Patho:
Excessive circulating ADH. Water is being retained. The patient is not urinating.
Assessment:
Edema
Weight gain
Increase BP
Increase HR
Pulmonary Edema
Decrease urine output
Frothy pink sputum, adventitious breath sounds, increase RR
Elevated CVP, PAP, PCWP
Serum Na+ <120
Serum Osmo <250
Urine Osmo increased
Urine SG >1.030
Interventions:
Want to diurese (lasix/bumex) do not use hydrochlorathiazide!
Restrict fluids
Restore normal fluid volume
Increase serum osmolality
Admin Declomycin (abx)-impairs action of ADH.
DI
Causes:
Damage to posterior pituitary lobe (tumor). Anything that can cause increase ICP. Head injury, tumors, major trauma, inflammation
Patho:
Decreased ADH. Water is not being retained. Patient is urinating a lot.
Assessment:
Low BP
High HR
Dry skin
Confusion, restlessness, lethargy, irritability
Thirsty
Dry mucous membranes
Hypomotility
Weight loss
Serum Na+ >145
Serum Osmo >300
Urine Osmo <300
Urine SG <1.005
Interventions:
Replace fluids (isotonic). Be careful administering NS
Blood more viscous= increase risk for clots
Vasopressin/Diabinase
Admin Desmopressin (DDAVP). 1-4mcg SubQ/IM/IV. Side effects: h/a, nausea, abd cramps. NI: watch for water intoxication, I&O, weight
DKA
Causes:
Not taking insulin, pt gets sick, medication compliance.
Patho:
NO INSULIN! DM Type 1. Body turns to breaking down fat and proteins as glucose sources for starving cells leading to ketone formation.
Assessment:
Dehydrated
Poor skin turgor
BP variable
Orthostatic hypotension
Increased HR
Serum pH <7.2
Positive urine glucose and serum ketones
Serum Osmolality 300-350
Lethargy/coma
Fruity/acetone breath
Cold/clammy skin
Kussmaul breathing BS 300-800
*Correlation between pH and K+. More acidic, higher K+
Interventions:
1st: Short-acting Insulin IV bolus
2nd: Insulin drip of 1-2 u/hr
Watch respiratory changes
Watch BS levels as well (don’t want to over correct with too much insulin)
Admin Sodium Bicarbonate to TX acidosis. Only utilize to bring pH >7.0
Once BS falls to 250, dextrose added to IV sol’n
HHNS
Causes:
Exacerbation of a chronic illness, trauma, infection, medication compliance
Patho:
Produces some insulin, poorly utilized insulin. Insulin production enough to prevent DKA but not enough to prevent severe hyperglycemia.
Assessment:
Similar to DKA
NO Kussmaul respirations
NO fruity odor to breath
Tachypnea/shallow breathing
BS 300-2000
High urine output pH normal or slightly acidic
Serum osmolality >350
Interventions:
Similar to DKA
Pulmonary Hypertension
Causes:
Right sided heart failure
Patho:
MAP sustained >25, primary is idiopathic, secondary r/t other causes
Assessment:
