Endocrine Case Study I

 DIABETES INSIPIDUS  -- DEFICIENT SECRETION OF ADH

 Authors:  Lisa Breece, Kimberly Crites, ??

 Definition - disorder of impaired renal water conservation due to impaired and/or inadequate ADH synthesis, secretion or hormonal activity; can be primary (Idiopathic glandular abnormality), or secondary (infection, trauma, CVA, tumor, medications: phenytoin, alcohol, lithium carbonate); neurogenic or nephrogenic, Medical Management: maintaining hemodynamic stability, ADH replacement (Vasopressin, Desmopressin Acetate (DDAVP))

 Write a scenario discussing a client with:

 1.      Detail a client history including etiology / pathophysiology and develop a client profile: expected manifestations assessment data (presenting signs and symptoms), lab data, diagnostic information that you would expect.

 Mr. Smith, a 45 year old male, was painting his house when he fell off his ladder and incurred a head injury two days ago. He began complaining of severe thirst and insisted on drinking water nonstop.  He presented to this nurse with the following: c/o of thirst and demonstrates restlessness, confusion, lethargy, agitation, UOP=1000cc/hr, urine is pale and clear, tachycardia, dry mucous membranes, tenting skin.  His lab results include the following: urine specific gravity<1.005, serum osmolality>300mOsm/kg, serum sodium>145mEq/L, increased BUN, CVP<2mmHg.

 2.      Develop a highest priority nursing diagnosis including the diagnostic statement, related to and secondary to segments, outcome criteria, and interventions (include both medical and nursing for review purposes)

Fluid Volume Deficit related to deficient ADH secondary to head injury and increased ICP AEB UOP=1000cc/hr, c/o thirst, urine specific gravity<1.005, serum osmolality>300mOsm/kg, serum sodium >145mEq/L, increased BUN, and CVP<2mmHg, lethary, restlessness, confusion, tachycardia.

Goals:

  • Patient will exhibit a sodium level between 135-145mEq/L.

  • Patient will exhibit a CVP above 2mmHg.

  • Patient will exhibit a serum osmolality of 275-295mOsm/kg

 Interventions:

  • Monitor VS,CVP, and I and O qh

  • Monitor lab values q4h

  • Maintain tissue perfusion: assess pulses, HOB=45 degrees

  • Administer IV fluids per MD order

 

Altered Thought Processes related to increased intracranial pressure and hypernatremia secondary to head injury AEB confusion and agitation

 3.      Do an Internet search to find a Web site appropriate for referring your client’s family to for more information.  Be sure to evaluate the site for correctness of content, appropriateness to the client situation, and value to the client’s family.

 http://hometown.aol.com/ruudh/dipagel.htm

This is the diabetes insipidus and related disorders (DIARD) page.  It has accurate, simple information for patients and their family.  It includes a link to the Diabetes Insipidus (DI) Foundation which has information regarding symptoms and management as well as a chat room and links to support groups and information in French and Spanish.