Diabetes Insipidus AND SIADH MY NOTES

DI ddiluted urine low specific gravity is

1.005

A client presents to the emergency department with a history of adrenal insufficiency. The following laboratory values are obtained sodium 130 potassium 5.6 glucose 76 which is the first request the nurse anticipates::

Administer insulin and dextrose in normal Celine to ship potassium into the cells

A pt with SIAD is admitted iwth serum levels of 105 what does the nurse address first

Adminster 150 of NACI over 3 hours

What are the key features of Diabetes Insipidus

Cardio: -hypotension (decreased BP) tachycardia ( Increase pulse) - Weak peripheral pulse -Hemoconcentration (thick blood) Skin / Kidney -Increased urine output -Poor skin turgor -Dry mucosa membrane -Increased thirst - Dilute Low specific gravity Neuro: -decreased cognition - ataxia ( loss body movement) - irritability

paraenteral

Any route of administration not involving the gastrointestinal tract (e.g., injection, topical, and inhalation).

The nurse is teaching a client about how to monitor therapy effectiveness for SIADH. What does the nurse tell the client to look for?

Daily weight gain of less than 2 pounds rational: The client was monitored daily weight because this assesses the degree of fluid restriction needed a weight gain of 2 pounds or more daily or gradual i

Interventions for SIADH

Daily weight; strict I&O; safety; Neuro check: watch for confusion, muscle twitch, irritability , restlessness check Every 2 hours Fluid restriction ( monitor overload) Monitor Fluid and Electrolytes Drug therapy : Vasopressin receptor antagonist - vaptans Diuretics safety measures: side rails being secure

Warning about Desmopresssin (DI AdH replacement drug therapy )

Decrease urine Put it BP goes up Caution : Headache is a "Priority : Low sodium can cause seizures or death

What happens if the thirst mechanism is poor in an adult with diabetes insipidus if the adult cannot maintain water independently?

Dehydration becomes more severe and can lead to death

Dry inside " High & Dry" LABS

Dry Inside "High & Dry" Labs HYPER osmolality (HIGH) HYPERnatremia over 145 Na+ (HIGH) DIluted oUTSIDE ' High urine output (Drains urine) LOW specific Gravity 1.005

SIADH: monitor every 2 hours for increase fluid overload which includes symptoms of

Bounding pulse increasing neck vein distention, lung crackles dysphasia, increasing pair of PERIPHERAL edema, reduce urine output. Pulmonary edema can occur very quickly and can lead to death

fluid restriction in some cases may be kept as low as 500-1000 ml/24 hr for a pt with fluid restriction SIADH

TRUE

In DI:Water loss changes urine and blood test so we need to

The 24 hour fluid intake and output is measured without restricting food or fluid. Diabetes Insipidus considered if you're an output is more than 4 L during this period in greater than the volume ingested - A mount varies 4-30

Primary Neurogenic diabetes insipidus is cause by

a defect in hypothalamus or pituitary gland resulting in a lack of ADH production

SIADH assessment

a. Signs of fluid volume overload b. change in consciousness and mental status changes: Lethargy c. Weight gain w/o edema (Free water no salt non dependent of edema is present ) d. Hypertension e. Tachycardiab f. Anorexia, nausea and vomiting g. Hyponatremia h. Decreased urine volume and increased urine osmolarity I. FULL BOUNDING PULSE J. HYPOTHERMIA

SIADH occurs when many conditions such as ( short version)

cancer therapy, pulmonary infection or impairment and which specific drugs including SSRIs

Tolvaptan has a black box warning that rapid increases in serum sodium levels have been associated with central nervous system demyelination that can lead to serious complications and

death

With a person with with SIADH the patient may have lethargic headaches, hostility disorientation and changes and level of consciousness Lethargic and headaches can progressed to

decreased responsiveness, seizures and coma

Provide a safe environment sodium levels fall below 120 the risk for neurologic changes and seizures increase as a result of osmotic fluid shifts in the brain. Observe the patient and

document the patient's neurological status

The client with DI who takes lifelong hormone replacement will need to report significant weight gain to monitor for water toxicity. Water toxicity causes .

headache, vomiting, and acute confusion

In Diabetes Insipidus (DI) Massive water loss - increases plasma osmolarity and serum sodium levels, which stimulate the sensation of thirst . What does this promote?

increased fluid intake and aids in maintaining hydration.

SIADH (or syndrome of inappropriate ADH secretion)

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

the client who has DI has excessive urination and dehydration. Clients who are dehydrated have decreased blood pressure, increased pulse (tachycardia), and poor skin turgor. The urine is dilute with a

low specific gravity.

Conditions causing SIADH

malignancy -Small cell lung cancer -pancreatic carcinoma's - Hodgkin lymphoma Pulmonary -Pneumonia - Active Tb -Pneomothroax CNS disorders - Sever brain trauma -Sepsis infections of brain Meningitis - tUMORS PRIMARY MESTASTIC -Strokes -Lupus Drugs: ExogenousADH Opioids Tricyclic

Pt with Di should wear a

medical bracelet thats says disorder and drug

ADH deficiency is classified as

neurogenic (primary or secondary )

Desmopressin teach: teach those pt who have mild DI that they need only one or two doses in 24 hours For SEVERE DI

one or two metered doses 2 or 3 times daily may be needed

SIADH intervention you can reduce environmental noise and lighting to prevent

overstimulation

What should you ensure if a patient is suspected of having diabetes insipidus

that the no patient is not deprived of fluids more than four hours because he or she cannot reduce urine output in severe dehydration can result

In DI urine is dialuted with a low specific gravity (<1.005) and low osmolarity (50 to 200 mOsm/kg) true or false

true

Secondary Neurogenic diabetes Insipidus is caused by

tumors, head trauma, infection , brain surgery

Drug therapy for DI induce water retention can cause fluid overload teach pt to

weight themsleves daily to idenitfy weight gain - same scale -similar clothes - If they weight more than 2.2 (1kg) with other signs of water toxicity occurs ( Persistent headache, acute confusion , nausea, vomiting ) Instruct pt to call 911

Drug therapy SIADH

• Vasopression receptor antagonists --Tolvaptan ***Conivaptan (Vasopresol) IV- used when hyponatremia is present; promote water excretion without causing sodium loss ***Monitor for rapid increases in sodium

A client with diabetes insipidus has dry lips and because of memory and poor skin sugar which intervention does the nurse provide first

Force fluids rational: dry lips and because a membrane and poor skin trigger are indications of G hydration which can occur with DI. This is a serious condition that must be treated rapidly encourage fluid initial step, provide client is able to tolerate oral intake

Diabetes Insipidus signs and symptoms

High Urine ouput Excessive thirst Dehydration Dry Skin and Mucosa Cracked skin

DI (dry inside)

Hight dry labs Hyperosomlaty is high Hypernatremia over 145

Which laboratory results indicate fluid restrictions have been effective in SIADH

Increase sodium i increase sodium due to fluid restriction indicates effective therapy

SIADH: Nuero checks

Is hyponatremic ( low sodium)make butt alert awake and oriented check every 2 to 4 hours. for a patient who is had a level change in consciousness perform neurological checks every hour

Diabets Insipidus- DI

It's a disorder of the posterior pituitary gland and which water loss is caused by either in antidiuretic hormone deficiency or an inability of the kidney to respond to a ADH. This result of DI is the excursion of large volumes of diluted urine because the distal kidney tubules and collecting ducks do not reabsorb water this leads to - Polyuria -dehydration -Disturbed F&E

Nephrongenic diabetes insipidus is a problem with he

Kidneys response to ADH rather than a problem with ADH production -Sever injury to kindey can produce ability of Kidney to respond to ADH - Can be genetic disorder

Ask the pt with DI if he has history of taking what meds

Lithium Lithium causes DI

Drug related Diabetes insipidus is most often caused by

Lithium carbonate and demeclocycline : These drugs interfere with response of kidneys to ADH

he nurse is caring for a client with adrenal insufficiency. What priority physical assessment would the nurse perform

Neuro assessment

The nurse is preparing to give tolvaptan for a client who has syndrome of inappropriate antidiuretic hormone (SIADH). For which potentially life-threatening adverse effect would the nurse monitor?

Rapid-onset hypernatremia

· nurse cares for a client who possibly has syndrome of inappropriate antidiuretic hormone (SIADH). The client's serum sodium level is 114 mEq/L (114 mmol/L). What nursing action would be appropriate? .

Restrict the client's fluid intake to 600 mL/day.

The 7 Sevens of SIADH

STOPs urination (LOW urine output) Urine retention STICKY & THICK "urine" HIGH Sp. Gravity 1.030+ SOAKED Inside "Low & Liquidy" Labs HYPO osmolality (LOW) (NO IV or drinking) + (IV 3% Saline + Eat Salt) HYPOnatremia below 135 Na+ (LOW) SODIUM Low!! (Headache Early Sign) NCLEX TIP SEIZURES- N C L E X key words: Headache, Confusion SEVERE HIGH blood pressure (NORMAL) STOP ALL FLUIDS + GIVE Salt + Diuretics NO IV or drinking) + (IV 3% Saline + Eat Salt)

nurse is reviewing care for a client who has syndrome of inappropriate antidiuretic hormone (SIADH) with assistive personnel. What statement by the AP indicates

"I will weigh the client carefully before breakfast and compare with yesterday

Hospital management for DI

- Early detection of dehydration and maintain hydration - measure intake and output - check urine specific gravity and record weight - Permanet DI needs life long drug therapy - Check pt ability to assess for symptoms and adujst dosage as prescribed for change in condition Teach

Demospressin ( DI ADH ) is available in

-Sublingual melt - Intranasally in metered spray

A client is being treated for diabetes insipidus (DI) with synthetic vasopressin (desmopressin). What is the priority health teaching that the nurse provides regarding drug therapy?

. The need to weigh every day and report weight gain

Mangaement for DI ADH replacement

1. Desmopressin "Vasopressin " -The replace the ADH hormone -Decreases urination

SIADH: Measure intake and outtake dailyweight to asses the degree of fluid restriction needed .. A weight gain of _____( 1kg) or more per day or gradually is cause for concern.

2.2 2.2 lb = 1000mLfluid retention

The parenteral from of desmopressin is ____ times stronger that oral form and the dosage must be reduced

10

I wish you were in properties indicate to the nurse that the client with a syndrome of SIADH antidiuretic hormone is responding to interventions

Urine output volume has increased, urine specific gravity has decreased

Nursing intervention for SIADH for mouth dryness

Use frequent oral rinsing but worn the patients not to swallow the rinses because they are on fluid restriction