Diabetes Insipidus Concept Map

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Cultural considerations, ethnicity, occupation, religion,

family support, insurance. (1) (14)

N.A is 30 years old and works as an accountant.S he

graduated from an economic university. She states that she is

very close to both her mother and father. She currently lives

with her husband and has no children.

History of Present Illness (HPI), Pathophysiology of Admitting Dx

(Cite References) Medical, Surgical, Social History (1).

The patient states that for the past months she started drinking more water

than usual. The problem started to disturb her when she was no longer

able to rest because she had to wake up to drink water. She describes as

being "always thirsty". Things started to frighten her and convincer her to

visit the physician when she realized that she was drinking around 8 l of

water per 24 h and that she was frequently going to the toilet to urinate.

Pathophysiology of admitting dx: Diabetes Insipidus is an

endocrinological pathology in which there is a lack of action of the

antidiuretic hormone which leads to massive amount of diluted urine.

There are two main categories of diabetes insipidus. In the central one

(also known as neurogenic) , we will see that there are small amounts of

ADH or totally absent. In the nephrogenic version, the ADH is present

but there is a malfunction at the level of the renal receptor, and the kidney

is not able to react at the action of the hormone.

(Kalra,Zargar,Jain,Sethi,Chowdhury,Singh,Malve,2016)

Medical History

The patient denies any remarkable medical history.

She states that when she was younger she used to face recurrent tonsillitis

due to an infection with Streptococcus which ultimately lead to her

having to undergo a tonsillectomy. Other than that situation, she has no

medical history that could influence the current diagnosis. She is not

taking any medication at this time.

Surgical History

Tonsillectomy ( age 13) - It is defined as the surgical excision of the

palatine tonsils. An absolute indication is represented by recurrent

infection of the throat which is defined as 7 or more episodes in a single

year, five episodes in 2 years, 3 episodes in 3 years, two weeks or more

of lost work days or school due to the infection. (Marhsall,1998)

Social History

The patient admits smoking for the last 8 years. N.A states that she

smokes around 1 to a maximum of 2 packs of cigarettes per day. She

denies consumption, telling the physician that she only drinks 1-2 glasses

of wine when she is at a party.

The patient is married and currently has no children. She states that the

reason for not having one is because she is not prepared to become a

mother as her job is currently a priority.

The patient admits to having in the family a member diagnosticated with

diabetes insipidus (her father).

Chief Complaint

Polyuria ( Large amount of urination )

Excessive thirst

Polydipsia

Admitting Diagnosis

Diabetes Insipidus

Patient Information

(1)

Name: N.A

Age: 30

Gender: F

Code Status: Full Status

DPOA: N/A

Living Will: N/A

Patient Education (In Pt.) & Discharge Planning (home needs)

- Take the medicine as directed as they have the role of keeping the level of

ADH as expected in order to decrease the amount of urination.

- Weigh yourself on a daily basis and inform the physician regarding any

fast weight loss as that might be a sign of dehydration

- Try to stay on a diet which consists of low amounts of salt (sodium).

-Contact the healthcare provider if you show any signs such as severe dry

mouth, asthenia, vision changes, headaches.

-Seek care immediately if you become thirsty all the time and you wake up

during the night to drink water, you urinate again a large amount of clear

urine, you fainted, you have a seizure.

Concept Map

Student Name:

Instructor:

Diagnostic Test/ Lab Results with dates

and Normal Ranges (3)

Test

Norms

Date

Current

Value

Serum

Osmolality

28502

mOsm/

5/11/20

288

Urine

Osmolality

500-

800

mOsm/

H2o(2

4 Hr

specie

mn)

5/11/20

180

ADH

1-5

pg/ml

5/11/20

0,1

pg/ml

The thirst test confirmed that we are

referring to diabetes insipisus as the

diuresis remained increased and the

urinary osmolarity was still low.

Desmopressin test confirmed that we are

referring to a diabetes insipidus central as

the osmolarity of the urine increased by

>50% after the administration of ADH.

Medical Management/ Orders/ Medications & Allergies (2)

Name

Dose

Freq.

MOA

Considerations

Onset/Peak/

Duration

(Insulin)

The patient denies any chronic diseases that required medical management. She states that the only

medication that she took in her life were represented by paracetamol, aspirin, and metamizole.

During her throat infection, she used to take

Ceftriaxone - Semisynthetic 3rd generation cephalosporin antibiotic which inhibits the third and

also the final stage of the synthesis of the bacterial cell wall and in this way kills it. It is efficient for

treaty various infections. Dosage = 1g/24 h, I.V; Nursing implications: make sure the patient is not

allergic to cephalosporins or penicillins calls , ensure that a culture and a sensitivity test is done

before initiating the therapy , check for possible fever or diarrhea if they occur , check of petechiae,

epistaxis ( the medication can alter vitamin K production)

Patient denies any medication allergies.

Erickson’s Developmental Stage Related to pt. & Cite

References (1)

The patient is 30 years old which puts her in the sixth

Erickson stage defined by intimacy vs isolation in which

the basic virtue is love. It represents the period in which the

patient shares intimately with others and explores the idea

of relationship. If the stage is completed successfully , it

will result in a happy relationship , the opposite will lead to

depression. More easily explained , the success of this stage

will lead in the end to the virtue represented by love.

(Malone,Rentz,Waldinger,Liu,2016)

Our patient works as an accountant and has been married

for the last two years . She defines her relationship as being

exactly what she had in mind . Based on that we can deduce

that the patient is handling well her current

Priority nursing diagnosis #1

Deficient Fluid Volume - The

patient presents an excessive

urinary output (over 6l /24 h).

This will manifest through

intensive thirst ,weight loss and

dehydration

Vital Signs (4)

Tachycardia = 133 b/min

Hypotension = 90/60

Tachypnea

Regular Pulse

Neurological (5)

The patient is oriented to

person,place and time.

Slighty hyporeflexic

Respiratory (7)

Tachypnea

No crackled

No rhonchi

No wheezing

Priority nursing diagnosis #2

Sleeping pattern disturbances -

this appears due to the fact that

patient has an interrupted sleep

because of the need to go to the

toilet and drink water

Outcome/Goal #2

-The patient reports an optimal

amount of hours of sleep

-The patient reports less interruption

during the sleep

-The patient is able to explain when

sleeping aids can be efficient and

how to take them.

Outcome/Goal #1

-Patient is normovolemic

-Normal urine output

-The patient is changing her

lifestyle in order to avoid these

states of dehydration

-The patient is able to explain

what measures should be taken

in order to both treat and

prevent possible fluid loss.

Interventions #1

-Assure that the patient is taking the

medication correctly

-Urge the patient to drink the amount

of water indicated by the physician

-In case the patient is hospitalized,

insert and iv catheter to have iv access

in case of sever dehydration

- Enumerate interventions that would

help minimize the future episodes of

dehydration

-Avoid overheating environments as

the patient might lose even more fluids

Interventions # 2

-The nurse can assess the patients

sleeping hours to understand her

pattern and after that try to develop a

sleeping plan

-The nurse will try to provide a

comfortable atmosphere for the patient

to be able to fall asleep (no sounds,

dark rooms)

-The nurse will avoid offering the

patient any large meal intakes with 2

hours prior sleeping time

- The nurse will educate the patient to

avoid drinking caffeine

- The nurse will instruct the patient

regarding the sleeping aids, when to

take them, and what are their benefits.

Assessment/ Evaluation #1

-Monitor and document vital signs

-Assess skin turgor for signs of dehydration

-Assess any neurological changes: confusion, slow responses,

agitation.

-Assess the amount and also the color of urine

-Note if the patient vomits or has fever

Assessment/ Evaluation #2

- The patient should be able to find ways to fall asleep and

decrease the interruption she has during the night.

PC Interventions

-Instruct the patient regarding the importance of the treatment . As

long as she takes her treatment , her ADH value will be normal

which means that her symptoms will disappear and her risk of

complications due to dehydration will be close to zero.

PC Evaluation Plan

-The patient is able to understand her pathology

-The patient is able to understand the importance of taking her

medications and knows when to take them

-The patient knows when to contact her physicians

-No complications arose

PC Outcomes/Goal

-By following the treatment the

patient should experience no

complications

-In case of complications , they

should be treated as fast as possible

and their importance shouldn’t be

neglected

Potential Complications/ at

risk for

Main complications are

represented by dehydration

pathologies such as

hypovolemic shock , seizures,

acute kidney injuries, coma ,

cerebral oedema.

Nutrition/Hydration

(8)

Dehydrated

Rest/ Exercise (11)

Astenia

GI (9)

Normal bowel sounds

in all the for quadrants

No abdominal

distension.

GU (10)

Bladder distensions due

to large amounts of

urine

Frequent urination (

over 7-8 l /day)

Misc. (Ht/Wt)

5’7”

132 pound

 BMI = 20,7

 Normal

weight

Endocrine (13)

Lab tests reveled very

low amounts of

antidiuretic hormone

which indicates a

possible Diabetes

Insipidus Central

Cardiovascular (6)

Regular Pulse

Low blood pressure

Elevated heart rate

Flattened neck vains

Psychosocial (14)

The patient looks

lethargic , not very

talkative , not very

interested in what

people have to say.

Integumentary (12)

Pallor

Dry mucus membranes

Scaphoid abdomen

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Concept Map Student Name: Instructor: Erickson’s Developmental Stage Related to pt. & Cite References (1) The patient is 30 years old which puts her in the sixth Erickson stage defined by intimacy vs isolation in which the basic virtue is love. It represents the period in which the patient shares intimately with others and explores the idea of relationship. If the stage is completed successfully , it will result in a happy relationship , the opposite will lead to depression. More easily explained , the success of this stage will lead in the end to the virtue represented by love. (Malone,Rentz,Waldinger,Liu,2016) Patient Education (In Pt.) & Discharge Planning (home needs) - Take the medicine as directed as they have the role of keeping the level of ADH as expected in order to decrease the amount of urination. - Weigh yourself on a daily basis and inform the physician regarding any f ...
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Tags: diabetes Diabetes Insipidus healthcare endocrinological pathology antidiuretic hormone