Diabetes insipidus is a disorder characterized by excessive production of dilute urine due to a deficiency of antidiuretic hormone (ADH). There are three main types: central, nephrogenic, and psychogenic. Central diabetes insipidus results from inadequate ADH secretion by the pituitary gland, often due to head trauma, tumors, or infections. Nephrogenic diabetes insipidus occurs when the kidneys do not respond to ADH. Symptoms include excessive thirst, urination, and fluid loss leading to dehydration. Treatment involves fluid replacement and administration of ADH analogs like desmopressin. Nursing care focuses on monitoring fluid status, administering medications, and
Diabetes insipidus is an uncommon disorder that causes an imbalance of fluids in the body. This imbalance makes you very thirsty even if you've had something to drink. It also leads you to produce large amounts of urine
Diabetes insipidus is an uncommon disorder that causes an imbalance of fluids in the body. This imbalance makes you very thirsty even if you've had something to drink. It also leads you to produce large amounts of urine
Slideshow is from the University of Michigan Medical School's M2 Endocrine sequence
View additional course materials on Open.Michigan:
openmi.ch/med-M2Endo
What is an electrolyte imbalance?
An electrolyte imbalance means that the level of one or more electrolytes in your body is too low or too high. It can happen when the amount of water in your body changes. The amount of water that you take in should equal the amount you lose. If something upsets this balance, you may have too little water (dehydration) or too much water (overhydration). Some of the more common reasons why you might have an imbalance of the water in your body include:
1. Certain medicines
2. Severe vomiting and/or diarrhea
3. Heavy sweating
4. Heart, liver or kidney problems
5. Not drinking enough fluids, especially when doing intense exercise or when the weather is very hot
6. Drinking too much water
Slideshow is from the University of Michigan Medical School's M2 Endocrine sequence
View additional course materials on Open.Michigan:
openmi.ch/med-M2Endo
What is an electrolyte imbalance?
An electrolyte imbalance means that the level of one or more electrolytes in your body is too low or too high. It can happen when the amount of water in your body changes. The amount of water that you take in should equal the amount you lose. If something upsets this balance, you may have too little water (dehydration) or too much water (overhydration). Some of the more common reasons why you might have an imbalance of the water in your body include:
1. Certain medicines
2. Severe vomiting and/or diarrhea
3. Heavy sweating
4. Heart, liver or kidney problems
5. Not drinking enough fluids, especially when doing intense exercise or when the weather is very hot
6. Drinking too much water
Syndrome of inappropriate antidiuretic hormone secretion (SIADH)silla elsa soji
SIADH is a disorder of impaired water excretion caused by the inability to suppress the secretion of antidiuretic hormone (ADH). Inappropriate, continued secretion or action of ADH despite normal or increased plasma volume. Results in impaired water excretion, and subsequently hyponatremia and hypo-osmolality.
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Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
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HEMORRHOIDS
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FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
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Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
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Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
2. Diabetes Insipidus
•Description
Diabetes insipidus is a disorder of the posterior
lobe of the pituitary gland characterized by a
deficiency of antidiuretic hormone or its action.
ADH stimulates kidney tubules to be permeable
to water, so that water is reabsorbed back into the
bloodstream,
Inadequate ADH means that large quantities
of dilute urine will be passed. As extracellular
dehydration results, hypotension and
hypovolemic shock can occur.
3. ADH secretion
•ADH is an octapeptide like oxytocin.
•In man, ADH is in the form of arginine vasopressin
(AVP).
•Neurosecretory cells in the supraoptic and
paraventricular nuclei of the hypothalamus
synthesize vasopressin and oxytocin,
•These pass down nerve fibers to be stored in, and
released from the posterior pituitary.
4. Regulation of ADH secretion.
•A plasma osmolality >290 mOsm/l
•A fall in plasma volume
•Emotional factors & stress
•Sleep
•Other stimulants include;- cholinergic stimulation,
adrenergic stimulation, angiotensin ii, prostaglandin
E, opiates, nicotine, histamine, ether and
phenobarbitone.
5. ADH secretion is inhibited by
•Alcohol
•Oropharyngeal water reflex
•B-drenergic stimulants
•Atrial natriuretic factor (ANF)
•Phenytoin
6. Clinical manifestations
•Polyuria, polydipsia & thirst
•Nocturia or nocturnal enuresis
•Hypernatremic dehydration
•Anorexia, and constipation
•Hyperthermia & lack of sweating
•Decreased cerebral perfusion,
•Seizures,
•Loss of consciousness, and
•Death.
7. Etiology
•There are 3 types diabetes insipidus, that is Central
DI, Nephrogenic DI and Psychogenic DI.
•In central DI, there is an inability to secrete an
adequate amount of ADH. This can be caused by;
head trauma,
brain tumor, or
surgical ablation or irradiation of the pituitary gland
Infections of the CNS (meningitis, encephalitis,
tuberculosis)
or tumors (e.g. metastatic disease, lymphoma of the
breast or lung).
8. Etiology cont.
• Nephrogenic DI is a rare congenital or acquired
disorder that occurs when the V2 receptors on the
kidney tubule become nonresponsive to the
action of ADH.
• Primary polydipsia, is a form of polydipsia
characterized by excessive fluid intake in the
absence of physiological stimuli to drink.
Psychogenic DI is a form of primary polydipsia
caused by psychiatric disorders, often
schizophrenia, which is often accompanied by the
sensation of dry mouth.
9. Assessment and Diagnosis
•The fluid deprivation test is carried out by
withholding fluids for 8 to 12 hours or until 3% to
5% of the body weight is lost.
•Plasma and urine osmolality studies are
performed at the beginning and end of the test.
•The following tests are done;-
Urine output
Low urine osmolality
Urine is “insipid”
Serum osmolality
Urine osmolality
Sodium
Serum ADH
10. Diagnosis cont.
•Laboratory criteria in dx of central DI
serum sodium level greater than 145 mEq/L,
serum osmolality greater than 295 mOsm/kg H2O,
urine osmolality less than 300 mOsm/kg H2O, and
urine specific gravity less than 1.005.
•Normal references
Serum sodium concentration (135 -145 mEq/L).
Serum osmolality (275 - 295 mOsm/kg.)
Normal ADH levels (1 to 5 picogram/mL (pg/mL)).
With normal hydration the normal morning fasting
serum level is lower than 4 pg/mL.
13. Medical Management
•Treatment goals include;
restoration of circulating fluid volume,
pharmacologic ADH replacement, and
treatment of the underlying condition
14. Cont.
• Medications to manage Central DI
Vasopressin (Pitressin)
Desmopressin (DDAVP)
Lypressin
• Medications to manage Nephrogenic DI
Thiazide diuretics
prostaglandin inhibitors (ibuprofen, indomethacin,
and aspirin)
15. Cont. Medical management
•Desmopressin can be given by IV or SC injection,
nasal inhalation, or oral tablet.
•The doses required to control pituitary DI
completely vary widely, depending on the patient
and the route of administration.
•However, they usually range from 1–2 g qd or bid by
injection, 10–20 g bid or tid by nasal spray, or 100–
400 g bid or tid orally.
•The onset of action is rapid, ranging from as little as
15 minutes after injection to 60 minutes after oral
administration.
17. Nursing care plan
•Nursing diagnosis
Deficient fluid volume related to; inability to
secrete an adequate amount of ADH, non
responsiveness of kidney tubules V2 receptors; as
evidenced by increased output of dilute urine.
•Desired outcome
To demonstrate adequate hydration as evidenced
by palpable peripheral pulse.
18. Interventions and Rationale
•Monitoring HR and BP. These are indicators of
hydration.
•Measuring urine input and output. To easily note
fluid loss or excess.
•Educating the client on the need to drink much
water. To replace lost fluids.
• Monitoring conditions of buccal membranes, skin
turgor and measuring daily weight. These are
indicators of hydration status.
•Administering DDAVP as prescribed. To replace the
body’s ADH.
19. Nursing diagnosis
Electrolyte imbalances related to; impaired
regulatory mechanisms, renal dysfunction; as
evidenced by changes in serum electrolytes
•Outcome
Client to display serum electrolytes with in normal
limits
•Interventions and Rationale
Monitoring BP. To easily note hypertension or
hypotension
20. Cont. interventions and rationale
Evaluating LOC and muscle strength. Sodium
imbalances may cause confusion or coma.
Monitoring serum electrolytes and osmolality. To
evaluate therapy needs and effectiveness.
Increase oral or IV intake of fluids. Replacement of
total body water deficit will gradually restore
sodium and water balance
21. Other diagnoses
•Decreased cerebral perfusion related to
hypovolemia as evidenced by decreased LOC.
•Risk for impaired skin integrity related to; decreased
skin perfusion or immobility.
•Deficient knowledge about the disease condition
related to unfamiliarity about the disease and
treatment as evidenced requests for more
information.