The client diagnosed with a pituitary tumor developed syndrome of inappropriate antidiuretic hormone (SIADH). Which interventions should the nurse implement? Show
1. Assess for dehydration and monitor blood glucose levels. 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. 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. 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. Which laboratory value should be monitored by the nurse for the client diagnosed with diabetes insipidus? 1. Serum sodium. 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. 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." 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. 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. 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. 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. 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. 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. ANS: 1, 2, 4 1. Fluids are restricted to 500 to 600 mL per 24 hours. The nurse is caring for a client diagnosed with diabetes insipidus (DI). Which intervention should be implemented? 1. Administer sliding-scale insulin as ordered. 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. 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. ANS: 3. The first action should be to determine if the
client is experiencing polyuria 1. The client should have the water pitcher filled, but this is not the first action. 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. 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. 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. 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. Normal serum sodium 135-145 Triggers thirst Increase in serum osmolality (>290), hypothalamus will trigger thirst Where is ADH synthesized and transported? Synthesized in hypothalamus, transported to posterior pituitary Most common cause of SIADH Small cell carcinoma of lung At what serum sodium level do changes in health happen 120 or less Names for ADH Vasopressin, arginine vasopressin, AVP, Antidiuretic horomone A high serum sodium level would trigger what reaction in ADH? An increase in ADH secretion Expected lab changes in SIADH for: Serum Na-
Decrease Treatment for SIADH 500-1000 mL/day fluid restriction What to assess for in neuro in SIADH patient Altered mental status or loss of conciousness. Can indicate low sodium, cerebral edema What to assess for in respiratory in SIADH patient Fluid volume excess, pulmonary edema What to assess for in cardiac in SIADH patient Dysrhythmias (deficient Na and K+) Blood pressure (excess fluid volume) How is diabetes insipidus typically recognized? Large quantities of very dilute urine Type of DI caused by hypothalamic-hypophyseal malformation, head trauma, brain infection, surgery, brain neoplasms or congenital brain defect Central or Neurogenic 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 Which type is treated with vasopressin? Central or Neurogenic Expected lab changes in DI for: Serum Na-Increase What medications are used to treat nephrogenic DI Thiazide diuretics What is the recommended treatment for diabetes insipidus?Central diabetes insipidus.
Typically, this form is treated with a synthetic hormone called desmopressin (DDAVP, Nocdurna). This medication replaces the missing anti-diuretic hormone (ADH) and decreases urination. You can take desmopressin in a tablet, as a nasal spray or by injection.
Which symptom should the nurse monitor the client for that is diagnosed with diabetes insipidus?The two main symptoms of diabetes insipidus are the frequent urge to pass high volumes of diluted urine and excessive thirst. These symptoms are also known as polyuria and polydipsia, respectively, and they are two of the three polys of diabetes.
What are nursing interventions for diabetes?Nursing Interventions. Educate about home glucose monitoring. ... . Review factors in glucose instability. ... . Encourage client to read labels. ... . Discuss how client's antidiabetic medications work. ... . Check viability of insulin. ... . Review type of insulin used. ... . Check injection sites periodically.. Which intervention would the nurse implement when caring for a client with syndrome of inappropriate antidiuretic hormone?The most commonly prescribed treatment for SIADH is fluid and water restriction.
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