NUR 6501 / NUR6501 PATHO MODULE 4 KNOWLEDGE CHECK

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Knowledge Check 4 Take Test: Module 4 Knowledge Check Test Information Description Instructions Multiple Attempts Not allowed. This test can only be taken once. Force Completion This test can be ... saved and resumed later. Expand Question Completion Status: QUESTION 1 A 67-year-old Caucasian woman was brought to the clinic by her son who stated that his mother had become slightly confused over the past several days. She had been stumbling at home and had fallen once but was able to ambulate with some difficulty. She had no other obvious problems and had been eating and drinking. The son became concerned when she forgot her son’s name, so he thought he better bring her to the clinic. PMH-Type II diabetes mellitus (DM) with peripheral neuropathy x 20 years. COPD. Depression after death of spouse several months ago Social/family hx - non contributary except for 30 pack/year history tobacco use. Meds: Metformin 500 mg po BID, ASA 81 mg po qam, escitalopram (Lexapro) 5 mg po q am started 2 months ago Labs-CBC WNL; Chem 7- Glucose-92 mg/dl, BUN 18 mg/dl, Creatinine 1.1 mg/dl, Na+120 mmol/L, K+4.2 mmol/L, CO237 m mol/L, Cl-97 mmol/L. The APRN refers the patient to the ED and called endocrinology for a consult for diagnosis and management of syndrome of inappropriate antidiuretic hormone (SIADH). Question: Define SIADH and identify any patient characteristics that may have contributed to the development of SIADH. Syndrome of inappropriate antidiuretic hormone (SIADH) is the production of excessive amounts of antidiuretic hormone (ADH). ADH is produced by the hypothalamus in the brain and is stored and released by the pituitary gland. ADH is responsible for how the body releases and conserves water. When ADH is elevated is causes the levels of electrolytes to fall due to water retention. Low sodium of Knowledge Check 4 hyponatremia is one major complication of SIADH and can cause symptoms such as cramping, nausea, vomiting, confusion, seizures, and eventually coma. Causes of SIADH include brain infections, bleeding of the brain, head trauma, hydrocephalus, Guillain-Barre syndrome, multiple sclerosis, infections such as HIV and Rocky Mountain spotted fever, cancers of the lung or gastrointestinal or genitourinary tract, lymphoma, sarcoma, asthma, lung infections, cystic fibrosis, medications, anesthesia, hereditary factors, and sarcoidosis. Medications that can cause SIADH include hypoglycemic medications, antidepressants, antipsychotics, narcotics, general anesthetics, chemotherapeutic agents, nonsteroidal anti-inflammatory drugs and synthetic ADH. In our patient she has COPD which can lead to SIADH. Medications that can cause SIADH that our patient is taking is her Lexapro, metformin, and ASA. Correct Answer: SIADH is a group of symptoms that occurs when antidiuretic hormone (ADH, arginine vasopressin) is secreted in the absence of osmotic or physiologic stimuli. These stimuli include: Increased serum osmolality, decreased plasma volume, and hypotension. A decrease in plasma osmolality normally inhibits ADH production and secretion. SIADH is characterized by fluid retention, dilutional hyponatremia, hypochloremia, concentrated urine, and lack of intravascular volume depletion. SIADH is characterized by normal to increased blood volume in normoproteinemia, nonedematous, and hyponatremic patients with normal renal and endocrine function. ADH regulates the body's water balance. It is synthesized in the hypothalamus and stored in the posterior pituitary gland. When released into the circulation, it acts on the kidney's distal tubules and collecting ducts, increasing their permeability to water. This decreases urine volume because more water is being reabsorbed and returned to the circulation. It also serves to produce more concentrated urine. QUESTION 2 A 43-year-old female presents to the clinic with a chief complaint of fever, chills, nausea and vomiting and weakness. She has been unable to keep any food, liquids or medications down. The symptoms began 3 days ago and have not responded to ibuprofen, acetaminophen, or Nyquil when she tried to take them. The temperature has reached as high as 102˚F. Allergies: none known to drugs or food or environmental Medications-20 mg prednisone po qd, omeprazole 10 po qam PMH-significant for 20-year history of steroid dependent rheumatoid arthritis (RA). GERD. No other significant illnesses or surgeries. Social-denies alcohol, illicit drugs, vaping, tobacco use Physical exam Thin, ill appearing woman who is sitting in exam room chair as she said she was too weak to climb on the exam table. VS Temp 101.2˚F, BP 98/64, pulse 110, Resp 16, PaO2 96% on room air. [Show More]

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