Hinkle & Cheever 14th ed.
Chap 52, pp. 1509-1524
Excessive secretion of antidiuretic hormone from the pituitary gland despite low serum
osmolality level
1. List five essential assessments that should be done for a client with SIADH.
assessments necessary?
Why are these
Nursing Management
1. Close monitoring of fluid intake and output
Patients with SIADH cannot excrete a dilute urine causing a low urinary output (oliguria), and
retain fluids.
2. Daily Weights>For a baseline. To see if they are experiencing weight gain, and if the
condition is getting worse
3. Urine Chemistry> Urine will have a high urine osmolality. Normal urine osmolality 500850. Also, Specific gravity will be >1.005…high from the image above is 1.030+
(possibly when urine is thick and sticky)
4. Blood Chemistry>
Serum sodium-For the development a sodium deficiency known as dilutional
hyponatremia. Your blood osmolality will be low (Hyposmolality) because the sodium in
your bloodstream will be diluted due to the increased fluid retention. Normal serum
osmolality 280-295 and Normal Sodium 135-145. Since the two electrolytes are tied
together, there will also be hypochloremia. Normal range is 95-105
BUN- Should see normal renal function
Creatinine- Should see normal renal function
Hgb-inappropriate release of ADH increases free water reabsorption, which
increases circulating blood volume, and lowers Hemoglobin
Hct- inappropriate release of ADH increases free water reabsorption, which
increases circulating blood volume, and lowers Hemoglobin
5. Neurologic Status>
When sodium levels in the blood are too low, extra water goes into body cells
causing them to swell. This swelling can be especially dangerous for brain cells, resulting in
neurological symptoms such as: Headache is the early sign, Confusion, Seizures, and Coma are
caused by Hyponatremia. Low sodium
OR
1.
2.
3.
4.
5.
Blood pressure for increase
Respiratory rate
O2 Sat
Monitor for fluid overload by listening to lungs
Assess Urine
2. What are four neurological signs and symptoms of SIADH?
Headache is the early sign, Confusion, Seizures, and Coma
3. Explain, why it is important to monitor a client with SIADH or Diabetes Insipidus serum
sodium and urine sodium.
With SIADH, Decreased Serum sodium will be < 134 mEq/L and Urine Sodium/Osmolality
will be increased
Normal Urine osmolality will be 500-850
With Diabetes Insipidus, Serum sodium will be>145 and Urine Sodium/Osmolality will be
decreased <100mOsm/kg
Normal Urine osmolality will be 500-850)
4. In the treatment of SIADH, correlate the therapeutic use of a 3% hypertonic saline.
If serum sodium < 120 mEq, Hypertonic saline 3-5% slow infusion. It will block the effect of
ADH on the renal tubules, thereby allowing more dilute urine.
Hypertonic solution will block ADH from allowing Aquaporins from putting more and more
water back into the bloodstream. It will increase the amount of sodium in the bloodstream, which
will go into the urine, allowing water is already in the in bloodstream to follow the sodium via
the concentration gradient, diluting more of the urine.
5. The physicians orders Lasix 40 mg IVP for your client with SIADH. You review your labs
and notice that their serum sodium is only 124 mEq/L. What should be your nursing intervention
and why?
You want to hold the med and contact the doctor about the lab results. The patient is
hyponatremia and you don’t want to cause any neurological complications.
6. When positioning a client with trauma (head) induced SIADH, which position should the
client maintain? Explain why.
Positioning: HOB no more than 10 degrees ( venous return to heart &  atrial filling pressure
which  ADH
? 7. When assessing your client being treated with Demeclocycline what symptoms would you
assess for to determine that the treatment is effective?
Demeclocycline has been used in treatment of the syndrome of inappropriate antidiuretic
hormone (ADH) secretion (SIADH), as it acts on collecting tubule cells to diminish their
responsiveness to ADH, in effect essentially inducing nephrogenic diabetes insipidus.
? 8. What diet constraints does a client with SIADH have?
NO FLUIDS
Hinkle & Cheever 14th ed.
Chap 52, pp. 1509-1524
9. What is Nephrogenic DI (NDI)?
Another cause of DI is failure of the renal tubules to respond to ADH; this nephrogenic form
may be related to hypokalemia, hypercalcemia, and a variety of medications (e.g., lithium,
demeclocycline [Declomycin]).
10.A client asks what is the “Water deprivation test?” What would you explain to him?
The fluid deprivation test is carried out by withholding fluids for 8 to 12 hours or until 3% to 5%
of the body weight is lost. The patient is weighed frequently during the test. Plasma and urine
osmolality studies are performed at the beginning and end of the test. The inability to increase
the specific gravity and osmolality of the urine is characteristic of DI. The patient continues to
excrete large volumes of urine with low specific gravity and experiences weight loss, increasing
serum osmolality, and elevated serum sodium levels.
11. What are your nursing responsibilities for the fluid deprivation test?
The patient’s condition needs to be monitored frequently during the test, and the test is
terminated if tachycardia, excessive weight loss, or hypotension develops.
.
12. Desmopressin acetate (DDAVP) is the drug of choice when treating a client with Diabetes
Insipidus. What is the action of this drug and what nursing responsibilities are important when
administering it?
Desmopressin (DDAVP), a synthetic vasopressin without the vascular effects of natural ADH
and works on the kidneys to reduce urine volume and serum osmolality in patients with diabetes
insipidus. It increases the reabsorption of water by the kidney. Desmopressin increases cyclic
adenosine monophosphate (cAMP) in the cells of the renal tubule to increase the water
permeability, decreasing urine volume and increasing its osmolality.
It is particularly valuable because it has a longer duration of action and fewer adverse effects
than other preparations previously used to treat the disease. It is given intra-nasally; the patient
sprays the solution into the nose through a flexible calibrated plastic tube.
One or two administrations daily (i.e., every 12 to 24 hours) usually control the symptoms.
Adverse effects of desmopressin reportedly occur in less than 5% of cases. The most common
effects are erythema, swelling, and burning of the parenteral injection site.
Other adverse effects include drowsiness, headache, dizziness, lethargy, shortness of breath,
gastric irritation with heartburn, abdominal cramping, vulval pain, nasal congestion, and nasal
irritation.
Vasopressin causes vasoconstriction; thus, it must be used cautiously in patients with coronary
artery disease.
A Creatinine clearance less than 50 mL/minutes contraindicates the use of desmopressin.
Black box warning; the drug can cause decreased urinary output, which can lead to hyponatremia
which can lead to death by headache, seizures, and death.
Another black box warning stipulates that changes in fluid volume status may result in cardiac
arrest in patients with known cardiovascular disease.
Water intoxicantion
Administering the Medication Guidelines for administration are as follows:
Use the IM, IV, and subcutaneous preparations for central diabetes insipidus. Withdraw the
dosage from the ampule and administer it using a small gauge needle and syringe (e.g., an insulin
syringe).
For intranasal administration, ensure that nasal passages are intact, clean, and free of obstruction
before giving intranasally. The nasal spray pump delivers only doses of 10 mcg DDAVP. If
doses other than these are necessary, use the nasal tube delivery system as directed below. Insert
the top of the dropper into the tube in a downward position. Then squeeze the dropper until the
solution reaches the desired calibrated dose and disconnect the dropper. Hold the tube 3/4 inch
from the end and insert one end into the nostril until the fingertips reach the nostril. Place the
opposite end into the patient’s mouth while the patient holds his or her breath. Have the patient
tilt the head back and blow into the tube, and into the nostril, with a strong, short puff. (In
children, the nurse or an adult needs to blow into the tube.)
13. List three (3) routes in which DDAVP can be administered.
For Central Diabetes Insipidus, use SQ, IV, or IM from Pharm book (Pages 874-876)
The Med surgical book mentions intranasal (Page 1510)
?14. Why is it important to monitor a client with DI vital signs, UOP, weight, and LOC so
closely?
To prevent death
15. What diet constraints does a client with DI have?
Eat a diet that is low in salt and protein to help your kidneys make less urine.
16. When assessing a client with neurogenic diabetes insipidus, which finding would indicate the
need for intervention?
a. Edema
b. Increased head circumference
c. Weight gain
d. Weight loss
17. In a client with diabetes insipidus, a nurse could expect which characteristics of the urine?
a. Pale in color; specific gravity less than 1.006
b. Concentrated; specific gravity less than 1.006
c. Concentrated; specific gravity greater than 1.010
d. Pale in color; specific gravity more than 1.025
18. Which is the best monitoring method for a client newly diagnosed with DI?
a. Measuring I&O’s, and urine specific gravity
b. Measuring abdominal girths every day
c. Checking daily weights and measuring intake
d. Checking pitting edema in the lower extremities
19. Which clinical manifestations should the nurse report in a client with SIADH?
a. Serum calcium of 10mg/dL and tented tissue turgor.
b. Serum magnesium of 1.2 mg/dL and large urinary output.
c. Serum sodium of 112 m Eq/L and a headache.
d. Serum potassium of 5.2 mEq/L and weight loss
20. What findings indicate that the treatment a client’s is receiving for SIADH is effective?
(Select all that apply)
a. Decrease in body weight
b. Rise in blood pressure; drop in HR
c. Absence of wheezes in the lung
d. Decrease in urine osmolarity
21. Which laboratory value is the most important to monitor in a client with SIADH?
a. Glucose
b. Hemoglobin
c. Creatinine
d. Sodium