Predisposing Factors
LEGENDS
Precipitating Factors
Malignancies
Drugs (e.g.
Pulmonary diseases carbamazepine, SSRIs,
CNS disturbances amitriptyline)
Infections
Post-surgery (pain)
Age (>30 years old)
Family history of SIADH
Risk factors/Etiology
Diagnostic test
Mechanism/
Pathophysiology
Nursing Diagnosis
Signs and symptoms
Nursing Interventions/ Medical
Management
certain proinflammatory cytokines and pain mediators affects hypothalamus,
thus producing more ADH
unsuppressed release of antidiuretic hormone (ADH) systemic circulation
from pituitary and non pituitary sources
increased levels and activity of ADH
Serum sodium:
< 135mEq/L
SIADH
Dilutional Hyponatremia
ADH stimulates AQP2 into the membranes of kidney tubules
Blood volume
Heart produces natriuretic
peptides (ANP,BNP)
GFR
Renin
headache, confusion, lethargy, change
in neurological status
High USG:
> 1.030
serum osmolality:
<275 mOsm/kg
Risk for injury related to lethargy and change in
neurological status
Blood pressure
Nursing Interventions
Assess edema
Change position side to side
Elevate the head of the bed
Deep breatjing technique
Angiotensin
Aldosterone
Blood volume
Serum osmolality
Renal Adaptation
Aquaporins
Nursing Interventions
Create a daily weight chart and a food
and fluid chart. Discuss with the patient
the short term and long-term goals of
weight loss.
Administer anti-emetic drugs as
prescribed by the physician
Help the patient to select appropriate
dietary choices to follow a high caloric
diet.
Refer the patient to the dietitian.
Nursing Interventions
C
Excess fluid volume related to excessive amount of
ADH as manifested by edema and decreased urine
output
Decreased RAAS activity
Naturesis
Imbalanced Nutrition: Less Than Body
Requirements related to nausea, vomiting,
weakness, loss of appetite aeb low serum sodium
level
weight gain
Urine Output
Serum osmolality
Heart muscle wall stretches
Nausea, Vomiting
loss of appetite
feeling of fullness
Edema
Increased water retention
Cycle continues (unknown mechanism)
Electrolyte Imbalance (Hyponatremia) related to
the disease process of SIADH aeb nausea, vomiting,
low level of sodium, irritability, and fatigue.
Nursing Interventions
Monitor I & O, daily weights
Continuous ECG monitoring
Assess and monitor vital signs every 1-2 hours
Assess and monitor respiratory status; note changes in
respiration, auscultate lungs
Administer medication and electrolyte supplements
appropriately
Monitor lab / diagnostic values
Nursing Interventions
C
concentrated urine
urine Na concentration:
> 40 mEq/L
urine osmolality:
> 100 mOsm/kg
Decreased reabsorption of
water in the kidney
Diuresis and
Naturesis
water and sodium excretion
EUVOLEMIA