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    Diabetes Insipidus1

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    Zanida Zainon
    This document discusses posterior pituitary gland disorders, specifically diabetes insipidus. It defines diabetes insipidus as resulting from a lack of antidiuretic hormone (ADH) production or kidney insensitivity to ADH, causing excessive urine production. There are two types - neurologic DI due to hypothalamic-pituitary damage, and nephrogenic DI due to kidney tubule insensitivity. Symptoms include excessive urination, thirst, dehydration. Treatment involves ADH replacement and fluid replacement to maintain fluid balance. Nursing care focuses on monitoring fluid intake and output, patient education on disease management and self-care.

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    Diabetes Insipidus1

    Uploaded by

    Zanida Zainon
    67 views29 pages
    This document discusses posterior pituitary gland disorders, specifically diabetes insipidus. It defines diabetes insipidus as resulting from a lack of antidiuretic hormone (ADH) production or kidney insensitivity to ADH, causing excessive urine production. There are two types - neurologic DI due to hypothalamic-pituitary damage, and nephrogenic DI due to kidney tubule insensitivity. Symptoms include excessive urination, thirst, dehydration. Treatment involves ADH replacement and fluid replacement to maintain fluid balance. Nursing care focuses on monitoring fluid intake and output, patient education on disease management and self-care.

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    Hand out to nursing student (sem4)

    Original Title

    . Diabetes Insipidus1

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    This document discusses posterior pituitary gland disorders, specifically diabetes insipidus. It defines diabetes insipidus as resulting from a lack of antidiuretic hormone (ADH) production or kidney insensitivity to ADH, causing excessive urine production. There are two types - neurologic DI due to hypothalamic-pituitary damage, and nephrogenic DI due to kidney tubule insensitivity. Symptoms include excessive urination, thirst, dehydration. Treatment involves ADH replacement and fluid replacement to maintain fluid balance. Nursing care focuses on monitoring fluid intake and output, patient education on disease management and self-care.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    67 views29 pages

    Diabetes Insipidus1

    Uploaded by

    Zanida Zainon
    This document discusses posterior pituitary gland disorders, specifically diabetes insipidus. It defines diabetes insipidus as resulting from a lack of antidiuretic hormone (ADH) production or kidney insensitivity to ADH, causing excessive urine production. There are two types - neurologic DI due to hypothalamic-pituitary damage, and nephrogenic DI due to kidney tubule insensitivity. Symptoms include excessive urination, thirst, dehydration. Treatment involves ADH replacement and fluid replacement to maintain fluid balance. Nursing care focuses on monitoring fluid intake and output, patient education on disease management and self-care.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 29

    POSTERIOR PITUITARY GLAND DISORDERS

    By: Pn Zanida Zainon


    Posterior pituitary hormone.

    Pituitary Gland
    Learning Objective
    1. Define diabetes insipidus
    2. State the etiology of diabetes insipidus
    3. State the pathophysiology of diabetes
    insipidus
    4. State the manifestations of diabetes
    insipidus
    5. State the management of diabetes
    insipidus
    6. Explain nursing intervention for patient
    diabetes insipidus using nursing proces.
    Introduction
    Diabetes insipidus results when the
    pituitary gland does not produce
    enough ADH, or from an acquired
    insensitivity of the kidney to ADH.
    Water is inadequately reabsorbed
    from the collecting ducts, so a large
    quantity of urine is produced.
    Antidireutic Hormon
    a hormone produced in a region of
    the brain called the hypothalamus.
    It is then stored and released from
    the pituitary gland, a small gland at
    the base of the brain.
    Responsible for re absoption of
    water by the distal tubules &
    collecting duct at the kidney.
    If ADH ; adequate absorption is
    prevented = diuresis
    Type of Diabetes Inssipidu
    1.1.Neurologic diabetes insipidus
    result from disruption of hypothalamus &
    pituitary gland (due to trauma, irridiation
    or cranial surgery, or idiopathic)

    2. Nephrogenic diabetes insipidus.


    due to renal tubules are not
    sensitive to ADH. Can be hereditary or
    result from renal failure.
    Etiology
    tumors or infections
    cerebral Vascular Accidents
    pituitary surgery or hypothalamic
    damage
    certain drugs that can interfere with
    ADH secretions or actions (e.g.,
    phenytoin, alcohol, lithium carbonate),
    complication of closed head trauma
    with increase intracranial pressure.
    Pathophysiology
    Occurs when injury to the posterior
    pituitary gland causes
    decrease in vasopressin secretion or

    an inability of the kidney tubules to

    respond to ADH.
    This leads to increase serum

    osmolarity & dehydration.


    Clinical Manifestations
    increase output (5 to 20 liter/ day) of
    dilute urine.
    Nocturia
    extreme thirst (polydipsia)
    Weight loss
    Possible tachycardia

    hypotension,

    weakness
    If water loss is not replaced; client
    become hydrated &
    hypernatremic.

    If disorder caused by cerebral


    injury = symptom may appear 3 to
    6 days after the initial injury & last
    for 7 to 10days.
    Laboratory & diagnostic study
    findings.

    plasma osmolarity & serum sodium


    levels
    water (fluid deprivation test
    demonstrate inability of kidneys to
    concentrate urine despite increase
    plasma osmolarity and low plasma
    vesopressin level.
    vasopressin test shows; kidney can
    Therapeutic Interventions for
    Diabetes Insipidus.

    Hypotonic intravenous (I/V) fluids


    such as 0.45% saline may be
    ordered to replace intravascular
    volume without adding excessive
    sodium.
    Medical treatment of DI involves
    replacement of ADH.

    In acute cases; vasopressin (synthetic form


    of ADH is given I/V or subcutaneous route)
    together with I/V fluid replacement.

    For long term therapy; synthetic ADH


    (Desmopressin, or DDAVP) nasal spray is
    used BD.
    Chlorpropamide (Diabinese) help kidney
    respond better to ADH.

    Tiazide diuretics may increase urine flow in


    the absence of ADH (increase urine output)
    Assessment/Data collection.

    Give special attention on fluid balance.


    daily weights = most reliable method
    for monitoring amount fluid lost.

    accurate I/O chart

    monitor skin integrity = dehydration


    causing skin breakdown easily

    monitor vital sign for sign of shock


    check specific gravity using
    urimeter/dipstick

    monitor serum electrolyte

    watch for client level of


    consciousness.

    assess client level of


    understanding about the disease
    & treatment.
    Deficient fluid volume related
    failure of regulatory mechanisms.

    Expected outcome: Fluid balance will


    be maintained as evidence by urine
    specific gravity between 1.010 and
    1.025, skin turgor within normal limits
    and stable daily weight.
    Provide free access to oral fluids if
    the DI is not psychogenic. If the
    patients thirst mechanism is not
    intact, give the patient fluids every
    hour.
    Oral fluids are essential to replace
    the excess lost in diereses. If the
    patient is alert with an intact thirst
    mechanism, the patient can usually
    manage this independently.
    Encourage the patient to participate
    in maintaining intake and output
    records, monitoring weight and
    checking urine specific gravity, if able.
    This involves the patient and helps
    prepare him or her for self-monitoring
    at home.

    Report a significant drop in blood


    pressure and a rising pulse to the
    registered nurse or physician
    because these may be signs of
    hypovolemic shock.
    Risk for ineffective health
    maintenance related to deficient
    knowledge.

    Expected outcome: Patient will


    verbalize and demonstrate
    understanding of medication
    administration and self-monitoring of
    disease.
    Assess patients understanding of
    his or her disease process and
    treatment. Teaching should build on
    baseline knowledge.
    Teach the patient about DI. The
    patient will have to self-meditate
    and monitor his or her disease at
    home.
    Include:
    How to administer medications
    and monitor their effectiveness.
    How to measure urine specific
    gravity and the significance of
    results.
    Sign and symptoms of
    dehydration and fluid overload.
    monitoring daily weight: losses or
    gains of greater than 2 pounds in a
    day should be reported to the
    physician.
    Weight loss or gain can indicate
    fluid imbalance and need for a
    change in medication regimen.

    Advise the patient to wear


    identification, such as a medical
    alert bracelet, that identifies the
    disorder.
    Faster treatment can be initiated
    if emergency personnel are aware
    Evaluation:

    If treatment has been effective,


    signs of dehydration will be
    absent and weight and vital signs
    will be stable. The patient should
    be able to explain what is
    happening in the disease,
    symptoms to report and
    demonstrate how to manage self-
    care.
    Specific nursing care for diabetes
    Insipidus.

    administer prescribed medications; which


    may include ADH replacements.
    Replace fluid as indicated; assess & report
    if any problem that can prevent adequate
    fluid intake.
    Encourage the client to drink fluid in
    respond to thirst.
    REFERENCES;
    LEMODE MEDICAL SURGICAL NURSING.
    Page 458

    WILLIAMS HOPPER MEDICAL SURGICAL


    NURSING
    Page 826

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