Exam 3: SIADH, Diabetes Insipidus

The nurse is discharging a client diagnosed with diabetes insipidus. Which statement made by the client warrants further intervention? 1. "I will keep a list of my medications in my wallet and wear a Medic Alert bracelet." 2. "I should take my medication in the morning and leave it refrigerated at home." 3. "I should weigh myself every morning and record any weight gain." 4. "If I develop a tightness in my chest, I will call my health-care provider."

ANS: 2. Medication for DI is usually taken every 8 to 12 hours, depending on the client. The client should keep the medication close at hand. 1. The client should keep a list of medication being taken and wear a Medic Alert bracelet. 3. The client is at risk for fluid shifts. Weighing every morning allows the client to follow the fluid shifts. Weight gain indicates too much medication. 4. Tightness in the chest could be an indicator the medication is not being tolerated; if this occurs, the client should notify the health-care provider.

The nurse is caring for a client diagnosed with diabetes insipidus (DI). Which intervention should be implemented? 1. Administer sliding-scale insulin as ordered. 2. Restrict caffeinated beverages. 3. Check urine ketones if blood glucose is >250. 4. Assess tissue turgor every four (4) hours.

ANS: 4. The client is excreting large amounts of dilute urine. If the client is unable to drink enough fluids, the client will quickly become dehydrated, so tissue turgor should be assessed frequently. 1. Diabetes insipidus is not diabetes mellitus; sliding-scale insulin is not administered to the client. 2. There is no caffeine restriction for DI. 3. Checking urine ketones is not indicated.

The nurse is admitting a client to the neurological intensive care unit who is postoperative transsphenoidal hypophysectomy. Which data warrant immediate intervention? 1. The client is alert to name but is unable to tell the nurse the location. 2. The client has an output of 2,500 mL since surgery and an intake of 1,000 mL. 3. The client's vital signs are T 97.6ºF, P 88, R 20, and BP 130/80. 4. The client has a 3-cm amount of dark-red drainage on the turban dressing.

ANS: 2. The output is more than double the intake in a short time. This client could be developing diabetes insipidus, a complication of trauma to the head. 1. Neurological status is monitored every one (1) to two (2) hours. This client's neurological status appears intact. Clients waking up in an intensive care area may not be aware of their surroundings. 3. These vital signs are within normal limits. 4. A transsphenoidal hypophysectomy is performed by surgical access above the gum line and through the nasal passage. There is no dressing. A drip pad is taped below the nares.

The nurse is caring for clients on a medical floor. Which client should be assessed first? 1. The client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) who has a weight gain of 1.5 pounds since yesterday. 2. The client diagnosed with a pituitary tumor who has developed diabetes insipidus (DI) and has an intake of 1,500 mL and an output of 1,600 mL in the last 8 hours. 3. The client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) who is having muscle twitching. 4. The client diagnosed with diabetes insipidus (DI) who is complaining of feeling tired after having to get up at night.

ANS:. 3. Muscle twitching is a sign of early sodium imbalance. If an immediate intervention is not made, the client could begin to seize. 1. Clients with SIADH have a problem with retaining fluid. This is expected. 2. This client's intake and output are relatively the same 4. The client has to get up all night to urinate, so the client feeling tired is expected.

The client is admitted to the medical unit with a diagnosis of rule-out diabetes insipidus (DI). Which instructions should the nurse teach regarding a fluid deprivation test? 1. The client will be asked to drink 100 mL of fluid as rapidly as possible and then will not be allowed fluid for 24 hours. 2. The client will be administered an injection of antidiuretic hormone, and urine output will be measured for four (4) to six (6) hours. 3. The client will be NPO, and vital signs and weights will be done hourly until the end of the test. 4. An IV will be started with normal saline, and the client will be asked to try to hold the urine in the bladder until a sonogram can be done.

ANS: 3. The client is deprived of all fluids, and if the client has DI the urine production will not diminish. Vital signs and weights are taken every hour to determine circulatory status. If a marked decrease in weight or vital signs occurs, the test is immediately terminated. 1. The client is not allowed to drink during the test. 2. This test does not require any medications to be administered, and vasopressin will treat the DI, not help diagnose it. 4. No fluid is allowed and a sonogram is not involved.

The unlicensed assistive personnel (UAP) complains to the nurse she has filled the water pitcher four (4) times during the shift for a client diagnosed with a closed head injury and the client has asked for the pitcher to be filled again. Which intervention should the nurse implement first? 1. Tell the UAP to fill the pitcher with ice cold water. 2. Instruct the UAP to start measuring the client's I & O. 3. Assess the client for polyuria and polydipsia. 4. Check the client's BUN and creatinine levels.

ANS: 3. The first action should be to determine if the client is experiencing polyuria and polydipsia as a result of developing diabetes insipidus, a complication of the head trauma. 1. The client should have the water pitcher filled, but this is not the first action. 2. This should be done but not before assessing the problem. 4. This could be done, but it will not give the nurse information about DI.

The male client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) secondary to cancer of the lung tells the nurse he wants to discontinue the fluid restriction and does not care if he dies. Which action by the nurse is an example of the ethical principle of autonomy? 1. Discuss the information the client told the nurse with the health-care provider and significant other. 2. Explain it is possible the client could have a seizure if he drank fluid beyond the restrictions. 3. Notify the health-care provider of the client's wishes and give the client fluids as desired. 4. Allow the client an extra drink of water and explain the nurse could get into trouble if the client tells the health-care provider.

ANS: 3. This is an example of autonomy (the client has the right to decide for himself). 1. Discussing the information with others is not allowing the client to decide what is best for himself. 2. This could be an example of beneficence (to do good) if the nurse did this so the client has information on which to base a decision on whether to continue the fluid restriction. 4. This is an example of dishonesty and should never be tolerated in a health-care setting.

At what serum sodium level do changes in health happen

120 or less

Normal serum sodium

135-145

Treatment for SIADH

500-1000 mL/day fluid restriction 3% NS given through CVC or large vein Lasix (monitor K+ and EKG/Telemetry)

What to assess for in neuro in SIADH patient

Altered mental status or loss of conciousness. Can indicate low sodium, cerebral edema

The nurse is planning the care of a client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). Which interventions should be implemented? Select all that apply. 1. Restrict fluids per health-care provider order. 2. Assess level of consciousness every two (2) hours. 3. Provide an atmosphere of stimulation. 4. Monitor urine and serum osmolality. 5. Weigh the client every three (3) day

ANS: 1, 2, 4 1. Fluids are restricted to 500 to 600 mL per 24 hours. 2. Orientation to person, place, and time should be assessed every two (2) hours or more often. 3. A safe environment, not a stimulating one, is provided. 4. Urine and serum osmolality are monitored to determine fluid volume status. 5. The client should be weighed daily.

The nurse is admitting a client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). Which clinical manifestations should be reported to the health-care provider? 1. Serum sodium of 112 mEq/L and a headache. 2. Serum potassium of 5.0 mEq/L and a heightened awareness. 3. Serum calcium of 10 mg/dL and tented tissue turgor. 4. Serum magnesium of 1.2 mg/dL and large urinary output.

ANS: 1. A serum sodium level of 112 mEq/L is dangerously low, and the client is at risk for seizures. A headache is a symptom of a low sodium level. 2. This is a normal potassium level, and a heightened level of awareness indicates drug usage. 3. This is a normal calcium level and the client is fluid overloaded, not dehydrated, so there would not be tented tissue turgor. 4. This is a normal magnesium level, and a large urinary output is desired.

Which laboratory value should be monitored by the nurse for the client diagnosed with diabetes insipidus? 1. Serum sodium. 2. Serum calcium 3. Urine glucose. 4. Urine white blood cells.

ANS: 1. The client will have an elevated sodium level as a result of low circulating blood volume. The fluid is being lost through the urine. Diabetes means "to pass through" in Greek, indicating polyuria, a symptom shared with diabetes mellitus. Diabetes insipidus is a totally separate disease process. 2. Serum calcium is not affected by diabetes insipidus. 3. Urine glucose is monitored for diabetes mellitus. 4. White blood cells in the urine indicate the presence of a urinary tract infection.

A high serum sodium level would trigger what reaction in ADH?

An increase in ADH secretion

Type of DI caused by hypothalamic-hypophyseal malformation, head trauma, brain infection, surgery, brain neoplasms or congenital brain defect

Central or Neurogenic

Which type is treated with vasopressin?

Central or Neurogenic

What to assess for in cardiac in SIADH patient

Dysrhythmias (deficient Na and K+) Blood pressure (excess fluid volume)

What to assess for in respiratory in SIADH patient

Fluid volume excess, pulmonary edema

Triggers thirst

Increase in serum osmolality (>290), hypothalamus will trigger thirst

How is diabetes insipidus typically recognized?

Large quantities of very dilute urine

Type of DI caused by inability of nephrons to respond to ADH, decrease or absence of ADH receptors, or kidney damage

Nephrogenic

Type of DI caused by water intoxication (intake of >5 L/day)

Primary or dispogenic DI

Expected lab changes in SIADH for: Serum Na Urine Na Urine Os Serum Os BUN/Cr Urine Specific Gravity Serum K+

Serum Na- Decrease Urine Na- Increase Urine Os- Increase Serum Os-Decrease BUN/Cr-Normal Urine Specific Gravity-Greater than 1.005 Serum K+-decrease

Expected lab changes in DI for: Serum Na Urine Na Urine Os Serum Os Urine Specific Gravity

Serum Na-Increase Urine Na-Decrease Urine Os-Decrease Serum Os-Increase Urine Specific Gravity- Less than 1.005

Most common cause of SIADH

Small cell carcinoma of lung

Where is ADH synthesized and transported?

Synthesized in hypothalamus, transported to posterior pituitary

What medications are used to treat nephrogenic DI

Thiazide diuretics

Names for ADH

Vasopressin, arginine vasopressin, AVP, Antidiuretic horomone

The client diagnosed with a pituitary tumor developed syndrome of inappropriate antidiuretic hormone (SIADH). Which interventions should the nurse implement? 1. Assess for dehydration and monitor blood glucose levels. 2. Assess for nausea and vomiting and weigh daily. 3. Monitor potassium levels and encourage fluid intake. 4. Administer vasopressin IV and conduct a fluid deprivation test.

ANS: 2. Early signs and symptoms are nausea and vomiting. The client has the syndrome of inappropriate secretion of antidiuretic (against allowing the body to urinate) hormone. In other words, the client is producing a hormone that will not allow the client to urinate. 1. The client has excess fluid and is not dehydrated, and blood glucose levels are not affected. 3. The client experiences dilutional hyponatremia, and the body has too much fluid already. 4. Vasopressin is the name of the antidiuretic hormone. Giving more increases the client's problem. Also, a water challenge test is performed, not a fluid deprivation test.