Diabetes Insipidus Case Study (60 min)
Included In This Lesson
Study Tools For Diabetes Insipidus Case Study (60 min)
Outline
Mrs. Ford is a 32 year old female who was admitted to the neuro ICU two days ago after a fall, which caused a large epidural hematoma over the left parietal lobe. She was intubated due to a low level of consciousness to protect her airway. An External Ventricular Drain (EVD) was placed to monitor her ICP. She also has an orogastric tube, and a Foley catheter in place
You just started your shift, what nursing assessments will be your priority at this point?
Mrs. Ford’s vital signs are as follows:
BP 124/68 MAP 86
HR 84 Temp 98.9
RR 16 (ventilated)
ICP 12
She is not on any sedation. You determine her GCS is 6, she withdraws to pain, but does not open her eyes. Her pupils are equal and reactive bilaterally, 4mm. For this hour she has put out 120 ml of urine that is clear and yellow. She is receiving normal saline at 75 mL/hour as well as tube feeds at 40 mL/hour. Her EVD is open at 15 cmH2O and draining a clear pink fluid, 6 ml this hour.
faq lesson=”true” blooms=”Application” question=”Calculate her cerebral perfusion pressure.”]
- CPP = MAP – ICP
- 86 – 12 = 74 mmHg [/faq]
Given the assessment information that you have, what are you most concerned for with this patient?
Hourly urine output for Mrs. Ford For the last 3 hours were 180 mL, 240 mL, and 440 mL. The urine is clear and barely pale yellow. Her blood pressure is 108/56, HR is 104. Her ICP is 15.
What could be going on physiologically with Mrs. Ford?
What further diagnostic testing do you expect the provider to order?
Lab Values:
Na+ 155 mg/dL
Serum osmo 310 mOsm/kg
Urine SG 1.005
Explain the significance of these lab values considering the patient's diagnosis.
What medications and or treatment changes do you expect the provider to order?
The provider orders the following:
Free water flush via OG Tube – 200 mL q4h
Change IVF to D5W at 125 mL/hr
Desmopressin (DDAVP) 2 mcg IV push q 12h
Daily weight
q4h Sodium and Serum Osmolality levels
You set the tube feeding pump to administer the free water and change the IV fluids while waiting for the DDAVP from the pharmacy
What regular monitoring will need to be done for Mrs. Ford during this treatment?
After 2 days of treatment, misses Fords urine output and urine specific gravity return to Baseline. However, she continues to have a GCS between 4 + 6, and now her left pupil is 8mm and fixed. The nurse notes her respiratory rate is erratic, her ICP is 18, and her heart rate is dropping.
What do you believe could be happening to Mrs. Ford at this time?
Medical-Surgical Nursing Study Plan
Concepts Covered:
- Cardiac Disorders
- Emergency Care of the Cardiac Patient
- Hematologic Disorders
- Acute & Chronic Renal Disorders
- Disorders of the Adrenal Gland
- Central Nervous System Disorders – Brain
- Documentation and Communication
- Preoperative Nursing
- Legal and Ethical Issues
- Immunological Disorders
- Oncology Disorders
- Female Reproductive Disorders
- Musculoskeletal Trauma
- Intraoperative Nursing
- Medication Administration
- Renal Disorders
- Disorders of Pancreas
- Shock
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Infectious Respiratory Disorder
- Vascular Disorders
- Respiratory Emergencies
- Peripheral Nervous System Disorders
- Studying
- Upper GI Disorders
- Communication
- Integumentary Disorders
- Lower GI Disorders
- Urinary Disorders
- Liver & Gallbladder Disorders
- Musculoskeletal Disorders
- Circulatory System
- EENT Disorders
- Noninfectious Respiratory Disorder
- Postoperative Nursing
- Neurological Emergencies
- Neurological Trauma
- Disorders of the Posterior Pituitary Gland
- Integumentary Important Points
- Disorders of the Thyroid & Parathyroid Glands
- Microbiology
- Tissues and Glands
- Disorders of Thermoregulation
- Urinary System
- Emergency Care of the Neurological Patient
- Central Nervous System Disorders – Spinal Cord
- Renal and Urinary Disorders
- Nervous System
- Respiratory Disorders
- Respiratory System
- Neurologic and Cognitive Disorders
- Integumentary Disorders
- Infectious Disease Disorders
- Perioperative Nursing Roles
- Shock
- EENT Disorders