SIADH vs Diabetes Insipidus DI | Endocrine System Nursing NCLEX

hey everyone it's Sarah gesture nurse Orion comm and in this video I'm going to be going over the differences between SIADH the syndrome of inappropriate antidiuretic hormone versus diabetes insipidus also called di I know a lot of people get these two conditions confuse so what I want to do for you is I want to break down and the key concepts you need to know for in cliques and bring your nursing lecture exams so what I'm going to do is I am going to explain how the antidiuretic hormone works at 88 because if you can understand that concept all of this other stuff like the causes the signs and symptoms and the nursing interventions will make complete sense so after this lecture I highly encourage you to go to my website registered nurse Orion comp and take the free quiz a link should be popping up in a card and to test your knowledge on the differences between SIADH and di so let's get started okay the key player in these two conditions is called the antidiuretic hormone ADH also called sometimes vasopressin this hormone plays a huge huge role in SI 88 and diabetes insipidus and they work in the opposite of them in Si 88 you're going to have an increase antidiuretic hormone in di diabetes insipidus you're going to have a decrease so first let's figure out the function of this hormone because if we know what it does normally then it'll help us understand what happens whenever there's too much of it or there's not enough of it okay first what is the function of ADH what it does is it played a major role in regulating the amount of water in the body so it likes to keep your body nice and level with its water and it constricts blood vessels so how does this do this okay what system ask yourself what system in the body helps regulate how much water we keep and how much we lose the kidneys so it accomplished this with the kidney and what ADH does is it causes the renal tubules to retain water whenever it's being released so that's how it does it so for instance so that and you have a lot of antidiuretic hormone in the body it's going to cause those radial renal tubules to keep water so you're going to have increased water in the body because it's not getting rid of it but if you don't have a lot of the ADH hormone antidiuretic hormone in the body it's going to cause the kidneys to be like hey let's just get rid of this and you're going to be losing too much water and we'll go over this in depth here in a second but let's look at the brain because areas of the brain are responsible for regulating your antidiuretic hormone okay in the brain you had your famous and right below the thalamus you have the hypothalamus that's where hypo comes in below so it's right below the thalamus and the thalamus is responsible for producing this antidiuretic hormone so it also plays a role in thirst whenever you get thirsty your cell your thalamus kicks in and says hey let's make the body have the urge to get something to drink now right below the hypothalamus is the pituitary gland and the pituitary gland splits into two areas you have the anterior posterior a pituitary gland then you have the posterior pituitary gland now what we want to pay attention to is the posterior pituitary gland because this is what plays a role in your ADH secretion and storing ADH so let's cover this again because you want to remember this your hypothalamus produces antidiuretic hormone now it signals to the posterior pituitary gland to secrete it and that is where it's stored so just commit that to memory now let's look at these two conditions since we understand how ADH works in the body let's look at what happens whenever there's too much or there's not enough of it okay first let's go over SIADH again SIADH cs4 syndrome of inappropriate antidiuretic hormone now how do you remember which ones increase in which ones decrease that's the big issue right well how I remember it is buy this little mnemonic this anchor acronym thing okay s ia th you have the eye in the middle and I just remember that I for increase ADH and then I know it's complete opposite for diabetes insipidus so we have increase ADH here and decrease ADH here so that will help you remember and then everything else literally makes sense okay now what causes for SIADH for this antidiuretic hormone to be over secreted well usually what's happened is either the hypothalamus has been damaged because remember that produces or antidiuretic hormone or it's being produced somewhere else in the body what else in the body could produce the antidiuretic hormone mimic it well one of the number one causes of SI 88 is lung cancer it's one of the first signs that a patient actually gets they maybe will go into the doctor they'll be presenting with this and the doctor will further look at it and we'll actually see maybe small cell lung cancer in the lungs because the cancer is causing to throw is causing the antidiuretic hormone to be over produced so that is I would remember that that's a huge cause of this condition also again damage to the hypothalamus or the posterior pituitary gland because those are responsible for your ADH regulation infection as well can cause it any really infections in the lungs such as pneumonia or in the neuro system like meningitis and other neuro systems like Gilliam Bray syndrome and of course medications can cause this as well and what you'll want to remember ones particular medication it's actually used to treat diabetes insipidus because this medication has properties to increase the diuretic hormone because again you want to increase the diuretic hormone in diabetes insipidus but if you increase it too much you can send them in SIADH and it's called diabetes or the generic name is chloraprep amide and again it just has those properties that increases the diuretic antidiuretic hormone now let's look at the opposite and diabetes insipidus what are the causes of that okay with this you have the decrease antidiuretic hormone and usually what's called causing this is there is either a problem with the kidneys because remember back in this part your kidneys are responsible for helping retain or getting rid of that water and it's sensitive to the antidiuretic hormone whatever that antidiuretic hormone tells the kidneys to do they do it so either there's an issue of the kidneys the patient's taking a medication that's causing it or the patient's pregnant which will go in that here in a second it usually in the last trimester or there's been trauma to the brain or the hypothalamus of the posterior pituitary gland so on the kidneys like I said they're usually not receptive to the ADH so it's like hey we don't see any ADH anymore and so we're just going to get rid of all this fluid because remember ADH helps you keep water and damage to the hypothalamus or pituitary gland it's not working appropriately so it's not sending those right signals and drugs remember this stroke decla myosin this is actually a treatment for SIADH and what it does it has properties it's part of the tetracycline the antibiotics family but it's really a cool drug and what it does is it causes the antidiuretic hormone to be inhibited so it has properties to do that so if you're taking this drug it could cause diabetes insipidus I'm just a tional whenever I'm the patient's pregnant the placenta which is responsible for producing all those hormones and can produce too much of what's called vasopressin ace and this actually causes the antidiuretic hormone to break down so you have no more antidiuretic hormone and the patient's just urinating like crazy and losing lots of fluids okay so how do these patients present with these conditions okay this right here it literally if you can understand the antidiuretic hormone these signs and symptoms of what you're seeing make sense just common sense okay so again let's recap SIADH remember the eye you have increased antidiuretic hormone antidiuretic hormone what does it do it retains water so when you are retaining too much water you're going to have water intoxication all over the body so how's this patient going to look they are going to have fluid overload too much water in the vascular system so it's going to be backing up everywhere you're going to have a Deema the patient's going to have drastic weight gain and high blood pressure from where you have all that extra fluid in the body and there's just way too much pressure going throughout the body you're going to have a fast heart rate from where the body is trying to compensate for all that fluid so they're gonna be tachycardic and you're going to have hyponatremia we talked about in that in the fluid and electrolytes video this is actually that euvolemic hyponatremia where there's an increase of water in the body but the sodium stays the same and what's happening is that the sodium is actually diluted because of all that water so the sodium level really didn't change it just call it diluted from conserving all that water and confusion patient will be confused because they have all that water the brain tissue is very sensitive to extra water so you're gonna have swelling in the brain that can be confused with argit at risk for seizures again that goes back to the brain swelling anorexia because they are so full of water they don't want to eat probably a lot of pressure on the stomach causing them not to feel hungry and another one this is very important they're going to have a low urine output and whenever they do urinate which isn't very often because they're conserving water remember the kidneys are like hey we have all this antidiuretic hormone going on in the body let's not pay because we got to keep all this in the body the whenever they do urinate the urine is going to be very concentrated so another way to say urine is concentrated that's going to have a they're going to have a high urinary specific gravity so now let's flip over and let's look at the opposite because remember these two conditions present oppositely of each other okay how's this patient going to look with diabetes insipidus they're the opposite they have not enough of the antidiuretic hormone whenever you don't have enough your kidneys are like hey we don't have enough of this so let's lose a lot of water we're going to get rid of all this water through the renal tubules so how do you water with the kidneys one of the kidneys ooh they cause you to urinate a lot and whenever people have diabetes insipidus they urinate up to four liters of 24 litres of fluid a day which is lots of fluid now to compensate for that they're going to have polydipsia which is increase in drinking this they're going to literally crave water and ice because they've lost all this water and the body's like hey we got to get some water back so they are going to just drink and drink and drink and try to hydrate themselves but they can't hydrate themselves because they're losing so much water through the kidneys and they're actually dehydrated you're going to see dry mucous membranes skin is going to be dry their skin turgor is going to be degree decreased and they're also going to have hypotension and this is because they've literally urinated all their fluids out and there's hardly anything for the body to pump the pressures want to be low and again remember back to the beginning and one of the things that antidiuretic hormone does is it constricts blood vessels that's another one of its properties so here you have opposite you don't have enough so you have dilation when you have dilation you have low blood pressure now remember back here you had hypertension in SIADH and that is again due to all the extra fluid but due to the constriction as well I'm here whenever because they're going to be urinating constantly like 24/7 their urine is going to be super diluted it's not going to be concentrated so they're going to have a low urinary specific gravity and they are going to be having hypernatremia they're going to have a high sodium level due to losing all that fluid all that fluids gone and all that's left is that sodium so there's going to be a lot of sodium in the body and not a lot of water now let's look at what you're going to do for this patient for your nursing interventions now two nursing management okay things you want to pay attention to this because a lot of questions like to hit on and they'll give you scenarios and you either going to educate the patient and see what statements correct what's not side effects of drugs and things like that so you want to make sure that you're looking at the education piece says and you're looking at those common side effects for the treatment that the physician may order so let's go over this okay for both of these conditions what you're going to do is you're going to make sure that you're getting daily weights on these patients that you are watching and their intake and output very strictly if the patient's alert and oriented have them participate in this because you want to make sure that you are writing down exactly what they are taking in and putting out and their safety because these patients are definitely at risk for safety issues either an SIADH due to all the brain tissue swelling water intoxication or diabetes insipidus they're getting up urinating a lot they're becoming dehydrated and hypo and hyper in the tree Nia can extenuate that confusion okay so for SIADH remember they have way too much fluid in the body because they have too much antidiuretic hormone which causes you to retain fluid so we are going to put them on a fluid restriction actually the doctor will order this and you will implement this and so you want to make sure that they follow the fluid restriction for diabetes insipidus as the nurse you want to make sure that they are not consuming any products like families bringing in or the patient themselves has ordered it on a tray foods that promote natural diuresis like watermelons lemons grapes foods like that that promote the body to naturally urinate and a big thing I would remember this is caffeine so teas and coffees and energy drinks things like that really promote diuresis so you don't want patients with diabetes insipidus to be taking that in now typical medical treatments let's go over the SIADH and what i would pay attention to is the side effects of these medications okay so our goal with SIADH is to remove the fluid we got to get them back to a good fluid status so typically what a physician may order is a loop diuretic remember we talked a little bit about diuretics at the beginning diuretics promote diuresis and they have too much antidiuretic hormone in this condition so they are not diary seen at all they're keeping all that water so this lasix Lices lasix is a loop diuretic is going to go in either IV or Pio and cause the patient to urinate that fluid off but what you got to watch out for that is that loop diuretics like to waste potassium whenever they're urinating so watch out for hypokalemia and always check your potassium levels before you give your next dose of lasix and also sometimes with that the physician may order a hypertonic IV solution like three percent saline we went over this in the hypo isotonic and hypertonic video we talked about how hypertonic solutions work on the body and it's really neat so let's go over that real quickly what's happened remember we have way too much fluid in the body those cells are swelling and what hypertonic solutions do they go in and they cause that fluid to be come out of that cell to shrink back down to normal and whenever that fluid comes out it's going to enter back into the vascular system so you can hopefully urinate that out with the help of that diuretic that there also started on as well but what you got to watch out for is the patient's already fluid water intoxicated with this condition so whenever you add the hypertonic solution on to it it you can cause more water intoxication because you're drawing all that water out to that of that cell so you've got to watch out for worsening of that fluid overload like all of a sudden you're hearing crackles they have difficulty breathing their o to saturations or going down things like that so watch out for that and when you give this medication usually they like to give it an ICU because it's one of those where you need to watch the patient very closely and get it slowly per your hospital protocol and usually through a central line because it's hard on the veins another treatment and which is another popular treatment for this condition is the decla myosin we talked about that a little bit earlier this is actually an antibiotic and the tetracycline family so think back to that and what this actually does it has properties of inhibiting the antidiuretic hormone so the patient takes this and it causes that over secretion of antidiuretic hormone to quit mean so much release and it promotes diuresis so one thing you need to watch out for this is of course with the tetracyclines you do not want to give this with calcium containing foods like milk and acids because it affects how the DI system absorbs the drug now to the medical treatment of diabetes insipidus what are what's going to be ordered by the physicians usually for these conditions okay for a mild case of di and it's not as popular due to the side effects is diabetes or the generic name chloraprep amide and what this actually is is a type 2 diabetic medication now diabetes insipidus and diabetes mellitus where patients have hyperglycemia hypoglycemia and things like that the require insulin is two completely different disease processes they are not alike even though they share the name diabetes so do not get di confused with diabetes mellitus okay so what does dive dive Bernese do diabetes and what actually does is it increases it has properties of increasing the diuretic hormone so um but a side effect of that whenever the patient takes this they don't have diabetes but it's going to increase or diuretic hormone because they're low in the diuretic hormone they can experience symptoms of hypoglycemia will drop their blood sugar so remember this with this drug you've got to watch these patients glucose levels very very closely and teach them about signs and symptoms of hypoglycemia and it causes the skin to be photosensitive to the Sun so they need to cover up whenever they go outside because their skin is a lot more susceptible to burns okay next another treatment is a medication called des o prescient this is actually a form of a fo press and remember vasopressin is also naturally occurring in the body as the it's also called antidiuretic hormone so this is just a form of an antidiuretic hormone replacement and so the patient takes this they can take this by mouth IV in the nasal passages things like that and it's also called signing so the patient will take it it's usually in extreme cases who are struggling with this and when what you need to watch for as the nurse is for signs of hyponatremia and because what you're doing is you're 9 to give the patient more antidiuretic hormone remember what does antidiuretic hormone duck do it conserves water so the patient's conserving water they're at risk for getting water intoxication which will dilute those sodium levels so you need to watch out for that okay so that is about diabetes insipidus and SIADH now go take that quiz on my website register nurse Orion comm and see how well you grasp this material and thank you so much for watching and please consider subscribing to this YouTube channel

Channel: RegisteredNurseRN

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Keywords: siadh vs diabetes insipidus, siadh nursing, siadh khan academy, siadh pathophysiology, siadh song, siadh vs di, siadh and di, diabetes insipidus, diabetes insipidus nursing, diabetes insipidus khan academy, diabetes insipidus pathophysiology, diabetes insipidus song, diabetes insipidus and siadh, registerednursern.com, syndrome of inappropriate antidiuretic hormone, endocrine system nursing, endocrine system nclex

Id: OxIl1r3N-hk

Length: 20min 32sec (1232 seconds)

Published: Wed Apr 06 2016