/s: ↑ ICP and cerebral edema – this is primary cause of clinical
manifestations
- Early: headache(not relieved by analgesics), weakness, muscle cramps,
wt. gain
- Later: personality changes, hostility, sluggish reflexes. N/V/D
- Impending crisis: confusion, lethargy, change in respirations
- Na = 110: Seizures may occur, and coma
- Daily weights, restrict fluids (600-1200mL/day)
- Give sodium supplements, mannitol(osmotic diuretic ↓swelling of brain) and
loop diuretics to get rid of fluids
- Demeclocycline is abx that ↓ availability of ADH
- Fluid volume over load: FLUIDS GIVEN: NaCl 9%
- if acute symptomatic hyponatremia – NaCl 3% rate not to exceed
50mL/hr or pt will be at risk for fluid overload/HF
2) Nursing assessment and clinical manifestations for Diabetes Insipidus
DI: Occurs d/t an insufficiency of ADH (central DI), or loss of sensitivity of the
nephrons of the kidney to the circulating ADH.
Insufficient ADH = kidney cannot concentrate urine =polyuria, hypothalamus
induces polydipsia.
Central DI – common after surgery for tumors of hypothalamus or pituitary gland
(If Pt is unconscious: RISK severe dehydration and hypovolemia)
- s/s: Extreme thirst (polydipsia), Excessive urination (2.5-20L/day), wt loss,
will want to eat all the time, High HR, hypovolemia
- Urine osmolarity ↓50-100, Urine specific gravity 1.001 -1.005, serum
osmolarity ↑>300
- Hypernatremia, Hypercalcemia, and HYPOkalemia
- Monitor HR and BP
, - PRIORITY Give fluids (Volume replacement) Hypotonic Solution (NaCl
0.45%) Flow rate ordered to match urine output
- Medications (ADH replacement) – Vasopressin, Desmopressin Acetate
(Nasal spray or PO)
3) Nursing assessment/findings and medical treatment for a patient with
increasing ICP.
Decreased LOC -
Abnormal respiration patterns
Pupils asymmetrical/Dilated – compression of cranial nerve 3 – dilation of same
side (ipsilateral).
- Sluggish, OR no response
Projectile vomiting (not preceded by nausea)
Sudden increase in urinary output
Hemiplegia/decorticate or decerebrate posturing
Late sign is Cushing’s triad: changes in breathing/decreased), widening pulse
pressure (Systolic↑ – diastolic↓), Bradycardia
Medical Tx:
- Osmotic Diuretic: Mannitol, Anti-seizure: Phenytoin (Dilantin),
Corticosteroids: dexamethasone, H2 receptor blocker: Cimetidine
(Tagamet), PPI: prevent GI Bleed/ulcer
- Elevate HOB 30 degrees, low lights, low stimulation enviornment
4) Types of strokes/ manifestations/treatment/risk factors
- Hemorrhagic: blood vessel in brain bursts, leaks blood into brain tissue or
surrounding spaces
(10% strokes are hemorrhagic – more likely to die from this stroke)
- S/s: Severe headache, high BP, N/V
- Subarachnoid - bleeding between the arachnoid meninges covering the brain
and the skull, but blood does not invade the brain tissue.
- Intracerebral hemorrhage occurs when blood enters the brain tissue after a
blood vessel ruptures. This can be caused by an aneurysm
- Ischemic: damage to brain d/t clogged artery/blood vessel – brain tissue supplied
by it dies.
(87% of strokes are ischemic)
- s/s: Weakness or paralysis, Blurred vision, inability to maintain balance,
slurred speech, dizziness, memory deficits
- Thrombus: blood clot that blocks a blood vessel
- Embolus (Emboli – multiple clots) – blood clot or plaque that breaks loose
and blocks a smaller blood vessel in the brain (atherosclerosis).
