ATI System Disorder Endocrine Template

ACTIVE LEARNING TEMPLATE: System Disorder 77 DISORDER/DISEASE PROCESS __________________________________________________________ REVIEW MODULE CHAPTER ___________ Pituitary Disorders: Syndrome of Inappropriate Antidiuretic Hormone Alterations in Health (Diagnosis) Pathophysiology Related to Client Problem Health Promotion and Disease Prevention This is an excessive release of ADH, also known as vasopressin, secreted by the posterior lobe of the pituitary gland. Excess ADH leads to renal reabsorption of water and suppression of renin angiotensin mechanism causing renal excretion of sodium leading to water intoxication, cellular edema, and dilutional hyponatremia. Fluid shifts within compartments causes decreased blood osmolarity Syndrome of inappropriate antidiuretic hormone (SIADH) Provide treatment rapidly to prevent complications of the disorder. ASSESSMENT SAFETY CONSIDERATIONS Risk Factors Expected Findings Conditions that stimulate the hypothalamus too hyper to create ADH include malignant tumors, increased intrathoracic pressure, head injury, meningitis, stroke, tuberculosis, and medications ( chemotherapy agents, TCAs, SSRIs, opioids, fluoroquinolone) Laboratory Tests Early manifestations include headache, weakness, anorexia, muscle cramps, and weight gain without a dime because water, not sodium is retained. As the blood sodium level decreases the client experiences personality changes, hostility, sluggish deep tendon reflexes, nausea, vomiting, diarrhea and all agree with dark yellow concentrated appearance. They will have confusion, lethargy, cheyne-stokes respirations, Seizures, coma and death can occur. Diagnostic Procedures Urine testing: Think concentrated, Increased urine sodium, increased urine osmolarity, as urine volume decreases urine osmolarity increases Blood testing: think diluted, Decreased blood sodium, decreased blood osmolarity, as the blood volume increases blood osmolarity decreases Blood and urine testing to measure sodium levels and osmolarity. PATIENT-CENTERED CARE Nursing Care Restrict all oral fluids to 5000 to 1000 mL/day, use 0.9% sodium chloride instead of water to flush enteral tubes, Monitor I&O, Monitor for decreased blood sodium osmolarity and elevated urine sodium osmolarity, Where the client daily, report altered mental status, reduce environmental stimuli and position the client as needed, provide a safe environment for clients who have altered levels of consciousness, monitor for indications of heart failure which can occur from fluid overload Therapeutic Procedures Hypertonic sodium chloride IV fluid, The goal is to elevate the sodium level enough to alleviate neurologic compromise A patient with SIADH could go into a coma if proper fluid restrictions are not followed, monitoring I+O is very important for this patient so they do not get fluid overloaded and that their sodium level does not rapidly change. Complications Medications Tetracycline derivative (demeclocycline ) vasopressin antagonist (tolvapatan, conivaptan) Client Education Educate to follow fluid restrictions to prevent worsening of the condition, educate that blood sodium levels will be monitored frequently to minimize the risk of complications from rapid increases, educated to perform frequent oral care when on medication's to treat this disorder Interprofessional Care Home care can be required for fluid, medication, in dietary management Water intoxication, cerebral/pulmonary edema, and severe hyponatremia. Without treatment this can lead to these complications which can result in, and death. Central Pontine myelinolysis, This is characterized by nerve damage that is caused by the destruction of the myelin sheath in the brain stem