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

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Published on December 9, 2008

Author: riddler2008

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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:

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

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

↑ 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

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

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

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

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 .

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).

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.

Need to maintain water restriction at home to prevent water intoxication.

Get daily weight. Call Dr. if ↑ in weight is ≥ 1 kg/d.

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