Diabetes Insipidus | Med Surg Nursing Lecture

Listen, friend, Med surg can be tough in nursing school, but it doesn't have to be. In this video, I'm going to break down diabetes insipidus in a way that you probably haven't heard before so you can actually understand it. Finally, I'm going to walk you through everything you need to know about it and give you the key critical thinking points that you need to know for diabetes insipidus when you go and take your nursing exams. Let's do this. Hello. Hello, my friend. My name is Christina Rafano and I am the creator of the nursing school show where we walk through how to pass a nursing school step by step. So hit that subscribe button and click the notification bell and let's dive in. So let's start with the basics and what diabetes insipidus is all about. It's a little hormone called adh, and this stands for antidiuretic hormone. And ADH is released from the posterior pituitary gland. So let's break down the name because it really does make sense. So antidiuretic hormone, or ADH is exactly what the name says. It's an antidiuretic. Now what do diuretics do? They make you urinate a lot. So ADH is an antidiuretic hormone, meaning that you won't urinate a lot. So when ADH is released into the body, it goes and it tells the kidneys to hold onto water instead of urinating it out. And that is it in a nutshell. That is the role of ADH in the body. Now, there are two disorders that you need to know about that have to do with adh. This one that we're talking about right now, diabetes insipidus and another one called syndrome of Inappropriate Antidiuretic hormone, or siadh. Now, we do have two videos on that one over SIADH for you to look at after you watch this video, so you can understand that one as well because most likely you will be learning about that soon, if you haven't already. Now, diabetes insipidus and SIADH are actually opposites. So understanding how ADH works and what happens in both DI and SAADH will help you fully understand and critically think about it on your nursing school exams. So I highly recommend that you check those videos out too. Okay? But for now, let's get back to diabetes insipidus. We'll focus on that. So what is happening with adh? Well, the posterior pituitary gland doesn't release enough ADH or the kidneys just don't respond to it. So there's really two causes that you need to know about. Either that posterior pituitary isn't doing its job well, it's not releasing it, or it is being released, but the kidneys are saying, nope, they're just not responding to it. Stroke, brain trauma, or a tumor can cause issues with that posterior pituitary gland, prevent it from releasing adh, or it can be caused by surgery as well. So normally, when the body has a low fluid volume, meaning that there isn't enough water in the body, ADH is released from that posterior pituitary gland, and that's step number one. And step number two, it travels down to the kidneys. And step number three, the kidneys respond to it, and they hold on to more water rather than sending that water out into the urine. All right, let's take a step back and think about the name again. Antidiuretic hormone. It prevents diuresis, so the kidneys hold on to more water. And then step number four, the fluid volume in the body goes down, up because of that increase in water. Now, during diabetes insipidus, if the pituitary gland isn't functioning properly, the problem occurs right at the beginning of this. In step number one, there is no ADH being released at all, or there's not enough. So the kidneys have nothing to respond to. And the kidneys just continue making more and more urine, even if the fluid volume is too low to begin with. So the fluid volume will just keep getting lower and lower because there's no ADH to tell the kidneys to hold on to water. All right. Another cause is if the kidneys aren't responding to the adh, then we go through steps one and two, but we get stuck at step three because the kidneys don't respond to that adh. So even though it's there, they don't do anything about it. So the kidneys just keep making more and more urine, Like, ADH was never there in the first place. They don't even recognize it. So the fluid volume, again, keeps getting lower and lower because the kidneys just keep making more and more urine. So those are the two main pathways and causes of diabetes insipidus. Either the posterior pituitary pituitary gland isn't releasing enough adh, or the kidneys just aren't responding to it. Now, adh, again, stands for antidiuretic hormone. So it prevents the kidneys from making a lot of urine, makes the kidneys retain more water. But during diabetes Insipidus, there's either not enough of that ADH or the kidneys aren't responding to it. Either way, the kidneys keep making more and more urine and the fluid volume keeps getting lower and lower. Now, just a quick side note. If you're a Nursing Essence member, make sure that you check out the endocrine course that we have for you inside the nursing SOS membership community. I know all this can be confusing, but I walk you through diabetes insipidus and all the other endocrine disorders that you need to know in nursing school. We walk you through it step by step and the critical thinking points that you need to know for them. We also give you the study guides to go along with it to help you study. So be sure to check out those inside the nursing SS membership community. And if you're not a member yet, you can sign up to be the first to know when enrollment opens again. Now, the link is down below in the description for you to check out all the details. All right, so now that we understand what is happening, what ADH does in the body, we can start to critically think about some signs and symptoms that we might see in a patient who has diabetes insipidus. Now, the primary signs and symptoms that you'll see, things like excess urination, which is also called polyuria. The urine labs will show that the urine is really dilute. There's a lot of water in it. And the specific gravity will be low excessive thirst, which is called polydipsia, decreased skin turgor and dry mucous membranes, decreased blood pressure, increased heart rate, neurological problems, neurological symptoms like fatigue or headaches, and the neuromuscular symptoms as well. Things like weakness and muscle pain could happen. So if you think about these signs and symptoms, you will notice that they all basically correspond to a low fluid volume in some shape or form. So let's walk through them and we'll do some critical thinking so that you can fully understand it and be able to answer the question about diabetes insipidus on your nursing school exams, which is why we are here right now. The first one we'll go through is excessive urination, which is also called polyuria. This happens because there isn't enough ADH in the body or the kidneys aren't responding to the ADH that's there. Right. Without adh, the kidneys are getting rid of a ton of water. And what happens to all of the water they're getting rid of? All that extra water gets sent out into the urine. This is also why the specific gravity will be low, meaning the urine is really dilute, because there is a lot of that excess water, the particles in the urine are not as concentrated, so the specific gravity will drop. Excessive thirst can happen because the body is so dehydrated with all of that water loss, right? Then the brain sees that low fluid volume and it wants to help. So it tells you to drink more fluids and get more water into the body. Then skin turgor can decrease, and the mucous membranes might be dry also. Also because of that dehydration. Right. We're getting rid of a ton of water. So we measure skin turgor by pulling on the skin near the collarbone or on the hand. And if it tends or stays up longer than normal, that's a sign of dehydration. And the same goes with mucous membranes. If you look into the patient's mouth and their tongue and gums are dry, that's also a sign of dehydration. And if the patient is dehydrated, that means their fluid volume is low, right? Their blood volume is low and their blood pressure is low. So when fluid volume drops in the body, like during diabetes insipidus, the blood pressure is going to drop because there's simply just not enough fluid volume inside the blood vessels to really keep that blood pressure up. Now, let's take it one step further. When the blood pressure is low, that means that less blood is going to the organs, right? So the heart rate will increase to try to compensate for that lack of blood flow. The heart will pump faster to try to get more blood to the organs. The patient may also have neurological symptoms, things like fatigue and headaches, because the brain, it's not getting the blood flow that it needs to function. Since there's not as much fluid volume, right. And the blood pressure is dropped, the brain may not get as much blood as it needs. So those neurological symptoms can happen, and things like muscle pain and weakness can happen for that same reason. The muscles aren't getting the blood flow that they need to to function, which can cause pain. Then electrolyte imbalances may also play a role here as well. With both those neurological issues and the neuromuscular symptoms. Because there's less fluid volume now, the electrolytes might become more concentrated in the blood, causing electrolyte imbalances, which can mess up with the brain and the muscles. So now we know the major signs and symptoms that you will need to look for that all have to do with that low fluid volume. But now let's go one step further. Let's talk about the major things that you'll to assess for and then the interventions that you'll be doing with your patients who have diabetes insipidus. So you'll want to do a whole patient history assessment to check for the cause. Check their vital signs, especially their blood pressure and their heart rate. Right? Look for signs of dehydration, like if their tongue and their gums are dry. Check their skin trigger to check for tenting. Ask how often they urinate and about how much they urinate each time. Monitor their intake and output. Check their urine specific gravity. Do daily weight checks. Ask about neurological, neuromuscular or neurological symptoms. Things like we talked about, right? Fatigue, weakness, headaches, muscle pain. Make sure that they have a working IV in place and assess their fluids, though this is important because it may help you identify the underlying cause. And then stroke, brain trauma or a tumor can cause issues with that posterior pituitary gland and then prevent it from releasing adh. Or it can also be caused by surgery as well. So you'll need to ask if they've had a stroke recently or if they've had any neurological changes or any surgeries recently. You'll need to check their vital signs to assess their fluid status. So remember, diabetes insipidus has everything to do with a low fluid volume. So you'll want to pay close attention to their blood pressure and their heart rate. And when fluid volume is low, there isn't as much blood for the heart to pump out, so the heart rate will increase to try to make up for that loss in fluid volume. Right. So you might see that heart rate go up. They may have those signs of dehydration because of that lack of water in the body. So you will take a look inside their mouth mouth and check for the dryness on their tongue or on their gums. We call those the mucous membranes. And so those might be dry. You'll also want to assess their skin to grow like we talked about, either on their collarbone or the back of their hand. So if the skin tents or stays up longer than usual, that's a sign that they might be dehydrated. And of course, you'll want to actually be assessing this. So track their intake and their output. They should have either a hat in the toilet or be using a urinal or have a catheter implant place for you to track their output accurately. And when you track their input, make sure to include all of the fluids that they're consuming, including IV fluids and you'll need to assess their urine specific gravity as well. So specific gravity, like we said, tells you how many particles are in the urine. And the specific gravity might be low, meaning that the urine is really dilute because of all the extra water. The particles in the urine are just not as concentrated, so the specific gravity will drop. And then lab values can also clue you in on their fluid and electrolyte status and urine specific gravity. So you can check the specific gravity in their urine, which checks for, like we said, how concentrated or diluted is. Then typically with diabetes insipidus, it will be really dilute because they are urinating out a whole lot of water. And with all this fluid loss, their electrolytes might be imbalanced. So some might be elevated in particular because there is less fluid and so they are more concentrated. Right. So you'll want to assess those electrolytes levels to make sure that they don't get too far out of whack. So there are a few key things that you will need to educate your patient on to make sure that they are able to manage diabetes insipidus on their own. They will need to be educated on consuming more water and fluids. Give any fluids or medications as prescribed. That's what you as a nurse will need to do. And then because the patient with diabetes insipidus is losing so much water, the doctor might order hypotonic fluids to help restore fluid volume to the cells. Now remember, hyp. Hypotonic fluids will help move fluid back into the cells to rehydrate them. I like to think of them as little hippos. Hypotonic, makes hippo cells, hippopotamuses, Right? Do you get it? Hippos, hypotonic. Okay, so hypotonic fluid will move fluid back into the cells to make them like little hippos. The doctor may also prescribe medications such as vasopressin, which is the ADHD hormone, or desmopressin, which is a synthetic adh. Now these will help to replace the ADH hormone in the body if that's the case for this patient's diabetes insipidus, so that the kidneys can start holding on to more water. So you'll need to give it appropriately. And then educate the patient on why they are getting it and what they should be looking for, particularly the signs of fluid volume overload, such as things like a bounding pulse, weight gain, edema, difficulty breathing, things like that. And finally, you'll want to educate your patient on changing positions carefully and slowly. With that low fluid volume, their blood pressure might be low, which can cause that orthostatic hypotension, which is where blood pressure decreases or drops significantly when the patient stands up. And this can be dangerous and can cause a patient to feel weak or even faint, which is a huge safety concern, right? So it's important to educate them about really changing their position slowly and safely. Now be sure to check out all of the other courses and med surg videos that we have for you inside of the Nursing SOS Membership community. We walk you through exactly what you need to study in nursing school and give you the must know information to help you pass your exams. We break it all down for you step by step so you can actually understand it. You don't need to figure it out alone anymore from your textbook or anything. We will teach you everything that you need to know, so be sure to join the next time that enrollment opens. It only opens a few times a year so don't miss it next time. The link is in the description down below and if you like this video, be sure to hit that like button. Leave a comment of course to let me know that you loved it. Share it with a friend and click that subscribe button and hit the notification bell so you never miss a future video. And click on one of these videos right here so you can keep rocking nursing school. And as always my friend, go become the nurse that God created only you to be be. And I'll catch you next time on the Nursing School show. Take care. Bye bye.