Chapter 18 | Endocrine Disorders 431
● Urine and blood are collected early in the day and tested for osmolarity and electrolytes. Then the child is deprived of water intake until significant dehydration occurs. ● The child is weighed every 2 hours until 3% to 5% of body weight is lost. The test is carried out for no more than 8 hours. Once completed, the child will be given desmo- pressin, and urine and blood tests are collected 4 hours later. During that time the child is allowed to drink 1.5 times the amount of fluid that they lost during the test. ● During the test, vital signs are carefully monitored for signs of hypotension and fever (Donaldson et al, 2019). Evidence-Based Practice Research Elder, C., & Demitri, P. J. (2017). Diabetes insipidus and the use of desmopressin in hospitalized children. Archives of Disease in Childhood Education and Practice Edition, 102 , 100–104. https://doi.org/10.1136/archdischild-2016-310763 In 2016, a group of researchers in England released a patient safety alert that highlighted the association between mortality and morbidity when desmopressin is omitted in individuals with DI. The UK National Reporting System reported 76 near-misses, 56 dosing errors leading to harm, and four cases where the lack of administering desmopressin resulted in severe dehydration and even death. Key messages from this research article for health-care personnel taking care of patients with DI are as follows: • The administration of desmopressin is highly individual, and patients should be monitored based on their clinical effect. • Never restrict fluids to a patient with DI. • Doses of different formulations of desmopressin are not interchangeable. Seek advice from a pharmacist or endocrine specialist when converting desmopressin to a different formulation. • Strict monitoring of intake and output, in addition to serum electrolytes, osmolality, and urine osmolality, is needed to ensure safe care of patients with DI. Nursing Interventions ● Recognition of the differences between central (neurogenic) and nephrogenic DI is essential to assess and make decisions regarding the appropriate nursing care of the patient. ● Acute hospital care includes nursing responsibility related to the diagnostic water deprivation test, such as obtaining vital signs, weights, blood and urine samples, and then careful assessment for signs and symptoms of dehydration. ● The nurse is responsible for administration and education regarding the use of medications to treat the two types of DI. ● Accurate intake and output should be constantly monitored. Caregiver Education ● Emergency care involves teaching the parents about the signs and symptoms of dehydration and the need to take the child to the hospital for IV fluid replacement.
● During the initial states of exacerbation, it is important to teach the parents and child to increase fluids until the medica- tion begins to take effect. ● Chronic home care involves teaching the parents of the child with DI the importance of medication compliance and the correct way to administer the medications because DI is a life- long condition that will require long-term use of medications for treatment. ● It is also important for the nurse to educate the parents re- garding the importance of making the child’s school aware of the condition so that appropriate care can be provided at school. ● The parents should provide the child with an emergency alert bracelet, and the bracelet should be worn at all times by the infant or child.
SAFE AND EFFECTIVE NURSING CARE: Understanding Medication
Types of Diabetes Insipidus Medications Central DI medications include vasopressin analogs such as vaso- pressin or desmopressin (DDAVP). This medication is usually given intranasally but can be given orally or subcutaneously. Vasopres- sin analogs are usually the first line of treatment for patients with DI. Diuretics may also be used to treat central DI because they paradoxically decrease urine volume as much as 50%. Amiloride and indomethacin are examples of medications that may be used in patients with nephrogenic DI (Donaldson et al, 2019).
CRITICAL COMPONENT Vasopressin
Vasopressin (DDAVP) cannot effectively treat nephrogenic DI because the kidney is unresponsive to the drug's mechanism of action, so it is critical to diagnose the correct type of DI.
CLINICAL JUDGMENT Intranasal Medications Tips regarding the administration of intranasal medications include: • Have the child blow their nose before the administration of the medication. • In infants, clear the nose with a bulb syringe before administering the medication. • Positioning with the child lying on the back can enhance the absorption of the medication. • Infants and children with colds or severe congestion should receive an alternative route of the medication because this interferes with its absorption.
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