Ch. 41 Diabetes Insipidus Flashcards
Which is the master gland?
Pituitary gland
How many lobes does the pituitary gland have?
2
What is central DI?
caused by a decreased secretion of antidiuretic hormone (ADH) from the posterior pituitary gland
DI patho
Decrease in ADH
ADH is
Produced where
Stores and released in
- Vasopressin
- Hypothalamus
- P. Pituitary
CM of DI
Polyuria Polydipsia Nocturia Hemoconcentration Hypotension Tachycardia S/S of FVD
Hemoconcentration
high serum sodium and hematocrit
Diagnosis of DI
Serum and urine electrolytes
Serum and urine osmolality
Urine specific gravity
C T scan and M R I (to view pituitary gland)
Levels of
- Sodium
- Hematocrit
- Sp gravity
- High
- High
- Low (<1.005)
Normal Sp gravity
1.005-1.030
Fluid management for unconscious pt with DI
hypotonic solution
-dextrose in water
**Monitor blood glucose
Meds for DI
-how is it given?
Desmopressin (DDAVP) = synthetic ADH
-given subq, intranasal, or PO
Synthetic vasopressin (Pitressin) **monitor urine output
Complications with DI
- Dehydration and hypovolemia = circulatory collapse
- Hemoconcentration = increase risk of hypernatremia = confusion, neuromuscular excitability, seizures, or coma
Nursing diagnosis
Fluid volume deficit related to loss of free water secondary to lack of A D H
Risk for ineffective therapeutic regimen management related to required administration of desmopressin (DDAVP)
Sensory perceptual alteration (vision) related to compression of CN II and III secondary to pituitary tumor
Nursing assessment: VS
Lack of A D H leads to excessive water loss with resulting decrease in blood pressure and increase in heart rate as a compensatory mechanism.
Nursing assessment: I&Os
Fluid replacement is largely dependent on the volume of urine output secondary to lack of A D H.
Assessment: Daily weight
Increased output of dilute urine, secondary to lack of A D H, leads to decrease in weight.
Assessment: Visual acuity
Growth of the pituitary tumor may compress CN II or CN III.
Assessment: Serum sodium and osmolality
Lack of A D H causes an increase in water excretion leading to the concentration of serum sodium (hypernatremia) and an increase in serum osmolality.
Assessment: Sp. gravity
Lack of A D H results in the excretion of large volumes of dilute urine; specific gravity is usually less than 1.005.
Nursing actions: Maintain IV access
In patients with a decrease in level of consciousness, IV fluids are usually indicated. The solution ordered is based on serum sodium level. It is important to maintain vascular access because placement of an IV catheter in a profoundly hypotensive patient is difficult.
Nursing actions: administer meds
Synthetic A D H is administered to cause water reabsorption in the kidney.
Nursing actions: Provide fluids
If the patient is alert and awake and has an intact gag reflex, the patient is allowed to drink fluids
Nursing actions: Provide mouth care
The patient is at risk for fluid volume deficient related to lack of A D H and requires mouth care to minimize complications of dry mucous membranes.
