Unit 5 & 6 Chapter 57 Diabetes Insipidus and Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

Question 1

What is Diabetes Insipidus (DI)

Answer 1

DRY INSIDE
FLUID VOLUME DEFICIT
Polyuria
Polydypsia
Diabetes insipidus (DI) is a disorder of the posterior pituitary gland in which water loss is caused by either an antidiuretic hormone (ADH) deficiency or an inability of the kidneys to respond to ADH.

Question 2

What is the cause of secondary

Answer 2

Secondary DI
-caused by diseases that affect the posterior pituitary
Traumatic head injury, neurosurgery,
neoplasms.
Tumors in brain
craniotomy

Question 3

Urine specific gravity range

Answer 3

1.005-1.030

Your urine specific gravity is generally considered normal in the ranges of 1.005 to 1.030. If you drink a lot of water, 1.001 may be normal. If you avoid drinking fluids, levels higher than 1.030 may be normal.

Question 4

Primary DI vs Secondary DI

Answer 4

Primary DI–defect in hypothalamus or pituitary gland resulting in dec. ADH production or release

-ANYTHING IN TH BRAIN
Secondary DI-caused by diseases that affect the posterior pituitary
Traumatic head injury, neurosurgery,
neoplasms.
pituaty tumor

Question 5

S/S of Diabetes Insipidus

Answer 5

Hypotension**
**Tachycardia
Weak peripheral pulses**
* Hemoconcentration
* **Increased urine output(polyuria)**
* **, low specific gravity**
* **Poor turgor**
* **Dry mucous membranes**
* Decreased cognition a
* Ataxia
**Increased thirst (polydyspsia)
* Irritability a

Question 6

Assessment questions for patient with DI

Answer 6

Ask about a history of recent surgery, head trauma, or drug use (e.g., lithium).

LITHIUM CAN CAUSE DIABTES INSIPIDUS

Question 7

What medication would you suspect the Health Care Provider to prescribe for a patient diagnosed with Diabetes Insipidus?

A. Furesomide
B. Levothyroxine
C. Epinephrine
D. Desmopressin

Answer 7

D. Desmopressin

This drug, a synthetic form of vasopressin, replaces antidiuretic hormone (ADH) and decreases urination. It is available orally, as a sublingual “melt,” or intranasally in a metered spray.

Question 8

Nursing Intervention for Diabetes Insipidus

Answer 8

-increase fluid intake
-Administer Desmopressin
- Monitor fluid volume status
- checking urine specific gravity,
- records of daily weight

Question 9

Does a patient with DI require lifelong drug therapy of Desmopressin?
A. yes
B. no

Answer 9

The patient with permanent DI requires lifelong drug therapy. Check his or her ability to assess symptoms, and adjust dosages as prescribed for changes in conditions. Teach that polyuria and polydipsia indicate the need for another dose.

Question 10

Complications of Desmopressin

Answer 10

Drug therapy for DI induces water retention and can cause fluid overload

• Weight gain
  -Edema
  -Crackles in lungs
  -Hypertention

Question 11

Patient teaching Desmopressin

Answer 11

Teach patients to weigh themselves daily to identify weight gain.

Stress the importance of using the same scale and weighing at the same time of day while wearing a similar amount and type of clothing.

If weight gain of more than 2.2 lb (1 kg) along with other signs of water toxicity occurs (e.g., persistent headache, acute confusion, nausea, vomiting), instruct him or her to go immediately to the emergency department or call 911.

Instruct the patient to wear a medical alert bracelet identifying the disorder and drug.

Question 12

Which urine characteristics indicate to the nurse that the client being managed for diabetes insipidus is responding appropriately to interventions?
A. Urine output volume increased; urine specific gravity increased
B. Urine output volume increased; urine specific gravity decreased
C. Urine output volume decreased; urine specific gravity increased
D. Urine output volume decreased; urine specific gravity decreased

Answer 12

C. Urine output volume decreased; urine specific gravity increased

Question 13

What is Syndrome of Inappropriate ADH (SIADH)

Answer 13

SWIM INSIDE
FLUID OVERLOAD
OLIGURIA
The syndrome of inappropriate antidiuretic hormone (SIADH) or Schwar -Bar er syndrome 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.

Question 14

Should you monitor for hyponatremia for patients with SIADH?
A. Yes
B. No

Answer 14

A. Yes

Question 15

S/s of SIADH

Answer 15

-hyponatremia)
-appetite, nausea, and vomiting,
-weight gain
-lethargy,
-headaches,
-hostility,
-edema
-hypertention
-disorientation,
-change in level of consciousness
-seizures
-coma.
-full and bounding pulse
-Increased urine specific gravity(1.030^)

Question 16

Nursing Interventions for SIADH

Answer 16

-restricting fluid intake
-promoting the excretion of water,
-replacing lost sodium
-monitoring response to therapy
-preventing complications,
-teaching the patient and family about fluid restrictions and drug therapy
-preventing injury.
-place side rails up
-Neurochecks Q2 hours
-Monior for complications of seizure

Question 17

Your patient presents with a serum sodium level of 89. What order would you anticipate the provider to order?
A. Hydrochlorithiazide
B. 3% Sodium Chloride
C. Lactaded Ringers
D. 0.45% Normal Saline

Answer 17

Hypertonic saline (i.e., 3% sodium chloride [3% NaCl]) is used for SIADH when the serum sodium level is very low

Question 18

Medications of choice for SIADH
A. Spirinolactone
B. Furosemide
C. Hydrochloritiazide
D.Acetominophen

Answer 18

B. Furosemide

Question 19

What medication is contraindicated for patients with SIADH?
A. Bumetadine
B. Furosemide
C. Hydrochloritiazide
D.Acetominophen

Answer 19

C. Hydrochloritiazide

This diuretic wastes all electrolytes except Calcium and puts the patient is a seizure risk

Question 20

Medication for SIADH Tolvaptan and Conivaptan

Answer 20

tolvaptan or conivaptan, is used to treat SIADH when hyponatremia is present in hospitalized patients (Burchum & Rosenthal, 2019). These drugs promote water excretion without causing sodium loss

Tolvaptan is an oral drug, and conivaptan is given IV. Tolvaptan has a black box warning that rapid increases in serum sodium levels

When this drug is used at higher dosages or for longer than 30 days, there is a significant risk for liver failure and death

Question 21

Should Tolvaptan be given only in a hospital setting?
A. Yes
B. No

Answer 21

A. Yes

Administer tolvaptan or conivaptan only in the hospital se ing so serum sodium levels can be monitored closely for the development of hypernatremia and other complications.

Question 22

Seizure precautions

Answer 22

-turn the client on side
-remove harmful objects
-suction as needed
-do not hold client
-loosen tight clothes
-time the seizure
-order IV benzodiazepine to break the seizure
-acquire patent iv access
-reduce environmental stimuli
*dim lights
*limit visitors
no cluster care

Question 23

Complications of SIADH

Answer 23

Monitor for increased fluid overload (bounding pulse, increasing neck vein distention, lung crackles, dyspnea, increasing peripheral edema, reduced urine output) at least every 2 hours.

Pulmonary edema can occur very quickly and can lead to death.
Notify the primary health care provider of any change that indicates the fluid overload is not responding to therapy or is worse.

Question 24

Seizure precautions continued

Answer 24

Observe for and document changes in the patient’s neurologic status.

Assess for subtle changes, such as muscle twitching, increasing irritability, or restlessness, before these progress to seizures or coma.

Check orientation to time, place, and person every 2 hours because disorientation or confusion may be present as an early indication.

Reduce environmental noise and lighting to prevent overstimulation.

Question 25

A nurse is caring for a client diagnosed with Syndrome of Inappropriate Antidiuretic Hormone (SIADH). Which assessment finding should the nurse prioritize?
A) Decreased urine specific gravity
B) Elevated serum sodium levels
C) Increased urine output
D) Decreased serum osmolality

Answer 25

B) Elevated serum sodium levels

Question 26

The healthcare provider prescribes fluid restriction for a client with SIADH. Which statement by the client indicates an understanding of the rationale behind this intervention?
A) “Limiting fluids will help prevent electrolyte imbalances.”
B) “Reducing fluids will decrease the risk of heart failure.”
C) “Fluid restriction will prevent excessive urination.”
D) “Limiting fluids will help normalize my body’s sodium levels.”

Answer 26

D) “Limiting fluids will help normalize my body’s sodium levels.”

Question 27

A client with SIADH is at risk for developing which complication due to the retention of water?
A) Hyperkalemia
B) Hyponatremia
C) Hypocalcemia
D) Hypernatremia

Answer 27

B) Hyponatremia

Question 28

Which medication is commonly prescribed for clients with SIADH to promote water excretion and increase serum sodium levels?
A) Furosemide (Lasix)
B) Hydrochlorothiazide (HCTZ)
C) Spironolactone (Aldactone)
D) Desmopressin (DDAVP)

Answer 28

A) Furosemide (Lasix)