Nursing 212

Health Differences Across the Lifespan 2 Study Guide GH levels. Surgery is most successful in patients with blood GH levels below 40 ng/ml before the operation and with pituitary tumors no larger than 10 mm in diameter. SIADH (Syndrome of Inappropriate Antidiuretic Hormone Secretion) SIADH is an increased secretion of serum ADH from the posterior pituitary gland resulting in water intoxication and hyponatremia (serum sodium less than 135mEq/L). Usual feedback mechanisms do not work to decrease posterior pituitary secretion of ADHwhen there is a decreased serumosmolality (indicating increased fluid). Elevated ADH leads to renal reabsorption of water and suppression of renin-angiotensin mechanisms, causing renal excretion of sodium; renal excretion of sodium leads to water intoxication, cellular edema, and dilutional hyponatremia. Causes include certain hormone secreting malignant tumors, injury, infection, increased intrathoracic pressure that stimulates aortic baroreceptors, and activation of limbic system from trauma, pain, stress, and acute psychosis. Signs and symptoms include oliguria, weight gain, fluid retention, cerebral edema, low potassium, low sodium, headache, anorexia, muscle aches, progressive altered LOC, seizures, coma, and small amounts of concentrated amber colored urine. Increased blood pressure, crackles auscultated in lung fields, distended jugular neck veins, taut skin, and intake greater than output are also signs. Diagnostics: high urine osmolality (greater than 1200 mOsm/kg H20) and specific gravity higher than 1.032; low serum osmolality (less than 275 mOsm/kg), decreased hematocrit, BUN and serum sodium Treatment: restrict oral fluids, including ice chips, to 800mL/day or less to prevent further hemodilution; supplement sodium intake orally or by hypertonic saline IV infusion; flush all enteral and gastric tubes with normal saline instead of water to replace sodium and prevent further hemodilution; monitor I&O accurately; monitor for low sodium, BUN and concentrated urine; weigh daily; a weight loss of 2.2 pounds (1 kilogram) indicates a loss of approximately 1 liter of fluid; monitor for changes in LOC, mentation, cognition, nutrition, muscle twitching, and comfort; medication therapy includes hypertonic saline (3%) and demeclocycline (Declomycin) to replace electrolytes, with diuretics to eliminate excessive fluid Teaching: reinforce signs and symptoms of SIADH; medication may be lifelong; identify hidden sources of water and fluid, such as ice and ice cream, to prevent accidental excessive intake; plan meal patterns and maintain fluid limitation and sodium prescription; weigh daily on same scale and report weight gain of two pounds in one day Hyperparathyroidism Hyperparathyroidism is the excessive secretion of PTH, which leads to bone demineralization. Hypercalcemia increases the risk of renal calculi. The primary type is hyperplasia, or tumor of the parathyroid gland, which increases absorption of calcium in the GI tract. The secondary type is a gland enlargement caused by chronic hypocalcemia in presence of elevated PTH. Increased calcium reabsorption and increased phosphate excretion lead to hypercalcemia and hypophosphatemia;

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