A male client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate?
A. Infusing I.V. fluids rapidly as ordered.
B. Encouraging increased oral intake.
C. Restricting fluids.
D. Administering glucose-containing I.V. fluids as ordered.
Correct Answer: C. Restricting fluids
To reduce water retention in a client with SIADH, the nurse should restrict fluids. Administering fluids by any route would further increase the client’s already heightened fluid load. Syndrome of inappropriate antidiuretic hormone ADH release (SIADH) is a condition defined by the unsuppressed release of antidiuretic hormone (ADH) from the pituitary gland or non-pituitary sources or its continued action on vasopressin receptors.
Option A: SIADH is characterized by impaired water excretion leading to hyponatremia with hypervolemia or euvolemia. SIADH treatment involves correction and maintenance of corrected sodium levels and correction of underlying abnormalities such as hypothyroidism or pulmonary or CNS infection. The goal of sodium correction is more than 130 mEq/L.
Option B: In patients with mild to moderate symptoms, the mainstay of the treatment is the restriction of oral water intake with the goal of less than 800 mL/day. If hyponatremia is persistent, sodium chloride in the form of oral salt tablets or intravenous saline can be given.
Option D: Loop diuretics such as furosemide (20 mg twice daily) can also be added to salt tablets as it helps decrease the urine concentration and thereby increase water excretion, particularly among the patients whose urine osmolality is much higher than serum osmolality (greater than 500 mOsm/kg).
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