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NURS 6501 Syndrome of Antidiuretic Hormone (SIADH)

NURS 6501 Syndrome of Antidiuretic Hormone (SIADH)

NURS 6501 Syndrome of Antidiuretic Hormone (SIADH)

Scenario 1: Syndrome of Antidiuretic Hormone (SIADH)

A 77-year-old female was brought to the clinic by her daughter who stated that her mother had become slightly confused over the past several days. She had been stumbling at home and had fallen twice but was able to walk with some difficulty. She had no other obvious problems and had been eating and drinking. The daughter became concerned when she forgot her daughter’s name, so she thought she better bring her to the clinic.

HPI: Type II diabetes mellitus (DM) with peripheral neuropathy x 30 years. Emphysema. Situational depression after death of spouse 6-months ago

SHFH: – non contributary except for 40 pack/year history tobacco use.

Meds: Metformin 1000 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-102 mg/dl, BUN 16 mg/dl, Creatinine 1.1 mg/dl, Na+116 mmol/L,

K+4.2 mmol/L, CO237 m mol/L, Cl97 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:

1.     Define SIADH and identify any patient characteristics that may have contributed to the development of SIADH 

Selected Answer: SIADH occurs when the body produces more ADH, causing water retention and electrolyte imbalance. ADH is produced by the hypothalamus, and it is secreted and stored by the posterior pituitary gland. ADH regulates water in the body by constricting blood vessels and regulating water retention. This is accomplished through the use of kidneys. ADH causes water retention in the renal tubules. ADH elevation causes extra water retention in the body, resulting in hyponatremia with hypo-osmolality and high urine osmolality.

Damage to the hypothalamus or posterior pituitary gland, or ADH produced elsewhere, can all be causes of SIADH. If the SIADH is not treated, the symptoms worsen, including confusion, hallucinations, seizures, and even coma. This patient has emphysema and currently smokes 40 packs of tobacco per year, according to the patient history. According to the most recent lab results, the patient’s carbon dioxide level is 37. Serum carbon dioxide levels should be between 23 and 29. In addition, their sodium level is abnormally high at 116. Serum sodium levels should be between 135 and 145. When serum sodium levels are abnormally low, the syndrome of inappropriate antidiuretic hormone secretion (SIADH) can be diagnosed.

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.
Response Feedback: [None Given]

In this exercise, you will complete a 10- to 20-essay type question Knowledge Check to gauge your understanding of this module’s content.

Possible topics covered in this Knowledge Check include:

    • Diabetes
    • Hyper- and hypothyroidism
    • Adrenal disorders
    • Parathyroidism (hyper and hypo)
    • Checks & balances / negative feedback
    • Syndrome of Inappropriate Antidiuretic Hormone
    • Pheochromocytosis
    • Diabetes insipidus
    • Diabetic ketoacidosis

Photo Credit: Getty Images/Science Photo Library RF

(Note: It is strongly recommended that you take the Knowledge Check at least 48 hours before taking the Midterm Exam.)

Also Read:

NURS 6501 Bipolar Disorder

NURS 6501 Explain what ALL is?

NURS 6501 Acute Lymphoblastic Leukemia

NURS 6501 Immune Thrombocytopenia Purpura (ITP) Pathophysiology

Complete the Knowledge Check By Day 5 of Week 6

To complete this Knowledge Check:

Module 4 Knowledge Check

Midterm Exam

This 101-question exam is a test of your knowledge in preparation for your certification exam. No outside resources, including books, notes, websites, or any other type of resource, are to be used to complete this exam. You are expected to comply with Walden University’s Code of Conduct.

This exam will be on topics covered in Weeks 1, 2, 3, 4, 5, and 6. Prior to starting the exam, you should review all of your materials. This exam is timed with a limit of 2 hours for completion. When time is up, your exam will automatically submit.

(Note: It is strongly recommended that you take the Knowledge Check at least 48 hours before taking the Midterm exam.)

Photo Credit: Getty Images

To prepare:

To help you review for your midterm exam, access the Midterm Exam Review document found in this week’s Learning Resources as

well as any Knowledge Check feedback you might have received. (Note: You will also need to review all of your materials from each of these weeks to also help you better prepare for your midterm.)NURS 6501 Syndrome of Antidiuretic Hormone (SIADH)

By Day 7 of Week 6

Submit your Midterm Exam.

To complete your exam:

Midterm Exam

Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: NURS 6501 Syndrome of Antidiuretic Hormone (SIADH)

What’s Coming Up in Module 5?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

In Module 5, you will analyze processes related to neurological and musculoskeletal disorders through case study analysis. To do this, you will analyze alterations in the relevant systems and the resultant disease processes. You will also consider patient characteristics, including racial and ethnic variables, which may impact physiological functioning and altered physiology.

Week 7 Knowledge Check: Neurological and Musculoskeletal Disorders

In the Week 7 Knowledge Check, you will demonstrate your understanding of the topics covered during Module 5. This Knowledge Check will be composed of a series of questions related to specific scenarios provided. It is highly recommended that you review the Learning Resources in their entirety prior to taking the Knowledge Check, since the resources cover the topics addressed. Plan your time accordingly.

Next Module

To go to the next Module:

Module 5

Week 6: Concepts of Endocrine Disorders

Endocrine disorders are complex matters, and there is not always a one-size-fits-all treatment. Particularly in matters requiring the adjustment of hormone levels, treatment may require a custom approach tailored to individual patients. An understanding of these complications is essential to supporting these individual treatment plans.

This week, you examine alterations in the endocrine system and the resultant disease processes. You also consider patient characteristics, including racial and ethnic variables, and the impact they have on altered physiology.

Learning Objectives

Students will:

  • Analyze concepts and principles of pathophysiology across the lifespan

Learning Resources

Required Readings (click to expand/reduce)

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.

  • Chapter 21: Mechanisms of Hormonal Regulation, including Summary Review
  • Chapter 22: Alterations of Hormonal Regulation, including Summary Review
  • Chapter 23: Obesity and Disorders of Nutrition, including Summary Review

American Diabetes Association (2020). Standards of medical care of patients with diabetes mellitus. Diabetes Care, 26(suppl 1), pp. s33-s50. https://care.diabetesjournals.org/content/26/suppl_1/s33

Orlander, P. R. (2018). Hypothyroidism. Retrieved from https://emedicine.medscape.com/article/122393-overview

Hoorn, E. J., & Zietse, R. (2017). Diagnosis and treatment of hyponatremia: Compilation of the guidelines. Journal of the American Society of Nephrology, 28(5), 1340–1349

Document: NURS 6501 Midterm Exam Review (PDF document) 

Note: Use this document to help you as you review for your Midterm Exam in Week 6.

Required Media (click to expand/reduce)

Module 4 Overview with Dr. Tara Harris 

Dr. Tara Harris reviews the structure of Module 4 as well as the expectations for the module. Consider how you will manage your time as you review your media and Learning Resources throughout the module to prepare for your Knowledge Check and your Midterm. (3m)

Concepts of Endocrine Disorders – Week 6 (24m)

Online Media from Pathophysiology: The Biologic Basis for Disease in Adults and Children

In addition to this week’s media, it is highly recommended that you access and view the resources included with the course text, Pathophysiology: The Biologic Basis for Disease in Adults and Children. Focus on the videos and animations in Chapters 21 through 23 related to the endocrine system and disorders. Refer to the Learning Resources in Week 1 for registration instructions. If you have already registered, you may access the resources at https://evolve.elsevier.com/

Optional Resources (click to expand/reduce)

The following source provides various tutorials related to maximizing your time management and managing stress. Feel free to access this resource to support you as you move through this course.

Walden University. (2019). ASC success strategies interactive tutorials. Retrieved from https://academicguides.waldenu.edu/academic-skills-center/skills/tutorials/success-strategies

Review Test Submission: Module 6 Knowledge Check

Course NURS-6501N-32-Advanced Pathophysiology-2021-Summer-QTR-Term-wks-1-thru-11-(05/31/2021-08/15/2021)-PT27
Test Module 6 Knowledge Check
Started 7/27/21 6:53 PM
Submitted 7/29/21 6:19 PM
Due Date 8/2/21 1:59 AM
Status Completed
Attempt Score 20 out of 20 points
Time Elapsed 47 hours, 25 minutes
Results Displayed All Answers, Submitted Answers, Correct Answers, Feedback, Incorrectly Answered Questions
  • Question 1

1.25 out of 1.25 points

The APRN is assessing a patient that states that Napoleon Bonaparte is the King of France even thought he has a book that says he is dead.   This is an example of:
Selected Answer: Delusion
Answers: Delusion
Hallucination
Anhedonia
Pressured speech
  • Question 2

1.25 out of 1.25 points

Monoamine neurotransmission is hypothesized to be _______________ during mania.
Selected Answer: increased
Answers: increased
decreased
absent
suspended
  • Question 3

1.25 out of 1.25 points

 Monoamine neurotransmission is hypothesized to be _______________ during depression.
Selected Answer: decreased
Answers: increased
decreased
absent
stimulated
  • Question 4

1.25 out of 1.25 points

The APRN is assessing a patient that has monotone speech and unchanged facial expressions even though he states he is happy and excited about his life.   This is an example of:
Selected Answer: Anhedonia
Answers: Delusion
Hallucination
Anhedonia
Pressured speech
  • Question 5

1.25 out of 1.25 points

Obsessive compulsive disorder is characterized by what types of thoughts and behaviors?
Selected Answer: repetitive irrational thoughts and ritualized behavior
Answers: disorganized irrational thoughts and disorganized behavior
constant  irrational thoughts and constant behavior
repetitive irrational thoughts and ritualized behavior
repetitive irrational thoughts and disorganized behavior
  • Question 6

1.25 out of 1.25 points

The APRN is assessing a patient that is talking to his mother in the corner of the room even although you are the only other person in the room.  This is an example of:
Selected Answer: Hallucination
Answers: Delusion
Hallucination
Anhedonia
Pressured speech
  • Question 7

1.25 out of 1.25 points

The APRN is treating a patient with bipolar II disorder.  The major focus of treatment is on:
Selected Answer: depression
Answers: mania
depression
anxiety
panic attacks
  • Question 8

1.25 out of 1.25 points

Abnormalities in brain development related to schizophrenia are thought to develop when?
Selected Answer: Prenatal
Answers: Prenatal
Infancy
Early Childhood
Adolescent
  • Question 9

1.25 out of 1.25 points

 A patient with schizophrenia will have alterations in their dorsolateral prefrontal cortex.   The APRN would expect it to be described as:
Selected Answer: hypoactive
Answers: stimulated
absent
hyperactive
hypoactive
  • Question 10

1.25 out of 1.25 points

 The neurobiology of depression is believed to be related to the atrophy of neurons in the:
Selected Answer: hippocampus
Answers: hypothalmus
hippocampus
thalmus
amygdala
  • Question 11

1.25 out of 1.25 points

What type of thoughts are characteristic of post traumatic stress disorder?
Selected Answer: intrusive
Answers: disorganized
intrusive
anxious
disturbing
  • Question 12

1.25 out of 1.25 points

Which of the following are positive clinical manifestations of schizophrenia?
Selected Answer: Hallucinations, delusions, and incoherent speech
Answers: Social withdraw, blunted affect, and failure to respond to simple questions
Hallucinations, delusions, and incoherent speech
Hallucinations, blunted affect, and social withdraw
Delusions, hallucinations, and failure to respond to simple questions
  • Question 13

1.25 out of 1.25 points

The APRN is assessing a patient that is talking so rapidly and urgently that it is difficult to understand.    This is an example of:
Selected Answer: Pressured speech
Answers: Delusion
Hallucination
Anhedonia
Pressured speech
  • Question 14

1.25 out of 1.25 points

Which of the following are negative clinical manifestations of schizophrenia?
Selected Answer: Social withdraw, blunted affect, and failure to respond to simple questions
Answers: Social withdraw, blunted affect, and failure to respond to simple questions
Hallucinations, delusions, and incoherent speech
Hallucinations, blunted affect, and social withdraw
Delusions, hallucinations, and failure to respond to simple questions
  • Question 15

1.25 out of 1.25 points

The APRN would expect to find elevated blood levels of which of the following markers for patients with a diagnosis of depression?
Selected Answer: Proinflammatory cytokines and cortisol
Answers: Proinflammatory cytokines and pH
 Calcium and Cortisol
Calcium and pH
Proinflammatory cytokines and cortisol
  • Question 16

1.25 out of 1.25 points

The APRN is treating a patient with bipolar 1 disorder.  The major focus of treatment is on:
Selected Answer: mania
Answers: mania
depression
anxiety
panic attacks

Question 18

Needs Grading

A 27-year-old man comes to the Veteran’s Administration Hospital at the insistence of his fiancée who accompanies him to the appointment. She tells the APRN that her fiancée has not “been the same” since he returned from his second tour in Iraq.  He was an infantryman with a local Marine Reserve unit and served 2 tours and was honorably discharged. Since his return, he has had difficulty sleeping, and says he “sleeps with one eye open” and fears sleep. Deep sleep brings vivid nightmares. He grudgingly admits to having experienced several traumatic events during his second tour of duty. He is unwilling to discuss them and will not reveal specific details. He is short tempered and irritable and is afraid to be around people as he doesn’t want to snap at people and alienate them. He startles easily at loud noises, especially the sounds of cars backfiring. He admits to thinking there are threats everywhere and spends an excessive amount of time searching for them but never finding any. He has intrusive memories almost every day and says he really isn’t interested in doing much of anything. He is very worried that these symptoms are irreparably hurting his relationship with his fiancée who he loves very much. The APRN diagnoses him with post-traumatic stress disorder (PTSD).

Question 2 of 2:

Briefly discuss the role glucocorticoids may have on the development of PTSD.

Selected Answer: People with PTSD   have normal-low circulating cortisol levels despite a high Corticotropin-Releasing Factor (CRF) and ongoing stress. Cortisol reduces CRF production. With low cortisol levels, the levels of CRF levels increase and this stimulates the release of norepinephrine by the anterior cingulate. Norepinephrine also plays a major role in increasing blood pressure and a rapid heartbeat seen in individuals with flashbacks.
Correct Answer: People with PTSD tend to have normal to low circulating levels of cortisol despite their ongoing stress and elevated levels of Corticotropin Releasing Factor (CRF). Cortisol leads to decreased production of CRF. If cortisol is low, then CRF continues to be high and stimulates norepinephrine release by the anterior cingulate. This norepinephrine contributes to the rapid heartbeat, and blood pressure elevations seen in people experiencing flashbacks.
Response Feedback: [None Given]

Question 19

Needs Grading

A 17-year-old male high school junior comes to the clinic to establish care. He recently moved from a relatively urban area to a very rural area and has just started his junior year in a new school. The mother states that she has noticed that her son has been frequently washing his hands and avoids contact with any dirty or soiled object. He uses paper towels or napkins over the knob on a door when opening it. According to the mother, this behavior has just appeared since moving. The patient, upon close questioning, admits that he is “grossed out” by some of the boys in the boys’ room since they use the toilet and do not wash their hand afterwards. He is worried about all the germs the boys are carrying around. Past medical history is noncontributory. Social history -lives with parents and 2 siblings in a house in a new town. Is an honors student. Based on these behaviors, The APRN thinks the patient has obsessive-compulsive disorder (OCD).

 

Question 1 of 2:

 

What is primary pathophysiology of OCD?

Selected Answer: Among people with OCD, primary studies have indicated that its pathogenesis is associated with increased metabolic activity and flow of blood in the limbic structures, orbitofrontal cortex, thalamus, and caudate with a high right-sided dominance. There is also a pathophysiological brain circuit that comprises the orbitofrontal cortex, anterior thalamus, dorsal anterior cingulate cortex, and in the subregions of the basal ganglia of the putamen and caudate.
Correct Answer: Neuroimaging studies have shown increases in blood flow and metabolic activity in the orbitofrontal cortex, limbic structures, caudate, and thalamus, with a trend toward right-sided predominance. There is a pathophysiological brain circuit that consists of the anterior thalamus, orbitofrontal cortex, dorsal anterior cingulate cortex, and predominately in the basal ganglia subregions of the caudate and putamen is involved in OCD.
Response Feedback: [None Given]

Question 20

Needs Grading

A 17-year-old male high school junior comes to the clinic to establish care. He recently moved from a relatively urban area to a very rural area and has just started his junior year in a new school. The mother states that she has noticed that her son has been frequently washing his hands and avoids contact with any dirty or soiled object. He uses paper towels or napkins over the knob on a door when opening it. According to the mother, this behavior has just appeared since moving. The patient, upon close questioning, admits that he is “grossed out” by some of the boys in the boys’ room since they use the toilet and do not wash their hand afterwards. He is worried about all the germs the boys are carrying around. Past medical history is noncontributory. Social history -lives with parents and 2 siblings in a house in a new town. Is an honors student. Based on these behaviors, The APRN thinks the patient has obsessive-compulsive disorder (OCD).

Question 2 of 2:

 

Describe the role the dorsal anterior cingulate cortex (dACC) has in reinforcement of obsessive behaviors.

Selected Answer: Neuroimaging studies indicate that individuals with OD have dACC hyperactivity. This is attributed to the fact that dACC is thought to be a primary center for receiving negative emotions, reinforces information, and integrates it to direct motivated behavior.

 

Correct Answer: Neuroimaging studies have demonstrated hyperactivity of the dACC in people with OCD as compared to controls. The dACC is thought to be a key center that receives negative emotion and reinforcing information and integrates that information to direct motivated behavior.
Response Feedback: [None Given]