Ch. 41 Diabetes Insipidus

Question 1

Which is the master gland?

Answer 1

Pituitary gland

Question 2

How many lobes does the pituitary gland have?

Answer 2

2

Question 3

What is central DI?

Answer 3

caused by a decreased secretion of antidiuretic hormone (ADH) from the posterior pituitary gland

Question 4

DI patho

Answer 4

Decrease in ADH

Question 5

ADH is
Produced where
Stores and released in

Answer 5

• Vasopressin
• Hypothalamus
• P. Pituitary

Question 6

CM of DI

Answer 6

Polyuria 
Polydipsia 
Nocturia 
Hemoconcentration 
Hypotension 
Tachycardia 
S/S of FVD

Question 7

Hemoconcentration

Answer 7

high serum sodium and hematocrit

Question 8

Diagnosis of DI

Answer 8

Serum and urine electrolytes
Serum and urine osmolality
Urine specific gravity
C T scan and M R I (to view pituitary gland)

Question 9

Levels of

• Sodium
• Hematocrit
• Sp gravity

Answer 9

• High
• High
• Low (<1.005)

Question 10

Normal Sp gravity

Answer 10

1.005-1.030

Question 11

Fluid management for unconscious pt with DI

Answer 11

hypotonic solution
-dextrose in water

**Monitor blood glucose

Question 12

Meds for DI

-how is it given?

Answer 12

Desmopressin (DDAVP) = synthetic ADH
-given subq, intranasal, or PO

Synthetic vasopressin (Pitressin)
**monitor urine output

Question 13

Complications with DI

Answer 13

• Dehydration and hypovolemia = circulatory collapse

- Hemoconcentration = increase risk of hypernatremia = confusion, neuromuscular excitability, seizures, or coma

Question 14

Nursing diagnosis

Answer 14

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

Question 15

Nursing assessment: VS

Answer 15

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.

Question 16

Nursing assessment: I&Os

Answer 16

Fluid replacement is largely dependent on the volume of urine output secondary to lack of A D H.

Question 17

Assessment: Daily weight

Answer 17

Increased output of dilute urine, secondary to lack of A D H, leads to decrease in weight.

Question 18

Assessment: Visual acuity

Answer 18

Growth of the pituitary tumor may compress CN II or CN III.

Question 19

Assessment: Serum sodium and osmolality

Answer 19

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.

Question 20

Assessment: Sp. gravity

Answer 20

Lack of A D H results in the excretion of large volumes of dilute urine; specific gravity is usually less than 1.005.

Question 21

Nursing actions: Maintain IV access

Answer 21

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.

Question 22

Nursing actions: administer meds

Answer 22

Synthetic A D H is administered to cause water reabsorption in the kidney.

Question 23

Nursing actions: Provide fluids

Answer 23

If the patient is alert and awake and has an intact gag reflex, the patient is allowed to drink fluids

Question 24

Nursing actions: Provide mouth care

Answer 24

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.

Question 25

Teaching for DI

Answer 25

Importance of taking medications (A D H replacement) as ordered — Taking the medications (Vasopressin/Pitressin) at the same time daily mimics normal release and supports water reabsorption in the kidneys.

Weigh daily at same time and on same scale — Weight is directly associated with water loss or gain, and changes of more than 2 lb per day should be reported to the healthcare provider.

Clinical manifestations of DI — The patient must understand the pathophysiology of this disorder and the importance of fluid volume balance.

Clinical manifestations of fluid overload — Overcorrection of DI with DDAVP or Pitressin may lead to fluid overload.