Republic of the Philippines

CENTRAL MINDANAO UNIVERSITY

COLLEGE OF NURSING
University Town, Musuan, Maramag, Bukidnon
E-mail: nursing@cmu.edu.ph

Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)

In Partial Fulfillment of the Requirements in

NCM 74 (Care of Clients with Problems in Nutrition, and Gastrointestinal, Metabolism
and Endocrine, Perception and Coordination, (Acute and Chronic)

BS NURSING 3B
ORATE, Eula Marie Victoria and
PAGUTE, Juliana Gabriel

NEDA JOY L. ESPINA, MAN, LPT, RN

NCM 74 Clinical Instructor

FEBRUARY 24, 2022

Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)
PREPARED BY: ORATE, Eula Marie Victoria and PAGUTE, Juliana Gabriel (BSN-3B)

Overview of SIADH Concept Map

Introduction
Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) is a condition
defined by the unsuppressed release of antidiuretic hormone (ADH) from the pituitary gland or
non-pituitary sources or its continued action on vasopressin receptors. As a result, the individual
will retain water and become hyponatremic. The most common causes are malignancy, pulmonary
disorders, CNS disorders and medication.

Etiology
Drugs: Antidepressants, Chemotherapy agents, Past antidiabetic agents
Pulmonary Tumors
Intrathoracic Conditions
Disease and Injury to the CNS: Brain tumor, hydrocephalus, head injury, encephalitis, meningitis

FACTORS

Predisposing Factors
Female
Hereditary
Children
Over 65 years of age

Precipitating Factors
Low sodium intake
Environmental factors (e.g., physical, chemical, biological)
Pathophysiology
 Signs and Symptoms, Medical Management, Pharmacological Management, Nursing
Diagnoses, and Nursing Management

General Physical Edema:

✓ Diagnostic tests: Physical exam, X-ray, CBC, Urine analysis, Metabolic Panel
✓ Medical management: Maintain circulation, Oxygenation, Improving
microvascular alterations
✓ Pharmacological management: Furosemide (Lasix), Hydrochlorothiazide,
Chlortalidone, Antiplatelets, Peripheral vasodilators, antihypertensive
✓ Nursing diagnosis: Ineffective Tissue Perfusion
✓ Nursing management:
1. Promote active/ passive ROM exercises.
2. Assist with repositioning patient from a supine to sitting/standing position
to reduce the risk for orthostatic BP changes.
3. Position patient properly in a semi-Fowler’s to high-Fowler’s as tolerated.
4. Elevate the swollen limbs above the level of the heart.

Brain Edema (e.g., headache, dizziness, nausea & vomiting, irritability)

✓ Diagnostic tests: CT scan, MRI, Blood Test, Lumbar puncture
✓ Medical management: Hyperbaric oxygen therapy, IV Fluids, Lowering body
temperature
✓ Pharmacological management: Osmotic Agents (Mannitol and hypertonic saline),
Loop diuretics (Furosemide), Corticosteroids (Dexamethasone)
✓ Nursing diagnosis: Excess fluid volume
✓ Nursing management:
1. Keep the head of the bed elevated 30 or 45 degrees with a neutral head
position to promote venous drainage
2. Monitor fluid and electrolyte levels to help maintain a normal electrolyte
balance
3. Institute seizure precautions in case the patient has a seizure
 Surgical management: Ventriculostomy, Decompressive Craniectomy

Natriuresis and Oliguria:

✓ Diagnostic tests: Serum sodium Test, Physical exam, Urine Test
✓ Medical management: Fluid restriction
✓ Pharmacological management: IV Furosemide (Lasix), Metolazone,
✓ Nursing diagnosis: Impaired urinary elimination
✓ Nursing management:
1. Bladder retraining: fluids between certain hours, digital stimulation of
trigger area, contraction of abdominal muscles, Crede maneuver.
2. Create a schedule when to void.
3. Insert indwelling catheter, as indicated.

Lethargy:
✓ Diagnostic tests: Physical Assessment
✓ Medical management: Bed rest
✓ Pharmacological management: Modafinil, Melatonin
✓ Nursing diagnosis: Fatigue
✓ Nursing management:
1. Restrict environmental stimuli especially during planned times for rest and
sleep
2. Assist the patient with setting priorities for preferred activities and role
responsibilities
3. Teach energy conservation methods
4. Promote sufficient nutritional intake.

Confusion:
✓ Diagnostic tests: Neurological Exam (Mental Status)
✓ Medical management: Address underlying problem, Provide adequate nutrition
✓ Pharmacological management: Haloperidol (Haldol), Risperidone (Risperdal)
✓ Nursing diagnosis: Acute confusion
 ✓ Nursing management:
1. Orient patient to surroundings, staff, necessary activities as needed. Present
reality concisely and briefly.
2. Modulate sensory exposure.
3. Plan care that allows for an appropriate sleep-wake cycle.
4. Offer reassurance to the patient and use therapeutic communication at
frequent intervals.

Seizures/Muscle twitching:
✓ Diagnostic tests: History, physical exam, neurologic exam, electroencephalogram
(EEG), magnetic resonance imaging (MRI), computerized tomography (CT)
✓ Medical management: Dietary therapy, electrical stimulation (e.g., vagus nerve
stimulation)
✓ Pharmacological management: Anticonvulsants (Lamotrigine), Anticonvulsants,
succinimide (Ethosuximide).
✓ Nursing diagnosis: Risk for suffocation
✓ Nursing management:
1. Explore and expound seizure warning signs (if appropriate) and usual
seizure patterns. Teach SO to determine and familiarize warning signs and
how to care for the patient during and after seizure attack.
2.Use and pad side rails with the bed in lowest position, or place bed up
against wall and pad floor if rails are not available or appropriate.
3.Uphold strict bedrest if prodromal signs or aura experienced. Explain the
necessity for these actions.
4. Do not leave the patient during and after a seizure.

Coma/Stupor:
✓ Diagnostic tests: History, physical exam (esp. reflexes), Glasgow coma scale
(GCS), Electroencephalography (EEG)
 ✓ Medical management: Maintain ventilation oxygenation, maintain circulations,
supportive care
✓ Pharmacological management: Diuretics (Mannitol), hypertonic saline
✓ Nursing diagnosis: Self-care deficit
✓ Nursing management:
1. Carry out patient dependent hygiene (bed bath and oral hygiene) care as
required.
2. Keep track of parenteral or enteral feeding.
3. Look out for signs of consciousness.

Orthostatic Hypotension:
✓ Diagnostic tests: Blood pressure test, blood tests, echo, EKG, exercise stress test
✓ Medical management: Physical counter maneuvers and resistance training, diet
(increase salt intake, fluid restriction), compression garments.
✓ Pharmacological management: Corticosteroids (Fludrocortisone), alpha-
adrenergic agonists (Midodrine), and acetylcholinesterase inhibitors
(Pyridostigmine).

Muscle Cramps and Weakness:

✓ Diagnostic tests: History, physical exam, CT scans or MRI, nerve tests,
electromyography (EMG)
✓ Medical management: Physical therapy, occupational therapy, dietary changes
✓ Pharmacological management: Furosemide (Lasix)

Nursing diagnosis: Risk for falls

Nursing management:
1. Design an individualized plan of care for preventing falls. Provide a plan
of care that is individualized to the patient’s unique needs.
2. Place items the patient uses within easy reach, such as call light, urinal,
water, and telephone.
 3. Place beds are at the lowest possible position. Set the patient’s sleeping
surface as near the floor as possible if needed.
4. Raise side rails on beds, as needed. For beds with split side rails, leave at
least one of the rails at the foot of the bed down.
5. Provide appropriate room lighting, especially at night.

Increased Body Weight:

✓ Diagnostic tests: History, physical exam (esp. BMI)
✓ Medical management: Fluid restriction
✓ Pharmacological management: Furosemide (Lasix)
✓ Nursing diagnosis: Risk for overweight
✓ Nursing management:
1. Weigh periodically as individually indicated and obtain appropriate body
measurements.
2. Determine current activity levels and plan progressive exercise program
(walking) tailored to the individual’s goals and choice.
3. Patients may be on fluid restrictions to help balance intake and output.
Monitor for retention through calculated intake and output and with daily
weights at the same time on the same scale each day.

Client/Family Health Education Key Points:

● If allowed or recommended by the doctor, educate patient to drink fluids that contain
sodium (such as sports drinks), and eat salty foods.

● Emphasize to limit intake of water, tea, coffee, juices, and other liquids that are mostly
water, as the doctor advises.

● Get your sodium levels tested as the doctor recommends.

● Be safe with medicines. Take medicines exactly as prescribed. Call the doctor or nurse call
line if having a problem with medicine.

● If the patient is confused, instruct the family to immediately call the doctor or nurse.
 ● Teach family members on how to respond immediately if the patient experiences seizure
activity after discharge.

Prognosis
If treated:
● With treatment, many people recover fully from SIADH and hyponatremia. Prompt and
complete recovery is generally the case with drug-induced SIADH once the offending
agent is withdrawn. Even long-term hyponatremia can be managed and problems
prevented.

If not treated:
● Hyponatremia worsens the prognosis of heart and renal failure and increases mortality in
hospitalized patients.
● Cerebral edema can lead to coma, irreversible neurological damage, and even death.
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