Unit 5 & 6 Chapter 57 Diabetes Insipidus and Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Flashcards
What is Diabetes Insipidus (DI)
DRY INSIDE
FLUID VOLUME DEFICIT
Polyuria
Polydypsia
Diabetes insipidus (DI) is a disorder of the posterior pituitary gland in which water loss is caused by either an antidiuretic hormone (ADH) deficiency or an inability of the kidneys to respond to ADH.
What is the cause of secondary
Secondary DI
-caused by diseases that affect the posterior pituitary
Traumatic head injury, neurosurgery,
neoplasms.
Tumors in brain
craniotomy
Urine specific gravity range
1.005-1.030
Your urine specific gravity is generally considered normal in the ranges of 1.005 to 1.030. If you drink a lot of water, 1.001 may be normal. If you avoid drinking fluids, levels higher than 1.030 may be normal.
Primary DI vs Secondary DI
Primary DI–defect in hypothalamus or pituitary gland resulting in dec. ADH production or release
-ANYTHING IN TH BRAIN
Secondary DI-caused by diseases that affect the posterior pituitary
Traumatic head injury, neurosurgery,
neoplasms.
pituaty tumor
S/S of Diabetes Insipidus
Hypotension**
**Tachycardia
Weak peripheral pulses**
* Hemoconcentration
* **Increased urine output(polyuria)**
* **, low specific gravity**
* **Poor turgor**
* **Dry mucous membranes**
* Decreased cognition a
* Ataxia
**Increased thirst (polydyspsia)
* Irritability a
Assessment questions for patient with DI
Ask about a history of recent surgery, head trauma, or drug use (e.g., lithium).
LITHIUM CAN CAUSE DIABTES INSIPIDUS
What medication would you suspect the Health Care Provider to prescribe for a patient diagnosed with Diabetes Insipidus?
A. Furesomide
B. Levothyroxine
C. Epinephrine
D. Desmopressin
D. Desmopressin
This drug, a synthetic form of vasopressin, replaces antidiuretic hormone (ADH) and decreases urination. It is available orally, as a sublingual “melt,” or intranasally in a metered spray.
Nursing Intervention for Diabetes Insipidus
-increase fluid intake
-Administer Desmopressin
- Monitor fluid volume status
- checking urine specific gravity,
- records of daily weight
Does a patient with DI require lifelong drug therapy of Desmopressin?
A. yes
B. no
The patient with permanent DI requires lifelong drug therapy. Check his or her ability to assess symptoms, and adjust dosages as prescribed for changes in conditions. Teach that polyuria and polydipsia indicate the need for another dose.
Complications of Desmopressin
Drug therapy for DI induces water retention and can cause fluid overload
- Weight gain
-Edema
-Crackles in lungs
-Hypertention
Patient teaching Desmopressin
Teach patients to weigh themselves daily to identify weight gain.
Stress the importance of using the same scale and weighing at the same time of day while wearing a similar amount and type of clothing.
If weight gain of more than 2.2 lb (1 kg) along with other signs of water toxicity occurs (e.g., persistent headache, acute confusion, nausea, vomiting), instruct him or her to go immediately to the emergency department or call 911.
Instruct the patient to wear a medical alert bracelet identifying the disorder and drug.
Which urine characteristics indicate to the nurse that the client being managed for diabetes insipidus is responding appropriately to interventions?
A. Urine output volume increased; urine specific gravity increased
B. Urine output volume increased; urine specific gravity decreased
C. Urine output volume decreased; urine specific gravity increased
D. Urine output volume decreased; urine specific gravity decreased
C. Urine output volume decreased; urine specific gravity increased
What is Syndrome of Inappropriate ADH (SIADH)
SWIM INSIDE
FLUID OVERLOAD
OLIGURIA
The syndrome of inappropriate antidiuretic hormone (SIADH) or Schwar -Bar er syndrome is a problem in which antidiuretic hormone (ADH, vasopressin) is secreted even when plasma osmolarity is low or normal, resulting in water retention and fluid overload.
Should you monitor for hyponatremia for patients with SIADH?
A. Yes
B. No
A. Yes
S/s of SIADH
-hyponatremia)
-appetite, nausea, and vomiting,
-weight gain
-lethargy,
-headaches,
-hostility,
-edema
-hypertention
-disorientation,
-change in level of consciousness
-seizures
-coma.
-full and bounding pulse
-Increased urine specific gravity(1.030^)
Nursing Interventions for SIADH
-restricting fluid intake
-promoting the excretion of water,
-replacing lost sodium
-monitoring response to therapy
-preventing complications,
-teaching the patient and family about fluid restrictions and drug therapy
-preventing injury.
-place side rails up
-Neurochecks Q2 hours
-Monior for complications of seizure
Your patient presents with a serum sodium level of 89. What order would you anticipate the provider to order?
A. Hydrochlorithiazide
B. 3% Sodium Chloride
C. Lactaded Ringers
D. 0.45% Normal Saline
Hypertonic saline (i.e., 3% sodium chloride [3% NaCl]) is used for SIADH when the serum sodium level is very low
Medications of choice for SIADH
A. Spirinolactone
B. Furosemide
C. Hydrochloritiazide
D.Acetominophen
B. Furosemide
What medication is contraindicated for patients with SIADH?
A. Bumetadine
B. Furosemide
C. Hydrochloritiazide
D.Acetominophen
C. Hydrochloritiazide
This diuretic wastes all electrolytes except Calcium and puts the patient is a seizure risk
Medication for SIADH Tolvaptan and Conivaptan
tolvaptan or conivaptan, is used to treat SIADH when hyponatremia is present in hospitalized patients (Burchum & Rosenthal, 2019). These drugs promote water excretion without causing sodium loss
Tolvaptan is an oral drug, and conivaptan is given IV. Tolvaptan has a black box warning that rapid increases in serum sodium levels
When this drug is used at higher dosages or for longer than 30 days, there is a significant risk for liver failure and death
Should Tolvaptan be given only in a hospital setting?
A. Yes
B. No
A. Yes
Administer tolvaptan or conivaptan only in the hospital se ing so serum sodium levels can be monitored closely for the development of hypernatremia and other complications.
Seizure precautions
-turn the client on side
-remove harmful objects
-suction as needed
-do not hold client
-loosen tight clothes
-time the seizure
-order IV benzodiazepine to break the seizure
-acquire patent iv access
-reduce environmental stimuli
*dim lights
*limit visitors
no cluster care
Complications of SIADH
Monitor for increased fluid overload (bounding pulse, increasing neck vein distention, lung crackles, dyspnea, increasing peripheral edema, reduced urine output) at least every 2 hours.
Pulmonary edema can occur very quickly and can lead to death.
Notify the primary health care provider of any change that indicates the fluid overload is not responding to therapy or is worse.
Seizure precautions continued
Observe for and document changes in the patient’s neurologic status.
Assess for subtle changes, such as muscle twitching, increasing irritability, or restlessness, before these progress to seizures or coma.
Check orientation to time, place, and person every 2 hours because disorientation or confusion may be present as an early indication.
Reduce environmental noise and lighting to prevent overstimulation.
