ASU NUR 426 Exam 3
What is ADH? - answer-Antidiuretic hormone
-Produced in hypothalamus, stored in posterior pituitary gland
-Acts on distal renal tubule: causes reabsorption of water(fluid retention)
-High doses of ADH causes vasoconstriction (vasopressin)
-Regulates water balance, serum osmolality (high osmolality indicates more
substances, low osmolality indicates less substances)
What does too much or too little ADH cause? - answer-Too much: fluid overload
-Too little: dehydration
T or F: High levels of ADH indicate low serum osmolality, and high urine osmolality -
answer True
T or F: Low levels of ADH indicated high serum osmolality, and low urine osmolality -
answer True
When is ADH released? - answer-Hypotension releases ADH to reduce urine to retain
fluid in the body which dilutes the blood and has a lower serum osmolality
-High serum osmolality/serum sodium will trigger release of ADH to retain fluid to dilute
the blood
-Stress triggers: hypoxia, pain, trauma to maintain blood pressure
-Drugs: chemotherapy, barbiturates, anesthetics
What is diabetes insipidus (DI)? - answerA disorder characterized by not enough ADH
What are two causes of DI? - answer-ADH deficiency: neurogenic/central problems
(cerebral edema, tumors, infections, TB, idiopathic)
-ADH insensitivity: nephrogenic problems (renal disease, nephrotoxic drugs)
What are clinical manifestations of DI? - answer-Polyuria (5-40L/day)
-Pale and dilute urine
-Hypovolemia: hypotension, tachycardia, weight loss, low CVP, wedge pressure,
polydipsia
-Dehydration:dry mouth, thirst
-Urine: Low urine osmolality
-Serum: High serum osmolality, hypernatremia, high BUN/Creatinine, high H&H
Whta are interventions for DI? - answer-Determine cause: central or nephrogenic?
-If central: Give ADH, subcutaneous or IV vasopressin or DDAVP
-If nephrogenic: thiazide diuretics and low sodium diet
-Fluid replacement: hypotonic solutions in acute DI (0.45% NaCl, D5W)
, -Electrolyte replacements
-Monitor vital signs, LOC, I&Os, weight, urine specific gravity
What is syndrome of inappropriate antidiuretic hormone (SIADH)? - answer-A disorder
characterized by too much ADH due to the failure of a negative-feedback loop
-Fluid retention: dilutional hyponatremia
-Unable to dilute urine
What are some causes of SIADH? - answer-Head injury, infection, hemorrhage,
surgery, CVA
-Malignancy, TB, pneumonia, COPD, some medications can trigger release of ADH
What are some SIADH clinical manifestations? - answer-Neuro: Weakness, lethargy,
confusion, unable to concentrate, headache, seizures
-Hypervolemia: hypterneison
-Serum: Low serum sodium/osmolality (dilutional hyponatremia)
-Urine: High urine osmolality/sodium
-Weight gain, edema
-Decreased BUN, creatinine, albumin
What are some SIADH interventions? - answer-Furosemide to promote diuresis
-Declomycin reduces tubule response to ADH
-Phenytoin, Dilantin for seizures
-Monitor labs, vital signs, LOC, I&Os, weight, and urine osmolality
-Initiate seizure precautions
-Administer hypertonic fluids: 3% NaCl (give slowly)
-Do not administer D5W- too hypotonic
-Restrict PO fluids: 800-1000mL/day
What is trauma? - answer-Situation that causes physical injury
What are the different types of trauma? - answer-Penetrating: (knife, bullet, dog bite)
-Blunt: (hit, compression, acceleration/deceleration, crush injury)
-Blast: explosion (may consist of blunt/penetrating traumas)
What are nursing priorities in trauma? - answer-Scene safety
Primary survey
-A:irway and cervical spine stabilization (patency, jaw thrust, hold c-spine,
patency/foreign bodies, gasping)
-B:reathing (chest movement, position of trachea (deviation can indicate tension
pneumothorax), signs of hypoxia)
-C:irculation (BP, pulses, signs of hypoperfusion)
-D:isability (neuro assessment, deformities, pain)
-E:xposure (full body assessment but keep warm and dignity)
What is ADH? - answer-Antidiuretic hormone
-Produced in hypothalamus, stored in posterior pituitary gland
-Acts on distal renal tubule: causes reabsorption of water(fluid retention)
-High doses of ADH causes vasoconstriction (vasopressin)
-Regulates water balance, serum osmolality (high osmolality indicates more
substances, low osmolality indicates less substances)
What does too much or too little ADH cause? - answer-Too much: fluid overload
-Too little: dehydration
T or F: High levels of ADH indicate low serum osmolality, and high urine osmolality -
answer True
T or F: Low levels of ADH indicated high serum osmolality, and low urine osmolality -
answer True
When is ADH released? - answer-Hypotension releases ADH to reduce urine to retain
fluid in the body which dilutes the blood and has a lower serum osmolality
-High serum osmolality/serum sodium will trigger release of ADH to retain fluid to dilute
the blood
-Stress triggers: hypoxia, pain, trauma to maintain blood pressure
-Drugs: chemotherapy, barbiturates, anesthetics
What is diabetes insipidus (DI)? - answerA disorder characterized by not enough ADH
What are two causes of DI? - answer-ADH deficiency: neurogenic/central problems
(cerebral edema, tumors, infections, TB, idiopathic)
-ADH insensitivity: nephrogenic problems (renal disease, nephrotoxic drugs)
What are clinical manifestations of DI? - answer-Polyuria (5-40L/day)
-Pale and dilute urine
-Hypovolemia: hypotension, tachycardia, weight loss, low CVP, wedge pressure,
polydipsia
-Dehydration:dry mouth, thirst
-Urine: Low urine osmolality
-Serum: High serum osmolality, hypernatremia, high BUN/Creatinine, high H&H
Whta are interventions for DI? - answer-Determine cause: central or nephrogenic?
-If central: Give ADH, subcutaneous or IV vasopressin or DDAVP
-If nephrogenic: thiazide diuretics and low sodium diet
-Fluid replacement: hypotonic solutions in acute DI (0.45% NaCl, D5W)
, -Electrolyte replacements
-Monitor vital signs, LOC, I&Os, weight, urine specific gravity
What is syndrome of inappropriate antidiuretic hormone (SIADH)? - answer-A disorder
characterized by too much ADH due to the failure of a negative-feedback loop
-Fluid retention: dilutional hyponatremia
-Unable to dilute urine
What are some causes of SIADH? - answer-Head injury, infection, hemorrhage,
surgery, CVA
-Malignancy, TB, pneumonia, COPD, some medications can trigger release of ADH
What are some SIADH clinical manifestations? - answer-Neuro: Weakness, lethargy,
confusion, unable to concentrate, headache, seizures
-Hypervolemia: hypterneison
-Serum: Low serum sodium/osmolality (dilutional hyponatremia)
-Urine: High urine osmolality/sodium
-Weight gain, edema
-Decreased BUN, creatinine, albumin
What are some SIADH interventions? - answer-Furosemide to promote diuresis
-Declomycin reduces tubule response to ADH
-Phenytoin, Dilantin for seizures
-Monitor labs, vital signs, LOC, I&Os, weight, and urine osmolality
-Initiate seizure precautions
-Administer hypertonic fluids: 3% NaCl (give slowly)
-Do not administer D5W- too hypotonic
-Restrict PO fluids: 800-1000mL/day
What is trauma? - answer-Situation that causes physical injury
What are the different types of trauma? - answer-Penetrating: (knife, bullet, dog bite)
-Blunt: (hit, compression, acceleration/deceleration, crush injury)
-Blast: explosion (may consist of blunt/penetrating traumas)
What are nursing priorities in trauma? - answer-Scene safety
Primary survey
-A:irway and cervical spine stabilization (patency, jaw thrust, hold c-spine,
patency/foreign bodies, gasping)
-B:reathing (chest movement, position of trachea (deviation can indicate tension
pneumothorax), signs of hypoxia)
-C:irculation (BP, pulses, signs of hypoperfusion)
-D:isability (neuro assessment, deformities, pain)
-E:xposure (full body assessment but keep warm and dignity)
