Chapter 50 - Endocrine Problems
When caring for a patient with nephrogenic diabetes insipidus, what should the nurse expect the treatment to include? b. Thiazide diuretics
b. In nephrogenic diabetes insipidus, the kidney is unable to respond to ADH, so vasopressin or hormone analogs are not effective. Thiazide diuretics slow the glomerular filtration rate (GFR) in the kidney and produce a decrease in urine output. Low-sodium diets (<3 g/day) are also thought to decrease urine output. Fluids are not restricted because the patient could easily become dehydrated.
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 c. a urine specific gravity of 1.002.
c. Normal urine specific gravity is 1.005 to 1.025 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. Headache, weight gain, and oral intake greater than urinary output are signs of volume excess that occur with overmedication. Nasal irritation and nausea may also indicate overdosage.
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 drunk. What is a diagnostic test that the nurse should expect to be done to help make a diagnosis? c. Urine specific gravity
c. Patients with diabetes insipidus (DI) excrete large amounts of urine with a specific gravity of less than 1.005. Blood glucose would be tested to diagnose diabetes mellitus. The serum sodium level is expected to be low with DI but is not diagnostic. To diagnose central DI a water deprivation test is required. Then a CT of the head may be done to determine the cause. Nephrogenic DI is differentiated from central DI with determination of the level of ADH after an analog of ADH is given.
The nurse determines that additional instruction is needed for a 60-year-old patient with chronic syndrome of inappropriate antidiuretic hormone (SIADH) when the patient says which of the following? a. "I need to shop for foods low in sodium and avoid adding salt to food."
Patients with SIADH are at risk for hyponatremia, and a sodium supplement may be prescribed. The other patient statements are correct and indicate successful teaching has occurred.
A 56-year-old patient who is disoriented and reports a headache and muscle cramps is hospitalized with possible syndrome of inappropriate antidiuretic hormone (SIADH). The nurse would expect the initial laboratory results to include a(n) b. decreased serum sodium.
When water is retained, the serum sodium level will drop below normal, causing the clinical manifestations reported by the patient. The hematocrit will decrease because of the dilution caused by water retention. Urine will be more concentrated with a higher specific gravity. The serum chloride level will usually decrease along with the sodium level.
Which information is most important for the nurse to communicate rapidly to the health care provider about a patient admitted with possible syndrome of inappropriate antidiuretic hormone (SIADH)? d. The patient has a serum sodium level of 118 mEq/L.
A serum sodium of less than 120 mEq/L increases the risk for complications such as seizures and needs rapid correction. The other data are not unusual for a patient with SIADH and do not indicate the need for rapid action
A 23-year-old patient is admitted with diabetes insipidus. Which action will be most appropriate for the registered nurse (RN) to delegate to an experienced licensed practical/vocational nurse (LPN/LVN)? d. Administer subcutaneous DDAVP.
Administration of medications is included in LPN/LVN education and scope of practice. Assessments, patient teaching, and titrating fluid infusions are more complex skills and should be done by the RN.
The nurse determines that demeclocycline (Declomycin) is effective for a patient with syndrome of inappropriate antidiuretic hormone (SIADH) based on finding that the patient's b. urinary output is increased.
Demeclocycline blocks the action of antidiuretic hormone (ADH) on the renal tubules and increases urine output. An increase in weight or an increase in urine specific gravity indicates that the SIADH is not corrected. Peripheral edema does not occur with SIADH. A sudden weight gain without edema is a common clinical manifestation of this disorder.
An expected nursing diagnosis for a 30-year-old patient admitted to the hospital with symptoms of diabetes insipidus is c. sleep pattern disturbance related to frequent waking to void.
Nocturia occurs as a result of the polyuria caused by diabetes insipidus. Edema, excess fluid volume, and fluid retention are not expected.
Which intervention will the nurse include in the plan of care for a 52-year-old male patient with syndrome of inappropriate antidiuretic hormone (SIADH)? b. Offer patient hard candies to suck on.
Sucking on hard candies decreases thirst for a patient on fluid restriction. Patients with SIADH are on fluid restrictions of 800 to 1000 mL/day. Peripheral edema is not seen with SIADH. The head of the bed is elevated no more than 10 degrees to increase left atrial filling pressure and decrease antidiuretic hormone (ADH) release.
The nurse is caring for a patient admitted with diabetes insipidus (DI). Which information is most important to report to the health care provider? a. The patient is confused and lethargic.
The patient's confusion and lethargy may indicate hypernatremia and should be addressed quickly. In addition, patients with DI compensate for fluid losses by drinking copious amounts of fluids, but a patient who is lethargic will be unable to drink enough fluids and will become hypovolemic. A high urine output, low urine specific gravity, and history of a recent head injury are consistent with diabetes insipidus, but they do not require immediate nursing action to avoid life-threatening complications.
A patient with SIADH is treated with water restriction. What does the patient experience when the nurse determines that treatment has been effective? b. Increased urine output, increased serum sodium, and decreased urine specific gravity
b. The patient with SIADH has water retention with hyponatremia, decreased urine output, 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.
The patient is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). What manifestation should the nurse expect to find? b. Decreased urinary output
b. With increased antidiuretic hormone (ADH), 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.
During care of the patient with SIADH, what should the nurse do? a. Monitor neurologic status at least every 2 hours.
a. The patient with syndrome of inappropriate antidiuretic hormone (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 (BP) indicates a reduction in total fluid volume and is an expected outcome of treatment.
In a patient with central diabetes insipidus, what will the administration of ADH during a water deprivation test result in? d. Increase in urine osmolality
d. A patient with central diabetes insipidus has a deficiency of ADH with excessive loss of water from the kidney, hypovolemia, hypernatremia, and dilute urine with a low specific gravity. When vasopressin is administered, the symptoms are reversed, with water retention, decreased urinary output that increases urine osmolality, and an increase in BP.
