ADH continues to be released even when plasma is hypo osmolar leading to

Adh continues to be released even when plasma is hypo

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ADH continues to be released even when plasma is hypo-osmolar, leading to disturbances of FLUID AND ELECTROLYTE BALANCE. Water is retained, which results in dilutional hyponatremia (a decreased serum sodium level) and fluid overload. o Symptoms: Loss of appetite, nausea, vomiting, water retention, hyponatremia, lethargy, headaches, hostility, disorientation, change in level of consciousness, full and bounding pulse, hypothermia, elevated urine sodium levels and specific gravity, and decreased serum sodium levels. o Interventions: Medical interventions for SIADH focus on restricting fluid intake, promoting the excretion of water, replacing lost sodium, and interfering with the action of ADH. Nursing interventions focus on monitoring response to therapy, preventing complications, teaching the patient and family about fluid restrictions and drug therapy, and preventing injury. DISORDERS OF THE ADRENAL GLAND: HYPOFUNCTION (ADDISON’S): o Pathophysiology: Adrenocortical steroid production may decrease as a result of inadequate secretion of adrenocorticotropic hormone (ACTH), dysfunction of the hypothalamic-pituitary control mechanism, or direct dysfunction of adrenal gland tissue. In acute adrenocortical insufficiency (adrenal crisis), life-threatening symptoms may appear without warning. Insufficiency of adrenocortical steroids causes problems through the loss of aldosterone and cortisol action. Decreased cortisol levels result in hypoglycemia.
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Gastric acid production and glomerular filtration decrease. Decreased glomerular filtration leads to excessive blood urea nitrogen levels, which cause anorexia and weight loss. Reduced aldosterone secretion causes disturbances of FLUID AND ELECTROLYTE BALANCE. Hyperkalemia, hyponatremia, hypovolemia, and acidosis. Acute adrenal insufficiency (Addisonian crisis) is a life-threatening event in which the need for cortisol and aldosterone is greater than the body's supply. Adrenal insufficiency (Addison's disease) is classified as primary or secondary. Primary causes: o Autoimmune disease o Tuberculosis o Metastatic cancer o AIDS o Hemorrhage o Gram-negative sepsis o Adrenalectomy o Abdominal radiation therapy o Drugs (mitotane) and toxins Secondary causes: o Pituitary tumors o Postpartum pituitary necrosis o Hypophysectomy o High-dose pituitary or whole-brain radiation o Cessation of long-term corticosteroid drug therapy o Symptoms: Muscle weakness, fatigue, joint/muscle pain, anorexia, nausea, vomiting, abdominal pain, constipation or diarrhea, weight loss, salt craving, vitiligo, hyperpigmentation, anemia, hypotension, hyponatremia, hyperkalemia, and hypercalcemia o Interventions: Nursing interventions focus on promoting fluid balance, monitoring for fluid deficit, and preventing hypoglycemia.
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