Diabetes Insipidus Nursing Care Plan & Management
Description
- Diabetes insipidus is hyposecretion of ADH caused by strokes, trauma, or idiopathic causes.
- Kidney tubules fail to reabsorb water.
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.
Exam
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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
