PRELUDE TO ENDOCRINE BLOCK

Dodo is a 36 year old Male from Lambunao, Iloilo brought to the

Emergency Room of a tertiary government hospital following a head injury
in a motorcycle accident. He was stabilized and sent to the ICU for
observation. On Day 3 in the ICU, BD’s vital signs and lab studies are
reported to the day shift nurse as:

• T- 37.7 C (oral)
• B/P: 80/60 mmHg
• P- 132 bpm
• RR-20 cpm
• SaO2- 94%

• Urine output for the past 24 hours: 8,150 ml.

• Na: 164
• K: 3.2
• Cl: 99

The night shift nurse reports that Dodo is more lethargic than last evening
and has complaints of generalized weakness. You begin your nursing
assessment and note that he is pale and slightly confused. Dodo is
diagnosed with Central Diabetes Insipidus.

GUIDE QUESTIONS:

1. Discuss the role of Antidiuretic Hormone (ADH) in the development of

Diabetes Insipidus.

* Without the action of ADH on the distal nephron of the kidney, an enormous daily
output (greater than 250 mL per hour) of very dilute urine with a speciɹc gravity of
1.001 to 1.005 occurs (Bader & Littlejohns, 2010; John & Day, 2012). The urine
contains no abnormal substances such as glucose or albumin. Because of the
intense
thirst, the patient tends to drink 2 to 20 L of ɻuid daily and craves cold water. In
adults, the onset of DI may be insidious or abrupt.
The disease cannot be controlled by limiting ɻuid intake, because the high-volume
loss of urine continues even without ɻuid replacement. Attempts to restrict ɻuids
cause the patient to experience an insatiable craving for ɻuid and to develop
hypernatremia and severe dehydration.

2. Based on the report from the night nurse, what are your nursing
priorities for BD?

 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.3. Discuss the goals of
management when treating diabetes insipidus. Include the nurse’s role.

3.Discuss the goals of management when treating diabetes insipidus.

Include the nurse’s role.

*Physical assessment and patient education are the pillars of skilled nursing
management of the patient with a diagnosis of DI. Initially, the nurse reviews the
patient history and physical assessment. The nurse is responsible to educate the
patient, family, and other caregivers about follow-up care, prevention of complications,
and emergency measures. Speciɹc verbal and written instructions should include the
dose, actions, side eʃects, and administration of all medications and the signs and
symptoms of hyponatremia. The nurse should demonstrate and observe a return
demonstration of medication administration to ensure that the patient received the
prescribed dosage. The patient should be advised to wear a medical identiɹcation
bracelet and carry required medication and information about DI at all times.

4. Review the medication used in the treatment of diabetes insipidus.

• What medication should the nurse expect to see ordered in the

treatment?

 desmopressin (DDAVP, Nocdurna)

 hydrochlorothiazide (Microzide)
 synthetic hormone desmopressin

Treatment options depend on the type of diabetes insipidus you have

• What are the nursing implications while administering these drugs?
Nursing Implications
Desmopressin
 Monitor I&O ratio and pattern (intervals). Fluid intake must be carefully controlled,
particularly in older adults and the very young to avoid water retention and sodium
depletion.
 Weigh patient daily and observe for edema. Severe water retention may require
reduction in dosage and use of a diuretic.
 Monitor BP during dosage-regulating period and whenever drug is administered
parenterally.
 Monitor urine and plasma osmolality. An increase in urine osmolality and a
decrease in plasma osmolality indicate effectiveness of treatment in diabetes
insipidus.
hydrochlorothiazide (Microzide)

 Give with food or milk if GI upset occurs.

 Mark calendars or provide other reminders of drug for alternate day or 3–5
days/wk therapy.
 Reduce dosage of other antihypertensives by at least 50% if given with thiazides;
readjust dosages gradually as BP responds.
 Administer early in the day so increased urination will not disturb sleep.
 Measure and record weights to monitor fluid changes.

GUIDELINES:
• Type your answers in a Long Paper addressing the concepts
asked. • Submit via Google Classroom
• Format:
• Font: Helvetica, 12
• Justifies
• Deadline: April 26, 2021; 12 Noon