endocrine: DI, SIADH
the hcp has ordered 40g/24 hr of intranasal vasopressin for a client dx with DI. each metered spray delivers 10g. the client takes the medication every 12 hrs. how many sprays are delivered at ea dosing time?
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the client dx 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
assess for nausea and vomiting and weigh daily: 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. Vasopressin is the name of the antidiuretic hormone. giving more increases the clients problem. also, water challenge test is performed, not a fluid deprivation test.
the UAP complains to the nurse she has filled the water pitcher 4 times during the shift for a client dx 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 clients I and O's 3. asess the client for polyuria and polydipsia 4. check the clients BUN and creatinine levels
assess the client for polyuria and polydipsia: 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 info. about DI (the nurse must apply a systematic approach to answering priority questions. maslows hierarchy of needs should be applied if it is a physiological problem and the nursing process if it is a question of this nature. assessment is the first step in the nursing process)
the nurse is caring for a client dx with 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 4 hours
assess tissue turgor every 4 hours: 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 isnt administered. 2. there is no caffeine restriction for DI. 3. checking urine ketones isn't indicated
the nurse is discharging a client dx 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 hcp
i should take my medication in the morning and leave it refrigerated at home: medication for DI is usually taken every 8 to 12 hours, depending on the client. The client should keep the medication close at hand. The client should keep a list of medication being taken and wear a medic alert bracelet. the client is at risk for fluid shifts. weighing every morning allows the client to follow the fluid shifts. wt gain indicates too much medication. tightness in the chest could be an indicator the medication is not being tolerated; if this occurs, the client should notify the hcp. (the medical treatment of DI involves replacement of ADH. In acute cases, vasopressin, a synthetic form of ADH, is given by the IV or subcu route, in long term therapy synthetic ADH in the form of a nasal spray is used (desmopressin or DDAVP))
the male client dx with 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 info the client told the nurse with the hcp and significant other 2. explain it is possible the client could have a seizure if he drank fluid beyond the restrictions 3. notify the hcp of the clients 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 hcp
notify the hcp of the clients wishes and give the client fluids as desired: this is an example of autonomy (the client has the right to decide for himself) 1. discussing the info 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 info 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
the nurse is planning the care of a client dx with SIADH. which interventions should be implemented? select all that apply 1. restrict fluids per health care provider order 2. assess level of consciousness every 2 hours 3. provide an atmosphere of stimulation 4. monitor urine and serum osmolality 5. weigh the client every 3 days
restrict fluids per hcp, assess LOC, monitor urine and serum osmolality: fluids are restricted to 500 to 600 mL/24 hrs. Orientation to person, place, and time should be assessed every 2 hours or more often. Urine and serum osmolality are monitored to determine fluid volume status. 3. a safe environment, not a stimulating one, is provided. 5. the client should be weighed daily not every 3 days
the nurse is admitting a client dx with SIADH. which clinical manifestations should be reported to the hcp? 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
serum sodium of 112 mEq/L and a headache: A serum sodium level of 112 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 lab value should be monitored by the nurse for the client dx with DI (diabietes insipidus)? 1. serum sodium 2. serum calcium 3. urine glucose 4. urine white blood cells
serum sodium: 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
the nurse is caring for clients on a medical floor. which client should be assessed first? 1. the client dx with syndrome of inappropriate antidiuretic hormone (SIADH) who has a wt. gain of 1.5 lbs since yesterday 2. the client dx with a pituitary tumor who has developed diabetes insipidus (DI) and has an intake of 1500 mL and an output of 1600 mL in the last 8 hours 3. the client dx with syndrome of inappropriate antidiuretic hormone (SIADH) who is having muscle twitching 4. the client dx with diabetes insipidus (DI) who is c/o feeling tired after having to get up at night
the client dx with syndrome of inappropriate antidiuretic hormone who is having muscle twitching: muscle twitching is a sign of early sodium imbalance. if an immediate intervention isnt made, the client could begin to seize. 1. clients with SIADH have a problem with retaining fluid. this is expected. 2. this clients 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 dx of rule out diabetes insipidus. 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 ADH, and urine output will be measured for 4 to 6 hours 3. the client will be NPO, and v/s and weights will be done hourly until the end of the test 4. an IV will be started with NS, and the client will be asked to try to hold the urine in the bladder until a sonogram can be done
the client will be NPO, and v/s and wts will be done hourly until the end of the test: the client is deprived of all fluids, and if the client has DI the urine production will not diminish. Vital signs and wts are taken every hour to determine circulatory status. if a marked decrease in wt 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 meds to be administered, and vasopressin will treat the DI, not help dx it. 4. no fluid is allowed and a sonogram is not involved
