SIADH vs DI

Nursing Management for DI

*Daily weights *Strict I & Os *Safety *Restrict foods that promote diuresis: Watermelon, grapes, caffeine, and lemons

Medical treatment for DI

*Diabinese/Chlorproamide: mild cases not as popular due to side effects...Type 2 diabetic meds that increase ADH (watch for Hypoglycemia and photosensitivity to the sun) *Desmopressin (form of Vassopressin): extreme cases : AKA STimate (watch fro hyponatremia due to fluid overload

Causes of DI

*Kidneys not receptive to ADH anymore *Damage to hypothalamus or pituitary gland (stroke, tumor) *Drugs like Declomycin (TX for SIADH) *Gestational: placenta producing too much Vassopressinase which causes ADH to breakdown

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

*increased antidiuretic hormone *ADH is being produced somewhere other than the hypothalamus or the hypothalamus is damaged

Medical treatments for SIADH

*loop diuretics (lasix) to remove extra fluid (watch K+ level (hypokalemia)) *hypertonic IV solution: 3% NS: draws fluid out of swollen cell back into vascular system (watch for worsening of fluid overload = crackles = give slowly/central line) *Declomycin: ADH inhibitor and promotes diuresis...don't give with Ca+ containing foods milk/antacids cause it will affect GI absorption

Nursing management of SIADH

1) fluid restrictions <1000 ml/day 2) head of bed flat or 10 degrees 3) protect from injury 4) seizure precautions 5) frequent turning, positioning, ROM 6) oral hygiene 7) distract from thirst discomfort 8) daily weights 9) strict I & Os

Signs and symptoms of DI

1. Polydipsia: Thirst/cravings for water (fluid intake 5-20 L/day) 2. Polyuria (4-24 L/day) and nocturia 3. Weight loss, fatigue 4. Changes in level of consciousness 5. Hypernatremia: due to concentrated Na+ levels for low fluid levels 6. Elevated temperature 7. Tachycardia 8. Hypotension: loss of fluids 9. Poor turgor and dry mucus membranes 10. Diluted urine = low specific gravity

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

Correct answer: c Rationale: Excess ADH increases the permeability of the renal distal tubule and collecting ducts, which leads to the reabsorption of water into the circulation. Consequently, extracellular fluid volume expands, plasma osmolality declines, the glomerular filtration rate increases, and sodium levels decline (i.e., dilutional hyponatremia). Hyponatremia causes muscle cramping, pain, and weakness. Initially, the patient displays thirst, dyspnea on exertion, and fatigue. Patients with the syndrome of inappropriate antidiuretic hormone secretion (SIADH) experience low urinary output and increased body weight. As the serum sodium level falls (usually to less than 120 mEq/L), manifestations become more severe and include headache, vomiting, abdominal cramps, muscle twitching, and seizures. As plasma osmolality and serum sodium levels continue to decline, cerebral edema may occur, leading to lethargy, anorexia, confusion, seizures, and coma.

Diabetes Insipidus (DI)

Decreased antidiuretic hormone *ADH decreased either due to kidney issue, drugs, pregnancy or trauma to the brain/hypothalamus

Signs and symptoms of SIADH

Increase ADH = Water retention *fluid overload (edema, weight gain) *hypertension (extra fluid in vascular system) *tachycardia (compensate for increase fluid) *hyponatremia (euvolemic = water increases in body but Na+ stays the same-watered down) *confusion: brain tissue swelling *seizures *anorexia (don't want to eat and feel full) *low urine output: very concentrated (high urine specific gravity)

Causes of SIADH

Lungs: Small cell carcinoma, TB, pneumonia CNS: Meningitis, head trauma, brain abscess Meds: Carbamazepine, Chlorpropamide Ectopic ADH production: Lymphoma, sarcoma, duodenal/pancreatic cancer

A nurse suspects a client has diabetes insipidus. What are the priority interventions? Select all that apply. a. monitor neuro status b. monitor urine specific gravity c. monitor hypernatremia d. strict I & Os e. monitor hyponatremia

The answer is A, B, C, D. Diabetes insipidus causes a massive loss of water via the urinary tract due to insufficient secretion of ADH. This leads to cellular dehydration and hypernatremia. Both of these things can cause significant neurological changes, including confusion and seizures. Monitoring neuro status is a priority. Due to insufficient ADH, the body dumps large amounts of dilute urine. Monitoring urine specific gravity helps to monitor the dilution and/or concentration of the urine Due to excessive loss of water, the client's blood will become concentrated, making the sodium level go UP. Monitoring for hypernatremia is a priority. Clients with diabetes insipidus lose large amounts of dilute urine, monitoring strict I&O measurements is a priority to know the client's fluid status.

A client who has suffered a traumatic brain injury (TBI) has developed diabetes insipidus. A home health nurse is seeing the client in his home to help him manage his care at home. Which of the following teaching points would the nurse offer to help prevent injury in this client? a. have client ensure easy access to bathroom or bedside commode b. Reinforce keeping a fan on in the room next to the bed while sleeping c. Encourage the client to wear socks and extra blankets when sleeping at night d. Tell the client to reduce fluid intake and avoid drinks that contain caffeine

The answer is A. A client with diabetes insipidus and a history of TBI may be at higher risk of injury, particularly if he must get up to use the bathroom frequently. The nurse should ensure that the client knows to keep the home organized and free from clutter and to keep a clear walkway to the bathroom or the commode so that the client will not be injured when he gets up to use the bathroom.

A nurse is developing a plan of care for a child recently diagnosed with diabetes insipidus. Which aspect of care should be included? a. Encourage the child to wear medical identification. b. Discuss with the child and family ways to limit fluid intake. c. Teach the child and family how to do required urine testing. d. Reassure the child and family that this is usually not a chronic or life-threatening illness.

The answer is A. Because of the unstable nature of the child's fluid and electrolyte balance, wearing medical identification is an extremely important intervention. With diabetes insipidus, the child should have unrestricted access to fluid. There is no required urine testing with diabetes insipidus. Diabetes insipidus is both lifelong and life-threatening. The medication must be taken and the effects monitored closely.

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.

The answer is A. Desmopressin acetate is used to treat diabetes insipidus by replacing the antidiuretic hormone that the patient is lacking. Diuresis will be decreased and is expected. Inhaled desmopressin can cause nasal irritation, headache, nausea, and other signs of hyponatremia, not hypernatremia. Drinking too much water or other fluids increases the risk of hyponatremia. The patient should follow the provider's directions for limiting fluids and be taught to seek medical attention they experience severe nausea; vomiting; severe headache; muscle weakness, spasms, or cramps; sudden weight gain; unusual tiredness; mental/mood changes; seizures; and slow or shallow breathing.

A 17-year-old is diagnosed with syndrome of inappropriate antidiuretic hormone (childhood SIADH) due to a brain tumor. What nursing care is indicated in the care of this adolescent? a. Maintaining a balanced intake and output and a urine specific gravity between 1.010 and 1.020. b. Preventing any weight gain due to fluid retention and any elevation of sodium levels. c. Keeping the urine specific gravity between 1.020 and 1.030 and prevention of respiratory infections. d. Restoring protein loss and replenishing the decreased erythrocyte level.

The answer is A. Essential care includes maintaining a balanced intake and output, a urine specific gravity between 1.010 and 1.020, and reducing fluid intake initially. Daily weights and a diet with increased sodium are indicated but not salty foods that can cause increased thirst. Weight gain is seen early in the illness, and elevated sodium levels are desired. The urine specific gravity should be between 1.010 and 1.020. Respiratory infections are not an issue with SIADH. Protein loss is not an issue; loss of sodium is. Erythrocytes are not involved with this condition.

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 the bed elevated to prevent antidiuretic hormone (ADH) release d. notify the HCP if the patient's blood pressure decreases more than 20 mm Hg from baseline

The answer is A. The patient with SIADH has marked dilutional hyponatremia and should be monitored for decreased neurologic function and seizures every 2 hours. Sodium intake is supplemented because of the hyponatremia and sodium loss caused by diuretics. ADH release is reduced by keeping the head of the bed flat to increase left atrial filling pressure. A reduction in blood pressure indicates a reduction in total fluid volume and is an expected outcome of treatment.

A client who has been diagnosed with diabetes insipidus has been prescribed vasopressin as an antidiuretic replacement. The nurse caring for the client reviews his other medications. Which drug should not be taken with vasopressin? a. Carbamazepine b. Levothyroxine c. Diphenhydramine d. Omeprazole

The answer is A. Vasopressin is a medication that has the effects of anti-diuretic hormone. It can be used to control blood pressure and is used for the treatment of diabetes insipidus. Vasopressin should not be used with carbamazepine, as carbamazepine can decrease the overall effects of vasopressin in the bloodstream.

The nurse is caring for a client with diabetes insipidus and is preparing to administer a scheduled vasopressin injection. Which of the following is an anticipated outcome for a client with diabetes insipidus receiving this drug? a. urine output of 2000 cc a day b. weight loss of 4 pounds a week c. urine specific gravity of 1.001 d. oral intake of 4500 L a day

The answer is A. When a client has diabetes insipidus (DI) they can have a urine output of up to 15,000 mL per day. With vasopressin injection, there should be less polyuria and polydipsia. A urine output of 2000 cc/day is a normal urine output, which indicates that the vasopressin is effective.

Which patient is most at risk for developing Syndrome of Inappropriate Anti-diuretic Hormone (SIADH)?* A. A patient diagnosed with small cell lung cancer. B. A patient whose kidney tubules are failing to reabsorb water. C. A patient with a tumor on the anterior pituitary gland. D. A patient taking Declomycin

The answer is A: A patient diagnosed with small cell lung cancer.

You are developing a care plan for a patient with SIADH. Which of the following would be a potential nursing diagnosis for this patient?* A. Fluid volume overload B. Fluid volume deficient C. Acute pain D. Impaired skin integrity

The answer is A: Fluid volume overload

A patient arrives to the ER and is unable to give you a health history due to altered mental status. The family reports the patient has gained over 10 lbs in 1 week and says it is mainly "water" weight. In addition, they report the patient hasn't been able to urinate or eat within the past week as well and was recently diagnosed with small cell lung cancer. On assessment, you note the patient's HR is 115 and BP 180/92. Patient sodium level is 90. Which of the following conditions do you suspect the patient is most likely presenting with?* A. SIADH B. Diabetes Insipidus C. Addison's Disease D. Fluid Volume Deficient

The answer is A: SIADH

A patient with a mild case of diabetes insipidus is started on Diabinese. What would you include in your patient teaching with this patient?* A. Signs and symptoms of hypoglycemia B. Restricting foods containing caffeine C. Taking the medication on an empty stomach D. Drinking 16 oz of water when taking the medication

The answer is A: Signs and symptoms of hypoglycemia

The nurse receives a phone call from a patient taking cyclophosphamide for treatment of non-Hodgkin's lymphoma. The patient tells the nurse that she has muscle cramps, weakness, and very little urine output. Which response by the nurse is best? a. "Start taking supplemental potassium, calcium, and magnesium." b. "Stop taking the medication now and call your health care provider." c. "These symptoms will decrease with continued use of the medication." d. "Increase your fluid intake to 3000 mL for 24 hours to improve your urine output."

The answer is B. Cyclophosphamide may cause syndrome of inappropriate antidiuretic hormone (SIADH). Medications that stimulate the release of ADH should be avoided or discontinued. Treatment may include restriction of fluids to 800 to 1000 mL/day. A loop diuretic such as furosemide (Lasix) is used to promote diuresis, and supplements of potassium, calcium, and magnesium may be needed.

When caring for a patient with nephrogenic diabetes insipidus, what should the nurse expect the treatment to include? a. fluid restriction b. thiazide diuretics c. a high sodium diet d. metformin (Glucophage)

The answer is B. In nephrogenic DI, the kidney is unable to respond to ADH, so vasopressin or hormone analogs are not effective.

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

The answer is B. The patient with SIADH has water retention with hyponatremia, decreased urine out0put, and concentrated urine with high specific gravity. improvement in the patient's condition is reflected by increased urine output, normalization of serum sodium, and more water in the urine, thus decreasing the specific gravity.

A client with diabetes insipidus must start taking vasopressin. Which information from the nurse is correct when providing teaching about this medication? a. The client will need to increase his or her fluid intake while on this medication b. The physician may order a routine ECG while the client is taking vasopressin c. Vasopressin is taken as an oral tablet or in syrup form d. Vasopressin can cause severe hypomagnesemia as a potential side effect

The answer is B. Vasopressin is a synthetic form of an anti-diuretic hormone that works by helping the body reabsorb water through the kidneys and by improving blood pressure. When a client must take this medication, the nurse should let the client know that some tests are required while the client is taking the drug. For example, the client may need routine ECG testing to monitor heart function while on this drug, due to the risk of arrhythmias.

The patient is diagnosed with SIADH. What manifestation should the nurse expect to find? a. decreased body weight b. decreased urinary output c. increased plasma osmolality d. increased serum sodium levels

The answer is B. With increased antidiuretic hormone, the permeability of the renal distal tubules is increased, so water is reabsorbed into circulation. Decreased output of concentrated urine with increased urine osmolality and specific gravity occur. In addition, fluid retention with weight gain, serum hypoosmolality, dilutional hyponatremia, and hypochloremia occur.

n the scenario above what drug do you anticipate the patient will be started on per doctor's order?* A. Desmopressin (DDAVP) IV B. Declomycin C. Diabinese D. Stimate

The answer is B: Declomycin

The floor nurse is reviewing lab results for a client with syndrome of inappropriate antidiuretic hormone (SIADH) and notes a sodium level of 132 mEq/L. The nurse continues to monitor the client closely for which of the following abnormal signs/symptoms? a. Palpitations in the chest b. Bilateral pupil constriction to light c. Decreased level of consciousness d. Complaints of excessive thirst

The answer is C. A client with severe hyponatremia will demonstrate symptoms which include weakness and a decreased level of consciousness. This indicates that the client may have cerebral edema, and need emergent intervention.

A patient with diabetes insipidus 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 greater than urinary output

The answer is C. Normal specific gravity is 1.005 to 1.030 and urine with a specific gravity of 1.002 is very dilute, indicating that there continues to be excessive loss of water and that treatment of diabetes insipidus is inadequate.

The parents of an 11-year-old girl with diabetes insipidus are learning about the therapeutic management of the condition. What information would the nurse reinforce after the physician has talked with the parents? A. Administration of thyroid and human growth hormones B. Progesterone therapy until development of secondary sex characteristics C. Administration of synthetic vasopressin and providing adequate nutrition for growth D. Estrogen therapy until menses are well established and height no longer increases

The answer is C. Synthetic vasopressin (DDAVP) is given. Prevention of severe dehydration and providing adequate nutrition for growth are needed for the care of this girl. Menstruation is not an issue with diabetes insipidus. Thyroid and growth hormones are not indicated. Progesterone has nothing to do with diabetes insipidus.

Where is the anti-diuretic hormone PRODUCED in the body?* A. Anterior pituitary gland B. Posterior pituitary gland C. Hypothalamus D. Medulla

The answer is C: Hypothalamus

Which of the following signs and symptoms is NOT expected with Diabetes Insipidus?* A. Polyuria B. Polydipsia C. Polyphagia D. Extreme thirst

The answer is C: Polyphagia

Where is the anti-diuretic hormone SECRETED in the body?* A. Hypothalamus B. Thyroid C. Posterior Pituitary gland D. Anterior pituitary gland

The answer is C: Posterior Pituitary gland

The anti-diuretic hormone is __________ in Diabetes Insipidus and _________ in SIADH.* A. high, low B. absent, absent C. low, high D. low, low

The answer is C: low, high

In patient with central diabetes insipidus, 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

The answer is D. A patient with central DI has a deficiency of ADH with excessive loss of water from the kidney, hypovolemia, hypernatremia, and dilute urine with a low specific gravity. When desmopressin acetate (DDAVP) is administered, the symptoms are reversed, with water retention, decreased urinary output that increases urine osmolality, and an increase in BP.

The patient with diabetes insipidus is brought to the emergency department 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 that the nurse should expect to be done first to help intake a diagnosis? a. blood glucose b. serum sodium level c. CT scan of the head d. water deprivation test

The answer is D. Patients with DI excrete large amounts of urine with a specific gravity of less than 1.005.

A client has been diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following is NOT a priority nursing intervention for this client? a. Flush NG tube with normal saline rather than sterile water b. Initiate seizure precautions c. Encourage increased dietary intake of sodium d. Increase fluid intake to at least 2L/day

The answer is D. SIADH causes extreme over-retention of water, therefore these clients should have a fluid restriction, not an increase. Typically these clients will be restricted to 500-1,000 mL per day to prevent further hemodilution.

A nurse is caring for a client who has been diagnosed with syndrome of inappropriate anti-diuretic hormone (SIADH). What type of electrolyte imbalance would the nurse most likely see in this situation? a. Hypermagnesemia b. Hypocalcemia c. Hyperkalemia d. Hyponatremia

The answer is D. Syndrome of inappropriate antidiuretic hormone (SIADH) is a condition in which the body produces too much anti-diuretic hormone. The condition causes the affected person to retain fluid. This causes low levels of sodium, which leads to many of the symptoms of SIADH, such as changes in level of consciousness and mental status.

A patient with SIADH is undergoing IV treatment of a hypertonic IV solution of 3% saline and IV Lasix. Which of the following nursing findings requires intervention?* A. Sodium level of 136. B. Patient reports urinating more frequently. C. Potassium level of 5.0. D. Assessment finding of crackles throughout the lung fields.

The answer is D: Assessment finding of crackles throughout the lung fields. Remember that when administering a hypertonic solution you have to do this very slowly and watch for volume overload. Hypertonic solutions pull fluid from the cell (which is already water intoxicated) and place it back into the vascular system...therefore, crackles in the lungs are a sign there is too much fluid in the body and the heart can not compensate so the fluid is backing up into the lungs. This would require intervention.

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. Minimize turning and range of motion. f. Keep the head of the bed at 10 degrees or less elevation.

The answers are B, D, F. The care for the patient with SIADH will include limiting fluids to 1000 mL/day or less to decrease weight, increase osmolality, and improve symptoms and keeping the head of the bed elevated at 10 degrees or less to enhance venous return to the heart and increase left atrial filling pressure, thereby reducing the release of ADH. Measure weights daily and maintain accurate intake and output. Monitor for signs of hyponatremia. Frequent turning, positioning, and range-of-motion exercises are important to maintain skin integrity and joint mobility.

Function of anti-diuretic hormone

plays a major role in regulating the amount of water in the body and constricts blood vessels accomplishes this with the kidneys =ADH causes the renal tubules to retain water