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Diabetes Insipidus, References Ignatavicius, D., Workman, L., Rebar, C.,…
Diabetes Insipidus
Patient Education
tell the patient to drink fluids in amount of urine output
Patient will have lifelong drug therapy
Teach the patient about signs and symptoms
teach that polydipsia and polyuria could indicate they need another dose of medication
teach patients to weight themselves daily to know if they are gaining weight
Report a weight gain of more than 1 kg per week
tell the patient to wear a medical ID bracelet
Assesment
s/s
increase in urination, excessive thirst, dehydration symptoms, poor skin turgor, dry, cracked mucus membranes, hypotension, tachycardia, weak peripheral pulses, hemoconcentration, decreased cognition, ataxia, irritability
Ask about history of recent surgery, head trauma or drug use
24 hour urine is measured and DI is considered if output is more than 4 L and greater than amount ingested
Low specific gravity - less than 1.005
low osmolarity and osmolality
Interventions
controlling symptoms with drug therapy
desmopressin (synthetic form of ADH and decreases urination)
Early detection is important
maintaining adequate hydration
accurately measure intake and output, check urine specific gravity, record the patients daily weight
Make sure IV is patent if give IV fluids
Pathophysiology
disorder of posterior pituitary gland in which water loss is caused by either an ADH deficiency or inability of the kidneys to respond to ADH
causes excretion of large amounts of dilute urine because distal tubule and collecting ducts do not reabsorb water
Massive water loss increases plasma osmolarity and serum sodium levels, which stimulate sensation of thirst
Different types
Primary neurogenic
defect in hypothalamus or pituitary gland resulting in lack of ADH production or release
Secondary neurogenic
not caused by abnormal posterior pituitary gland but is a result of tumors in or near the hypothalamus or gland, head trauma, infectious processes, or brain surgery
Nephrogenic
problem with the kidneys response to ADH rather than problem with production, a severe kidney injury can reduce the ability of tubules to respond to ADH.
Drug related
caused by lithium carbonate and demeclocycline, can interfere with response of kidneys to ADH
References
Ignatavicius, D., Workman, L., Rebar, C., & Heimgartner, N. (2021). Medical-surgical nursing:
Patient-centered collaborative care.
Evolve
, (10th ed.). ISBN: 978-0-323-61242-5
Holman, H. C., Williams, D., Johnson, J., Ball, B. S., Wheless, L., Leehy, P., & Lemon, T. (2019). RN Adult medical surgical nursing: Review module. Assessment Technologies Institute