Exam 3: SIADH and DI
Polydipsia Polyuria
Diabetes Insipidus DI is characterized by _________ and ________. The primary characteristic seen is the excretion of large quantities of urine with a very low specific gravity and urine osmolality of less than 100
Fluid Hormone
Diabetes Insipidus For central DI, _______ and _______ therapy is the cornerstone of treatment
Hypotonic
Diabetes Insipidus In acute DI, IV __________ saline or dextrose 5% in water is given and titrated to replace urine output
Dehydration
Diabetes Insipidus It is important to assess for signs of acute ___________. In addition, maintain an accurate record of intake and output and daily weights to determine fluid volume status
Indomethacin (Indocin)
Diabetes Insipidus Limiting sodium intake to no more than 3 g/day often helps to decrease urine output. If a low-sodium diet and thiazide diuretics are not effective, ____________ may be prescribed
Compensate
Diabetes Insipidus Most patients ___________ by drinking large amounts of water so that serum osmolality remains normal or is moderately elevated.
200
Diabetes Insipidus Patients with DI excrete dilute urine at a rate greater than _____ mL/hr with a specific gravity of less than 1.005
Central
Diabetes Insipidus Patients with __________ DI undergoing the water deprivation test will exhibit a dramatic increase in urine osmolality and a significant decrease in urine volume
Hypernatremia
Diabetes Insipidus Serum osmolality in DI is elevated because of _____________ caused by pure water loss in the kidneys.
Dehydration
Diabetes Insipidus Severe ___________ can result if oral fluid intake cannot keep up with urinary losses. The patient will have hypotension, tachycardia, and hypovolemic shock
Chlorpropamide (Diabinese) Carbamazepine (Tegratol)
Diabetes Insipidus These two medications are useful in the treatment of diabetes insipidus because they act to increase ADH release or enhance the effect of ADH on the renal tubules
Desmopressin (DDAVP)
Diabetes Insipidus This is a man-made synthetic version of vasopressin (ADH) that aids in the treatment of diabetes insipidus
1.000-1.030
Diabetes Insipidus What is the normal specific gravity of urine?
a
During care of the patient with SIADH, what should the nurse do? a. monitor neurologic status at least every 2 hours b. teach the patient receiving treatment with diuretics to restrict sodium intake c. keep the head of bed elevated to prevent ADH release d. notify the HCP is the patient's BP decreases more than 20 mm Hg from baseline
d
A patient is treated with demeclocycline (Declomycin) to control the symptoms of syndrome of inappropriate antidiuretic hormone (SIADH). The nurse determines that the demeclocycline is effective upon finding that the a. peripheral edema is decreased. b. patients weight has increased. c. urine specific gravity is increased. d. patients urinary output is increased.
c
A patient with DI is treated with nasal desmopressin acetate (DDAVP). The nurse determines that the drug is not having an adequate therapeutic effect when the patient experiences a. headache and weight gain b. nasal irritation and nausea c. a urine specific gravity of 1.002 d. an oral intake great than urinary output
b
A patient with SIADH is treated with water restriction. What does the patient experience when the nurse determines that treatment has been effective? a. increased urine output, decreased serum sodium, and increased urine specific gravity b. increased urine output, increased serum sodium, and decreased urine specific gravity c. decreased urine output, increased serum sodium, and decreased urine specific gravity d. decreased urine output, decreased serum sodium, and increased urine specific gravity
c
A patient with a head injury develops SIADH. Manifestations the nurse would expect to find include a. hypernatremia and edema b. muscle spasticity and hypertension c. low urine output and hyponatremia d. weight gain and decreased glomerular filtration rate
d
In a patient with central DI, the administration of ADH during a water deprivation test will result in what? a. decrease in body weight b. increase in urinary output c. decrease in blood pressure d. increase in urine osmolality
a
A patient with symptoms of diabetes insipidus is admitted to the hospital for evaluation and treatment of the condition. An appropriate nursing diagnosis for the patient is a. insomnia related to frequent waking at night to void. b. impaired gas exchange related to fluid retention in lungs. c. excess fluid volume related to intake greater than output. d. risk for impaired skin integrity related to generalized edema.
Deprivation
Diabetes Insipidus A diagnostic study for DI called the water __________ test, can be done. The patient is deprived of water for 8-12 hours and then given desmopressin acetate (DDAVP).
Serum Urine
SIADH A _______ osmolality much lower than the _______ osmolality indicates the body is inappropriately excreting concentrated urine in the presence of dilute serum
d
A 24-year-old patient with diabetes insipidus makes all of these statements when the nurse is preparing the patient for discharge from the hospital. Which statement indicates to the nurse that the patient needs additional teaching? a. "I will drink fluids equal to the amount of my urine output." b. "I will weigh myself every day using the same scale." c. "I will wear my medical alert bracelet at all times." d. "I will gradually wean myself off the vasopressin."
b
A nurse is assessing a client during a water deprivation test. For which of the following complications should the nurse monitor the client? a. bradycardia b. orthostatic hypotension c. neck vein distention d. crackles in lungs
b
A nurse is caring for a client who has DI. Which of the following urinalysis laboratory findings should the nurse expect? a. presence of glucose b. decreased specific gravity c. presence of ketones d. presence of RBC
a c
A nurse is caring for a client who has SIADH. Which of the following findings should the nurse expect? Select all that apply a. decreased blood sodium b. urine specific gravity 1.001 c. blood osmolarity 230 d. polyuria e. increased thirst
d
A nurse is providing teaching to a client who has a new diagnosis of DI. Which of the following client statements indicates an understanding of teaching? a. "I can drink up to 2 quarts of fluid a day" b. " I will need to use insulin to control my blood glucose levels" c. "I should expect to gain weight during the illness" d. "I might experience confusion or balance problems"
a c d e
A nurse is reviewing the health record of a client who has SIADH. Which of the following laboratory findings should the nurse expect? Select all that apply a. low sodium b. high potassium c. increased urine osmolality d. high urine sodium e. increased urine specific gravity
d
A patient is admitted with possible syndrome of inappropriate antidiuretic hormone (SIADH). Which information obtained by the nurse is most important to communicate rapidly to the health care provider? a. The patient complains of dyspnea with activity. b. The patient has a urine specific gravity of 1.025. c. The patient has a recent weight gain of 8 lb. d. The patient has a serum sodium level of 119 mEq/L.
b
A patient is hospitalized with possible syndrome of inappropriate antidiuretic hormone (SIADH). The patient is confused and reports a headache, muscle cramps, and twitching. The nurse would expect the initial laboratory results to include a. an elevated hematocrit. b. a decreased serum sodium. c. an increased serum chloride. d. a low urine specific gravity.
ADH
Diabetes Insipidus DI is caused by a deficiency of production or secretion of ______ or a decreased renal response to _____. The decrease results in fluid and electrolyte imbalances caused by increasing urine output and increased plasma osmolality
Furosemide (Lasix)
SIADH A loop diuretic such as ________ may be used to promote diuresis. It is important to first assess the sodium level though, as the serum sodium must be at least 125 because it may promote further sodium loss
Edema
SIADH As plasma osmolality and serum sodium levels continue to decline, cerebral _______ may occur, leading to lethargy, confusion, seizures, and coma
Sodium
SIADH As the serum _______ levels start to fall (usually <120), manifestations become more severe and include vomiting, abdominal cramps, and muscle twitching.
Hypertonic
SIADH In cases of severe hyponatremia, small amounts of IV __________ saline solution may be slowly given. Quickly increasing levels can cause osmotic demyelination syndrome with permanent damage to nerve cells in the brain
Hyponatremia
SIADH In treating SIADH, it is important to monitor intake and output, vital signs, and heart and lungs sounds. Obtain daily weights, and observe for signs of ___________, including seizures, headache, vomiting, and decreased neurologic function
10
SIADH Position the head of bed flat or elevated no more than ____ degrees to enhance venous return to the heart and increase left atrial filling pressure, thereby reducing the release of ADH
Retention Hypoosmolality Hyponatremia
SIADH SIADH is a disorder that causes fluid __________, serum ____________, dilutional ___________, hypochloremia, and concentrated urine in the presence of normal or increased intravascular volume
Normal Low
SIADH SIADH is characterized as a release of ADH despite ___________ or ________ plasma osmolarity
Oat Cell Carcinoma
SIADH Some causes of SIADH include CNS disorders such as a head injury or CVA, drug therapy, or this specific type of small lung cell carcinoma
Thirst Dyspnea
SIADH The patient with SIADH experiences low urine output and increased body weight. Initially, the patient displays ___________, _________ on exertion, and fatigue
Declomycin Lithium
SIADH These two medications have a side effect that causes diabetes insipidus. Thus, they can be used in the treatment of SIADH as an off-label use
a c e
The nurse is admitting a client who is diagnosed with SIADH and has serum sodium of 118. Which health care provider prescriptions should the nurse anticipate receiving? Select all that apply a. initiate an infusion of 3% NaCl b. administer IV furosemide c. restrict fluids to 800 ml over 24 hours d. elevate the HOB to high fowler's e. administer a vasopressin antagonist as prescribed
b
The nurse is caring for a 25-year-old patient admitted to the acute care unit with an extra strong thirst, and dilute, excessive straw-colored urine output (up to 15 L/day). What does the nurse suspect? a. Type 2 diabetes b. Diabetes insipidus (DI) c. Cushing disease d. Addison disease
a c d e
The nurse is caring for a patient with syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which patient care actions should the nurse delegate to the experienced unlicensed assistive personnel? Select all that apply a. Monitor and record strict intake and output. b. Provide the patient with ice chips when requested. c. Remind the patient about his or her fluid restriction. d. Weigh the patient every morning using the same scale. e. Report a weight gain of 2.2 lb (1 kg) to the nurse. f. Provide mouth care allowing the patient to swallow the rinses.
a
The nurse is providing discharge instructions to a patient with diabetes insipidus. Which instruction regarding desmopressin acetate would be most appropriate? a. Expect to experience some nasal irritation while using this drug. b. Monitor for symptoms of hypernatremia as a side effect of this drug. c. Drink at least 3000 mL of water per day while taking this medication. d. Report any decrease in urinary elimination to the health care provider.
b
The patient is diagnosed with SIADH. What manifestations should the nurse expect to find? a. decreased body weight b. decreased urinary output c. increased plasma osmolality d. increased serum sodium levels
d
The patient with DI is brought to the ED with confusion and dehydration after excretion of a large volume of urine today even though several liters of fluid were consumed. What is a diagnostic test the nurse should expect to be done first to help make a diagnosis? a. blood glucose b. serum sodium level c. CT scan of the head d. water deprivation test
b d e
The patient with systemic lupus erythematosus is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). What should be included in the plan of care? Select all that apply a. Obtain weekly weights. b. Limit fluids to 1000 mL/day. c. Monitor for signs of hypernatremia. d. Administration of diuretics as ordered. e. Keep the head of the bed at 10 degrees or less elevation.
b
Vasopressin is administered to the client with DI because it a. decreases blood pressure b. increases tubular reabsorption of water b. increases release of insulin from the pancreas d. decreases glucose production within the liver
b
When developing a plan of care for a patient with syndrome of inappropriate antidiuretic hormone (SIADH), which interventions will the nurse include? a. Encourage fluids to 2000 mL/day. b. Offer patient hard candies to suck on. c. Monitor for increased peripheral edema. d. Keep head of bed elevated to 30 degrees.
d
When teaching a patient with chronic syndrome of inappropriate antidiuretic hormone (SIADH) about long-term management of the disorder, the nurse determines that additional instruction is needed when the patient says, a. I should weigh myself daily and report any sudden weight loss or gain. b. I need to limit my fluid intake to no more than 1 quart of liquids a day. c. I will eat foods high in potassium because the diuretics cause potassium loss. d. I need to shop for foods that are low in sodium and avoid adding salt to foods.
a
Which indicates that the client with DI understands how to manage care? a. the client will maintain normal fluid and electrolyte balance b. the client will select a diabetic diet correctly c. the client will state dietary restrictions d. the client will exhibit serum glucose levels within normal range
b
Which information obtained by the nurse when caring for a patient who has diabetes insipidus (DI) is most important to report to the health care provider? a. The patient had a recent head injury. b. The patient is confused and lethargic. c. The patient has a urine output of 400 mL/hr. d. The patients urine specific gravity is 1.003.
d
Which of these nursing actions in the plan of care for a patient who has diabetes insipidus will be most appropriate for the RN to delegate to an experienced LPN/LVN? a. Titrate the infusion of 5% dextrose in water. b. Teach patient how to use DDAVP nasal spray. c. Assess patients hydration status every 8 hours. d. Administer subcutaneous desmopressin (DDAVP).
c
Which prescribed order for a patient with diabetes insipidus (DI) would the nurse be sure to question? a. Monitor and record accurate intake and output. b. Check urine specific gravity. c. Restrict fluids for 6 hours. d. Weigh the patient every morning.