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because really concentrated bloodooCentral(Neurogenic) Diabetes InsipidusCaused by insufficient production of ADHOrigin of Problem is in the BrainAcute or Chronic Condition (usually result of trauma)Symptoms:oPolydipsia, polyuria, enuresisoThirstythrough the nightoInfants are irritable but calmed when given free water(not calmed with milk)oConstipation, dehydration, hypernatremiaooNephrogenicDiabetes InsipidusCaused by the kidneys lack of responsive or under-responseto appropriate levels of ADHOrigin of Problem is in the Kidneys – tx with hydrochlorothiazide Chronic ConditionSymptoms Include:oPolyuria, polydipsiaoHypernatremia oDilute urine, vomiting, dehydrationopossible mental status changesoDI: TestingWater Deprivation TestElevated serum sodium24-hour urine collectionoDecreased urine osmolalityoDecreased specific gravityDI: TreatmentCentral DITreat underlying causeGive desmopression or hydrochlorothiazide (synthetic vasopressin/ADH/DDAVP) Diabetes Insipidus: Nursing ConsiderationsWeight Monitoring (watch for sudden weight loss)Careful I&OEducation
omedication administration (desmopression given orally, IV, IM, intra-nasally)oAppropriatePO fluid intake Not allowing child to drink from toilets, flower vases, puddles and knowing what to do if they want to do thatoMedical alert braceletsSyndrome of Inappropriate Antidiuretic Hormone (SIADH)Increased Antidiuretic hormone (aka vasopressin)Observed with increased frequency in conditions involving infections, tumors or other CNS disease/traumaExcess ADH causes most of the filtered water to be reabsorbedfrom the kidneys back into central circulationAlmost always acuteSIADH: Signs and SymptomsWater intoxicationDecreased to no UOPHyponatremiaNausea, vomitingSeizuresMalaiseMental status changesSIADH: DiagnosticsHigh urine osmolarity (concentrated urine)High urine specific gravityLow serum osmolarityLow serum sodiumDecreased BUNDecreased HctSIADH: Treatment and Nursing ConsiderationsTreat underlying causeCareful I&OWeight Monitoring
Fluid restriction(nofree water)May need hypertonic NaClSeizure precautionsEducation regardingthese measuresDiet high in proteinand sodiumFrequent neurochecksWhich is the bestchoice of food for a child withSIADH?French FriesFried Chicken – high in salt and proteinChocolate ShakeWatermelonDisorder of Thyroid FunctionThyroid FunctionThyroid Gland produces two types of hormones:oThyroid Hormone (TH)Thyroxine (T4)Triiodothyronine (T3)oCalcitoninoThe secretion of Thyroid Hormone is controlled by thyroid stimulating hormone (TSH), from the pituitaryoHigh thyroid – neg feedback less TSH less THHypothyroid: Low T3, T4, High TSHHyperthyroid: High T3, T4, Low TSHHypothyroidism