SIADH Nursing Interventions Diagnosis and Care Plans

SIADH Nursing Diagnosis Care Plan NCLEX Review

Nursing Study Guide for SIADH

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

  1. 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.
  2. 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

  1. 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.
  2. 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.
  3. Surgery. Severe and/or chronic SIADH may require surgical intervention wherein the surgeon removes the tumor that produces ADH.

Nursing Care Plans 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.

InterventionRationale
Obtain a urine sample and blood samples from the patient.Urinalysis – to check for urine concentration by means of measuring urine sodium and osmolality levelsBlood 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).  
SIADH Care Plan 1
  • Nursing Diagnosis: Imbalanced Nutrition Less than Body 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.

InterventionRationale
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.  
SIADH Care Plan 2
  • 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.

InterventionsRationales
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.
SIADH Care Plan 3

Other Nursing Diagnoses:

  • Excess Fluid Volume
  • Elimination disorders related to a decrease in urine volume
  • Disturbed Thought Processes
  • Nursing resources

References

Nursing resources

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. (2017). 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. (2018). 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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