Exam 2 AA Med 3 notes

Exam 2 Chapters: 51, 52, 13 (267-272), 21, 23 ⎯ week 3-4 (class 6–9) Lecture notes ⎯ Book notes ⎯ Anything extra (success book, q’s, ect.) Diabetes Insipidus (DI) & Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) • Content starts on page 1469 • Endocrine system is made up of organ and glands. Were talking about hyper or hypo secretion, hormones, and glands. Talking about F/E and acid base balance. Growth and development, and energy in terms of metabolism and response to stress. • A pt has an endocrine prob → educate to AVOID STRESSERS • Understand common labs o CBC ▪ Hematocrit • Male: 42–52% • Female: 35–47% ▪ Hemoglobin • Male: 13–18 g/dL • Female: 12–16 g/dL ▪ Platelets: 150,000–450,000 (mm3) ▪ White blood cell (WBC) count: 4500–110,00 (mm3) o Sodium (Na+): 135–145 mEq/L o Normal serum osmolality is 275 to 290 mOsm/kg o BNP ▪ 100 pg/mL o T3, T4, TSH ▪ Normal range for serum T3 is 80 to 200 ng/dL (1.2 to 3.1 nmol/L) ▪ Normal range for T4 is 5.4 to 11.5 µg/dL (57 to 148 nmol/L) • The range of free T4 in serum is normally 0.9 to 1.7 ng/dL (11.5 to 21.8 pmol/L) ▪ TSH: 0-15 mIU/L o Hemoglobin A1C ▪ Patients without diabetes and patients with diabetes with good glycemic control: 4.4%–6.4% ▪ Normal values typically range from 4% to 6% and indicate consistently near-normal blood glucose concentrations. The target range for people with diabetes is less than 7% • VERY IMPORTANT TO UNDERSTAND o 24-hr urine collection ▪ Post a sign on the patient’s bathroom door as a helpful reminder not to discard urine. ▪ Initiate a collection at a specific time (which is recorded) by asking the patient to empty the bladder. • Discard this urine and then collect all urine voided for the next 24 hours. ▪ At the end of the 24 hours, ask the patient to void. • Add this urine to the previously collected urine, and then send the entire specimen to the laboratory. 2 ▪ The laboratory usually specifies whether a preservative is used to retard decomposition and whether the specimen is to be refrigerated or kept on ice. o Performing an accucheck can be a life saver o Must make sure that the pt has patent IV o Monitor the pt weight o Urine output monitoring o Urine specific gravity ▪ Know the normal value ▪ The normal range of urine specific gravity is 1.010 to 1.025 ▪ Urine specific gravity can be measured by sending approximately 20 mL of urine to the laboratory for testing, or carefully assessed with dipstick o Normal urine sodium levels range from 75 to 200 mEq/24 hours (75 to 200 mmol/24 hours). A random specimen usually contains more than 40 mEq/L of sodium • Diabetes Insipidus o Description ▪ Disorder of the posterior lobe of the pituitary gland ▪ Deficiency of ADH (vasopressin) o Etiology ▪ Head trauma ▪ Brain tumor ▪ Surgical ablation of pituitary gland ▪ Failure of renal tubules to respond to ADH ▪ CNS infections ▪ Tumors o Basically the kidney is not responding properly to ADH o 45-yr-old male comes in saying he’s not feeling well ⎯ we assess o Posterior hormones ▪ ADH AKA VASOPRESSIN ▪ OXYTOCINE • Clinical Manifestations & Diagnostics o Clinical Manifestations ▪ Dilute, waterlike urine