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Posterior pituitary hormones are actually produced in the hyopthalamus and only stored in the posterior pituitaries. SIADH - Syndrome oI Inappropriate Antidiuretic Hormone secretion (SIADH) occurs when there is too much vasopressin (ADH) with inappropriate secretion.
Posterior pituitary hormones are actually produced in the hyopthalamus and only stored in the posterior pituitaries. SIADH - Syndrome oI Inappropriate Antidiuretic Hormone secretion (SIADH) occurs when there is too much vasopressin (ADH) with inappropriate secretion.
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Posterior pituitary hormones are actually produced in the hyopthalamus and only stored in the posterior pituitaries. SIADH - Syndrome oI Inappropriate Antidiuretic Hormone secretion (SIADH) occurs when there is too much vasopressin (ADH) with inappropriate secretion.
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Attribution Non-Commercial (BY-NC)
Доступные форматы
Скачайте в формате PPT, PDF, TXT или читайте онлайн в Scribd
Diabetes Insipidus Syndrome oI Inappropriate Antidiuretic Hormone (SAIDH) Posterior Pituitary Posterior pituitary hormones are actually produced in the hyopthalamus and only stored in the posterior pituitary Posterior pituitary hormones Antidiuretic hormone (ADH) Oxytocin The hormones secreted by the posterior pituitary are Antidiuretic hormone (ADH) (Also call vasopressin) and oxytocin. ADH contributes to Iluid balance by Controlling renal reabsorption oI Iree water It also has potent vasoconstrictive properties. Posterior Pituitary Antidiuretic hormone (ADH) (Also called vasopressin) Disorders/diseases resulting Irom dysIunction Excess: Syndrome oI Inappropriate ADH secretion (SIADH) Deficiency: Diabetes Insipidus SIADH Posterior Pituitary Hypersecretion SIADH - Syndrome oI Inappropriate Hormone Secretion ADH (anti-diuretic hormone) is a hormone made in the pituitary gland. ADH does what the name says - it stops urination - diuresis Slowing or stopping urine production leads to Iluid retention. That in turn causes a dilution oI body sodium SIADH - Syndrome oI Inappropriate Hormone Secretion Depending on the rapidity & the extent oI the sodium drop, a battery oI S/S appear. Lethargy, weakness, & Ioggy thinking are common. Personality changes can happen. Low sodium levels oIten make pt nauseated II the situation is not corrected, seizures, coma, & even death can Iollow. Syndrome oI Inappropriate Antidiuretic Hormone Secretion - SIADH $ADH occurs when there is too much vasopression (ADH) with inappropriate water retention and decreased blood Na levels Results Irom many diIIerent conditions and drugs May be produced by certain tumors such as lung cancer or may result Irom chronic lung diseases. Medicines associated with SIADH include common meds as antidepressants, antianxiety agents, antipsychotic agents, seizure meds, and desmopressin (DDAVP) Syndrome oI Inappropriate Antidiuretic Hormone Secretion - SIADH Results Irom Inability to produce & secrete dilute urine Water retention Increased extra cellular Iluid volume Hyponatremia Diseases that aIIect the hypothalamus Dx oI SIADH The Iollowing criteria should be IulIilled beIore a diagnosis oI SIADH can be made: persistent excretion oI concentrated urine with no reason Ior ADH release normal renal and adrenal Iunction no edema or hypovolaemia should be present the urine osmolarity should be greater than the serum osmolarity Physical Assessment oI SIADH Initially, S/S are R/T retention oI water. Most common complaints GI disturbances-loss oI appetite, N,V Nurse Weighs pt & documents any recent weight gain Checks pt extremities Ior presence oI edema Pt with SIADH have Iree water, not salt, that is retained & edema is not usually present due to intracellular Iree water Assessment-Clinical ManiIestations oI SIADH ater retention, hyponatremia, & resulting fluid shifts have an eIIect on $ function, especially when serum sodium level drops. Normal serum Na 135-145. S/S occur when serum Na level drops below 125, and especially below 115 linical $$ Lethargy, headaches, hostility, uncooperativeness, disorientation Early sign -Change in LOC Neurological S/S can progress Irom lethargy and headaches to decreased responsiveness, seizures, and coma. Nurse assess deep tendon reIlexes, which are oIten or sluggish V/S changes-tachycardia associated with increased Iluid volume & hypothermia associated with CNS disturbance Normal Lab Values serum osmolality (285-295 mOsm/kg) sodium (Na 135-145 mEq/L) chloride (95-105 mEq/L) Urine osmolality - -24 hr specimen 500-800 mOsm/kg H20 -Random specimen: 50-1200 mOsm/kg/H20 Osmolality is measures in milliosmoles per kilogram oI water (mOsm/kg). The major determinants oI plasma osmolality are Na, glucose, & urea Urine speciIic gravity 1.003-1.030 1.002-1.035 Highdehydration Lowdiabetes insipidus concerntrated urine ~ than 50-100 mOsm/kg with normal vascular volume and normal renal Iunction Lab Assessment in SIADH W 97,cellular Iluid volume expansion aIIects electrolyte levels in the serum and the urine Lcv|'cd urine sodium levels and speciIic gravity reIlect an 3.7c|cd concentration oI the urine Serum sodium levels are /0.70,80/, oIten as low as 110 mEq/L (normal serum sodium 135-145 mEq/L) due to emxm<eIIwImx <<Iwre emgmrm1<r and 3.70,80/ Na excretion ~.~ ..~..~ causes changes in both plasma and urine osmolality Plasma osmolality is decreased, and the urine is hyperosmolar in relation to the plasma Osmolality &rine osmolality -24 hr specimen 500-800 mOsmg H20 Random specimen: 50-1200 mOsmgH20 Osmolality is measures in milliosmoles per kilogram oI water (mOsm/kg). The major determinants oI plasma osmolality are Na, glucose, & urea. The Kidneys are mainly responsible Ior maintaining the concentration oI body Iluids within this range oI osmolality. hen the plasma osmolality becomes abnormal, changes in the level oI antidiuretic hormones (ADH) cause the kidneys to conserve or increase the excretion oI water to return the osmolality to normal Posterior Pituitury hypersecretion - SIADH $ymptoms - fluid retention low serum osmolality (normal285-295 mOsm/kg) dilutional low sodium (normal Na 135-145 mEq/L) low chloride (normal95-105 mEq/L) Causes - Diseases eIIect the hypothalmus pneumonia TB positive pressure ventilation Trauma concerntrated urine (~ than 50-100 mOsm/kg) with normal vascular volume and normal renal Iunction muscle cramps & weakness cerebral edema, lethargy, anorexia, headache, seizures, coma. AIDs delirium tremens Ectopic ADH secreting tumor SIADH - Diagnostic Tests Blood & Urine tests Must have low serum sodium low plasma osmolality level Inappropriated concentrated urine (increased urine osmolality level) These tests indicate excess oI body water relative to the amount oI body sodium. In other words, ADH is inappropriately holding onto too much water. Important to eliminate other causes of a low sodium level, such as hypothyroidism or adrenal insuIIiciency, beIore settling on a dx oI SIADH Rx- removing the oIIending drug or tumor, & treat the underlying condition. Posterior Pituitary: SIADH,DI Affect kidney's ability to concentrate urine Measured by urine speciIic gravity Measures number and size oI particles Normal: 1.003 - 1.030 High dehydration Low Diabetic Insipidus 1.001-1.005 Concentrated urine: SIADH Dilute urine: DI Posterior pituitary: SIADH ADH excess water intoxication water is reabsorbed, so assess Ior increased blood volume, Iluid retention concentrated urine, low urine output dilutional hyponatremia (same Na, more H20) muscle cramps and weakness anorexia, n/v, irritable, conIused, disorient, seizure SIADH and Hyponatremia Hyponatremia- a lower than normal concentration oI sodium in the blood Caused by inadequate excretion oI water oI by excessive water in the circulating bloodstream In a severe case the pt may experience water intoxication, with conIusion and lethargy, leading to muscle excitability, convulsions, and coma. Treatment: Fluid and electrolyte balance may be restored by IV inIusion oI a balanced solution or a Iluid restricted diet. SIADH Diagnosis & Treatment Diagnosis measure urine volume and osmolality Treatment II Na125 Restrict Iluids 800 - 1000 ml/day. Daily weigh Monitor 3 - 5 Saline solution IV Na 134mmol/L se osmol ~280mmol/kg SG~1005 low BUN, creatinine, Hb, Hct. Lasix iI Na105 (cardiac symptoms) SIADH Diagnostic Study Hyponatremia Decreased plasma osmolality Urine sodium and urine osmolality elevated Elevated ADH levels Normal renal, adrenal, & thyroid Iunctions Nursing Assessment Headache,Personality change, ConIusion,Irrritability, Dysarthria(diIIicult, poorly articulated speech), Lethargy,Impaired memory Restless, weakness, Iatigue, gait disturbances Weight gain SIADH Treatment Water Restriction is the cornerstone oI treatment Decreased water intake allows serum sodium level to rise normally. The maximum amount oI water that pt with SIADH are allowed to drink is just slightly more that the amount oI urine they produce Pt must have regular serum sodium measurements to ensure that the water restriction has been eIIective Dehydration- The most concerning potential side eIIect Irom treatment is dehydration. SIADH treatment Restrict Iluid intake (800-1000 cc/day) Daily weight $trict I & O Monitor urine speciIic gravity 0.9 NS inIusion(to raise the serum Na level iI ater intoxication is severe) Monitor Ior hyponatremia Lasix may be admin to block circulatory overload Drugs-demeclocyclin HCL & lithium-may be admin to block renal response to ADH, intereIeres with action oI ADH Drugs - Phenytoin - inhibits ADH release Surgery & Chemo -to remove or destroy neoplasms that may be the underlying cause oI this syndrome SIADH treatment Demeclocycline (Declomycin) Lithium Used Ior: Excess secretion oI ADH or SIADH Action: Inhibits ADH action in kidney Blocks renal response to ADH, interIeres with action oI ADH Therapeutic outcome: Decreased urine speciIic gravity Analysis - Nursing Diagnosis - SIADH 1. Fluid Volume Excess R/T compromised regulatory mechanism, excess ADH 2. High Risk Ior Injury R/T an altered level oI consciousness, conIusion, & the possibility oI seizures 3. Altered Nutrition: Less than Body Requirements R/T an inability to ingest or digest Iood or absorb nutrients because oI biologic Iactors (ex-anorexia, N/V) 4. Altered Thought Processes R/T physiologic changes within the central nervous system Planning & Implementation !lanning: !t Goals The primary goal is that the pt`s Iluid balance will be restored nterventions to treat $ADH (!t are !lan) consists of Restriction water intake Using diuretics to promote the excretion oI water Administering drugs that interIere with the action oI ADH Replacing lost sodium Fluid Restriction Any excessive Iree water intake will Iurther dilute the serum sodium concentration Strict I&O, daily weights, guides the determination oI the degree oI Iluid restriction necessary. A wt gain oI 2 pounds (or 1 Kg) or more per day or a gradual increase during several days is cause Ior concern. A 1 Kg weight increase is equivalent to 1000ml Iluid retention (1Kg 1 L) Planning & Implementation Drug Therapy Diuretics are sometimes used to treat pt with SIADH, to rid the body oI excessive Iluid, especially iI CHF results Irom Iluid overload II diuretics are used, be aware oI potential eIIect oI electrolyte losses; sodium loss can be potentiated, which Iurther contributes to the clinical picture oI SIADH Hypertonic saline (3 NaCl) may be used to treat SIADH Helps correct serum sodium level Raises Na osmolality in the blood Removes excess intracellular Iluid Cells shrink in hypertonic solution IV saline is given cautiously because it may contribute to the Iluid overload already present & precipitate an episode oI CHF. II the pt needs routine IV Iluids, the MD orders a solution in saline (5 dextrose in saline) rather than a solution in water. Planning & Implementation High Ris for njury Promote saIety Monitor pt neuro status Subtle Changes, such as muscle twitching beIore neuro S/S progress to seizures or coma. Check LOC to time, place, & person because disorientation may be present. ConIusion is another neuro sign. Nurse reduces environmental stimuli & explain interventions in simple terms. Flow sheets contain ongoing inIo about LOC, motor & sensory neuro assessment, & pertinent lab data helpIul in detecting trends. Decreased LOC and seizures are complications oI the low serum sodium level R/T SIADH ursing issues Moniforing fIuid boIonce(s/s fIuid refenfion): Cordioc probIems (wofer reobsorbed so bId voIume): MeuroIogicoI probIems (heodoche sei;ures,cerebroI edemo, como,): Energy Iimifofions (muscIe cromps, weokness): AIIied heoIfh probIems (onorexio): Pisk for injury: (confusion, muscIe fremors, efc.) ursing issues Fluid Volume Excess R/T inability to excrete water Hyponatremia with plasma hypo-osmolality eight gain !otential for njury Institute seizure precautions and saIety measures Reorient conIused pt !revent complications of immobility Recognize decreased gastric motility due to hyponatremia, combined with Iluid restriction and decreased mobility - ~constipation Diabetes Insipidus Posterior Pituitary Diabetes Insipidus Uncommon syndrome oI posterior pituitary hypoIunction S/S Increased thirst - polydipsia Increased urination - polyruia Results Irom ADH (Vasopression) deIiciency, which prevents the kidneys Irom reabsorbing water Inability to conserve water Posterior pituitary : DI Diabetes insipidus: 'to pass through Decreased ADH diuresis Water is lost, so assess Ior: Kidneys produce large amts oI du'c urine (5L-1L in 24hrs) low urine speciIic gravity (1.1-1.5) polyuria (~urine output), polydipsia (~thirst) Iluid deIicit weight loss, turgor,dehydration, hypotension, constipation, shock Posterior Pituitury hyposecretion Diubetes Insipidus Symptoms- Thrist & polyuria 5 - 20Lday $G < 1005 &rine osmol < 100 mmolL $e osmol > 295 mmolg Nocturia eaness > weight loss, hypotension, tachycardia, constipation, shoc $leep deprivation-due to interrupted by need to drin fluids & urinate Urine speciIic gravity low (1.001-1.005) Urine osmolality decreased (50-200 mOsm.kg) Urine less concentrated than plasma Plasma osmolality elevated (~295 mOsm/kg) Hypernatremia in -lood Diabetes Insipidus Etilogy Familial or idiopathic Head injury Neuorsurgery Damage to the hypothalamic areas that produce ADH uuse Lesion of hypofhoImus inferferes wifh ADH synfhesis/fronsporf/reIeo se broin fumour pifuifory/cronioI surgery heod froumo CMS infecfion voscuIor diseose. Diabetes Insipidus Etilogy Drug Related Ethanol & Phenytoin (ClassiIication: Antiarrhythmic, Anticonvulsant): Inhibit ADH secretion Lithium (ClassiIication: Antimanic) & Demeclocycline(ClassiIication:anti-inIective-Tetracycline): Inhibit ADH action in kidney 4 Types oI Diabetes Insipidus eurogenic -oIso known os - cenfroI - hypofhoIomic - pifuifory - neurohypophyseoI - uused by o deficiency of fhe Anfidiurefic hormone, vosopressin Z ephrogenic-oIso known os - Vosopressin - resisfonf - uused by insensifivify of fhe kidneys fo fhe effecf of fhe onfidiurefic hormone, vosopressin 3) 0esfogenic-oIso known os - 0esfesfionoI - uused by o deficiency of fhe onfidiurefic hormone, vosopressin, fhof occurs onIy during pregnoncy 4) Dipsogenic, o form of primory poIydipsis - uused by AbnormoI fhirsf ond fhe Excessive infoke of wofer or ofher Iiquids Diagnosis & Rx Diabetes Insipidus Diugnosis D,I, History and examination Water deprivation test (see next slide) Vasopressin challenge test (see next slide) 24 hours urine 84/:2 in -44/ MRI oI pituitary, hypothalmus and skull to see damaged areas %reutment Intravenous Iluids Hypertonic saline IV- Extracellular solution to pull Iluid Irom outside the cell to inside the cell Vasopressin SC/IM/IV, nasal prep Long term DDAVP (Desmopression) nasal prep. (analog ADH) Diagnosis - Fluid Deprivation Test (To identiIy cause oI polyuria) Baseline VS, then check hourly-allows RN to detect changes, esp postural hypotensin & tachycardia Deprive pt oI Iluid-Observe Ior compliance with Iluid restriction Hourly- urinary output, speciIic gravity, & osmololity Urine test results determine whether testing can proceed. Testing can proceed iI urinary osmolality stabilized Ior 3 samples and 3 wt loss is noted Dx- Vasopressin challenge Order Ior 5 Units oI aqueous vasopressin sc Continue hourly urinary measurements Vasopressin triggers and ongoing assessment detects anges in urinary specific gravity and osmolality SpeciIic gravity & osmolality decrease with primary and secondary diabetes insipidus No response is seen with nephrogenic diabetes insipidue Diabetes insipidus treatment Vasopressin (!itressin) : is ADH lassification: Hormone (antidiuretic) &ses: Treatment oI central diabetes insipidus sue to deIicient antidiuretic hormone. RouteDose: IM, sc, nasal spray Nsg mplications: replace Iluid: saline and glucose monitor I & O check speciIic gravity observe electrolytes Monitor adverse reactions-abdominal cramps, angina, MI Diabetes insipidus treatment Desmopressin (DDAV!) lassification: Hormone (andiuretic) ndication: Management oI primary nocturnal eneuresis unresponsive to other treatment modalities po, sc, IV, Intranasal Action: An anologue oI naturally occuring vasopressin (antiuretic hormone). Primary action is enhanced reabsorption oI water in the kidneys Therapeutic Effects: Prevention oI nocturnal enuresis. Maintenace oI appropriate body water content in diabetes insipidus. Nsg mplication: Monitor urine & plasma osmolality & urine volume Irequently. Assess pt Ior symptoms oI dehydration (excessive thirst, dry skin & mucous membranes, tachycardia, poor skin turgor) Weigh pt daily & assess Ior edema Observe Ior Water Intoxication with all agents ADH excess water intoxication water is reabsorbed, so assess Ior increased blood volume, Iluid retention concentrated urine, low urine output dilutional hyponatremia (same Na, more H20) muscle cramps and weakness anorexia, n/v, irritable, conIused, disorient, seizure Diabetes Insipidus Fluid Volume DeIicit R/T inability to conserve water Thirst, dry mucous membranes Decreased skin turgor Hypotension, tachycardia Hemoconcentration, plasma hyperosmolality, hypernatremia Increased urine output Dilute urine-monitor speciIic gravity ursing Issues FIuid ond eIecfroIyfe imboIonce: P/T >diuresis, monifor urine ond pIosmo osmoIorify monifor specific grovify (usuoIIy wiII be Iow wifh diuresis) monifor urine voIume (usuoIIy wiII be high b-I0L in Z4 hr) Theropy successfuI when urine oufpuf ond specific grovify begin fo refurn fo normoI monifor s/s dehydrofion weighf pf doiIy & ossess for edemo FIuid voIume deficif Murse wiII monifor for hypofension, consfipofion, shock SIeeping probIems: P/T nocfurio & increosed fhirsf