1. Diabetes Insipidus
    Hyposecretion of ADIH caused by strokes, trauma, or idiopathic causes. Kidney tubules fail to reasborb water.

    Polyuria, Polydipsia, Dehydration, Decrease Skin Turgor, Inability to Concentrate Urine (Specific Gravity 1.006 or less) Fatigue, Muscle Pain, Weakness, Headache, Postural Hypotension, Tachycardia

    Administer chlorprpamide (Diabinese), vasopressin tannate (Pitressin) and desmopressin (DDAVP, Stimate) as prescribed.
  2. Syndrome of Inappropriate Antidiuretic Hormone
    Excess ADH is released, but not in response to a bodily need for it. Causes include trauma, stroke, malignaices (often in lungs & pancreas), medications & stress.

    Hyponatremia, FVO, Changes in Level of Consciousness & Mental Status Changes, Weight Gain, HTN, Tachycardia, Anorexia, Nausea, Vomiting.

    Administer diuretics and IV fluids as prescribed. Administer demeclocycline (Demclomycin) as prescribed (inhibits ADH-induced water reabsopriton and produces water diuresis).
  3. Addison's Disease
    Hyposecretion of Adrenal Cortex Hormones (Glucocorticoids & Minerocorticoids)

    Lethargy, Fatigue, Muscle Weakness, Hypoglycemia, Hyperkalemia, GI Disturbances, Weight Loss, Menstrual Changes, Postural Hypertension, Dehydration, Emotional Distrubances

    • Avoid individuals with infection.Avoid strenuous exercise & stressful situations. Avoid over-the-counter meds.
    • Monitor for hypoglycemia.
    • Diet: High Protein & Carbohydrate, Dietary intake of Sodium should be increased especially in times of stress.
    • Need for lifelong glucocorticoid therapy. Steriod replacement.
  4. Cushing's Disease
    Hypersecretion of Adrenal Cortex Hormones (Glucocorticoids & Mineralcorticoids)

    Can be caused by an increased pituitary secretion of ACTH, a pituitary adenoma, or an adrenal adenoma.

    Trunchal Obesity with Thin Extremities, Moonface, Buffalo Hump, Generalized Muscle Wasting & Weakness, Fragile Skin that Bruises Easily, Reddish-Purple Stiae on the Abdomen & Upper Thighs, Hirsutism (masculine characteristics in female), HTN, Elevated Glucose, Elevated Na and Elevated WBCs and Decreased Ca and K Levels. Fatigue, Weakness, Osteoporosis, Edema, Trunk Obesity, Decreased Resistance to Infection, Mood Swings, Depression.

    • Diet: Incr. Protein & Potassium, Decr. Carb, Na & Calorie. Fluid Restriction.
    • Prevent Infection
    • Monitor for FVO/CHF d/t increased retention of Na and Water.
  5. Addisonian Crisis
    Life threatening disorder caused by acute adrenal insufficiency. Caused by stress, infection, trauma or surgery.

    Severe HA, Severe Abdominal, Leg & Lower Back Pain, Generalized Weakness, Irritability & Confusion, Severe Hypotension, Hypoglycemia, Hyponatremia, Hyperkalemia and Shock

    Prepare to administer glucocorticoids IV; hydrocortisone sodium succinate (Solu-Cortef) is usually initially prescribed. Protect client from infection, maintain BR and quiet environment.
  6. Myxedema
    • Hypothyroidism resulting from a hyposecretion of the thyroid hormones T3 and T4
    • Assessment: Decreased Basal Metabolic Rate, Lethargy, Fatigue, Weakness, Muscle Aches, Intolerance to Cold, Weight Gain, Dry Skin & Hair, Loss of Body Hair, Bradycardia, Constipation, Generalized Puffiness & Edema, Menstrual Disturbances, Cardiac Enlargement (CHF)

    Administer thyroid replacement: levothyroxine sodium (Synthroid) Monitor for overdose (tachycardia, restlessness, nervousness, insomnia)

    • Diet: Low calorie, Low cholesterol, low saturated fat diet.
    • Provide warm environment and avoid sedatives & narcotics b/c of increased sensitivity to these medications.
  7. Grave's Disease
    Hyperthyroidism: hypersecretion of thyroid hormones.

    Assessment: Increased Rate of Body Metabolism, Enlarged Thyroid Gland (Goiter), Palpitations, Cardiac Dysrhythmias (Tachycardia/Atrial Fibrillation), Protruding Eyeballs (Exophthalmos), HTN, Heat Intolerance, Diaphoresis, Weight Loss, Diarrhea, Smooth & Soft Skin and Hair, Nervousness & Fine Tremors of Hands, Personality Changes, Irritability & Agitation, Mood Swings

    • Provide rest, cool and quiet environment.
    • Provide high calorie diet & daily weight. Avoid Stimulants (caffeine)

    • Administer antithyroid medications (propylathiouracil PTU) that block thyroid synthesis.
    • Administer propranolol (Inderal) for tachycardia
    • Prepare client for radioactive iodine therapy to destroy thyroid cells or thyroidectomy.
  8. Thyroid Storm
    Acute & Life-threatening condition that occurs in clients with uncontrollable hyperthyroidism. Occurs from manipulation of gland during surgery.

    Elevated Temp, Tachycardia, Systolic HTN, NV & Diarrhea, Agitation, Tremors, Anxiety, Irritability, Agitation, Restlessness, Confusion, Seizures, Delirium and Coma.

    Maintain patent airway, Administer antithyroid medication (PTU), Sodium Iodine, Inderal, and glucocorticoids, Monitor for cardiac dysrhyhmias and administer nonsalicylate antipyretics. Use cooling blanket.
  9. Thyroidectomy
    Removal of Thyroid Gland when persistant Hyperthyroidism exists.

    Administer antithyroid medications, sodium iodine solution, Inderal and glucocorticoids as prescribed to prevent Thyroid Storm postoperatively.

    Tracheostomy Set, Suction and Oxygen at bedside.

    Limit client talking and assess level of hoarsness (larygneal nerve damange)

    Monitor for Hypocalcemia & Tetany (d/t trauma to parathyroid gland) Prepare to administer calcium glucanate if occurs.

    Monitor for Thyroid Storm [Incr. Temp, Incr. Pulse, HTN, Abd. Pain, Diarrhea, Confusion, Agitation]

    Give fluids as tolerated.

    Low, Semi-fowler's position with HOB at 30 degrees and support head, neck & shoulders to prevent flexion/extension of suture line.
  10. Hypoglycemia

    Mild: Hunger, Nervousness, Palpitations, Sweating, Tachycardia, Tremor

    Moderate: Confusion, Double Vision, Drowsiness, Emotional Changes, HA, Impaired Coordination, Inability to Concentrate, Irrational/Combative Behavior, Light-headedness, Memory Lapses, Numbness of lips & tongue, Slurred Speech

    Severe: Difficutly arousing from sleep, Disoriented behavior, Loss of Consciousness, Seizure
  11. Hypoparathyroidism
    Decreased Secretion of Parathyroid Hormone. Can occur following thyroidectomy b/c of removal of parathyroid tissue.

    Decreased Ca+ (cardiac dysrhthmias & Tetany & positive Chvosteks & Trousseau's Signs), Decreased Mg, Increased Phosphorus, Tachycardia, Muscular Irritability (cramps & spasms), Dysphagia, Anxiety, Depression, Irritability, Risk for Laryngospasm, Decreased PTH (parathyroid hormone), Numbness & Tingling in Face, Hypotension, Seizures

    • Intiate seizure precautions.
    • Place trach set, suction and O2 at bedside.
    • Prepare to administer Calcium Gluconate IV. Vitamine D enhances absorption of Calcium.
    • Diet: High-Calcium, Low-Phosphorus Diet
  12. Hyperparathyroidism
    Hypersecretion of parathyroid hormone by parathryoid gland.

    Hypercalcemia, Hypophosphatemia, Fatigue, Muscle Weakness, Skeletal Pain & Tenderness, Bone Deformities that result in Pathological Fractures, Anorexia, N/V, Epigastric Pain, Weight Loss, Constipation, HTN, Cardiac Dysrythmias and Renal Stones.

    • Move client slowly & carefully, monitor telemetry, encourage fluid intake & IV NaCl.
    • Administer Lasix to lower Ca+ levels. Prepare client for parathyroidectomy.
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