because really concentrated blood o o Central Neurogenic Diabetes Insipidus

Because really concentrated blood o o central

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because really concentrated blood o o Central ( Neurogenic ) Diabetes Insipidus Caused by insufficient production of ADH Origin of Problem is in the Brain Acute or Chronic Condition (usually result of trauma) Symptoms: o Polydipsia, polyuria, enuresis o Thirsty through the night o Infants are irritable but calmed when given free water (not calmed with milk) o Constipation , dehydration, hypernatremia o o Nephrogenic Diabetes Insipidus Caused by the kidneys lack of responsive or under-response to appropriate levels of ADH Origin of Problem is in the Kidneys – tx with hydrochlorothiazide Chronic Condition Symptoms Include: o Polyuria, polydipsia o Hypernatremia o Dilute urine, vomiting, dehydration o possible mental status changes o DI: Testing Water Deprivation Test Elevated serum sodium 24-hour urine collection o Decreased urine osmolality o Decreased specific gravity DI: Treatment Central DI Treat underlying cause Give desmopression or hydrochlorothiazide (synthetic vasopressin/ADH/ DDAVP ) Diabetes Insipidus: Nursing Considerations Weight Monitoring (watch for sudden weight loss) Careful I&O Education
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o medication administration (desmopression given orally, IV, IM, intra-nasally) o Appropriate PO fluid intake Not allowing child to drink from toilets, flower vases, puddles and knowing what to do if they want to do that o Medical alert bracelets Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Increased Antidiuretic hormone (aka vasopressin) Observed with increased frequency in conditions involving infections, tumors or other CNS disease/trauma Excess ADH causes most of the filtered water to be reabsorbed from the kidneys back into central circulation Almost always acute SIADH: Signs and Symptoms Water intoxication Decreased to no UOP Hyponatremia Nausea, vomiting Seizures Malaise Mental status changes SIADH: Diagnostics High urine osmolarity (concentrated urine) High urine specific gravity Low serum osmolarity Low serum sodium Decreased BUN Decreased Hct SIADH: Treatment and Nursing Considerations Treat underlying cause Careful I&O Weight Monitoring
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Fluid restriction (no free water) May need hypertonic NaCl Seizure precautions Education regarding these measures Diet high in protein and sodium Frequent neuro checks Which is the best choice of food for a child with SIADH? French Fries Fried Chicken – high in salt and protein Chocolate Shake Watermelon Disorder of Thyroid Function Thyroid Function Thyroid Gland produces two types of hormones: o Thyroid Hormone (TH) Thyroxine (T4) Triiodothyronine (T3) o Calcitonin o The secretion of Thyroid Hormone is controlled by thyroid stimulating hormone (TSH), from the pituitary o High thyroid – neg feedback  less TSH  less TH Hypothyroid: Low T3, T4, High TSH Hyperthyroid: High T3, T4, Low TSH Hypothyroidism
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