ISABELA STATE UNIVERSITY

CITY OF ILAGAN CAMPUS

COLLEGE OF NURSING
BACHELOR OF SCIENCE IN NURSING

CARE OF THE CLIENTS WITH

ENDOCRINE AND METABOLIC
DISORDER
CHARLES Z. ARIOLA JR., RN, MSN, LPT.
DIABETIC
INSIPIDUS
Disorder of the
posterior lobe
characterized by
deficiency
of Anti-Diuretic
Hormone
MAJOR SIGNS AND SYMPTOMS
1. POLYDIPSIA
2. LARGE VOLUME OF DILUTE URINE
3. FATIGUE
4. MUSCLE WEAKNESS
5. IRRITABILITY
6. WEIGHT LOSS
7. SIGNS OF DEHYDRATION
8. TACHYCARDIA
CAUSES
1. HEAD TRAUMA
2. BRAIN TUMOR
3. SURGICAL ABLATION
4. MENINGITIS
5. ENCEPHALITIS
6. TUBERCULOSIS
7. METASTATIC DISEASE
8. FAILURE OF RENAL TUBULE TO RESPOND
TO ADH
 ASSESSMENT AND DIAGNOSTIC
FINDINGS
1. FLUID DEPRIVATION TEST
- Withholding fluids 8-10 hours
- Patient is weighed frequently during the test
- Plasma and urine osmolality is studied at the
beginning and end of the test
- The inability to increase specific gravity and
osmolality isindication of D.I
 ASSESSMENT AND DIAGNOSTIC
FINDINGS

2. PLASMA LEVELS OF ADH

3. DESMOPRESSIN TRIAL
 MEDICAL MANAGEMENT

OBJECTIVES:

1. Replace ADH (long-term)

2. Ensure adequate fluid replacement
3. Identify and correct underlying pathologic cause
 PHARMACOLOGIC THERAPY

1. DESMOPRESSIN
- Synthetic vasopressin without vascular effects of natural
ADH
- Given intranasally
- Solution is sprayed into the nose through flexible
calibrated tube
- 1 or 2 dosages daily (q12-24 hours)
 PHARMACOLOGIC THERAPY
2. IM VASOPRESSIN AND VASOPRESSIN
- Given q24-96 hours
- Vial should be warmed or shaken vigorously
- Given evening for maximum results
SIDE EFFECT/S: Abdominal Cramping
NX RESPONSIBILITY: Rotate injection site to prevent
lipodystrophy
 PHARMACOLOGIC THERAPY
3. CLOFIBRATE
- Hypolipidemic agent
- It has anti-diuretic effect

4. CHLORPROPRAMIDE (Diabenese) and THIAZIDE

- Advise or warn patient for hypoglycemic reactions
 PHARMACOLOGIC THERAPY
FOR NEPHROGENIC CAUSE;
1. Thiazide Diuretics
2. Mild Salt Depletion
3. Prostaglandin Inhibitors
- Ibuprofen
- Aspirin
- Indomethacin
 NURSING MANAGEMENT
1. MAINTAIN FLUID AND ELECTROLYTE BALANCE
2. KEEP ACCURATE INPUT AND OUTPUT MONITORING
3. WEIGH DAILY
4. ADMINISTER IV AND ORAL FLUIDS
5. MONITOR VITAL SIGNS
6. OBSERVE FOR SIGNS AND SYMPTOMS OF DEHYDRATION AND
HYPOVOLEMIA
7. PROVIDE CLIENT TEACHING (lifelong replacement of hormone to
prevent polyuria and polydipsia)
8. CAUTION WITH CORONARY ARTERY DISEASE
SYNDROME OF INAPPROPRIATE ANTI-
DIURETIC HORMONE (SIADH)

- EXCESSIVE SECRETION OF ADH

- PATIENT CANNOT EXCRETE DILUTE URINE
- PATIENT RETAINS FLUID AND CAUSE SODIUM
DEFICIENCY KNOWN AS DILUTIONAL
HYPONATREMIA
 CAUSES
1. BRONCHOGENIC CARCINOMA
- Synthesizes the release of ADH
2. PNEUMONIA
3. PNEUMOTHORAX
4. HEAD INJURY
5. BRAIN SURGERY
6. MEDICATIONS LIKE Vincristine, Phenothiazides, TCA,
Thiazide Diuretics
7. NICOTINE
ASSESSMEN
T
1. CANNOT EXCRETE DILUTE URINE
2. FLUID RETENTION
3. SODIUM DEFICIENCY
MANAGEMENT

1. ELIMINATING UNDERLYING CAUSE

2. DIURETICS (FUROSEMIDE)
 NURSING MANAGEMENT
1. RESTRICT FLUID TO PROMOTE FLUID LOSS AND
GRADUAL INCREASE IN SERUM SODIUM
2. MONITOR SERUM ELECTROLYTES AND BLOOD
CHEMISTRIES
3. MONITOR INPUT AND OUTPUT
4. DAILY WEIGHT
5. NEUROLOGIC STATUS