A nurse has a four-patient assignment in the medical step-down unit. When planning care for the clients, which client would have the following treatment goals: fluid replacement, vasopressin replacement, and correction of underlying intracranial pathology?
A. The client with diabetes mellitus.
B. The client with diabetes insipidus.
C. The client with diabetic ketoacidosis.
D. The client with syndrome of inappropriate antidiuretic hormone (SIADH) secretion.
Correct Answer: B. The client with diabetes insipidus.
Maintaining adequate fluid, replacing vasopressin, and correcting underlying intracranial problems (typically lesions, tumors, or trauma affecting the hypothalamus or pituitary gland) are the main objectives in treating diabetes insipidus. Diabetes insipidus (DI) is a disease process that results in either decreased release of or response to antidiuretic hormone (ADH, also known as vasopressin or AVP), which can cause electrolyte imbalances.
Option A: Diabetes mellitus does not involve vasopressin deficiencies or an intracranial disorder, but rather a disturbance in the production or use of insulin. The physiology and treatment of diabetes are complex and require a multitude of interventions for successful disease management. Diabetic education and patient engagement are critical in management.
Option C: Diabetic ketoacidosis results from severe insulin insufficiency. Fluid resuscitation and maintenance, insulin therapy, electrolyte replacement, and supportive care are the mainstays of management in diabetic ketoacidosis.
Option D: An excess of vasopressin leads to SIADH, causing the client to retain fluid. The patients with SIADH have a combination of ADH-induced water retention and secondary solute loss. The overall solute loss is more prominent than water retention in patients with chronic SIADH. SIADH treatment involves correction and maintenance of corrected sodium levels and correction of underlying abnormalities such as hypothyroidism or pulmonary or CNS infection.
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