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mental status Weight gain Hypertension Tachycardia Hyponatremia (Thus, making the patient at risk of cardiac dysrhythmia) Medical Management Demeclocycline (declomycin) Inhibits ADH induce water reabsorption and produces water diuresis Nursing Management Monitor Intake and Output Monitor Fluid and Electrolyte balances Restrict fluids as prescribed Administer diuretics Monitor IV fluids carefully DIABETES INSIPIDUS Hyposecretion of ADH and deficiency of vasopressin Clinical Manifestation Polyuria of 4-24L/day Polydipsia; dehydration ↓ skin turgor Dry mucus membranes Inability to concentrate urine ↓ specific urine gravity of 1.004 or less (main indicator of DI) Fatigue Postural hypotension Headache Medical Management Vasopressin tannate (pitressin tannate) Desmopressin acetate (DDAVP, stimate) Lypressin (diapid) Enhances reabsorption of Water in kidneys promoting antidiuretic effect and regulates fluid balance Adverse reaction: Hypertension Rationale: Vasopressin is a vasoconstrictor Nasal congestion
Nursing Management Provision of safe environment especially with ↓ LOC Monitor Intake and Output with specific gravity wear medic alert bracelet Disorders of Adrenal Glands Addison’s Disease Hyposecretion of the adrenal cortex hormones Clinical Manifestation: Subjective Muscle Weakness Fatigue Lethargy Dizziness Fainting Nausea Abdominal Pain and Cramps Objective ↓ Blood Pressure Orthostatic hypotension ↑ Pulse; collapsing and irregular Subnormal temperature Weight Loss Vomitting and Diarrhea Tremors Poor Turgor Excessive Pigmentation(bronze tone) Hyponatremia Hypoglycemia Hyperkalemia Medical Management Glucocorticoids (prednisone, hydrocortisone) Should be given with foods or milk (Rationale: Glucocorticoids → Release of Histamine) Mineralocorticoids (fludrocortisone) Nursing Management Decrease stress: provide quiet environment and appropriate schedule Promote adequate nutrition Diet Acute phase: ↑ sodium
easy bruising Moon face. Hypokalemia Headache Polydipsia Polyuria Hypernatremia low urine specific gravity Medical Management Administer spironolactone (aldactone) Potassium supplements Maintain Sodium secretion Administer antihypertensive as prescribed Nursing Management Monitor Intake and Output wear medic alert bracelet . hirsutism. weight gain. hyperpigmentation. Potassium ↓ Calories and Sodium Replacement Hormones Signs and Symptoms of disease progression Preparation for adrenalectomy Hyperaldosteronism (Conn’s Syndrome) Hypersecretion of aldosterone from the adrenal cortex of adrenal gland commonly caused by adenoma Clinical Manifestation Hypertension. backache. infection. acne. bruises and petechiae Medical Management Cytotoxic Agents aminoglutenthimide (cytaden) trilostane (modrastane) mitotane (lysodren) ↓ cortisol production Nursing Management Promote comfort: protect from trauma Prevent complications Monitor fluid balance Glucose metabolism. surgery May cause hyponatremia. purple striae. severe hypotension. breast atrophy.Non acute phase: ↑ carbohydrates and ↑ protein Fluids force to balance fluid Monitor Intake and Output weigh daily Addisonian Crisis Life threatening disorder caused by acute adrenal insufficiency precipitated by stress. impotence Virilization in women. ↓ work capacity Objective Hypertension. weakness. ↓ height Slow wound healing Personality changes ↑ Susceptibility to infection Hyperglycemia CNS irritability Na and fluid retention Hypernatremia Hypokalemia Thin extremities GI distress: ↑ acid Males Gynecomastia. infection Health teachings: Diet ↑ Protein. truncal and cervical obesity (buffalo hump) Pendulous abdomen. hypertension. fat deposits on back. hyperkalemia and shock severe generalized muscle weakness. osteoporosis Females Hirsutism. amenorrhea Pathologic fractures. pitting edema Characteristics fat deposits. hypovolemia shock (vascular collapse) Management Administer glucocorticoids IV Check BP and electrolyte levels Strict bed rest in quiet environment and protect from infection Cushing’s Syndrome Hypersecretion of corticoids Assessment Subjective headache. purple striae. thin skin. amenorrhea. trauma. hypoglycemia.
coffee or tea Monitor blood glucose and urine for glucose and acetone • Disorders of the Thyroid Gland o Myxedema Coma rare but serious which result from persistently low thyroid hormone precipitated by acute illness. administer glucocorticoids pre and post op Pheochromocytoma Catecholamine producing tumor usually found in the adrenal gland Causes Hypersecretion of epinephrine and norepinephrine by the adrenal medulla Complications hypertensive. use of sedatives and narcotics Signs & symptoms: • Hypotension • Bradycardia • Hypothermia • Hyponatremia • Hypoglycemia • respiratory failure • stupor • coma and death Medical Management • Administer IV fluids and levothyroxine Na (synthroid) • Give IV glucose and corticosteroids Nursing Management • Patent airway • Keep patient warm and check VS frequently • Thyroid Storm o Acute and life threatening condition in uncontrolled hyperthyroidism o Risk Factors Infection Surgery o Signs And Symptoms Fever Tachycardia Hypotension Irritability Respiratory Distress Apprehension Irritability Agitation Restlessness Confusion Seizures o Medical Management PTU Sodium Iodide IV Lugol’s Solution Propranolol Aspirin Steroid Diuretics Thyroidectomy • removal of thyroid gland and performed in persistent hyperthyroidism • Nursing Management o Pre-Operative Care Monitor VS. retinopathy.usually will be undergoing adrenalectomy. drink cola. weight. rapid withdrawal of thyroid meds. electrolyte and glucose level Teach Deep Breathing Exercises and coughing as well as how to support neck in post-op period when coughing and moving o Post-Operative Care . CVA and CHF o Clinical Manifestation Hypertension severe heart ailment palpitations pain in chest/abdomen hyperglycemia and glycosuria profuse sweating nausea and vomiting dilated pupils tachycardia cold extremities o Nursing Management monitor for hypertensive crisis and avoid stimuli which triggers it such as: • Vigorous abdominal palpitation o To prevent ↑ abdominal pressure • micturation Instruct patient not to smoke.
kidneys try to compensate by excreting glucose. dysphagia. normal or high depending on H2O loss from dehydration Inc. urination leads to dehydration and electrolyte loss. inc. hypertension) HYPOPARATHYROID CRISIS-acute loss of PPH DANGER SIGNS OF HYPOCALCEMIA -positive chvostek’s sign -positive trosseau’s sign Administer: calcium supplements.post cardiac arrest caused by arrythmia -usually as type 1 disorder -due to deficieny of insulin -usually caused by non adherence to insulin regimen. high pitched voice. liver produces and releases glucose.6. insulin production. inc.10-30 mmHg Reflects respiratory compensation (kussmaul respiration) for the metabolic acidosis Ketones in blood and urine Na and K can be low.3 Low PCO2. secretion of autoimmune destruction of beta cells from pancreas Type 2: dec. phosphate binders Avoid precipitating stimulus such as bright lights and noise-may lead to seizure Bedside: tracheostomy set due to laryngospasms Hormonal replacement therapy-lifetime DM II Type 1: no insulin production. nervousness. electrolytes. liver converts free fatty acids into ketones. myxedema and cretinism (cramps.0-15meq/L Low PH. dehydration and electrolyte imbalance Glucose entering cells is decreased/reduced. polyuria. creatinin or BUN MANAGEMENT: -rehydration -normal saline at rapid rate (1L/hr) . concurrent illness or infection Main clinical features: hyperglycemia. severe dehydration DKA (DIABETIC KETOACIDOSIS). breakdown of fat into free fatty acids and glycerol. demand for insulin. insulin resistance HYPEROSMOLAR HYPERGLYCEMIC NON KETOTIC SYNDROME Intercurrent illness – inc. dysphonia and restlessness Monitor for signs of hypocalcemia and tetany and have calcium • Calcium gluconate Thyroid Hormones Levothyroxine • controls the metabolic rate of tissues and accelerates heat production and oxygen consumption • for hypothyroidism. H2O. tremors. edema Immobilized head with pillows/sandbags. calciferol.Monitor for respiratory distress and have tracheostomy Set oxygen and suction machine Maintain semi fowler’s position to dec. stridor. dec. diarrhea. prevent flexion and hyperextension of neck Check surgical site for edema and bleeding Limit client from talking and assess for hoarseness Assess for laryngeal nerve damage.8-7. accumulation of ketones is DKA LAB VALUES: GLUCOSE varies between 300-800 Severity does not depend on glucose Low serum bicarb. insulin actions.
ketosis minimal or absent due to insulin resistance Persistent hyperglycemia-osmotic diuresus. tachycardia.45% NS HYPOGLYCEMIA -occurs in more than 90% of type 1 DM -also called insulin shock SYMPTOMS -cold sweats -blood glucose 45-60 mg/dL -palor -tremors -anxiety -tachycardia -palpitations -hunger -diaporesis -headache -deep sleep -confusion -visual disturbances -seizures -coma TREATMENT AND PREVENTION: Provide immediate replacement of glucose Glucagon 1mg IM D50 Milk and sandwich for those who are able to eat Prevention achieved with individual treatment Blood glucose monitoring and education . profound dehydration. hypernatremia or risk of CHF -may switch to D5W with glucose 300mg/dL or less to prevent sudden decrease -frequent VS and I&O monitoring -restore electrolyte.-initially .45% normal saline can be used for hypertension.potassium -shift from intracellular to extracellular -monitor potassium frequently -factors reducing serum K rehydration MANAGEMENT: -reverse acidosis -administer insulin (inhibit fat breakdown) at slow but continuous rate Insulin drip continued until serum bicarb at least 15-18 meq/L or until patient can eat INSULIN: slows down fat metabolism HHNS Hyperosmolarity and hyperglycemia predominate with change of mental status.9% or 0. osmolality greater than 350 mOsm/kg MANAGEMENT: -fluid replacement -correction of electrolyte imbalances -insulin administration -CVP or hemodynamic pressure monitoring -glucose fluid replacement -potassim added to IV fluids when urinary output is adequate -continuous EKG monitoring -frequent lab determination of potassium start with 0. diagnostic findings: glucose between 600-1200 mg/dL. change of mental status. loss of H2O and potassium H2O shift from intracellular to extracellular Usually occurs in type 2 Glycosuria and dehydration--hypernatremia SIGNS AND SYMPTOMS: hypertension.
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