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Concept Map of Syndrome of Inappropriate (ly high) Anti-Diuretic Hormone (SIADH)
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Concept Map of Syndrome of Inappropriate (ly high) Anti-Diuretic Hormone (SIADH)

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Concept Map of Syndrome of Inappropriate (ly high) Anti-Diuretic Hormone (SIADH) Concept Map of Syndrome of Inappropriate (ly high) Anti-Diuretic Hormone (SIADH) Presentation Transcript

  • Concept Map of Syndrome of Inappropriate Anti-Diuretic Hormone (SIADH)
    • Causes / Etiology /Risk Factors:
    • Pathophysiology:
    • Complications:
    • Clinical Manifestations:
    • Assessment / Diagnostics:
    • Treatment:
    • Nursing Diagnoses & Interventions:
    • Teaching:
  • Causes / Etiology / Risk Factors:
    • Lung tumor; head injury; pituitary surgery; pancreatic & prostatic cancer; Hodgkin’s disease; pulmonary disease; viral/bacterial COPD;bronchogenic carcinoma, psychosis; myxedema; positive pressure ventilation
    • Use of (iatrogenics):
      • Barbiturates, anesthetics, thiazide diuretics
      • Chlorpropamide, vincristine, cyclophosphamide, clofibrate, metoclopramide, morphine , isoproteronal
  • Pathophysiology:
    • ↑ Anti-Diuretic Hormone (ADH) or vasopressin causing:
      • inability to excrete dilute urine
      • retention of free water
      • expansion of extracellular fluid volume
      • dilutional or euvolemic hyponatremia
  • Complications:
    • Heart failure R/T fluid overload
    • Cerebral edema secondary to water intoxication from fluid retention
  • Clinical Manifestations:
    • Oliguria
    • Water retention
      • ↑ CVP, ↑ PWP
    • Weight gain
    • Anorexia
    • Nausea & vomiting
    • Muscle weakness; muscle twitching
    • Lethargy; restlessness; confusion
    • Possible seizures; coma
    • Edema is rare unless water overload > 4 L
      • Much of free-water excess is within cellular boundaries
  • Assessment / Diagnostics:
    • Urine specific gravity > 1.030
    • High urine Na + secretion (> 20 mEq/L) without diuretics
    • Dilutional of euvolemic hyponatremia (< 135 mEq/L): mild (< 135); moderate (< 130); severe (< 125)
    • Serum hypoosmolarity (< 280 mOsm/kg H 2 O)
    • Normal renal function
    • CT scan, MRI
  • Treatment:
    • Treatment – correction of underlying cause of SIADH (e.g., tumor surgery, radiation, chemotherapy)
    • Drugs:
      • Cornivaptan (Vaprisol) is anti-ADH
        • only in IV form so cannot be used in outpatient setting
        • Expensive
      • Diuretics such as furosemide (Lasix)
        • Ototoxic
      • Demeclocycline – to block renal response to ADH
        • Not used during the acute phase
        • Overdose may cause diabetes insipidus
  • Nursing Diagnoses & Interventions:
    • Excess Fluid Volume R/T ↑ ADH
      • Enforce fluid restrictions as ordered ( ½ to 1L/day) .
      • For severe water intoxication, 200-300 ml of 3% saline solution to  serum Na + level gradually (  should be < 8mEq/day).
      • Monitor 24-hour I & O, VS, and  LOC frequently.
      • Monitor daily weight and auscultate lungs. A weight gain of 1 kg/day or gradual increase over several days is cause for concern.
      • Observe for restlessness, irritability, seizures, heart failure, and unresponsiveness R/T hyponatremia & water retention.
      • Provide frequent mouth rinsing (remind client not to swallow rinses). Client is uncomfortable during fluid restrictions .
  • Nursing Diagnoses & Interventions: (cont.)
    • Risk for Injury R/T seizure
      • Assess and document changes in neurologic status. Assess subtle changes like muscle twitching, before they progress to seizure or coma. Check LOC q2h (q4h if client is alert; q1h if decreasing LOC) because disorientation or confusion may be present.
      • Reduce environmental stimuli.
      • Make sure side rails are padded and securely in place (up position).
  • Teaching:
    • Need to maintain water restriction at home to prevent water intoxication.
    • Get daily weight. Call Dr. if ↑ in weight is ≥ 1 kg/d.