ACTIVITY ON PITUITARY DISORDERS AND DIABETES MELLITUS

Fill in the table to summarize the Pituitary Disorders and Diabetes Mellitus

Syndrome of Inappropriate Anti- Diabetes Insipidus

Diuretic Hormone
Possible Causes (3 each) -Meningitis (inflammation of the -Brain tumor that damages
meninges) hypothalamus or pituitary gland
-Encephalitis (inflammation of (cranial)
the brain) -Severe head injury that
-Brain tumors damages hypothalamus or
pituitary gland (cranial)
-Congenital (Nephrogenic)
Urine Output Less than 3ml/kg/hr More than 40ml/kg/24 hr
Urine Specific Gravity Greater than or equal to 1020 1.005 or less
Serum Osmolality < 275 mOsm/kg <200 mOsm/kg
Electrolyte Imbalance (if any) Sodium Sodium and Potassium
Signs and Symptoms (5 each) -Nausea and Vomiting -dehydration
-Malaise -dizziness and lethargy
-Headache and Lethargy -nausea
-Seizures -fainting
-Personality changes such as -confused and sluggish
combativeness, confusion, and
hallucinations
Danger Signs (2 each with Hyponatremia Polyuria
rationale) Rationale: Decreased in sodium Rationale: It can cause
level can lead to decreased dehydration which can lead to
consciousness, hallucination, seizures, permanent brain
coma, brain herniation, and damage, and death.
death
Hypernatremia
Rationale: Extreme water loss or
excess sodium intake can cause
dehydration
Nursing Management (5 each w/ -Monitor I and O, daily weights. -Monitor I and O, Report urine
rationale) Rationale: Water retention may volume >200mL for each 2
cause poor urine output. Monitor consecutive hours or 500mL in 2-
for retention daily weights-same hour period.
scale, same time of the day. Rationale: Patients void large
-Restrict fluids. urine volumes independent of
Rationale: It is vital as this the fluid intake. Urine output
prevents further fluid retention in ranges from 2-3L/ day with renal
the body. DI to > 10L with central DI
-Assess and monitor respiratory -Monitor for Polydipsia
status. Rationale: If the patient is
Rationale: Excess fluid can settle conscious and the thirst center is
around lungs, and heart. Monitor intact, thirst can be reliable
for signs of congestion and indicator or fluid balance and
 difficulty breathing.
-Administer medications as
indicated or prescribed by
physician.
Rationale: Vasopressin
antagonist medications are given
to block the action of ADH.
Diuretics are also administered
to decrease urine concentration
and increase water excretion.
-Monitor laboratory or
diagnostic values.
Rationale: Hyponatremia is the
hallmark sign of SIDH. Monitor
serum sodium, serum potassium,
serum chloride, serum
concentration, urine specific
gravity.
Medical Management (3 each w/ -Furosemide
indication/action) Indication: Acute pulmonary
edema, edema, hypertension
Action: Inhibits sodium and
chloride reabsorption at the
proximal and distal tubules and
the ascending loop of Henle.
-Demeclocycline
Indication: used to treat
infections caused by bacteria
including pneumonia and other
respiratory tract infections,
certain infections of the skin,
eye, lymphatic, intestinal,
genital, and urinary system.
Action: inhibits cell growth by
inhibiting translation. It binds to
the 30S and 50S ribosomal
subunit and prevents the amino-
acyl tRNA from binding to the A
site of the ribosome, which
impairs protein synthesis by
bacteria. It  impairs the action of
antidiuretic hormone, but it is
thought that it blocks the
strongly suggest DI
-Monitor laboratory or
diagnostic values.
Rationale: Specific gravity may
be 1.005 or less, urine osmolality
will be decreased and serum
osmolality will increase, patient
with DI has increased urine
sodium levels and
hypernatremia, hypokalemia
may result from the increase in
urinary output of potassium.
-Provide easily accessible fluid
source, keeping adequate fluids
at bedside.
Rationale: Encourages fluid
intake
-Monitor for signs of
hypovolemic shock.
Rationale: Frequent assessment
can detect changes early for
rapid intervention. Polyuria
causes decreased circulatory
blood volume.
-Sulfonylureas
Indication: used as adjunct to
diet and exercise for the
treatment of type 2 diabetes ,
and adjunct treatment for
polycystic ovary syndrome.
Action: Stimulates insulin release
from the beta cells in pancreas.
They improve insulin binding
receptors and may actually
increase the number of insulin
receptors.
-Hydantoins
Indication: Controls tonic-clonic
and psychomotor seizures,
prevention of seizures during
neurosurgery, control of status
epilepticus.
Action: Stabilize the CNS nerve
membranes by decreasing the
excitability and hyperexcitability
of ionic channels in the cell
membrane through stimulation.
-Sulfonamides
Indication: considered to be a

Type of DM
CBG level
Ketone
Medical Management (3 each
with 5 nursing responsibilities
each and w/ rationale)
binding of the hormone to its
receptor.
-Tolvaptan
Indication: Hypervolemic and
euvolemic hyponatremia in
hospitalized patients, including
those with heart failure or
SIADH, to slow kidney function
decline in patients at risk for
rapidly progressing autosomal
dominant polycystic kidney
disease.
Action: Antagonizes the effect of
vasopressin, causing an increase
in urine excretion, which results
in an increase in free water
clearance, a decrease in urine
osmolality, and ultimately an
increase in serum sodium level.
DKA
Type 1
>250 mg/dL
1.6- 2.9 mmol/L
- Maintain fluid intake of
at least 2500 liters/ day
within cardiac tolerance
when oral intake is
resumed.
Rationale: This maintains
hydration and adequacy of
circulating volume.
Hydration causes a decline in
counter-regulatory
hormones, enhances renal
glucose clearance following
improved renal perfusion,
and augments insulin
sensitivity.
- Monitor laboratory
studies such as blood
glucose levels, serum
ketones, potassium,
sodium, creatinine, and
BUN.
Rationale: DKA occurs when
the blood glucose level is >
250mg/dL. Elevated ketones
are associated with DKA.
milder form of diuretics
compared to loop diuretics.
Action: it causes active pumping
out of chloride from the cells
lining the ascending limb of loop
of Henle and distal tubule by
blocking the chloride pump.
HHNS
Type 2
>600mg/dL
normal
Diabetes medications
- Assess blood glucose
levels before meals and
at bedtime
Rationale: Ransom blood
glucose test results should be
between 140-180 mg/dL
- Explore client’s health
beliefs about physical
exercise and review
exercise program
recommendations
Rationale: Stress that the
patient should exercise at
the same time and the same
intensity each day. Exercise
should be done prefereably
when the blood glucose
levels are at their optimum.
- Educate client on
medications prescribed.
Rationale: to enhance
patient knowledge and to
promote compliance
- Educate patient on
 Initially hyperkalemia occurs
in response to metabolic
acidosis. As the fluid volume
deficit progresses, the
potassium level decreases.
- Monitor ABG for amount of food and time
metabolic acidosis.
Rationale: ABGs frequently
show typical manifestations
of metabolic acidosis, low
bicarbonate, and low pH of <
7.3.
- Insert indwelling urinary
catheter as indicated.
Rationale: This provides
accurate measurement of
urinary output, especially if
autonomic neuropahies
result in neurogenic bladder
with urinary retentiton and
overflow incontinence. The
catheter may be removed
when client is stable to Insulin therapy
reduce risk of infection.
- Administer Isotonic
solutions initially.
Rationale: The initial goal of
the therapy is to correct
circulatory fluid volume
deficit. Isotonic normal saline
will rapidly expand effects.
extracellular fluid volume
without causing a rapid fall
in plasma osmolality. Client
typically need one to three
liters within first two hours
of treatment.
Electrolyte replacement
- Administer dextrose to
IV fluid when blood
glucose level is less than
180 mg/dL.
Rationale: When blood sugar
decreases, isotonic sodium
chloride solution is replaced
with 5%-10% dextrose with
half isotonic sodium chloride
solution. This is to prevent
occurance of hypoglycemia
maintaining consistency
in food and approximate
time intervals between
meals
Rationale: A consistent
interval between meals helps
prevent hypoglycemic
reactions and maintain
overall glucose control.
- Provide intructions to
patients using self-
monitoring blood
glucose
Rationale: It is an important
factor in diabetes
management. When patients
know their blood glucose,
they can adjust their
treatment regimen and
obtain optimal blood glucose
control.
- Ensure patient has
dietary and exercise
regime and using good
hygiene practices.
Rationale: To improve the
effectiveness of the insulin
and decrease adverse
- Rotate injection sites.
Rationale: To avoid damage
to muscles and to prevent
subcutaneous atrophy.
- Always verify name of
the insulin being given.
Rationale: Each insulin has a
different peak and duration,
and names can be confused.
- Monitor patients food
intake and exercise.
Rationale: To ensure
therapeutic effect and avoid
hypoglycemia.
- Provide client education
about drug effects and
warning signs .
Rationale: To report to
 and excessive decline in enhance patient knowledge
plasma osmolality. and to promote compliance.
- Administer IV potassium Weight Loss surgery
and other electrolytes as - Monitor tolerance to
indicated. fluid and food intake,
Rationale: If potassium level noting abdominal
is greater than 6 mEq/L, do distention, and reports
not administer potassium of increased pain,
supplement. Monitor until cramping, nausea, and
potassium level are 4.5-6 vomiting.
mEq/L, then administer. Rationale: Complications of
- Administer bicarbonate paralytis ileus, obstruction,
as indicated. delayed gastric emptying,
Rationale: It is only infused if and gastric dilation may
decompensated acidosis occur, possibly requiring NG
starts to threaten the client’s tube.
life, especially when - Note admission weight
associated with either sepsis and compare with
or lactic acidosis. subsequent readings
- Educate patient about Rationale: provides
dietary sources of information about the
electrolytes. adequacy of dietary intake
Rationale: Electrolytes such and determination of
as sodium, potassium, nutritional needs.
calcium, magnesium, and - Caution patient to limit
chloride. A balanced diet intake of ice chips
provides sources of Rationale: Excessive intake of
electrolytes. Whole grains, ice produces nausea and can
nuts fruits are good sources wash out electrolytes via NG
of potassium. tube
- Educate patient and - Provide oral hygiene on
family on signs and a regular, frequent basis,
symptoms of electrolyte including petroleum jelly
abnormalities. for lips
Rationale: This will provide Rationale: prevents
the patient with more discomfort of dry mouth and
independence in managing cracked lips caused by fluid
their care and preventing restriction and NG tube
further complications. - Assess site for any signs
Insulin therapy of infection.
- Ensure patient has Rationale: Redness, swelling,
dietary and exercise pain, prulent discharge from
regime and using good incision, are signs of
hygiene practices. infection.
Rationale: To improve the
effectiveness of the insulin
and decrease adverse
effects.
- Rotate injection sites.
 Rationale: To avoid damage
to muscles and to prevent
subcutaneous atrophy.
- Always verify name of
the insulin being given.
Rationale: Each insulin has a
different peak and duration,
and names can be confused.
- Monitor patient’s food
intake and exercise.
Rationale: To ensure
therapeutic effect and avoid
hypoglycemia.
- Provide client education
about drug effects and
warning signs .
Rationale: To report to
enhance patient knowledge
and to promote compliance.

Rapid Short Intermediate Long

Onset Lispro Aspart Glulis Regular NPH (Neutral Glargine detemir
15-30 15 ine 30-60 min protamine Hagedorn) 3-6 hrs unknown
min min 5-15 1-1.5 hrs
min
Peak 30-90 1-3 1 hr 2-3 hrs 4-12 hrs Continuous (no
min hrs peak)
Duration Great 3-4 5 hrs 4-6 hrs Up to 24 hrs 24 hrs
er hrs
than
or
equal
to 5
hrs
Best time No more than 15 30 minutes before 10-30 minutes before Before bedtime
to minutes before eating. eating a meal breakfast and dinner
administer
Nursing - Monitor client’s food - Provide - Use caution - Monitor
Responsibi intake and exercise patient when mixing patient’s
lities (5 Rationale: to ensure education types of sensory
each w/ therapeutic effect about insulin losses
rationale) - Ensure that effects and Rationale: to ensure Rationale: to
*Do not patient has warning appropriate incorporate its
include dietary and signs suspension and needs into safety.
rotate exercise Rationale: to therapeutic effect - Assess for
site, WOF regimen and enhance patient - Monitor contraindi
s/sx of have a good knowledge and nutritional cation or
hypoglyce hygiene promote status cautions
mia) Rationale: to improve compliance Rationale: to provide Rationale:
the effectiveness of - Monitor nutritional appropriate
medication and results of consultation monitoring and
decrease adverse effect laboratory - Inspect the dose adjustments
- Always check or skin areas can be completed
the name of diagnostic potential for - Do not
the insulin values injection. give
being given Rationale: include Rationale: areas that insulin
Rationale: Insulins have urinalysis, for are bruised, injection
different peak and evidence of thickened, or scarred concentra
duration and names glucosuria interfere with insulin ted IV
can be confusing - Assess absorption Rationale: severe
- Store insulin in activity - Provide anaphylactic
a cool place level, comfort reactions can
away from including measures occur
direct sunlight amount Rationale: to help - Carefully
Rationale: to ensure and degree patient cope with monitor
the effectiveness of the Rationale: to drug effects patients
medication determine which - Provide good being
- Monitor can alter serum skin care switched
patient glucose levels and Rationale: to prevent from one
response the need for drugs. development of type of
carefully - Obtain infections and insulin to
Rationale: to avoid and blood changes in another
address adverse effect glucose therapeutic insulin Rationale: it can
if there is any level as doses result in transient
ordered and serious hypo-
Rationale: to hyperglycemia
monitor response - Educate
to insulin the client
- Perform to avoid
physical alcohol
assessment Rationale: it can
Rationale: to cause serious
establish a baseline reactions
before beginning
insulin therapy
Brand Lispro, Novolog, Humulin (R), NPH Lantus
Names Glulisine Velosulin Humulin Levemir
available Novolin Novolin N Tresiba
in the
Philippine
s (3 each)

Reference/s:
https://go.drugbank.com/drugs/DB00618
https://www.merckmanuals.com/home/hormonal-and-metabolic-disorders/electrolyte-balance/
syndrome-of-inappropriate-secretion-of-antidiuretic-hormone-siadh#:~:text=Vasopressin%20decreases
%20water%20excretion%20by,of%20sodium%20in%20the%20body.
https://pubmed.ncbi.nlm.nih.gov/3121240/#:~:text=Immediate%20treatment%20of%20the
%20symptomatic,chronic%20SIADH%20is%20fluid%20restriction.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3943070/#:~:text=Also%2C%20patients%20with
%20hyponatremia%20(serum,were%20considered%20to%20have%20SIADH.
https://nurseslabs.com/diabetes-insipidus-nursing-care-plans/
https://www.ncbi.nlm.nih.gov/books/NBK279011/