ATI Endocrine

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Diabetes Insipidus & ADH

Too little antidiuretic hormone (ADH)

SIADH & ADH

Too much antidiuretic hormone (ADH)

DI Manifestations

- Polyuria - Urine output 5-20 L/day
- Polydipsia - Drinking 4-30 L/day
- Dehydration - Poor skin turgor, dry mucous membranes, hypotension, tachycardia, wt. loss, headache, dizziness, constipation
- Hypovolemic shock - hypotension, tachycardia, decreased CO, decreased cerebral perfusion

SIADH Manifestations

- Oliguria - excretion of Na+, reabsorption of water
- Fluid volume excess - wt gain w/o edema, crackles, distended neck veins, taut skin, tachycardia, HTN

- Early manifestations - headache, weakness, anorexia, muscle cramps, wt gain
- Late manifestations - personality changes, hostility, decreased deep-tendon reflexes, n&v, diarrhea, confusion, lethargy, Cheyne-Stokes respirations, seizures, coma, death

DI (Urine & Serum Concentration)

URINE DILUTE/SERUM CONCENTRATED

Urine
• Specific gravity less than 1.005
• Low osmolality (50-200 mOsm/kg)
• Decreased pH
• Decreased urine sodium
• Decreased urine potassium

Serum
• Increased serum osmolality (greater than 295 mOsm/kg)
• Increased serum sodium
• Increased serum potassium
• Serum Na+ & K+ are high only because serum is concentrated

SIADH (Urine & Serum Concentration)

URINE CONCENTRATED/SERUM DILUTE

Urine
• Specific gravity greater than 1.025
• High osmolality (greater than 295 mOsm/kg)
• Increased urine sodium
• Increased urine potassium

Serum
• Decreased serum osmolality (less than 270 mOsm/kg)
• Decreased serum sodium
• Decreased serum potassium

Most definitive test for Addison's disease

ACTH stimulation test

PTU is given to suppress the thyroid hormone. Tx goals have been met when client reports...

An increase in weight

(Note: Will also cause decrease in sweat, stool, and appetite)

Before intranasal adm of desmopressin acetate (DDAVP), the nurse should instruct the client to do this

Prior to adm of this med, blow nose gently

Side effects of long term corticosteroid therapy include...

Osteoporosis (depletion of calcium), development of moon-shaped face (due to distribution of fat in face, upper back, trunk), increased risk of infection, and muscle wasting of extremities (depletion of nitrogen)

2 to 3 days prior to vanillylmandelic acid test, this should be avoided.

Caffeine should be avoided

To promote proper absorption, how should thyroid hormone replacement therapy be taken?

On an empty stomach

Increased hematocrit level is an expected finding related to...

Dehydration

Hyperglycemic-hyperosmolar nonketotic syndrome expected findings

- Blood glucose >600 mg/dl
- pH within expected range

For a client with pheochromocytoma, avoid palpation of...

Abdomen

(Note: could cause sudden release of catecholamines from adrenal gland precipitating hypertensive crisis)

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