A client is experiencing diabetes insipidus as a result of cranial surgery. The nurse who is caring for the client plans to implement which of these anticipated therapies?

Appeared in: DHS 2018 shift 1st

Explanation

Diabetes insipidus (DI) is characterized by a deficiency of antidiuretic hormone (ADH), leading to the excretion of large volumes of dilute urine (polyuria).
This massive fluid loss places the client at high risk for severe dehydration, hypovolemia, and elevated serum sodium levels (hypernatremia).
The primary goal of therapy is to replace the lost fluid volume to prevent circulatory collapse and correct electrolyte imbalances.
In a postoperative client who may have an altered level of consciousness or be unable to drink enough to compensate, intravenous fluid replacement is the most critical and anticipated intervention.

Option A: Fluid restriction is the treatment for the opposite condition, Syndrome of Inappropriate Antidiuretic Hormone (SIADH), where there is too much ADH causing water retention. In DI, restricting fluids would lead to rapid and severe dehydration.
Option B: While thiazide diuretics are used paradoxically to treat nephrogenic DI (a renal issue), they are not the primary treatment for central DI, which is a pituitary/hypothalamic issue. The priority for central DI is hormone and fluid replacement.
Option C: Clients with DI are already at high risk for hypernatremia (high sodium) because they are losing large amounts of free water in their urine. Increasing sodium intake would worsen this dangerous electrolyte imbalance.

Clinical Relevance

Nursing practice connection: Use the key finding related to Management of Central Diabetes Insipidus to guide bedside assessment, documentation, and the next nursing action.
A nurse's primary role in managing a patient with new-onset DI post-cranial surgery is meticulous monitoring of fluid balance. This includes hourly intake and output, daily weights, and frequent assessment of vital signs for tachycardia and hypotension.
The nurse must assess for signs of dehydration, such as poor skin turgor, dry mucous membranes, and changes in mental status, and report them immediately.
Patient safety is paramount. The patient must have continuous access to water if they are conscious and able to drink. For unconscious or NPO patients, IV fluid replacement must be diligently maintained.

How to Approach the Question

First, identify the key diagnosis in the question stem: 'diabetes insipidus'.
Next, note the clinical context: 'as a result of cranial surgery'. This points specifically to central DI, caused by a lack of ADH from the pituitary gland.
Recall the core pathophysiology of DI: Without ADH, the kidneys cannot reabsorb water, leading to massive excretion of dilute urine (polyuria).
Consider the primary consequence of this pathophysiology: significant fluid volume deficit (dehydration) and concentration of serum electrolytes (hypernatremia).
Evaluate each option based on its effect on fluid balance. The most logical intervention must counteract the massive fluid loss.
Fluid restriction, diuretics, and increased sodium would all worsen the patient's condition. Therefore, replacing the lost fluid is the only correct and safe intervention.

Concept Tested & Keywords

Concept Tested: Management of Central Diabetes Insipidus
Stem keywords: diabetes insipidus, cranial surgery, anticipated therapies
Lead-in keywords: plans to implement
Clinical cues: The context of 'cranial surgery' is a strong indicator for central (or neurogenic) diabetes insipidus, which is caused by a deficiency in ADH production or release.

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E6 Nursing Brunner Adult Health 3SA Vol 1 Part 4 p. 11-13

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 1177-1179

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 1 p. 148-150

Practise the full DHS 2018 shift 1st

Attempt every question from this paper in a timed mock, then review the full solution for each one.