Syndrome of Inappropriate Antidiuretic

ACTIVE LEARNING TEMPLATE: System Disorder Safa Abassy Syndrome of Inappropriate Antidiuretic DISORDER/DISEASE PROCESS __________________________________________________________ Hormone (SIADH) STUDENT NAME _____________________________________ Alterations in Health (Diagnosis) Pathophysiology Related to Client Problem Overproduction of antidiuretic hormone (ADH) by the posterior pituitary gland even when plasma osmolarity is low or normal Causes water retention by the renal tubules, reduced urine output and increased extracellular fluid 78 REVIEW MODULE CHAPTER ___________ Health Promotion and Disease Prevention Seek prompt medical attention to prevent worsening and to treat the underlying cause ASSESSMENT SAFETY CONSIDERATIONS Risk Factors Malignant tumors, meningitis, head injury, high intrathoracic pressure, certain medications (ie: chemotherapy meds, fluoroquinolones, diuretics, barbiturates, opioids); older age Expected Findings Weakness, headache, anorexia, weight gain, muscle cramps, nausea, vomiting, oliguria, slower deep tendon reflexes, confusion, signs of excess fluid volume Laboratory Tests Diagnostic Procedures Decreased BUN, creatinine clearance, Hgb, Hct, serum sodium, blood osmolarity (< 270 mEq/L) Increased urine specific gravity, urine sodium, urine osmolarity Based on lab findings and clinical findings mentioned previously. PATIENT-CENTERED CARE Nursing Care Fluid restriction (500-1000 ml/day; I&Os; monitor for ↑ BP, HR, or hypothermia; assess lungs for pulmonary edema; daily weights; monitor neuro status Therapeutic Procedures Hypertonic NS (3% NS) IV for severe hyponatremia; Fluid restrictions Maintain seizure precautions & trend serum sodium Fall precautions due to orthostatic hypotension Older adults have a higher hyponatremia risk Complications Medications Demeclocycli ne (helps stimulate urine flow); vasopressin antagonists (conivatan, tolvaptan); loop diuretics Client Education Report shortness of breath or dyspnea, decreased appetite, nausea or vomiting; avoid alcohol; change positions slowly Interprofessional Care Home health (for medication, fluid, and diet management) registered dietician nutritionist Worsening hyponatremia can cause confusion or Cheyne-Strokes breathing which need prompt intervention; if not, coma, seizures, or death can occur Source: Assessment Technologies Institute, 2023 ACTIVE LEARNING TEMPLATES