NR283 Pathophysiology Final Exam Study Guide
Endocrine
SIADH- Syndrome of Inappropriate Diuretic Hormone Too much ADH (antidiuretic
hormone ) secretion leads to water intoxication and hyponatremia
Causes include trauma, stroke, malignancies (often in the lungs or pancreas), medications, and
stress
S/S include signs of fluid volume overload, changes in level of consciousness and mental status
changes, weight gain, hypertension, tachycardia, anorexia, nausea, vomiting, hyponatremia,
concentrated urine, decreased urine output, serum osmolality decreased
Nursing considerations include monitoring vital signs and cardiac and neurological status,
providing a safe environment, particularly for the patient with changes in level of consciousness
or mental status, monitoring intake and output and weight daily; monitoring fluid and electrolyte
balance, monitoring serum and urine osmolality; restriction of fluids
DI (Diabetes Insipidus)- Kidney tubules fail to reabsorb water
Etiology includes stroke or trauma or may be idiopathic
S/S include excretion of large amounts of dilute urine, polydipsia, dehydration (decreased skin
turgor and dry mucous membranes), inability to concentrate urine, increased urine output, urine
very dilute, Low urinary specific gravity, fatigue, muscle pain and weakness, headache, postural
,hypotension that may progress to vascular collapse without rehydration, tachycardia,
hypernatremia
Nursing Considerations: monitor vital signs and neurological and cardiovascular status, provide
a safe environment, particularly for the patient with postural hypotension; monitor electrolyte
levels and for signs of dehydration; maintain patient intake of adequate fluids; monitor intake
and ouput, weight, serum osmolality and specific gravity of urine; instruct the patient to avoid
foods and/or liquids that produce diuresis
Hyperthyroidism- Too much thyroid hormone (T3 and T4) Characterized by an increased rate
of body metabolism
Common cause is Graves’ disease, also known as toxic diffuse goiter
S/S include: personality changes such as irritability, agitation and mood swings, nervousness and
fine tremors of the hands, heat intolerance, weight loss, smooth, soft skin and hair, palpitations,
cardiac dysrhythmias such as tachycardia or atrial fibrillation, diarrhea, protruding eyeballs
(exophthalmos) may be present, diaphoresis (sweating), hypertension, enlarged thyroid gland
(goiter)
Nursing Considerations: Provide adequate rest, provide a cool and quiet environment, provide a
high-calorie diet, obtain daily weight, avoid administration of stimulants, administer sedatives as
prescribed, administer antithyroid medications, administer blood pressure medication for
tachycardia, prepare for thyroidectomy if prescribed
,Hypothyroidism- Hyposecretion of thyroid hormones (T3 and T4) Characterized by a decreased
rate of body metabolism
Causes: autoimmune disease, treatment for hyperthyroidism, radiation therapy, thyroid surgery,
certain medications
S/S: lethargy, fatigue, weakness, muscle aches, paresthesias, intolerance to cold, weight gain, dry
skin and hair and loss of body hair, bradycardia, constipation, generalized puffiness and edema
around the eyes and face (myxedema), forgetfulness and loss of memory, menstrual
disturbances, cardiac enlargement, tendency to develop heart failure, goiter may or may not be
present
Hyperparathyroidism- Hypersecretion of parathyroid hormone (PTH)
Causes: Tumor, Hyperplasia, Genetics; secondary causes-severe calcium or vitamin D
deficiency, chronic kidney failure
S/S: Hypercalcemia and hypophosphatemia, fatigue and muscle weakness, skeletal pain and
tenderness, bone deformities that result in pathological fractures, anorexia, nausea, vomiting,
epigastric pain, weight loss, constipation, hypertension, cardiac dysrhythmias, renal stones
Nursing Considerations: Monitor vital signs, particularly blood pressure; monitor for cardiac
dysrhythmias, monitor for intake and output and for signs of renal stones, monitor skeletal pain,
move the patient slowly and carefully; encourage fluid intake, administer furosemide (Lasix) as
prescribed to lower calcium levels, administer phosphates, which interfere with calcium
reabsorption as prescribed, administer calcitonin as prescribed to decrease the skeletal calcium
, release and increase renal excretion of calcium, monitor calcium and phosphorus levels, prepare
the patient for parathyroidectomy as prescribed
Hypoparathyroidism-Hyposecretion of parathyroid hormone (PTH)
Can occur following a thyroidectomy because of removal of parathyroid tissue
S/S: Hypocalcemia and hyperphosphatemia, numbness and tingling in the face, muscle cramps
and cramps in the abdomen or extremities, positive Trousseau’s and Chvostek’s sign, signs of
overt tetany such as bronchospasm, laryngospasm, carpopedal spasm, dysphagia, photophobia,
cardiac dysrhythmias, seizures; hypotension, anxiety, irritability, depression
Nursing Considerations: Monitor vital signs, monitor for signs of hypocalcemia and tetany,
initiate seizure precautions, place a tracheostomy set, oxygen and suctioning equipment at
bedside, prepare to administer calcium gluconate intravenously for hypocalcemia, provide a
high-calcium, low-phosphorus diet, instruct the patient on administration of calcium supplements
as prescribed, instruct the patient on administration of vitamin D supplements as prescribed,
vitamin D enhances the absorption of calcium from the GI tract, instruct the patient on
administration of phosphate binders as prescribed to promote the excretion of phosphate through
the gastrointestinal tract, instruct to wear a Medic-Alert bracelet
Cushing’s Syndrome/Disease- is a metabolic disorder characterized by abnormally increased
secretion (endogenous) of cortisol, caused by increased amounts of ACTH secreted by the
pituitary gland
