Ch. 41 SIADH

Question 1

SIADH

Answer 1

disorder related to an increase in ADH.

Question 2

CM SIADH

Answer 2

Headache
Seizures, comatose
Cerebral edema
IICP
Hyponatremia = seizures and comatose when levels fall below 120

Question 3

The neurological signs associated with the hyponatremia are r/t

Answer 3

osmotic fluid shifts in the brain that lead to cerebral edema and increased intracranial pressure (IICP).

Question 4

Diagnosis of SIADH

Answer 4

Hematocrit = decreased
Sodium = decreased
Sp. gravity = increased

patients presenting with scant, concentrated urine would have signs indicative of dehydration, including elevated serum sodium, serum osmolality, and urine-specific gravity.

Question 5

Complications with SIADH

Answer 5

While the sodium concentration drops below 120 mEq/L, life-threatening complications are likely to occur, including seizures and coma

Question 6

Nursing diagnosis

Answer 6

Fluid volume excess r/t increased water reabsorption secondary to increased ADH secretion

• High risk for injury r/t cerebral edema and CNS dysfunction
• Knowledge deficit r/t required fluid restriction

Question 7

Assessment: Neuro changes

Answer 7

Fluid overload with resulting hyponatremia may lead to confusion, headache, and changes in level of consciousness.

Question 8

Assessment: I&Os

Answer 8

Excess secretion of ADH leads to reabsorption of water in the renal tubules.

Question 9

Assessment: Serum sodium and osmolality

Answer 9

Serum sodium and osmolality levels decrease secondary to dilution.

Question 10

Assessment: Sp. gravity and urine osmolality

Answer 10

With reabsorption of water in the kidneys, the urine is concentrated, resulting in increased specific gravity and urine osmolality.

Question 11

Assessment: Skin integrity

Answer 11

Fluid reabsorption may result in skin tautness.

Question 12

Actions: Restrict fluids

Answer 12

<1000 ml

Question 13

Actions: give delomycin

Answer 13

(Declomycin) Demeclocycline increases excretion of water from the kidneys.

Question 14

Actions: Give 3% saline

Answer 14

Hypertonic saline solution to increase serum sodium levels

Question 15

Actions: Seizure precautions

Answer 15

Risk of seizures increases with hyponatremia, particularly when serum sodium levels fall below 120 mEq/L.

Question 16

Teaching for SIADH

Answer 16

Disease process and management Because of complications associated with hyponatremia, it is important for the patient and family to understand the pathophysiology and treatment of SIADH.

Follow fluid restriction It is important that the patient follow restrictions to decrease exacerbating fluid overload.

Signs of fluid overload Signs of fluid overload may be associated with falling serum levels that increase the risk of seizures and other neurological changes. For ex. Swelling (feet, legs, hands, or face), elevated BP, SOB