Last updated on May 18th, 2022 at 10:26 am
SIADH Nursing Care Plans Diagnosis and Interventions
SIADH NCLEX Review and Nursing Care Plans
Syndrome of inappropriate antidiuretic hormone (SIADH) is a medical condition characterized by low serum sodium levels (hyponatremia), blood dilution, and urine concentration.
SIADH results in fluid retention in the body and imbalance of electrolytes. The volume of the blood remains stable (euvolemia), but the blood is more dilute than normal.
There is an impaired free water excretion in SIADH, due to the increased production of arginine vasopressin (AVP), an antidiuretic hormone (ADH).
The symptoms of SIADH are usually neurological, which include altered mental status, coma, and seizures.
Signs and Symptoms of SIADH
- Hypertension
- Nausea or vomiting
- Cramps or tremors
- Depressed mood
- Memory impairment
- Altered mental status
- Irritability
- Personality changes, such as confusion, combativeness, and hallucinations
- Seizures
- Stupor or coma
Causes of SIADH
SIADH is usually a complication of nervous system disorders, which include head trauma, epilepsy, and Guillain-Barre syndrome. It can also be caused by cancer of the brain, gastrointestinal, pulmonary, or genitourinary systems. SIADH occurs when there is a stimulation of the hypothalamus to produce higher than normal levels of the antidiuretic hormone AVP. When this happens, the kidneys are signaled to retain fluid in the tubules and remove more sodium from the body. Electrolyte imbalance, urine concentration, and blood dilution eventually occur.
Complications of SIADH
- Cerebral edema. Severe hyponatremia can result from untreated SIADH. This can lead the water to enter the brain cells, resulting to swelling. The brain becomes compressed when swollen because it is enclosed by the skull.
- Noncardiogenic pulmonary edema. The tissues lining the lungs may swell, causing the fluid to enter the alveoli and other lung tissues. This can be associated with increased intracranial pressure due to severe hyponatremia.
Diagnosis of SIADH
- Physical examination and history taking – to check for neurological symptoms of SIADH
- Urinalysis – to check for urine concentration by means of measuring urine sodium and osmolality levels
- Blood test – Biochemistry to check for the level of sodium (normal serum sodium level is 135-145mEq/L); ADH test – to measure the level of circulating ADH in the body (normal ADH range is 0-5 picograms/mL)
Treatment for SIADH
- Fluid and water restriction. This is the most common treatment for SIADH and is needed to stop the buildup of excess fluid in the body.
- Vasopressin antagonists. These medications block the action of the vasopressin ADH. Some examples of vasopressin antagonists include conivaptan (Vaprisol) and tolvaptan (Samsca). Other medications may be prescribed to help in the regulation of fluid volume in the body.
- Surgery. Severe and/or chronic SIADH may require surgical intervention wherein the surgeon removes the tumor that produces ADH.
Nursing Diagnosis SIADH
Nursing Care Plan for SIADH 1
Nursing Diagnosis: Electrolyte Imbalance (Hyponatremia) related to the disease process of SIADH as evidenced by nausea, vomiting, serum sodium level of 160 mEq/L, irritability, and fatigue
Desired Outcome: Patient will be able to re-establish a normal electrolyte and fluid balance.
| SIADH Nursing Interventions | Rationale |
| Obtain a urine sample and blood samples from the patient. | -Urinalysis – to check for urine concentration by means of measuring urine sodium and osmolality levels -Blood test – Biochemistry to check for the level of sodium (normal serum sodium level is 135-145mEq/L); -ADH test – to measure the level of circulating ADH in the body (normal ADH range is 0-5 picograms/mL) |
| Place the patient on fluid restriction as per the physician’s order. | Fluid restriction helps to prevent more buildup of fluid in the body. |
| Start a strict input and output monitoring. | To accurately measure the input and output of the patient and to ensure that fluid restriction is performed. |
| Administer vasopressin antagonists as prescribed. | To block the action of the vasopressin ADH. Some examples of vasopressin antagonists include conivaptan (Vaprisol) and tolvaptan (Samsca). |
Nursing Care Plan for SIADH 2
Nursing Diagnosis: Imbalanced Nutrition Less than Body requirments related to nausea, vomiting, weakness, loss of appetite, and verbalization of decreased energy levels
Desired Outcome: The patient will be able to achieve a weight within his/her normal BMI range, demonstrating healthy eating patterns and choices.
| SIADH Nursing Interventions | Rationale |
| Explain to the patient the relation of SIADH to nausea and vomiting and loss of appetite. | To help the patient understand why nausea and vomiting associated with loss of appetite is one of the signs of SIADH. |
| Create a daily weight chart and a food and fluid chart. Discuss with the patient the short term and long-term goals of weight loss. | To effectively monitory the patient’s daily nutritional intake and progress in weight loss goals. |
| Help the patient to select appropriate dietary choices to follow a high caloric diet. | To increases the caloric intake of the patient that can be used by the body to increase energy levels and be able to perform ADLs. |
| Refer the patient to the dietitian. | To provide a more specialized care for the patient in terms of nutrition and diet in relation to newly diagnosed SIADH. |
Nursing Care Plan for SIADH 3
Nursing Diagnosis: Deficient Knowledge related to new diagnosis of SIADH as evidenced by patient’s verbalization of “I want to know more about my new diagnosis and care”
Desired Outcome: At the end of the health teaching session, the patient will be able to demonstrate sufficient knowledge of SIADH and its management.
| SIADH Nursing Interventions | Rationales |
| Assess the patient’s readiness to learn, misconceptions, and blocks to learning (e.g. denial of diagnosis or poor lifestyle habits)To address the patient’s cognition and mental status towards the new diagnosis of SIADH and to help the patient overcome blocks to learning. | |
| Explain what SIADH is, and how it affects the vital organs such as the kidneys, brain, and lungs. Avoid using medical jargons and explain in layman’s terms. | To provide information on SIADH and its pathophysiology in the simplest way possible. |
| Educate the patient about hyponatremia. Inform him/her the target range for serum sodium levels. | To give the patient enough information on the hyponatremia and its effects to the body. The normal serum sodium level is 135-145mEq/L. |
| Teach the patient on how to perform fluid restriction and input and output monitoring. | To empower patient to monitor his/her fluid restriction and input/output. |
| Inform the patient the details about the prescribed medications (e.g. drug class, use, benefits, side effects, and risks) to block the ADH action, and explain how to properly self-administer each of them. Ask the patient to repeat or demonstrate the self-administration details to you. | To inform the patient of each prescribed drug and to ensure that the patient fully understands the purpose, possible side effects, adverse events, and self-administration details. |
Nursing Care Plan for SIADH 4
Fluid Volume Excess
Nursing Diagnosis: Fluid Volume Excess related to impaired water secretion secondary to SIADH as evidenced by crackles upon auscultation, edema, oliguria, shortness of breath, tachycardia, and restlessness.
Desired Outcomes:
- The patient will be able to maintain an adequate urine production of more than or equal to 30 mL/hr.
- The patient will have a constant weight and a balanced intake and output.
- The patient will be able to demonstrate a maintained heart rate between 60 and 100 beats per minute.
- The nurse will be able to determine an absence of pulmonary crackles upon auscultation, which may indicate that the patient’s lungs are clear.
- The patient will be able to express knowledge of the circumstances that cause fluid excess as well as the actions that are necessary to correct the symptoms.
| SIADH Nursing Interventions | Rational |
| Determine the patient’s medical history to figure out what’s causing the SIADH. | Reviewing the patient’s medical history can aid in the treatment plan by identifying the cause. Increased fluid or salt consumption may have occurred in the past. |
| Monitor the patient’s weight and advise the patient that the weight should be checked on a regular basis, preferably at the same time of day and with the same amount of clothing on. | Fluid retention can be caused by rapid weight gain. Weight differences between scales and clothes are possible. |
| Monitor the patient’s input and output. | Even if the fluid intake is adequate, fluid shifting might cause dehydration. |
| Examine the patient’s weight in relation to dietary needs. | Weight may be a poor indicator of fluid volume status in certain patients. Poor nutrition and a decrease in appetite cause weight loss over time, which may be accompanied by fluid retention despite the fact that the net weight stays the same. |
| Keep track of the patient’s intake. If the patient is on a hydration restriction. | When having restrictions, patients should be reminded to incorporate things like gelatin, sherbet, soup, and frozen juice pops that are liquid at room temperature in the diet. |
| Monitor and record the patient’s blood pressure and heart rate regularly. | Early signs include sinus tachycardia and elevated blood pressure. |
| Palpate the patient’s tibia, ankles, feet, and sacrum for the presence of edema. | Fluid collects in the extravascular spaces, causing edema. Edema indications appear more frequently in dependent regions. Another method of edema measurement is using a measuring tape to measure an extremity. |
| Auscultate the patient’s lungs for crackles, changes in breathing patterns, shortness of breath, and orthopnea. | A buildup of fluid in the lungs may be indicated by these symptoms. |
| Assess the patient’s S3 and bounding peripheral pulses. | The result of the assessment may indicate signs of fluid overload. |
| Assess the patient, determine the presence of ascites and swollen neck veins. | CVP elevation causes distended neck veins. When fluid collects in extravascular spaces, ascites develop. |
| Instruct the patient, caregiver, and family members about the patient’s fluid limitations. | Patients who will be co-managing fluids require information and expertise about the medical condition. |
| Keep the patient on a low-salt consumption diet as advised. | Sodium restriction helps to reduce fluid retention. |
| Educate the patient and the family about the medical condition and explain the possible cause, signs and symptoms, and management. | Having knowledge will allow the patient and the family to fully understand the treatment plan and will be able to participate in resolving the issue. |
| Explain to the patient the treatment programs designed for individual care and anticipated results. | The patient or caregiver will be responsible for follow-up care. Information is required to make informed decisions in the future. |
| Explain to the patient why anti-embolic stockings or bandages must be worn as directed. | These will enhance venous return and reduce fluid retention in the extremities. |
| Educate the patient and the family about the need for good nutrition, hydration, and dietary changes. | Knowledge heightens compliance with the treatment plan and a well-balanced diet is necessary for the patient’s recovery. |
| Position the patient and elevate and handle edematous extremities with care. | Elevating the extremity will promote venous return to the heart, which reduces edema. Skin that is edematous is more prone to injury. |
| Assist the patient with repositioning every 2 hours if the patient is not mobile. | Fluid buildup in dependent regions is avoided by repositioning the patient. |
Nursing Care Plan for SIADH 5
Nursing Diagnosis: Acute Confusion related to chronic hyponatremia secondary to SIADH, as evidenced by a decrease in psychomotor activities, increased restlessness, hallucinations, and unwillingness to participate in treatment plan.
Desired Outcomes:
- The patient will be able to have a normal serum sodium level.
- The patient will be able to have a normal state of consciousness and orientation
- The patient will be able to express knowledge about the disease and participate in the treatment plan.
- The patient will be able to perform daily activities.
| SIADH Nursing Interventions | Rationale |
| Assess the patient’s mental health status that covers the following: Overall appearance, demeanor, and attitude, observations of behavior and level of psychomotor behavior, mood and affect, insight and judgment, cognition, time, place, and person orientation, thought process and content. | Confusion is associated with abnormal attention, which is a key diagnostic feature. Agitation is a behavioral symptom of delirium, which is a mental state. Some patients may be confused without being agitated and may even be withdrawn. This is a type of delirium that is less active. Some people experience a delirium that is both hypoactive and hyperactive. |
| Assess the patient’s behavior and cognition on a regular basis, as needed, during the day and night. | Confusion always entails a rapid shift in mental status; consequently, knowing the patient’s baseline mental status is critical in determining whether or not they are delirious. |
| Examine and describe the patient’s physiological changes that occur such as sepsis, hypoglycemia, hypotension, infection, changes in temperature, fluid and electrolyte imbalances, and medications. | These changes may be causing the confusion and should be addressed. |
| Assess the patient for the severity of the impairment in orientation, attention span, capacity to follow directions, send/receive communication, and response appropriateness. | This is necessary to establish the severity of the disability and determine the proper treatment plan. |
| Record the occurrence of the patient’s agitation, hallucinations, and violent actions, Sundown syndrome should be considered. | This confusion-related phenomena occurs in the late afternoon. The patient is becoming increasingly restless, agitated, and confused. Sleep problems, hunger, thirst, or unmet toileting needs could all be signs of sundowning. |
| Assist in the treatment of the patient’s underlying issue most especially the hyponatremia. | It is critical to focus on the underlying problem’s treatment to maximize function and avoid additional deterioration. |
| Orient the patient to the environment, staff, and appropriate tasks. Present the facts concisely and briefly. Avoid criticizing irrational thinking because defensive reactions may occur. | Increased orientation provides the patient with a higher level of safety. |
| Provide a tranquil environment for the patient by removing distracting sounds and stimuli. | The disoriented patient may misinterpret increased amounts of visual and auditory stimuli that will increase confusion. |
| Encourage the patient’s family and significant others to take part in the reorientation process and to provide continuing feedback on the current news and family happenings. | The confused patient may not fully comprehend what is going on. The presence of relatives and significant others may help the patient to relax. |
| Provide clear instructions to the patient, given enough time to respond, communicate, and make decisions. | This type of communication can help to alleviate anxiety in unfamiliar situations. |
| Avoid posing questions to irrational thinking. | Challenges to the patient’s thinking can be interpreted as dangerous, leading to a defensive response. |
| Encourage the patient to maintain normal fluid and electrolyte balance; establish/maintain normal nutrition, body temperature, supplementary oxygen should be administered if needed, monitor blood glucose levels, and blood pressure. | These will help in treating the underlying causes of confusion and maintaining a normal fluid will help prevent further fluid buildup. |
| All healthcare providers should be informed about the patient’s condition, cognition, and behavioral manifestations. | Recognize that the patient’s erratic cognition and conduct are a symptom of delirium and should not be misinterpreted as a preference for caregivers. |
| Offer the patient reassurance and employ therapeutic communication on a regular basis. | Nursing skills such as patient reassurance and communication help to build trust and minimize the patient’s anxiety. |
| Assist the family and significant others in establishing coping mechanisms. | The family must allow the patient to do all possible to improve the patient’s level of functioning and quality of life. |
| Teach the patient’s family how to identify early indications of confusion and seek medical treatment. | Early interventions for confusion help to avoid further complications. |
Nursing Care Plan for SIADH 6
Nursing Diagnosis: Nausea related to gastric distention secondary to SIADH, as evidenced by stomach upset, excessive salivation, gagging sensation, and verbal reports of nausea.
Desired Outcome:The patient will be able to verbalize decreased severity or total elimination of nausea and stomach upset.
| SIADH Nursing Interventions | Rationale |
| Examine the characteristics of the patient’s nausea and vomiting including history, duration, frequency, severity, precipitating factors, medications, and methods used to ease the problem. | An in-depth assessment and evaluation of nausea and vomiting can aid in the development of therapies to alleviate or reduce the problem. |
| Monitor and record the patient’s hydration, weights, blood pressure, intake and output, and skin turgor. | Nausea is frequently associated with vomiting, which can result in a change in a patient’s hydration status due to fluid loss. |
| Make a conducive environment for the patient, remove any strong scents from the area like perfumes, dressings, and emesis. | Strong and unpleasant odors can make the patient sicker. |
| Maintain the patient’s fluid balance. | It has been proven that adequate hydration reduces the likelihood of nausea but keeping the fluid level according to the patient’s restrictions. |
| Allow the patient to use non-pharmaceutical nausea and vomiting management methods including relaxation, guided visualization, music therapy, distraction, or deep breathing exercises. | These techniques have benefited patients with their symptoms, but they must be employed before the nausea and vomiting occur. |
| Advise the patient to stay away from foods and scents that may trigger nausea and vomiting. | Strong and unpleasant odors can make the patient feel sicker. |
| Advise the patient to maintain an upright position during the mealtime and for 1 to 2 hours afterward. | Positioning may be beneficial in lowering the risk. |
| Maintain enough ventilation in the patient’s room and assist the patient in getting some fresh air if at all possible. | Breathing is much simpler in a well-ventilated area or with a fan nearby. |
| Educate the patient or caregiver on how to deal with nausea by providing proper liquids and nutritional options. | Patients and caregivers can help patients maintain proper hydration and nutrition by being aware of food considerations to consider when the patient is nauseated. |
| Educate the patient on the importance of taking prescription drugs exactly as prescribed. | Medication administration according to the doctor’s instructions decreases nausea and vomiting. |
| Discuss with the patient the importance of shifting postures carefully and gradually. | Acute or jerky motions can aggravate the problem. |
| Evaluate the patient’s response to antiemetics or other treatments to help alleviate the symptoms and feel better. | This method can be used to assess the effectiveness of such interventions. |
| Educate the patient and caregiver on how to use acupressure or stimulation bands. | If the intervention was determined to be useful and effective, patients and caregivers may wish to continue. |
| Advise the patient or the caregiver to seek immediate medical help if the patient experiences vomiting that lasts more than 24 hours. | Dehydration, electrolyte imbalance, and dietary deficiencies can all be caused by persistent vomiting. |
| Offer the patient dry foods like crackers or toast, bland, basic foods like broth, rice, bananas, or jelly frequently in small, tolerable amounts. | This method will help in the maintenance of nutritional status of the patient. An empty stomach can make nausea worse for certain patients. These foods may be tolerated by patients. |
| If tolerated and acceptable to the patient’s diet, introduce cold water, ice chips, ginger items, and room temperature broth or bouillon. | These help with hydration. Ginger, whether in the form of ginger ale, ginger tea, or candied ginger, can assist to reduce nausea. Fluids that are too cold or hot might be uncomfortable to drink. |
More Nursing Diagnosis for SIADH
- Elimination disorders related to a decrease in urine volume
- Disturbed Thought Processes
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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