Nursing Care and Pathophysiology for Diabetes Insipidus (DI)
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Study Tools For Nursing Care and Pathophysiology for Diabetes Insipidus (DI)
Diabetes Insipidus (Mnemonic)
Diabetes Insipidus Pathochart (Cheatsheet)
Endocrine System Study Chart (Cheatsheet)
Pituitary Gland (Image)
Diabetes Insipidus Assessment (Picmonic)
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Outline
Pathophysiology:
There is a deficiency of antidiuretic hormone (ADH). With inadequate amounts of antidiuretic hormone, the body continues to excrete urine and polyuria occurs.
Overview
- Hyposecretion or failure to respond to ADH from posterior pituitary
- Excess water loss
Nursing Points
General
- Urine output → 4L to 30L in a 24-hour period
- Excessive dehydration
- Causes
- Neurogenic→ stroke, tumor
- Infection
- Pituitary surgery
Assessment
- Polyuria → Excessive urine output
- Dilute urine
- Urine Specific Gravity <1.006
- Polydipsia (extreme thirst)
- Hypotension leading to cardiovascular collapse
- Tachycardia
- Hypernatremia
- Neurological changes
Therapeutic Management
- Water replacement
- PO Free Water (plain water)
- D5W if IV replacement required
- Hormone replacement
- DDAVP (Desmopressin)
- Synthetic ADH
- Vasopressin
- DDAVP (Desmopressin)
- Monitor urine output hourly
- Urine specific gravity
- Report UO >200mL/hour
- Daily weight monitoring
Nursing Concepts
- Fluid & Electrolytes
- Monitor electrolytes
- Monitor hemodynamics
- Administer fluid replacement
- Hormone Regulation
- Administer hormone replacement
- Titrate closely as ordered
- Intracranial Regulation
- Seizure precautions r/t hypernatremia
- Determine cause (may be neurogenic)
Patient Education
- Increase water intake
- Report excessive urine output if at risk (neuro disorders or pituitary surgery)
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ADPIE Related Lessons
Related Nursing Process (ADPIE) Lessons for Nursing Care and Pathophysiology for Diabetes Insipidus (DI)
Transcript
In this lesson we’re going to cover Diabetes Insipidus. This is something I’ve seen quite a few times working in the Neuro ICU. Now, this is a bit of a misnomer. It was originally named diabetes because they noticed polyuria and polydipsia, which are signs of diabetes mellitus. But, Insipidus actually means “undefined” – so they weren’t sure exactly what was going on, just that it was similar. But now we know it has nothing to do with blood sugar at all.
Diabetes Insipidus is actually caused by decreased action of antidiuretic hormone. Remember that diuresis means to urinate, anti means no, so antidiuretic hormone makes you not pee, or it makes the kidneys retain water. In Diabetes Insipidus, something is causing decreased antidiuretic hormone – either hyposecretion by the pituitary gland, which sits at the base of the brain here. Or it could be that the body just isn’t responding to the ADH anymore. Either way we have a LACK of ADH action. So instead of retaining water, the patient will begin losing excessive amounts of water in their urine. This is extreme, guys. They could put out anywhere from 4 to 30 liters of urine in one day. That leads to excessive dehydration and volume depletion. Usually this is neurogenic – something is usually going on in the brain like a stroke or a tumor. Both of these things could cause swelling and put pressure on the pituitary gland. It could also be caused by infection or pituitary surgery. There’s actually a surgery that we see quite often in the Neuro ICU where they actually go through the nose and remove the pituitary gland. It’s called a transsphenoidal hypophysectomy. Obviously if we were to remove the pituitary gland, we wouldn’t get enough secretion, right?
So we begin to see this excessive diuresis. The kidneys can’t hold onto the water and they just dump water like crazy. Patients will put out extreme amounts of urine and it’s very dilute. It’s nearly like water. So we’ll see a urine specific gravity of less than 1.006. When it comes to specific gravity, water is 1.0, and urine is normally around 1.010 to 1.025. So the lower that number gets, the more dilute and like water it is. With all that water loss, patients will also be very thirsty. This is where it began to mimic Diabetes Mellitus. Because of the excessive water loss, we see a decreased intravascular volume so the patient gets very hypotensive. And if you remember from the hemodynamics lesson, when the blood pressure goes down, the heart rate goes up to compensate, so we see tachycardia. Now, remember the kidneys are dumping tons and tons of water. So the blood becomes very concentrated and the patient’s sodium level will be extremely high. This can put the patient at risk for seizures and other neuro complications because of the severe cellular dehydration. They may be lethargic, or even comatose. Again, this may also have a neurogenic source, so you could see symptoms of that as well.
So, how do we manage Diabetes Insipidus. Well we want to replace the lost volume. Except in this case we are replacing water loss. So we want them to drink Free Water. This means plain, regular water – no tea or juice or soda – just water. If they can’t take PO, we could insert an NG tube and give them free water flushes that way, or we could replace the water in the IV. We can’t give straight water in the IV, so we give D5W, this is 5% Dextrose in Water. Once it’s in the body, the dextrose gets used up and it is essentially like giving them water. We can also replace some of the hormones they have lost. One option is DDAVP or Desmopressin – this is a synthetic form of ADH and can help improve ADH levels and stop diuresis. The other is vasopressin, which also mimics ADH and is a potent vasoactive drug. We usually give this in the ICU in the form of a titrated IV infusion, whereas the DDAVP can be given PO. We need to monitor their urine output and specific gravity every hour and report any hourly output above 200 to the provider. We keep a really close eye on the specific gravity during treatment so we can see if the kidneys are able to concentrate urine like they should. And of course we monitor their weight daily. We have to make sure we use the same scale, same clothes or linens, same time every day so we can be consistent. Remember that 1 kg of body weight equals 1 liter of fluid, so we need to keep a close eye on the weight.
So, this is probably relatively obvious, but our priority nursing concepts for a patient with Diabetes Insipidus are fluid & electrolytes, hormone regulation, and intracranial regulation. We need to monitor their electrolytes and replace water and hormones. And remember this is not only likely a neurological issue, but that hypernatremia and cellular dehydration can cause seizures or neuro changes, so we want to watch that as well. Make sure you check out the care plan attached to this lesson to see more detailed nursing interventions and rationales.
So let’s recap. Diabetes Insipidus is a decreased secretion of antidiuretic hormone from the posterior pituitary gland. It could be caused by some sort of neurological issue or by surgery or removal of the pituitary gland. It leads to excessive diuresis and water loss, which causes very dilute urine, hypernatremia and cellular dehydration. We want to replace that free water and replace hormones with meds like Vasopressin or DDAVP. And we want to make sure we maintain strict intake and output and measure their urine output and specific gravity regularly.
So those are the basics of Diabetes Insipidus. You’ll see that SIADH is the exact opposite of this, so make sure you check out that lesson as well. Now, go out and be your best selves today. And, as always, happy nursing!
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GERD causes Nursing Mnemonic (Reflux Is Probably Mean)
Global Symptoms for Brain Tumors Nursing Mnemonic (HAS)
Gluten Free Diet Nursing Mnemonic (BROW)
Heart Failure – Right Sided Nursing Mnemonic (HEAD)
Heart Failure-Left-Sided Nursing Mnemonic (CHOP)
Heart Failure-Origin Nursing Mnemonic (Left – Lung|Right – Rest)
Heart Sounds Nursing Mnemonic (APE To Man – All People Enjoy Time Magazine)
HELLP Syndrome – Signs and Symptoms Nursing Mnemonic (HELLP)
Hemodynamics
Nursing Care and Pathophysiology for Hemorrhagic Stroke (CVA)
Hemorrhagic Stroke Risk Factors Nursing Mnemonic (HATS)
Hiatal Hernia Symptoms Nursing Mnemonic (Her Belly Really Hurts Following Dinner)
High Pressure Vent Alarms Nursing Mnemonic (Kings Eat Big Cakes)
High Risk Behavior Nursing Mnemonic (HEADSS)
Hypercalcemia – Signs and Symptoms Nursing Mnemonic (GROANS, MOANS, BONES, STONES, OVERTONES)
Hyperglycemia Management Nursing Mnemonic (Dry and Hot – Insulin Shot)
Hyperkalemia – Causes Nursing Mnemonic (MACHINE)
Hyperkalemia – Management Nursing Mnemonic (AIRED)
Hyperkalemia – Signs and Symptoms Nursing Mnemonic (Murder)
Hypernatremia – Causes Nursing Mnemonic (MODEL)
Hypernatremia – Signs and Symptoms 2 Nursing Mnemonic (FRIED)
Hypernatremia – Signs and Symptoms 2 Nursing Mnemonic (SWINE)
Hypernatremia – Signs and Symptoms 3 Nursing Mnemonic (SALT)
Hypertension – Nursing care Nursing Mnemonic (DIURETIC)
Hypertension- Complications Nursing Mnemonic (The 4 C’s)
Hypocalcemia – Definition, Signs and Symptoms Nursing Mnemonic (CATS)
Hypoglycemia – Signs and Symptoms Nursing Mnemonic (TIRED)
Hypoglycemia Management Nursing Mnemonic (Cool and Clammy – Give ‘Em Candy)
Hypoglycemia symptoms Nursing Mnemonic (DIRE)
Hypokalemia – Signs and Symptoms Nursing Mnemonic (6 L’s)
Hyponatremia- Definition, Signs and Symptoms Nursing Mnemonic (SALT LOSS)
Hypoxia – Signs and Symptoms (in Pediatrics) Nursing Mnemonic (FINES)
Hypoxia – Signs and Symptoms Nursing Mnemonic (RAT BED)
IADLS (Instrumental Activities of Daily Living) Nursing Mnemonic (SCUM)
Increase MAP Nursing Mnemonic (VAK)
Inflammation- Signs and Symptoms Nursing Mnemonic (HIPER)
Insulin Mnemonic (Ready, Set, Inject, Love)
Interventions for Aphasia Nursing Mnemonic (PROP)
Intra Uterine Device – Potential Problems Nursing Mnemonic (PAINS)
Intrarenal Causes of Acute Kidney Injury Nursing Mnemonic (TONIC)
Leukemia – Signs and Symptoms Nursing Mnemonic (ANT)
Levels of consciousness Nursing Mnemonic (Never Carry Dirty Socks Or Smelly Clothes)
Lidocaine Toxicity – Signs and Symptoms Nursing Mnemonic (SAMS)
Low Pressure Vent Alarms Nursing Mnemonic (Cake Everyday)
Lymphoma – Signs and Symptoms Nursing Mnemonic (NURSE For Pete’s Sake)
Management of Glomerulonephritis Nursing Mnemonic (Please Help Deliver Diuretics)
Management of Lyme Disease Nursing Mnemonic (BAR)
Management of Pressure Ulcers (Pressure Injuries) Nursing Mnemonic (SKIN)
Manic Attack – Signs and Symptoms Nursing Mnemonic (DIG FAST)
MAO Inhibitors Nursing Mnemonic (TIPS)
Medication Classess for IBD Nursing Mnemonic (Sometimes I Can’t Answer)
Medications for Pancreatitis Nursing Mnemonic (Please Make Tummy Better)
Medications to Prevent Seizures Nursing Mnemonic (Pretty Little Liars Forever)
Meningitis Assessment Findings Nursing Mnemonic (FAN LIPS)
Mnemonic for Organ Systems (MR DICE RUNS)
Multiple Sclerosis Symptoms Nursing Mnemonic (DEMYELINATION)
Murmur locations Nursing Mnemonic (hARD ASS MRS. MSD)
Nursing Care and Pathophysiology of Myocardial Infarction (MI)
Myocardial Infarction Nursing Mnemonic (MONATAS)
OB Non-Stress Test Results Nursing Mnemonic (NNN)
OLD CARTS Mnemonic (OLD CARTS)
Oral Birth Control Pills – Serious Complications Nursing Mnemonic (Aches)
Pain Assessment Questions Nursing Mnemonic (OPQRST)
Nursing Care and Pathophysiology for Parkinsons
Asthma
Pediatric Gastrointestinal Dysfunction – Diarrhea
Pharmacokinetics Nursing Mnemonic (ADME)
Planning Community Health Interventions Nursing Mnemonic (PRECEDE-PROCEED)
Pneumonia Risk Factors Nursing Mnemonic (VENTS)
Pneumothorax Signs and Symptoms Nursing Mnemonic (P-THORAX)
Possible Infections During Pregnancy Nursing Mnemonic (TORCH)
Post-Partum Assessment Nursing Mnemonic (BUBBLE)
Postpartum Hemorrhage (PPH)
Preeclampsia: Signs, Symptoms, Nursing Care, and Magnesium Sulfate
Pregnancy Outcomes Nursing Mnemonic (GTPAL)
Probable Signs of Pregnancy Nursing Mnemonic (CHOP BUGS)
Process of Labor – Mom Nursing Mnemonic (4 P’s)
Process of Labor – Baby Nursing Mnemonic (ALPPPS)
Promotion and Evaluation of Normal Elimination Nursing Mnemonic (POOPER SCOOP)
Prostate Nursing Mnemonic (FUN)
Proton Pump Inhibitors
Pulmonary edema treatment Nursing Mnemonic (MAD DOG)
Pupil Reactions Nursing Mnemonic (PERRLA)
Reactivation of Herpes Zoster Nursing Mnemonic (FICA)
Reasons for a Bronchoscopy Nursing Mnemonic (Please Assess His Weird Bronchoscopy Results)
Reasons for Chest Tube Nursing Mnemonic (Don’t Ever Fail)
Restrictive Lung Disease Causes Nursing Mnemonic (PAINT)
Rheumatoid Arthritis Assessment Nursing Mnemonic (RHEUMATOID)
Risk Factors for Cholelithiasis Nursing Mnemonic (5-F’s)
Risk Factors for Osteoporosis Nursing Mnemonic (ACCESS)
Safety Check Nursing Mnemonic (MADLE)
SBAR Communication Nursing Mnemonic (SBAR)
Schizophrenia
Scleroderma Symptoms Nursing Mnemonic (CREST)
Seizure Causes Nursing Mnemonic (VITAMIN)
Seizure Documentation Nursing Mnemonic (TDOC)
Senile Dementia – Assess for Changes Nursing Mnemonic (JAMCO)
Shock – Signs and symptoms Nursing Mnemonic (TV SPARC CUBE)
Nursing Care and Pathophysiology for SIADH (Syndrome of Inappropriate antidiuretic Hormone Secretion)
Signs of Osteoarthritis Nursing Mnemonic (OSTEO)
Sprains and Strains – Nursing Care Nursing Mnemonic (RICE)
SSRI’s Nursing Mnemonic (Effective For Sadness, Panic, and Compulsions)
Stages of Fetal Development Nursing Mnemonic (Proficiently Expanding Fetus)
Stages of Hepatitis Nursing Mnemonic (PIP)
Steps in the Nursing Process 1 Nursing Mnemonic (ADPIE)
Steps in the Nursing Process 2 Nursing Mnemonic (AAPIE)
Steps In The Nursing Process 3 Nursing Mnemonic (SOAPIE)
Steroids – Side Effects Nursing Mnemonic (6 S’s)
Stoke Assessments Nursing Mnemonic (FAST)
Symptoms of Hyperthyroidism Nursing Mnemonic (SWEATING)
Symptoms of Hypothyroidism Nursing Mnemonic (MOM’S SO TIRED)
Symptoms of Nephrotic Syndrome Nursing Mnemonic (NAPHROTIC)
Symptoms of Wernicke’s Encephalopathy Nursing Mnemonic (COAT)
TB Drugs Nursing Mnemonic (RIPE)
Toxicity Sepsis- Signs and Symptoms Nursing Mnemonic (The 6 T’s)
Tracheal Esophageal Fistula – Sign and Symptoms Nursing Mnemonic (The 3 C’s)
Traction – Nursing Care Nursing Mnemonic (TRACTION)
Transient Incontinence – Common Causes Nursing Mnemonic (P-DIAPERS)
Trauma – Assessment (Emergency) Nursing Mnemonic (ABCDEFGHI)
Trauma – Complications Nursing Mnemonic (TRAUMATIC)
Trauma Surgery – Medical History Nursing Mnemonic (AMPLE)
Treatment of Sickle Cell Nursing Mnemonic (HOP to the hospital)
Triage Nursing Mnemonic (START)
Two pathways of the peripheral nervous system Nursing Mnemonic (SAME)
Types of Anemia Nursing Mnemonic (Always Introduce Special Patients)
Types of Hemorrhoids Nursing Mnemonic (Pie)
Ulcerative Colitis – Assessment Nursing Mnemonic (MADE 10)
Umbilical Cord Vasculature Nursing Mnemonic (2A1V)
Vascular Disease – Deep Vein Thrombosis Nursing Mnemonic (HIS Leg Might Fall off)
Vascular disease – Raynaud’s symptoms Nursing Mnemonic (COLD HAND)
Vasospasm Therapy Nursing Mnemonic (Triple H Therapy)
VEAL CHOP Nursing Mnemonic (Fetal Accelerations and Decelerations) (VEAL CHOP)
Vitamins – Fat Soluble Nursing Mnemonic (All Dogs Eat Kibble)
Vitamins – Water Soluble Nursing Mnemonic (Birth Control)
Walkers Nursing Mnemonic (Wandering Wilma Always Late)
Who Needs Dialysis Nursing Mnemonic (AEIOU)