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Questions and Answers
A patient presents with polyuria, polydipsia, and a recent head trauma. Which type of diabetes insipidus (DI) is MOST likely?
A patient presents with polyuria, polydipsia, and a recent head trauma. Which type of diabetes insipidus (DI) is MOST likely?
- Gestational DI
- Nephrogenic DI
- Central DI (correct)
- Primary DI
Which assessment finding would differentiate primary (psychogenic) diabetes insipidus (DI) from central or nephrogenic DI?
Which assessment finding would differentiate primary (psychogenic) diabetes insipidus (DI) from central or nephrogenic DI?
- Hypernatremia
- Tachycardia
- Hypervolemia (correct)
- Hypotension
A patient with diabetes insipidus (DI) is undergoing a water restriction test. Which finding would suggest central DI rather than nephrogenic DI?
A patient with diabetes insipidus (DI) is undergoing a water restriction test. Which finding would suggest central DI rather than nephrogenic DI?
- Continued excretion of large volumes of dilute urine
- Development of severe hypernatremia
- Decreased plasma osmolality during water restriction
- Increased urine osmolality after ADH administration (correct)
What is the primary therapeutic goal in managing a patient with diabetes insipidus (DI)?
What is the primary therapeutic goal in managing a patient with diabetes insipidus (DI)?
A patient with nephrogenic diabetes insipidus (DI) is prescribed hydrochlorothiazide. What is the rationale for this medication in this context?
A patient with nephrogenic diabetes insipidus (DI) is prescribed hydrochlorothiazide. What is the rationale for this medication in this context?
Which electrolyte imbalance is MOST likely to contribute to nephrogenic diabetes insipidus (DI)?
Which electrolyte imbalance is MOST likely to contribute to nephrogenic diabetes insipidus (DI)?
A patient with central diabetes insipidus (DI) is prescribed desmopressin (DDAVP). Which statement indicates effective teaching about this medication?
A patient with central diabetes insipidus (DI) is prescribed desmopressin (DDAVP). Which statement indicates effective teaching about this medication?
A patient with diabetes insipidus (DI) develops a sudden change in mental status and severe dehydration. Which intervention is the PRIORITY?
A patient with diabetes insipidus (DI) develops a sudden change in mental status and severe dehydration. Which intervention is the PRIORITY?
What is the PRIMARY underlying mechanism leading to polyuria in diabetes insipidus (DI)?
What is the PRIMARY underlying mechanism leading to polyuria in diabetes insipidus (DI)?
A nurse is caring for a patient with diabetes insipidus (DI). Which assessment finding requires IMMEDIATE intervention?
A nurse is caring for a patient with diabetes insipidus (DI). Which assessment finding requires IMMEDIATE intervention?
A patient with central diabetes insipidus (DI) is being treated with Desmopressin acetate (DDAVP). Which finding suggests the medication is not having the intended therapeutic effect?
A patient with central diabetes insipidus (DI) is being treated with Desmopressin acetate (DDAVP). Which finding suggests the medication is not having the intended therapeutic effect?
What treatment should a nurse expect to see prescribed for a patient with nephrogenic diabetes insipidus (DI)?
What treatment should a nurse expect to see prescribed for a patient with nephrogenic diabetes insipidus (DI)?
In a patient with central diabetes insipidus (DI), how will the administration of Aqueous vasopressin (Pitressin) affect the patient during a water deprivation test?
In a patient with central diabetes insipidus (DI), how will the administration of Aqueous vasopressin (Pitressin) affect the patient during a water deprivation test?
A patient with central diabetes insipidus is receiving DDAVP. The nurse should monitor for which of the following adverse effects that would indicate a need to adjust the dosage?
A patient with central diabetes insipidus is receiving DDAVP. The nurse should monitor for which of the following adverse effects that would indicate a need to adjust the dosage?
A patient with nephrogenic diabetes insipidus is prescribed a low-sodium diet and thiazide diuretic. What is the rationale for this combination of therapies?
A patient with nephrogenic diabetes insipidus is prescribed a low-sodium diet and thiazide diuretic. What is the rationale for this combination of therapies?
Which of the following is the priority nursing assessment for a patient newly diagnosed with diabetes insipidus?
Which of the following is the priority nursing assessment for a patient newly diagnosed with diabetes insipidus?
A patient with diabetes insipidus is ordered to receive vasopressin. What is the most important nursing intervention related to this medication?
A patient with diabetes insipidus is ordered to receive vasopressin. What is the most important nursing intervention related to this medication?
A patient with diabetes insipidus is being discharged home on desmopressin (DDAVP). Which of the following instructions is most important for the nurse to emphasize?
A patient with diabetes insipidus is being discharged home on desmopressin (DDAVP). Which of the following instructions is most important for the nurse to emphasize?
A patient with nephrogenic diabetes insipidus is prescribed indomethacin (Indocin) in addition to a low-sodium diet and thiazide diuretic. What is the purpose of adding indomethacin to the treatment regimen?
A patient with nephrogenic diabetes insipidus is prescribed indomethacin (Indocin) in addition to a low-sodium diet and thiazide diuretic. What is the purpose of adding indomethacin to the treatment regimen?
A nurse is caring for a patient with diabetes insipidus (DI) who is receiving fluid replacement therapy. Which assessment finding is the best indicator that the fluid resuscitation is effective?
A nurse is caring for a patient with diabetes insipidus (DI) who is receiving fluid replacement therapy. Which assessment finding is the best indicator that the fluid resuscitation is effective?
Flashcards
Diabetes Insipidus (DI)
Diabetes Insipidus (DI)
Deficiency in ADH production/secretion or decreased renal response to ADH.
Central DI (Neurogenic)
Central DI (Neurogenic)
Most common type; caused by issues with the brain's ADH production.
Nephrogenic DI
Nephrogenic DI
Type of DI caused by kidney's decreased response to ADH; may be linked to electrolyte imbalances.
Primary DI (Psychogenic)
Primary DI (Psychogenic)
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Polyuria
Polyuria
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Polydipsia
Polydipsia
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Fluid Volume Deficit Symptoms
Fluid Volume Deficit Symptoms
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CNS Manifestations of DI
CNS Manifestations of DI
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Water Restriction Test
Water Restriction Test
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Therapeutic goal for DI
Therapeutic goal for DI
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Central Diabetes Insipidus
Central Diabetes Insipidus
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Fluid Replacement (in DI)
Fluid Replacement (in DI)
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Hormone Replacement (in DI)
Hormone Replacement (in DI)
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I&O Monitoring in DI
I&O Monitoring in DI
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Desmopressin (DDAVP)
Desmopressin (DDAVP)
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Fluid Volume Excess in DI Treatment
Fluid Volume Excess in DI Treatment
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Aqueous Vasopressin (Pitressin)
Aqueous Vasopressin (Pitressin)
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Low-Sodium Diet (for Nephrogenic DI)
Low-Sodium Diet (for Nephrogenic DI)
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Thiazide Diuretics (for Nephrogenic DI)
Thiazide Diuretics (for Nephrogenic DI)
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Pitressin Effect on Urine Osmolality
Pitressin Effect on Urine Osmolality
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Study Notes
- Diabetes Insipidus (DI) is associated with a deficiency of production or secretion of antidiuretic hormone (ADH), or a decreased renal response to ADH.
- DI can either be transient or a chronic, lifelong condition, depending on its cause.
Types of DI
- Central DI, also known as neurogenic, is the most common form.
- Nephrogenic DI, which may lead to hypokalemia and hypercalcemia.
- Primary DI, also known as psychogenic, is less common.
Clinical Manifestations
- Excretion of large quantities of urine, referred to as polyuria.
- Polydipsia, characterized by excessive thirst.
Fluid Volume Deficit (Manifestations)
- Weight loss
- Poor tissue turgor
- Hypotension
- Tachycardia
- Constipation
- Shock
Central Nervous System (CNS) Manifestations
- Irritability.
- Mental dullness.
- Coma.
Diagnostic Studies
- Identification of the cause is the initial step.
- It is important to collect Patient History.
- A Physical Examination is required.
- Primary or psychogenic DI is associated with overhydration and hypervolemia.
- Dehydration and hypovolemia are seen in other forms of DI.
- Water restriction test is done to confirm the diagnosis of central DI.
Nursing and Collaborative Management
- Early detection is essential.
- Maintenance of adequate hydration is important.
- Patient teaching for long-term management is required.
- The therapeutic goal is maintenance of fluid and electrolyte balance.
Central DI Management
- Fluid replacement.
- Hormone replacement.
- Fluid Volume Status Assessment is required.
- Accurate records of intake and output are needed.
- Monitor urine specific gravity.
- Perform daily weight checks.
- Desmopressin acetate (DDAVP) is the hormone replacement of choice.
- Notify the healthcare provider immediately if the patient has increased fluid volume with low specific gravity.
Other Drugs for ADH Replacement include
- Aqueous vasopressin (Pitressin).
- Vasopressin tannate.
- Lysine vasopressin (Diapid).
Treatment of Nephrogenic DI
- Dietary measures such as a low-sodium diet and thiazide diuretics are recommended.
- If these are ineffective, indomethacin (Indocin) may be prescribed.
Student Response Questions
- For a patient with DI treated with nasal Desmopressin acetate (DDAVP), the nurse recognizes inadequate drug effect if the urine specific gravity is 1.001.
- When attending to a patient with nephrogenic DI, the nurse would expect treatment with thiazide diuretics.
- In a patient with central DI, administration of Aqueous vasopressin (Pitressin) during a water deprivation test will result in a decrease in urine output and an increase in urine osmolality.
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Description
Diabetes Insipidus (DI) is related to deficiency of antidiuretic hormone (ADH). DI can either be transient or a chronic condition, depending on its cause. Common symptoms include excretion of large quantities of urine and excessive thirst.
