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Exam 6 > Diabetes Insipidus > Flashcards

Diabetes Insipidus Flashcards

1
Q 
Pathophysiology of Diabetes Insipidus:
Pituitary consists of 2 lobes:
\_\_\_\_\_\_\_ aka (\_\_\_\_\_\_):
Secretes 
Growth hormone (somatotropin)
Prolactin 
Thyroid-stimulating hormone 
Follicle-stimulating hormone
Luteinizing hormone 
\_\_\_\_\_\_\_\_\_\_
Posterior Pituitary > adenohypophysis
A

Adrenocorticotropic hormone (ACTH)

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2
Q 
Pathophysiology of Diabetes Insipidus:
Pituitary consists of 2 lobes:
\_\_\_\_\_\_\_ Aka  (\_\_\_\_\_\_) :
Secretes
Oxytocin
\_\_\_\_\_\_\_
A 
Anterior Pituitary > neurohypophysis
Antidiuretic hormone (ADH, vasopressin)
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3
Q

Pathophysiology of Diabetes Insipidus:
These hormones are produced in the hypothalamus and are ______ in the Posterior Pituitary until their release is triggered by the appropriate stimuli.
Hormones secreted by the ______ Pituitary gland regulate growth, metabolism, pigment changes, and sexual development. These functions are affected when the pituitary gland secretes too much or too little of one or more hormones.
The _______ Pituitary gland secretes vasopressin, also known as antidiuretic hormone (ADH).

A

stored
Anterior
Posterior

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4
Q

Pathophysiology of Diabetes Insipidus:
______ is the single most important hormone responsible for fluid balance by either increasing the rate of water reabsorption (recovery) from the renal tubules (collecting ducts in the kidney) or decreasing the rate of water reabsorption (elimination). It also stimulates peripheral blood vessels to constrict.

A

Anti-Diuretic Hormone (ADH)

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5
Q

Pathophysiology of Diabetes Insipidus:
________ Pituitary problems result in fluid and electrolyte imbalances. ADH causes reabsorption of water improves low BP and low blood volume. This hormone also contributes to control of the sodium level in the ECF by control of plasma osmolality ADH is released to stimulate fluid reabsorption thus retaining water and maintain NA balance which results in dilution of Extra Cellular Fluid. Blood ______ is the most important stimulus to increase ADH secretion (a measure of solute concentration of circulating blood) this is used to compensate for hyperosmolar blood.

A

Posterior

osmolality

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6
Q

Diabetes Insipidus Defined: DI is a condition which is caused by a deficiency of production or secretion of ADH or a decreased ____ response to the secretion of ADH which results in the inability of the body to concentrate or retain water. ADH deficiency results in the excretion of large volumes of dilute urine resulting in ______. The amount of urine excreted may vary from ___ to ___ liters per day. This results in fluid and electrolyte imbalances caused by the increased DILUTE urine output, decreased urine specific gravity, decreased urine osmolality and increased blood plasma osmolality.

A

renal
polyuria
4 to 20 Liters

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7
Q

Types of Diabetes Insipidus: This is the Most common. __________- Insufficient production of ADH by the hypothalamus or ineffective secretion by the posterior pituitary. Examples: Brain tumors, CNS infections, brain lesions, head injury.

A

Central DI (Neurogenic)

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8
Q

Types of Diabetes Insipidus: _________- Inadequate renal response to ADH despite presence of adequate ADH. Can be drug induced such as Lithium or can be secondary to renal disease such as polycystic kidney disease or chronic renal insufficiency. Can be secondary to hypercalcemia and hypokalemia, or with disease of the renal tubules.

A

Nephrogenic DI

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9
Q

Types of Diabetes Insipidus: Rare. Excessive water intake as in water toxicity. Lesion in the thirst center or psychiatric disorder.

A

Psychogenic DI

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10
Q

Diabetes Insipidus Pathophysiology:
Diabetes insipidus is caused by decrease in the functioning and levels of antidiuretic hormone (ADH), also known as _______. Manufactured in the ________ and stored in the pituitary gland, ADH helps to regulate the amount of fluid in the body.

A

vasopressin

hypothalamus

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11
Q

Diabetes Insipidus Pathophysiology:
In healthy NORMAL individuals, when the bodily fluids are LOW, ADH is released from the pituitary gland which ______ the excretion of fluids from the body in the form of urine. ADH acts on the ______ to increase water permeability and reabsorption in the collecting duct and distal convoluted tubule and water is reabsorbed. In an unhealthy ABNORMAL condition of low ADH this results in _____ of tubular reabsorption of water in the kidneys leading to polyuria and dehydration. Dehydration increases plasma osmolality which stimulates osmoreceptors. This increases thirst. If thirst mechanism is ______ severe dehydration and death can occur.

A

prevents
kidneys
failure
absent

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12
Q

Diabetes Insipidus Pathophysiology:
In ______ diabetes insipidus, the production or release of ADH is too low to stop the kidneys from passing dilute urine, which results in an increased loss of water or polyuria.

A

Central / Neurogenic

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13
Q

Diabetes Insipidus Pathophysiology:
People with ________ diabetes insipidus, have adequate amounts of ADH in the body but the kidneys fail to respond which again results in polyuria with a very low urine specific gravity (less than ____), and very low urine osmolality (less than _____mOsm/Kg). Loss of water by the kidney results in _______ which increases thirst. Dehydration and resulting in increased serum Na+ causes increased plasma osmolality (hyperosmolar) which in turn stimulates osmoreceptors which also stimulates the thirst center. Therefore, patient experiences severe _______. Signs and symptoms of dehydration and hypernatremia can be seen as clinical manifestations.

A 
nephrogenic
1.005
100 mOsm/Kg
hypernatremia
polydipsia
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14
Q

Nursing Assessment of Diabetes Insipidus:
Most of the manifestations of DI are related to dehydration.
The key manifestations are an increase in the frequency of urination and excessive thirst. Urine output may be __ to ___ l/day or about ____ ml per hour. Patient can go into hypovolemic shock.
Although increased fluid intake prevent serious dehydration and volume depletion, the patient who is deprived of fluids or who cannot increase oral intake may develop shock from fluid loss.
Watch for manifestations of dehydration, such as poor skin turgor and dry or cracked mucous membranes or skin.

A

4 –20 liters per he

200

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15
Q

Nursing Assessment of Diabetes Insipidus:
S/S vary depending on the type/cause – to certain extent
___________ DI s/s occur suddenly.
Nephrogenic DI less dramatic than central
Increased thirst – compensation for water loss
Increased urination, nocturia
Large quantities of dilute urine 5 – 20 liters/day with ____ specific gravity (____ mOsm/Kg)
Dehydration

A

Central
low
295 mOsm/Kg

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16
Q

Nursing Assessment of Diabetes Insipidus:
Weight loss
Increased serum osmolality d/t hypernatremia d/t pure water loss from kidneys
Increased temperature
Electrolyte imbalances – serum ___ greater than 145 mEq/L
_________ – leads to hypovolemia – vascular collapse (which can happen if water loss is NOT replaced with fluids)

A

Sodium

Hypotension

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17
Q 
Clinical Manifestations of Diabetes Insipidus:
\_\_\_\_\_\_\_\_\_\_:
Hypotension (postural)
Decreased pulse pressure
Tachycardia
Weak peripheral pulses
Hemoconcentration
-Increased Hgb & Hct
-Increased BUN
A

Cardiovascular

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18
Q

Clinical Manifestations of Diabetes Insipidus:
________:
Increased Urine Output : dilute, low specific gravity, hypo-osmolar

A

Renal

19
Q 
Clinical Manifestations of Diabetes Insipidus:
\_\_\_\_\_\_\_\_:
Dehydration 
Poor turgor
Dry mucous membranes
A

Integumentary

20
Q 
Clinical Manifestations of Diabetes Insipidus:
\_\_\_\_\_\_\_\_\_:
Increased sensation of thirst
Irritability, headache
Decreased cognition
Hyperthermia
Lethargy to coma
Ataxia 
Hypernatremia
A

Neurological

21
Q

Diagnosis of SIADH:
A. History and Physical.
B. CT / MRI of brain
C. Water loss produces changes in blood and urine tests. The first step in diagnosis is to measure a ______ intake and output
D. Urine is dilute with a ____ specific gravity (less than 1.005) and ____ osmolality (less than 100 mOsm/kg)

A

24-hour
low
low

22
Q

Diagnosis of SIADH:
Fluid Deprivation Test:
1. Baseline body weight, urine volume, urine osmolality and specific gravity.
2. NPO for __ to __ hours
3. Administer ______ via intranasally or subcutaneously
4. ___ to ___ minutes after administration, obtain urine and serum osmolality and compare to baseline if it is :
A. Central DI – If the urine MOsm is greater than ____and there is a decreased urine output
B. Nephrogenic DI – ____change in urine output

A 
8 to 12 hours
desmopressin (DDAVP)
30-60 minutes
300 
NO 
ASK PROF PAUL?
Is urine output increased or decreased in central DI?
23
Q

Diagnosis of SIADH:
To differentiate between central and nephrogenic DI, 1st obtain baseline weight, urine specific gravity and osmolality and the volume is obtained. After 8 to 12 hours of being NPO, desmopressin is given SC or intra nasally. After 30 to 60 minutes, the urine output and osmolality is measured again. Both urine volume and specific gravity/ mOsm is increased significantly in ____ whereas not much change is seen in if the cause is ______.

A

central

nephrogenic

24
Q

Management of Central Diabetes Insipidus:
Fluids are _____ restricted. Fluids are replaced both orally and by IV. In acute DI, the nurse will use _____ SOLUTIONS Ex. D5W or 0.45% NS is used. The volume of IVF is titrated depending on the urine output. Monitor blood ______ levels with dextrose solutions.

A

NOT
HYPOTONIC
glucose

25
Q 
Management of Central Diabetes Insipidus:
Desmopressin acetate (DDAVP) with URTI, oral, or SQ vasopressin is used. (Ex. Vasopressin Tannate) increases the action of existing ADH and possibly has a \_\_\_\_\_\_\_ effect on the production of ADH in the hypothalamus to increase secretion.
A

stimulating

26
Q

Management of Central Diabetes Insipidus:
When ADH deficit is severe, ADH analogues like _____ is replaced in amount sufficient to maintain BP and water balance. DDAVP is a synthetic form of vasopressin given orally, IV, SC or intranasally in a metered spray and is the drug of choice. During severe dehydration, ADH may be given IV or IM. Intranasal route is avoided with ______ or ______.

A

DDAVP or acqueous vasopressin (Pitressin)

upper respiratory tract infections or nasal congestions

27
Q

Management of Central Diabetes Insipidus:
_______ constricts smooth muscle and can elevate systemic BP. May cause ulcers of the mucous membranes, sensation of chest tightness. Monitor for weight gain, headache, depression, restlessness, LOC, hyponatremia, and urine output.

A

DDAVP

28
Q

Management of Central Diabetes Insipidus:
Vasopressin tannate: SQ, can cause abscesses and _______ at the site of injection due to changes in SQ fat; so the nurse must rotate injection sites. Contraindicated if allergic to _______.

A

lipodystrophy

peanuts

29
Q

Management of Central Diabetes Insipidus:
_______ and ______ – thought to potentiate the action of ADH (enhance the effect of ADH on the renal collecting tubule and stimulate release) and also helps decrease the thirst response associated with DI.

A

Chlorpropamide and carbamazepine

30
Q

Management of Nephrogenic DI:
For central - ______ replacement therapy has little effect because there is adequate ADH production.
For nephrogenic – correct underlying cause or stop causative medications; begin ____ diet.
Treatment revolves around dietary measures: Low ______, Low Na+ diet, less than ___ grams of salt per day and low protein is thought to help ______ urine output.

A 
Hormone
low-salt 
Protein
3
decrease
31
Q

Management of Nephrogenic DI:
______diuretics – these slow the GFR and allow the kidneys to reabsorb more water in the loop of Henle and distal tubule. Eg. Hydrochlorothiazide (Hydrodiuril), Chlorothiazide (diuril)

A

Thiazide

32
Q

Management of Nephrogenic DI:
________ - Indocin (indomethacin), Ex. Naproxen, Ibuprofen) helps increase _____ responsiveness to ADH, is used when a low sodium diet and thiazide diuretics are NOT effective. _____ are given with these medications to prevent gastric ulcers. Combination of ____ used with NSAIDs are known to work better.

A

NSAIDS
renal
PPIs
thiazides

33
Q

Nursing Diagnosis in Diabetes Insipidus:
Impaired _____ elimination related to polyuria.
______ related to dehydration and hyperosmolality.
Fluid volume _____ related to polyuria
Knowledge deficit related to diagnosis, tests, and treatment.
Risk for altered body ______ related to dehydration.

A

urinary
Confusion
deficit
temperature

34
Q

Nursing Interventions in Diabetes Insipidus:
Assessment:
Determine if the client had a recent hypophysectomy, a head trauma, a brain tumor, an infection, or the use of drugs that inhibit ADH release (____, ____, or ______)
Obtain a list of current or past medications?
Determine what manifestations associated with DI are present.

A

ethanol, lithium, phenytoin

35
Q

Nursing Interventions in Diabetes Insipidus:
Assessment:
Does the individual complain of urinary frequency or excessive _____?
Are the signs of dehydration? (such as tachycardia), poor skin turgor (hydration indicator), or dry mucous membranes and skin, or neurologic changes (ALOC, disorientation, decreased attention span, or irritability)
Are measures of fluid and electrolyte status WNL? (weight, specific gravity, sodium, I & O, and serum / urine osmolality
Is bladder _______ present?

A

thirst

distention

36
Q

Nursing Interventions in Diabetes Insipidus:
Interventions:
Monitor vital signs and neurological and cardiovascular status
Provide a ______ environment, particularly in the client with a change in LOC or mental status
Monitor electrolyte values and for signs of dehydration
Monitor I&O, daily weights, and _____ of urine
Maintain the intake of adequate fluids.

A

safe

specific gravity

37
Q

Nursing Interventions in Diabetes Insipidus:
Interventions:
Instruct the client to avoid foods or liquids with a diuretic type action. Ex. Coffee, or Alcohol
Administer DDAVP or thiazide diuretics with ____ as indicated.
Monitor for overtreatment with _____ – weight gain with fluid overload or water retention, headache, hyponatremia and change in LOC.
Limit sodium to less than ____ g and do NOT restrict water intake because this will make the dehydration worse.

A

NSAIDS
DDAVP
3 grams

38
Q

Pathophysiology of Diabetes Insipidus: the _______ Located in the sphenoid bone, enclosed by the sella turcica. 2 lobes are separated anatomically by an intermediate lobe (pars intermedia).

A

Pituitary

39
Q

Evaluation and Outcomes in Diabetes Insipidus:
Has the client noted a _____ in urinary frequency and excessive thirst?
Are I & O, specific gravity, lab values normalized?
Is the client able to verbalize understanding of the disease process, tests, and care needs?
Is the client _____ with therapy?

A

decrease

compliant

40
Q 
Quick Review of Diabetes Insipidus:
Diabetes insipidus (DI) is associated with a deficiency of production or secretion of ADH or decreased renal response to ADH. Depending on cause, DI may be transient or a chronic lifelong condition. 
There are three types of DI: \_\_\_\_\_\_\_, which is most common, nephrogenic, and primary.
A

central (neurogenic)

41
Q

Quick Review of Diabetes Insipidus:
DI is characterized by _____ and _____. If oral fluid intake cannot keep up with urinary losses, severe fluid volume deficit results as manifested by poor tissue turgor, hypotension, and hypovolemic shock. The increased urinary output and increases plasma osmolality can cause severe fluid and electrolyte imbalances.

A

polydipsia and polyuria

42
Q

Quick Review of Diabetes Insipidus:
DI is characterized by a dilute urine with urine output at greater than ____ mL per hour and specific gravity of less than ____. Identification of cause as central neurogenic DI often requires a ______ test.

A

200 mL/hr
1.005
water deprivation

43
Q

Quick Review of Diabetes Insipidus:
For central DI, _____ and _____ therapy is the cornerstone of treatment. MOST COMMON FORM OF DI.
Nursing care includes early detection, maintenance of adequate hydration, and patient teaching for long-term management.

A

fluid and hormone

Exam 6 (3 decks)

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