Diabetes Insipidus is a rare disorder characterized by increased urine output, thirst and excessive fluid intake. It causes symptoms such as frequent urination, frequent waking up at night to urinate, and, in some cases, involuntary urination while asleep, also known as bed wetting. The frequency of urination increased because the urine produced was not concentrated as it was supposed to be.
Instead of being yellow, the urine is pale and watery in appearance, and its osmolality is low when measured. Once diagnosed with diabetes insipidus, there are a variety of nursing care plans that can be implemented. Here is a look at the significant nursing plans for diabetes insipidus:
Deficient Fluid Volume
This is often related to neurohypophysial dysfunction, compromised endocrine regulatory mechanism, Nephrogenic DI, hypopituitarism or hypophysectomy. The patient experiences polyuria; urine output exceeds intake, increased thirst, sudden weight loss, altered mental status, frequent request for cold or ice water and urine osmolality less than 300 mOsm/L.
The desired outcome for this nursing care plan is for the patient to experience normal fluid volume, stable weight and average serum sodium level.
|Monitor the intake of water and output of urine. Report of urine volume greater than 200 mL for two consecutive hours or 500 mL in 2 hours.
|With Diabetes Insipudis, the patient pees large urine volumes independent of the fluid intake.The Urine output ranges from 2 to 3 L/day with renal diabetes insipidus to greater than 10 L/day with central diabetes insipidus.
|If the patient is conscious and always thirsty, thirst can be an indicator of fluid balance. Polydipsia and polyuria and strongly suggest DI. Also, the diabetes insipidus patient prefers ice water.
|Weight loss occurs with excessive fluid loss.
|Monitor urine-specific gravity.
|Usually 1.005 or less.
|Monitor serum and urine osmolality.
|Urine osmolality will be decreased, and serum osmolality will increase.
|Monitor urine and serum sodium levels.
|The patient with DI has decreased urine sodium levels and hypernatremia.
|Monitor serum potassium.
|Hypokalemia may result from the increase in the urinary output of potassium.
|Monitor for signs of hypovolemic shock
|Polyuria can cause decreased circulatory blood volume.
|Allow the patient to take water when they want to.
|Patients with intact thirst mechanisms may drink large quantities of water to replace the amount they pee . Patients often prefer cold or iced water.
|Provide an easily accessible fluid source, keeping adequate fluids at reach.
|This encourages regular intake of fluids or water
|Administer intravenous fluids:
|IV fluids are admistred if the patient cannot take sufficient fluids through the mouth.
|· 0.45% sodium chloride or 5% dextrose in water or
|Hypotonic Intravenous fluids provide free water and help lower sodium levels gradually in the body
|· 0.9% sodium chloride
|Isotonic fluids are administered for the patient who has had significant fluid loss and is hemodynamically unstable. Once the circulatory volume has been restored, hypotonic IV fluids can be given.
|Administer medication as prescribed.
|Aqueous vasopressin is usually used for diabetes insipidus of short period (e.g. head trauma or postoperative neurosurgery).
Patients with milder forms of diabetes insipidus may use clofibrate (Atromid), chlorpropamide (Diabinese), or carbamazepine (Tegretol) to stimulate the release of ADH from the pituitary glands HydroDIURIL may also be used for nephrogenic diabetes insipidus.
|If vasopressin is given, monitor for rebound hyponatremia or water intoxication.
|Overmedication can result in volume excess.
Risk Of Impaired Skin Integrity
High volumes of urine output can cause incontinence. The desired outcome for this nursing care plan is for the patient’s skin to remain intact.
|Inspect skin; document condition and status changes.
|Early detection and intervention may prevent the occurrence or progression of impaired skin integrity. Fluid loss from polyuria contributes to decreased skin turgor and dryness.
|Assess for continence or incontinence.
|Excessive moisture on the skin increases the risk of skin breakdown.
|Assess other factors that may risk the patient’s skin integrity (e.g., immobility, nutritional status, altered mental status).
|Excessive moisture from urinary incontinence can increase skin breakdown risk from other sources.
|Provide easy access to the bathroom, urinal, or bedpan.
|Both polyuria and polydipsia disrupt the patient’s everyday activities (including sleep).
|Use skin barriers as needed.
|These prevent redness or excoriation from urinary frequency.
|Keep bed linen clean, dry, and wrinkle-free.
|This prevents shearing forces.