Ward Class

An Online Resource Site For Student Nurses

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Ward Class is an online resource for student nurses. Created with the aim of helping student nurses cope with the demands of nursing school and clinicals, it offers free downloads, notes, sample NCPs, sample drug studies, study aids, news and updates, and practical tips to its users.

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The December 2012 PRC Nursing Board Exam Result is already available here at Ward Class and at Pinoy R.N.




Endocrine Disorders: Diabetes Insipidus

  • a disorder characterized by intense thirst and the excretion of large amounts of urine
  • hypofunction of the posterior pituitary gland resulting in deficiency of ADH (antidiuretic hormone)
  • types: central, nephrogenic, gestational
  • common causes: tumor, trauma, inflammation, pituitary surgery
Assessment Findings
  • polydipsia (excessive thirst) and severe polyuria (2.5 to 15L per day) with low specific gravity
  • fatigue, irritability, weight loss, muscle weakness, and signs of dehydration
  • tachycardia, and shock if fluids are not replaced
  • for infants and young children:
    • unexplained fussiness or inconsolable crying
    • unusually wet diapers
    • fever, vomiting, or diarrhea
    • dry skin or cool extremities
  • diagnostic tests:
    • water deprivation test reveals inability to concentrate urine
    • urinalysis-->urine specific gravity less than 1.004
    • magnetic resonance imaging (MRI) of the head-->for abnormalities near or in the pituitary gland
Medical Management
  1. hormone replacement like Vasopressin (Pitressin)-->will eliminate increased urination
  2. maintenance of fluid & electrolyte balance
Nursing Management
  1. maintain fluid and electrolyte balance: I&O, weigh daily, administer oral/IV fluids as ordered
  2. monitor VS and observe for signs of dehydration and hypovolemia
  3. administer hormone replacement as ordered:
    • vasopressin (Pitressin) and vasopressin tannate (Pitressin tannate in oil): give via IM injection, warm to body temperature before giving, shake tannate suspension to ensure uniform dispersion
    • lypressin (Diapid)-->nasal spray
    • note: some books state desmopressin (DDAVP) as the drug of choice
  4. provide client teaching on:
    • lifelong hormone replacement to control polyuria and polydipsia
    • need to wear Medic-Alert bracelet (if applicable)
Prognosis

Mortality is rare in adults as long as fluid lost is readily replaced. Severe dehydration, cardiovascular collapse, and death can ensue in children, elderly, and those with complicating illnesses.

Prevention

There are no known ways to prevent diabetes insipidus. Complications, however, can be prevented by immediately seeking medical attention once symptoms appear.

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