Nursing Care Plan for Diabetes Insipidus

Pathophysiology

Diabetes insipidus refers to the condition where the kidneys are unable to retain water. Even though the patient may be dehydrated, the kidneys cannot balance the fluid and produce large amounts of insipid urine (dilute and odorless). The kidneys normally produce 1-2 quarts of urine per day, but with diabetes insipidus, they may produce 3 – 20 quarts per day. This results in the patient feeling very thirsty and have the urge to drink large amounts of liquid.

Etiology

The hypothalamus produces a hormone called vasopressin, an antidiuretic hormone (ADH) that tells the kidneys how much fluid to absorb from the bloodstream. This normally results in a lower amount of urine produced.  When there is damage to the hypothalamus (Central diabetes insipidus, or CDI) or the kidneys are not able to respond to the vasopressin (Nephrogenic diabetes insipidus or NDI), the kidneys do not know when to stop removing fluid from the body, even if the body is already dehydrated. This results in the patient feeling extremely thirsty, which prompts them to drink more fluids, and therefore, secrete more dilute urine.

Desired Outome

Prevent dehydration, manage symptoms and prevent complications

Diabetes Insipidus Nursing Care Plan

Subjective Data:

  • Excessive thirst
  • Polyuria, excessive urination
  • Headache
  • Fatigue
  • Nausea
  • Dry mouth
  • Loss of appetite
  • Muscle cramps
  • Confusion

Objective Data:

  • Dry mucous membranes
  • Tachycardia
  • Weight loss
  • Hypotension
  • Hypernatremia
  • Decreased skin elasticity

Nursing Interventions and Rationales:

  1. Monitor I & O, daily weights, and polydipsia
    • Weight loss will occur with excessive fluid loss. Thirst can be an indicator of fluid balance.
  2. Monitor for signs / symptoms of hypovolemia
    • Excess fluid loss results in decreased circulatory volume. Early detection and intervention can prevent hypovolemic shock from occuring.
  3. Monitor for signs of hypotension and provide education and assistance with ambulation
    • Dehydration and hypernatremia can cause the blood pressure to drop which may result in dizziness or weakness with position changes. Assist patient when standing or walking to prevent falls and injury. Educate patient to make slow changes in position.
  4. Encourage hydration and provide easy access to fluids; administer IV fluids if necessary: Hypotonic- D5W or 0.45% sodium chloride, Isotonic - NS (0.9% sodium chloride) if hemodynamically unstable
    • If the patient has intact thirst, offer plenty of fluids to prevent dehydration. If the patient cannot orally tolerate fluids, initiate IV fluids.
  5. Monitor labs / electrolyte balance: Serum and urine osmolality, Serum and urine sodium levels, Serum potassium
    • Excess fluid loss results in the body excreting potassium and retaining sodium. This results in too much sodium and too little potassium in the blood.
  6. Administer medications appropriately: Chlorpropamide or carbamazepine - stimulates the release of vasopressin (ADH), Hydrochlorothiazide- may be used for nephrogenic DI, Aqueous vasopressin - used for short term DI, Pitressin tannate is a long-acting vasopressin
    • Depending on the type of diabetes insipidus, medications may be given to stimulate the production of vasopressin, or it may be given as a supplement. When giving medications, monitor for effectiveness and changes in blood pressure due to changes in fluid balance.
  7. Provide easy access to bathroom
    • Frequent urination can be frustrating for the patient. Provide easy access for voiding including urinal or bedside commode as appropriate.
  8. Prevent injury and initiate fall precautions
    • Frequent trips to the bathroom can increase the risk of falls. Provide assistance as needed with ambulation, especially if patient has confusion, muscle cramps or muscle weakness from electrolyte imbalance.
  9. Assess for skin integrity, apply skin barriers as needed
    • Polyuria may lead to bouts of incontinence and increase the risk of skin breakdown. Apply barriers and precautions as necessary to avoid redness or excoriation.

References

Date Published - Nov 1, 2018
Date Modified - Nov 1, 2018