Question

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Ed is a 17-year-old football player who experienced a head injury while playing football. Ed was diagnosed with traumatic brain injury (TBI) and is currently undergoing TBI rehabilitation.

1. What signs and symptoms would alert the nurse to the possible post-trauma complication of diabetes insipidus (DI)?
2. What laboratory findings are consistent with DI?

The primary care provider has prescribed desmopressin, 10 mcg nasally every 8-12 hours.

3. What teaching points should the nurse provide to Ed regarding nasal inhalation of desmopressin?

Answer 1

Signs and symptoms of diabetes insipidus include:

Extreme thirst

Producing large amounts of diluted urine

Frequent need to get up to urinate during the night

Preference for cold drinks

If your condition is serious, urine output can be as much as 20 quarts (about 19 liters) a day if you're drinking a lot of fluids. A healthy adult typically urinates an average of 1 or 2 quarts (about 1 to 2 liters) a day.

An infant or young child with diabetes insipidus may have the following signs and symptoms:

Heavy, wet diapers

Bed-wetting

Trouble sleeping

Fever

Vomiting

Constipation

Delayed growth

Weight loss

Diabetes insipidus (DI) is a disorder characterized by excretion of large volumes of hypotonic urine. The underlying cause is either a deficiency of the hormone arginine vasopressin (AVP) in the pituitary gland/hypothalamus (central DI), or resistance to the actions of AVP in the kidneys (nephrogenic DI). In most circumstances, DI is also characterized by excessive consumption of water (polydipsia). A third condition called primary polydipsia can clinically show overlapping features with DI. Both DI and primary polydipsia are collectively referred to as ‘polyuria-polydipsia syndromes. Like other endocrine disorders, an accurate diagnosis of DI can be challenging. This is mainly because the results obtained from diagnostic testing can show significant overlap among the different forms of DI and primary polydipsia

patient whose clinical presentation suggests diabetes insipidus .laboratory tests must be performed to confirm the diagnosis. A 24-hour urine collection for determination of urine volume is required. In addition, the clinician should measure the following:

Serum electrolytes and glucose

Urinary specific gravity

Simultaneous plasma and urinary osmolality

Answer:Hypotension, decreased pulse pressure, weak peripheral pulses, polyuria, polydipsia, and nocturia, as well as decreased skin turgor and cracked or dry mucous membranes.Rationale:Water loss is a concern for patients who develop DI; signs and symptoms will mirror those found in patients who are dehydrated.2.answer:Increased hemoglobin and hematocrit; increased BUN; excessive urine output (> 4 L and greater than the amount of intake); diluted urine; low specific gravity (< 1.005), hypo-osmolarity (50 to 200 mOsm/kg).Rationale:Laboratory manifestations will be consistent with dehydration.The primary care provider has prescribed desmopressin, 10 mcg nasally every 8-12 hours. Answer:The nurse should teach the importance of blowing the nose before taking the medication nasally, sitting upright before administration, and holding the breath while spraying into the nostril. In addition, the nurse should teach the patient to inform the primary care provider abnormal adverse effects of the drug. The patient can also be informed to discuss the medication with the pharmacist. Rationale:Nasal administration of desmopression indicates that the drug will be absorbed through the nasal mucosa. Blowing the nose prior to administration decreases the amount of nasal secretions that could interfere with absorption; sitting upright and holding the breath keeps the drug in contact with thenasal mucosa, as opposed to allowing it to run down the throat, which in turn increases absorption.