Term
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Definition
Growth hormone
ACTH
TSH
FSH
LH |
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Term
|
Definition
ADH (vasopressin)
Oxytocin |
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Term
| ADH/Arginine Vasopressin (AVP) |
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Definition
| renal reabsorption of water, vasoconstriction |
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Term
|
Definition
| letdown reflex, uterine contractions (usually not problem unless fetus) |
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Term
|
Definition
Promotes growth (skeletal and cellular)
Promotes protein synthesis
Increased CHO metabolism
Lipid mobilization
Retention of sodium, phosphorus, potassium
Antagonizes insulin |
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Term
| Adrenocorticotropic Hormone/ACTH |
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Definition
Works on the adrenal cortex
Glucocorticoid (cortisol)
Mineralcorticoid (aldosterone)
Na/water retention
Potassium excretion
Androgens |
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Term
| SIADH (Posterior Excess) Etiology |
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Definition
Client Contexts/Etiologies
Head injury
Tumor
Pulmonary disease
Drugs (oxytocin, chemo, opioids)
Distinguish from hypervolemia with psyche |
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Term
|
Definition
Pathophysiology
Excessive ADH leads to:
Hypervolemia
Electrolyte disturbances secondary to fluid issues |
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Term
|
Definition
S/ S fluid volume overload
S/S hyponatremia
LOC
Seizures
Low serum osmolality (<280)
Decreased urine output
Increased specific gravity (> 1.005)
Decreased BUN
Decreased Hct/Hgb
Complications – CHF, cerebral edema (S/S) |
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Term
|
Definition
Labs
CT Scan/MRI brain
Clinical presentation |
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Term
| SIADH Nursing Diagnoses/Outcomes |
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Definition
Fluid volume overload
Safety – possibly risk for seizure/falls
Other related to other diagnoses |
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Term
| SIADH Medical Therapeutics |
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Definition
Fluid restriction – (600 – 1500 cc/day)
3% - 5% NaCl very low Na+ and extreme caution
Why caution?
Drugs - furosemide (Lasix), butorphanol (Stadol) – inhibits ADH secretion, demeclocycline (Declomycin) – causes nephrogenic DI by blocking ADH at renal tubule |
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Term
| SIADH Nursing Interventions |
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Definition
Fluid volume overload
Safety
Other related to complications |
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Term
|
Definition
Head injury
Tumor
CNS infections
Drugs (Stadol, Declomycin) |
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Term
|
Definition
Lack of ADH leads to:
Hypovolemia
Electrolyte disturbances secondary to fluid issues |
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Term
|
Definition
Central/neurogenic (lack of ADH from PP) vs. nephrogenic (problem at tubule level) vs. psychogenic
Thirst
S/S fluid volume deficit
S/S hypernatremia
High serum osmolality (>295)
Hyperchloremia
Decreased urine osmolality (<100)
Increased urine output/nocturia (5 – 20 liters/day)
Decreased specific gravity (< 1.003)
Increased BUN
Increased Hct/Hgb
Complications – hypertonic encephalopathy, shock (S/S) |
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Term
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Definition
Labs, water deprivation test (with DI—urine osmo still low), vasopressin stimulation test (differential central vs. nephrogenic DI—nephrogenic won’t respond)
CT Scan/MRI brain
Clinical presentation |
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Term
| DI Nursing Diagnoses/Outcomes |
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Definition
Fluid volume deficit
Safety – possibly risk for seizure
Other related to other diagnoses |
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Term
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Definition
IVF (D5 NaCl)
Glucose (establishes tonicity)
Drugs
ADH (Vasopressin), desmopressin acetate (DDAVP) – less effect of vasoconstriction, thiazide diuretics,
clofibrate (Atromid), carbamazepine (Tegretol) for symptoms |
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Term
|
Definition
Fluid volume deficit
Safety
Other |
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Term
|
Definition
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Term
| Acromegaly Pathophysiology |
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Definition
Excess of GH after ephiphyseal plate closure leads to:
Bone enlargement
Soft tissue enlargement |
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Term
| Acromegaly Manifestations |
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Definition
Bone thickness (hands, feet, face)
Tissue thickness (tongue, skin)
HTN
Cardiomegaly/LVH
CHF
Oily skin
Neuropathies
Visual defects
Muscle weakness
Joint pain
Menstrual disturbances
Complications – arteriosclerosis, diabetes, seizure |
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Term
|
Definition
Labs
CT Scan/MRI brain
Clinical presentation |
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Term
| Acromegaly Nursing Diagnoses |
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Definition
Body image disturbance
Safety (visual defect)
Altered health maintenance
Other related to other complications |
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Term
| Acromegaly Medical Therapeutics |
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Definition
External radiation (palliative most times and may cause hypopituitarism)
Surgery – transsphenoidal hypophysectomy (replacement hormone required for rest of life)
Drugs - bromocriptine (Parlodel), octreotide (Sandostatin) to reduce GH
Combination therapy |
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Term
| Acromegaly Nursing Therapeutics |
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Definition
Body image disturbance – prepare, counsel
Safety – screen for visual defect, other safety measures
Surgical care
ABC
Neuro status/ICP
Prevent CSF leakage, test fluid for CSF
How do you know?
Pain control
Infection control
Fluids and electrolytes
Altered health maintenance – monitoring (BP weekly, daily weight), medication teaching |
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Term
| Cushing's Disease Etiologies |
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Definition
Pituitary tumors
Too much ACTH released from pituitary
Adrenal tumors
Excessive release of cortisol from adrenal gland
ACTH is actually LOW due to - feedback
Lung/pancreas tumors
Compare to Cushing’s induced syndrome |
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Term
| Cushing's Pathophysiology |
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Definition
Excess of ACTH leads to:
Glucocorticoid/Cortisol excess – increased blood glucose
Mineralcorticoid/Aldosterone excess – increased sodium and volume, decreased potassium |
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Term
|
Definition
Due to cortisol excess:
Weight gain
Changes in tissue (truncal obesity, moon face)
Glucose intolerance (insulin resistance)
Muscle wasting from protein catabolism
Osteoporosis from loss of protein matrix, altered calcium (renal stones)
Impaired wound healing from catabolism
Mood disturbances
Manifestations
Due to aldosterone excess:
Hypertension
Volume overload
Hypokalemia
Other manifestations:
Purplish striae on abdomen
Hirsutism (androgens)
Menstrual disorders (androgens)
Bronze/brown skin color (melanotropic activity of ACTH)
Won’t see if abnormal adrenal release of cortisol is the problem
Complications – CHF, diabetes |
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Term
|
Definition
Labs
CT Scan/MRI
Clinical presentation |
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Term
| Cushing's Nursing Diagnoses |
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Definition
Fluid volume overload
Body image disturbance
Altered nutrition
Risk for injury
Risk for infection |
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Term
| Cushing's Medical Therapeutics |
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Definition
Surgery – transsphenoidal hypophysectomy, adrenaletomy
Drugs – mitotaine (Lysodren), ketoconazole (Nizoral), antihypertensives, diuretics, potassium, insulin |
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Term
| Cushing's Nursing Therapeutics |
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Definition
Fluid volume overload
Body image disturbance
Altered nutrition – increase protein, high calcium, low sodium, high potassium, low calorie
Risk for injury – bones and bruising
Risk for infection |
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Term
| Addison's Disease Etiology |
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Definition
Client Contexts/Etiologies
Autoimmune disease
Rare – AIDS, TB, chemo
Compare to adrenal suppression from corticosteroids |
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Term
| Addison's Pathophysiology |
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Definition
Deficiency of ACTH leads to:
Glucocorticoid/Cortisol deficit – decreased blood glucose
Mineralcorticoid/Aldosterone deficit – decreased sodium and volume, increased potassium |
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Term
|
Definition
Due to cortisol deficiency:
Weight loss
Hypoglycemia
Fatigue
Anorexia
Due to aldosterone deficiency:
Hypotension/tachycardia
Volume deficiency/fever
Hyponatremia/weakness, confusion, abdominal pain
Hyperkalemia
Other manifestations:
Bronze/brown skin color (negative feedback stimulation of ACTH)
Complications – shock, Addisonian crisis |
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Term
|
Definition
Labs
CT Scan/MRI
Clinical presentation |
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Term
| Addison's Nursing Diagnoses |
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Definition
Decreased cardiac output (fluid and dysrhythmias from high potassium)
Fluid volume deficit
Body image disturbance
Altered nutrition
Safety
Altered Health Maintenance - Prednisone |
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Term
| Addison's Medical Therapeutics |
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Definition
Drugs – hydrocortisone (glucocorticoid and mineralcorticoid), hyperkalemia management
Crisis requires IVF, glucose, hydrocortisone |
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Term
| Addison's Nursing Therapeutics |
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Definition
Decreased cardiac output
Fluid volume deficit
Body image disturbance
Altered nutrition – increase cals, balance
Safety – including seizure precautions if necessary
Altered Health Maintenance – Prednisone (see resp notes) |
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Term
|
Definition
Primary Hyperaldosteronism and Pheocromocytoma – Review
Adrenal Cortex – Hyperaldosteronism
Adrenal Medulla - Pheocromocytoma |
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