Hormonal Regulation

Hormonal Regulation

DI & SIADH

Endocrine Glands

​Pituitary Tumors

Tumors can also be classified as:

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• Functional

  • Excessive secretion of hormones

• Non-Functional

  • No hormone secretion

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Vision changes

Headache

__________ Changes

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​General Symptoms - Pituitary

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Pituitary Tumors

3 Types

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• Benign Pituitary Adenomas

  • _______ growth

  • Do not spread

• Invasive Pituitary Adenomas

  • Benign tumors

  • Spread to skull and/or sinus cavity

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• Pituitary Carcinomas

  • ____________

  • Rare

  • ____________

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Transphenoidal Hypophysectomy

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​Treatment

ADH​

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Posterior Pituitary Disorders

Too Much ADH

SIADH

Not Enough ADH

DI​

DI

Diabetes Incipidus​

Diabetes Insipidus (DI)

​Causes

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• Central

  • Posterior Pituitary production of ADH decreased

• Nephrogenic

  • Receptors on kidney do not recognize ADH

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Symptoms ​

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• Fluid deprivation test

  • Confirms diagnosis

  • Identifies etiology

• Procedure

  • No fluids for ________ hours

  • Given desmopressin

• Nursing Interventions

  • Vital signs hourly

  • Urine specific gravity hourly

  • Urine osmolality hourly

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Diagnosis-Central

Treatment

• Central

  • DDAVP (Desmopressin)

• Nephrogenic

  • _____ salt, ______ protein diet

  • NSAID

  • Thiazide diuretics

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• Desmopressin

  • Intra-nasally

  • Side Effects:

    • Headache

    • Nausea

    • Facial flushing

  • Teach

    • Don’t skip dose

    • ________ fluid intake

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​Medication Therapy

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Nursing Interventions

• Interventions for ________

• Replace fluids ( oral & IV therapy)

• Safety

• Promote bowel elimination

• DDAVP administration

• Monitor

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Multiple Choice

A nurse is caring for a client with DI. What is the priority assessment for the nurse? Assess:

• Skin temperature

• BUN & Creatinine

• Urine Output

• BP & HR

SIADH

The syndrome of inappropriate secretion of antidiuretic hormone

Syndrome of Inappropriate ADH

​Causes

​

• Tumors in lung, pancreas, prostate, & brain

• Infections: meningitis & encephalitis

• _________ Injury

• Drug therapy

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​Sympotoms

Multiple Select

While caring for a client with SIADH, which findings would the nurse expect to find? Select all that apply.

Normal Values

Serum os: 270-300 mOsm/kg

Urin SG: 1.010-1.025

Urine os: 250-900 mOsm/kg

• Serum Osmolality 230 mOsm/kg

• Urine specific gravity 1.001

• Serum Sodium 130 mEq/L

• Increased thirst

• Polyuria

Medication Therapy

• Furosemide

• Demeclocycline

  • Oral

  • Contraindicated in children, pregnant women, lactating women

  • SE:

    • Photosensitivity

    • Skin reactions

    • Nephrogenic diabetes insipidus

    • Do not give with food, dairy products

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Nursing Care

• __________ fluids: 800-1000 ml/day

• Monitor I & O

• Vital signs

• Monitor Labs

• Weigh ________

• Assess neuro function – ____________ precautions

• Safety

• Assess cardiac function – Heart Failure!

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Open Ended

What are we noticing?

Open Ended

What are we interpreting?

Open Ended

What is your plan of care?

Open Ended

Interrelated conecpts!