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Diabetes Insipidus Concept Map

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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
95
mOsm/
kg
5/11/20
18
288
Urine
Osmolality
500-
800
mOsm/
Kg
H2o(2
4 Hr
specie
mn)
5/11/20
18
180
ADH
1-5
pg/ml
5/11/20
18
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
RT
Freq.
MOA
RN
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

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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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