Diabetes Insipidus Nursing Care Plan & Management

Notes

Description
  • Diabetes insipidus is hyposecretion of ADH caused by strokes, trauma, or idiopathic causes.
  • Kidney tubules fail to reabsorb water.

Diabetes Insipidus

Assessment
  • Polyuria of 4 to 24 L per day
  • Polydipsia
  • Dehydration
  • Decreased skin turgor, dry mucous membranes
  • Inability to concentrate urine
  • A low urinary specific gravity: 1.006 or less
  • Fatigue
  • Muscle pain and weakness
  • Headache
  • Postural hypotension that may progress to vascular collapse without rehydration
  • Tachycardia
Medical Management

Objectives of theraphy are to ensure adequate fluid replacement, to replace vasopressin, and to search for and correct the underlying intracranial pathology. Treatment for diabetes insipidus of nephrogenic origin involves using thiazide, diuretics, mild salt depletion, and prostaglandin inhibitors (eg., ibuprofen, indomethacin, and aspirin).

Vasopressin Replacemeny
  • Desmopressin (DDAVP), administered intranasally, 1 or 2 administrations daily to control symptoms
  • Lypressin (Diapid), absorbed through nasal mucosa into blood; duration may be short for patients with severe disease
  • Intramuscular administration of ADH (vasopressin tannate in oil) every 24 to 96 hours to reduce urinary volume (shake vigorously or warm; administer in the evening; rotate injection sites to prevent llipodystrophy)
Fluid Conservation
  • Clofibrate, a hypolipidemic agent, has an antidiuretic effect on patients who have some residual hypothalamic vasopressin.
  • Chlorpropamide (Diabinese) and thiazide diuretics are used in mild forms to potentiate the action of vasopressin; may cause hypoglycemic reactions.
Nursing Interventions
  • Monitor vital signs and neurological and cardiovascular status.
  • Provide a safe environment, particularly for the client with a change in level of consciousness or mental status.
  • Monitor electrolyte values and for signs of dehydration.
  • Monitor intake and output, weight, and specific gravity of urine.
  • Maintain the intake of adequate fluids, and monitor for signs of dehydration.
  • Instruct the client to avoid foods or liquids that produce diuresis.
  • Administer chlorpropamide (Diabinese) if prescribed for mild diabetes insipidus.
  • Administer vasopressin tannate (Pitressin) or desmopressin acetate (DDAVP,Stimate) as prescribed; these are used when the ADH deficiency is severe or chronic.
  • Instruct the client in the administration of medications as prescribed (DDAVP may be administered by injection, intranasally, or orally).
  • Instruct the client to wear a Medic-Alert bracelet.

 


image courtesy of : http://www.patient.co.uk/

 

Exam

Welcome to your MSN Exam for Diabetes Insipidus! This exam is carefully curated to help you consolidate your knowledge and gain deeper understanding on the topic.

 

Exam Details

  • Number of Questions: 18 items
  • Mode: Practice Mode

Exam Instructions

  1. Practice Mode: This mode aims to facilitate effective learning and review.
  2. Instant Feedback: After each question, the correct answer along with an explanation will be revealed. This is to help you understand the reasoning behind the correct answer, helping to reinforce your learning.
  3. Time Limit: There is no time limit for this exam. Take your time to understand each question and the corresponding choices.

Tips For Success

  • Read each question carefully. Take your time and don't rush.
  • Understand the rationale behind each answer. This will not only help you during this exam, but also assist in reinforcing your learning.
  • Don't be discouraged by incorrect answers. Use them as an opportunity to learn and improve.
  • Take breaks if you need them. It's not a race, and your understanding is what's most important.
  • Keep a positive attitude and believe in your ability to succeed.

Remember, this exam is not just a test of your knowledge, but also an opportunity to enhance your understanding and skills. Enjoy the learning journey!

 

Click 'Start Exam' when you're ready to begin. Best of luck!

💡 Hint

Think about the primary function of Desmopressin in managing diabetes insipidus and how it impacts the body's fluid balance.

1 / 18

1. A patient with diabetes insipidus is receiving Desmopressin acetate (DDAVP). To evaluate the effectiveness of this medication, the nurse should monitor the patient's:

💡 Hint

Consider how desmopressin, a synthetic analogue of vasopressin, would affect urine concentration in a patient with central diabetes insipidus during a diagnostic test.

2 / 18

2. Nurse Evans is explaining the process of confirming a diagnosis of central diabetes insipidus to a group of nursing students. She describes the test involving desmopressin injection and the expected changes in urine osmolarity post-injection compared to pre-injection levels. To confirm central diabetes insipidus, what should be the percentage of post-injection urine osmolarity relative to pre-injection osmolarity?

💡 Hint

Consider the importance of adhering to prescribed medication regimens, especially with hormone replacement therapies, and the potential risks of altering medication dosages without medical guidance.

3 / 18

3. As a nurse preparing a 25-year-old patient with diabetes insipidus (DI) for discharge, you assess the patient's understanding of self-care. Which statement by the patient suggests that more teaching is needed?

💡 Hint

Consider the primary hormone that is deficient in diabetes insipidus and the synthetic form of this hormone used for replacement therapy.

4 / 18

4. Nurse Juliet is managing the care of a male client diagnosed with diabetes insipidus. She is preparing the medication regimen and expects to administer a drug that is most appropriate for treating this condition. Which medication should she anticipate giving?

💡 Hint

Focus on the drugs known to interfere with the kidney's response to ADH, thereby hindering water reabsorption and potentially leading to a form of diabetes insipidus.

5 / 18

5. Nurse Patel is reviewing medications that may affect the renal response to antidiuretic hormone (ADH), potentially leading to nephrogenic diabetes insipidus. She is educating her colleagues about which drugs can antagonize the effects of ADH on the renal tubules. Which medication pair should Nurse Patel mention as possibly causing nephrogenic diabetes insipidus?

💡 Hint

Consider which intervention is crucial for immediate assessment and can provide insight into the client's current physiological status, especially in a potentially unstable condition.

6 / 18

6. Nurse Peterson is attending to a client with a history of diabetes insipidus who has been admitted with symptoms of polyuria, polydipsia, and mental confusion. Understanding the urgency of the situation, she must decide on the priority intervention for this client. What should she focus on first?

💡 Hint

Consider which electrolyte disturbances are known to affect kidney function and how these might impact the body's ability to concentrate urine.

7 / 18

7. Nurse Carter is discussing with her team the potential electrolyte imbalances that can lead to or exacerbate diabetes insipidus. She points out the specific electrolyte abnormalities that are known to influence the condition. Which electrolyte abnormalities should Nurse Carter mention as being capable of causing or contributing to diabetes insipidus?

💡 Hint

Consider the imbalance in water retention and excretion characteristic of diabetes insipidus, and how this would affect the concentration of solutes in the urine and blood.

8 / 18

8. Nurse Thompson is monitoring Cyrill, who was admitted to the ICU with severe head trauma after a car accident. Noticing an abrupt increase in Cyrill's urine output to more than 200 ml/hour, Nurse Thompson suspects diabetes insipidus and decides to verify this by checking for specific lab results. Which lab findings would confirm Nurse Thompson's suspicion of diabetes insipidus?

💡 Hint

Consider which disorder's symptoms often include skeletal issues, mood changes, and increased urination, often related to an overactivity of certain endocrine glands.

9 / 18

9. Nurse Richard is evaluating a 67-year-old male patient who reports several symptoms: increased need for sleep, more frequent urination, loss of appetite, general weakness, irritability, depression, and bone pain that limits outdoor activities. Considering these symptoms, Nurse Richard is contemplating which disorder might be affecting his patient. Which condition should Nurse Richard suspect based on these assessment findings?

💡 Hint

Think about the practical implications and limitations of administering medication nasally, especially in the context of conditions that may interfere with nasal passage clearance.

10 / 18

10. Nurse Johnson is preparing discharge instructions for a male patient diagnosed with primary diabetes insipidus who will be taking desmopressin (DDAVP). She wants to ensure he understands how to manage his condition effectively at home. Which guidance should Nurse Johnson provide about using desmopressin?

💡 Hint

Focus on the condition where there is a deficiency of antidiuretic hormone (ADH), leading to excessive thirst and urination, and where ADH replacement would be a key part of the treatment.

11 / 18

11. Nurse Hamilton is formulating a care plan for a patient diagnosed with an endocrine disorder. She notes that adequate fluid replacement and vasopressin replacement are critical objectives in the management of the patient's condition. Which disease process is Nurse Hamilton focusing on in her care plan?

💡 Hint

Consider how desmopressin compensates for the deficiency seen in central diabetes insipidus, focusing on its effect on water balance.

12 / 18

12. Nurse Wilson is administering desmopressin (DDAVP) to a patient diagnosed with central diabetes insipidus and explains the drug's function to the patient's family. She describes how desmopressin works in treating this condition. What is the mechanism of action of desmopressin (DDAVP) in managing central diabetes insipidus?

💡 Hint

Consider the treatment goal for diabetes insipidus, which typically involves managing fluid balance and reducing excessive thirst and urination.

13 / 18

13. Nurse Thompson is monitoring the progress of Mr. Allen, a male patient undergoing treatment for diabetes insipidus. She's reviewing his health parameters to assess the effectiveness of the treatment. Which of the following outcomes would indicate a positive response to the treatment?

💡 Hint

Consider the primary symptoms of diabetes insipidus, focusing on the aspect of the condition that directly relates to the quantity of urine produced.

14 / 18

14. A patient is under evaluation for potential diabetes insipidus. Which of the following methods is the most effective for assessing this condition?

💡 Hint

Focus on the condition that is often associated with an increased rate of urine production and might be related to brain surgery or head trauma.

15 / 18

15. Nurse Daniels is closely monitoring a patient who has just undergone a craniotomy. Noticing that the patient's catheter recorded a urine output of 1500 ml for the first hour and the same for the second hour, Nurse Daniels begins to consider possible underlying issues. Which condition should Nurse Daniels suspect, given the unusually high urine output in such a short period?

💡 Hint

Think about which organ is involved in the production and regulation of antidiuretic hormone (ADH), which plays a crucial role in water balance in the body.

16 / 18

16. Nurse Cooper is discussing central diabetes insipidus with a group of nursing students and explaining the underlying cause of the condition. She emphasizes the significance of one particular organ, damage to which can lead to central diabetes insipidus. Which organ is Nurse Cooper referring to as being primarily responsible for the development of central diabetes insipidus?

💡 Hint

Consider the hormone directly involved in the regulation of water balance in the body, which is crucial in the pathology of diabetes insipidus.

17 / 18

17. Nurse Smith is preparing an educational session for a male patient recently diagnosed with diabetes insipidus. Part of this session involves discussing the hormonal imbalance associated with this condition. Which hormone should Nurse Smith explain is deficient in patients with diabetes insipidus?

💡 Hint

Consider the primary effects of the condition on fluid balance and how this would manifest in the patient's intake and output.

18 / 18

18. Nurse Jenkins is educating a group of nursing students about the typical presenting signs of diabetes insipidus. She emphasizes the key symptoms that are most commonly associated with this condition. Which signs should Nurse Jenkins include as typical presentations of diabetes insipidus?

Nursing Care Plan

Nursing Diagnosis
  • Deficient Fluid Volume

May be related to

  • Compromised endocrine regulatory mechanism
  • Neurophypophyseal dysfunction
  • Hypopituitarism
  • Hypophysectomy
  • Nephrogenic DI

Defining Characteristics

  • Polyuria
  • Output exceeds intake
  • Polydipsia (increased thirst)
  • Sudden weight loss
  • Urine specific gravity less than 1.005
  • Urine osmolality less than 300 mOsm/L
  • Hypernatremia
  • Altered mental status
  • Requests for cold or ice water
Desired outcomes
  • Patient experiences normal fluid volume as evidenced by absence of thirst, normal serum sodium level, and stable weight.
Nursing Interventions
  • Monitor intake and output. Report urine volume greater than 200 mL for each of 2 consecutive hours or 500 mL in a 2-hour period.
    • Rationale: With DI, the patient voids large urine volumes independent of the fluid intake. Urine output ranges from 2 to 3 L/day with renal DI to greater than 10 L/day with central DI.
  • Monitor for increased thirst (polydipsia).
    • Rationale: If the patient is conscious and the thirst center is intact, thirst can be a reliable indicator of fluid balance. Polyuria and polydipsia strongly suggest DI. Also, the DI patient prefers ice water.
  • Weigh daily.
    • Rationale: Weight loss occurs with excessive fluid loss.
  • Monitor urine specific gravity.
    • Rationale: This may be 1.005 or less.
  • Monitor serum and urine osmolality.
    • Rationale: Urine osmolality will be decreased and serum osmolality will increase.
  • Monitor urine and serum sodium levels.
    • Rationale: The patient with DI has decreased urine sodium levels and hypernatremia.
  • Monitor serum potassium.
    • Rationale: Hypokalemia may result from the increase in urinary output of potassium.
  • Monitor for signs of hypovolemic shock (e.g., tachycardia, tachypnea, hypotension).
    • Rationale: Frequent assessment can detect changes early for rapid intervention. Polyuria causes decreased circulatory blood volume.
  • Allow the patient to drink water at will.
    • Rationale: Patients with intact thirst mechanisms may maintain fluid balance by drinking huge quantities of water to compensate for the amount they urinate. Patients prefer cold or ice water.
  • Provide easily accessible fluid source, keeping adequate fluids at bedside.
    • Rationale: This encourages fluid intake.

Administer intravenous (IV) fluids:IV fluids are indicated if the patient cannot take in sufficient fluids orally.

  • 5% dextrose in water or 0.45% sodium chloride
    • Rationale: Hypotonic IV fluids provide free water and help lower serum sodium levels gradually.
  • 0.9% sodium chloride
    • Rationale: Isotonic fluids may be indicated for the patient who has sustained significant fluid loss and is hemodynamically unstable. Once circulatory volume has been restored, hypotonic IV fluids can be given.
  • Administer medication as prescribed.
    • Rationale: Aqueous vasopressin is usually used for DI of short duration (e.g., postoperative neurosurgery or head trauma). Pitressin tannate (vasopressin) in oil (the longer-acting vasopressin) is used for longer-term DI. Patients with milder forms of DI may usechlorpropamide (Diabinese), clofibrate(Atromid), or carbamazepine (Tegretol) to stimulate release of ADH from the posterior pituitary and enhance its action on the renal tubules. Hydrochlorothiazide (HydroDIURIL) may also be used for nephrogenic DI.
  • If vasopressin is given, monitor for water intoxication or rebound hyponatremia.
    • Rationale: Overmedication can result in volume excess.

Nursing Diagnosis
  • Risk for Impaired Skin Integrity

Risk factors

  • Urinary frequency with high volume output and the potential for incontinence
Desired outcome
  • Patient’s skin remains intact.
Nursing Interventions
  • Inspect skin; document condition and changes in status.
    • Rationale: Early detection and intervention may prevent occurrence or progression of impaired skin integrity. Fluid loss from polyuria contributes to decreased skin turgor and dryness.
  • Assess for continence or incontinence. Evaluate need for an indwelling urinary catheter.
    • Rationale: Excessive moisture on the skin increases the risk of skin breakdown.
  • Assess other factors that may risk the patient’s skin integrity (e.g., immobility, nutritional status, altered mental status).
    • Rationale: Excessive moisture from urinary incontinence can add to the risk for skin breakdown from other sources.
  • Provide easy access to the bathroom, urinal, or bedpan.
    • Rationale: Both polyuria and polydipsia disrupt the patient’s normal activities (including sleep). Easy access to void will decrease inconvenience and frustration.
  • Use skin barriers as needed.
    • Rationale: These prevent redness or excoriation from urinary frequency.
  • Keep bed linen clean, dry, and wrinkle-free.
    • Rationale: This prevents shearing forces.

Nursing Diagnosis
  • Deficient Knowledge

May be related to

  • New condition
  • Unfamiliarity with the disease and treatment

Defining characteristics

  • Questioning
  • Requests for more information
  • Verbalization of misconceptions or misinterpretations
Desired outcomes
  • Patient verbalizes correct understanding of DI and the medications used in treatment
Nursing Interventions
  • Assess level of knowledge of DI cause and treatment.
    • Rationale: An individualized teaching plan is based on the patient’s current knowledge and desire for additional information.
  • Assess readiness to learn.
    • Rationale: Rapid fluid loss from polyuria can lead to impaired cognitive function. This change in mental status can limit the patient’s ability to learn new information.

Give written information concerning the diagnosis and treatment of DI:

  • Water deprivation ADH stimulation test
    • Rationale: This test may be done to differentiate nephrogenic causes from neurogenic causes of DI. The patient is instructed to take nothing by mouth (NPO) for 12 hours before a blood sample is drawn to measure ADH levels. The ADH level is increased in nephrogenic DI and decreased in neurogenic (central) DI. Vasopressin may be given to evaluate renal response. There is no response to the drug in nephrogenic DI.
  • Computed tomography scan or magnetic resonance imaging
    • Rationale: These scans may be ordered if a pituitary tumor is suspected.
  • Desmopressin acetate (DDAVP)
    • Rationale: This is the drug of choice for the management of DI. This medication is a synthetic form of ADH and is administered intranasally.
  • Aqueous form of ADH (vasopressin)
    • Rationale: This drug has a shorter half-life than DDAVP and therefore requires more frequent daily administration. Vasopressin is usually given parenterally and is not recommended for the long-term management of chronic DI.
  • Other drugs used in combination to manage DI, including chlorpropamide (Diabinese), clofibrate (Atromid), carbamazepine (Tegretol), and hydrochlorothiazide
    • Rationale: These secondary drugs work on the kidney or the posterior pituitary gland to increase pituitary release of ADH or increase renal response to ADH.
  • Teach the patient the necessity of closely monitoring fluid balance, including daily weights (same time of day with same amount of clothing), fluid intake and output, and measurement of urine specific gravity.
    • Rationale: This assists the patient in monitoring the condition so that adjustments can be made accordingly, helping prevent undertreatment or overtreatment with the medication.
  • Discuss when to seek further medical attention (at signs of underdosage or overdosage of medications).
    • Rationale: Patients with chronic disease need to be able to recognize important changes in their condition to avert complications and possible hospitalization.
  • Instruct the patient to wear a medical alert bracelet, listing DI and the medications that the patient is using.
    • Rationale: This allows for prompt intervention in the event of an emergency.