In this video we’re walking through the nursing treatment and interventions of syndrome of inappropriate antidiuretic hormone, aka SIADH. Now with SIADH, there is too much antidiuretic hormone being released, which tells the kidneys to hold onto water. This excess water dilutes the sodium levels making them decrease. So all of these nursing interventions really do have something to do with either fixing or tracking fluid volume or their sodium level.
SIADH Nursing Interventions:
Neurological Assessment and monitoring: Increased intracranial pressure and seizures can happen because SIADH keeps the body retaining too much water, there can be too much fluid shifting into the neurological system, along with a decrease in sodium because it’s so diluted, from all the excess water. Monitor for symptoms such as headaches, confusion, vomiting, weakness, lethargy, and other mental status changes.
Fluid Volume Status: Weight gain, increased blood pressure, increased heart rate and a bounding pulse, decreased urine output, concentrated urine, GI disturbances, decreased deep tendon reflexes, neurological or mental status changes, low body temperature.
Monitor Sodium Levels: Now since there is excess ADH being secreted, and the fluid volume is increased, we know that the sodium level is diluted from all the extra fluid, or decreased.
Monitor Intake and Output: Accurately measure and recording their intake and output to track their fluid.
Medications: The doctor might prescribe fluids or other medications, such as diuretics to help the kidneys get rid of some of the fluid, and possibly IV fluids such as hypertonic or isotonic solutions.
Education: You’ll need to educate them on the purpose of this, the fluid restriction parameters that the doctor has ordered, and encourage them to adhere to it.
I hope this video helped clear some of these nursing interventions and treatments for SIADH up for you. You are doing awesome, friend!
TIMESTAMPS:
0:00 Intro
1:07 What is SIADH?
1:33 Nursing interventions
2:47 Neurological assessment
6:19 Fluid volume status
8:19 Medications
VIDEO TRANSCRIPT
Hello, hello friend! In this video we’re walking through the nursing treatment and interventions for syndrome of inappropriate antidiuretic hormone, aka SIADH. After this video, you’ll know what the nursing interventions are, and WHY we do them. Don’t worry, you won’t need to memorize a list of interventions and treatments for your nursing school exam, but you’ll actually understand the critical thinking behind it.
Because you know your nursing exam is not going to test you on how well you memorize things. They want to know how well you apply the information you’re learning and how well you critically think about it. Think like a nurse, right?
So that’s why we walk through the critical thinking behind it all, step by step. So you’ll be a lot more confident for your nursing exam on SIADH after watching this video.
And of course, I have a free cheat sheet to help you learn things faster in nursing school. So be sure to stay until the end of the video and I’ll let you know where you can snag that.
Now hit that subscribe button and click the notification bell and let’s dive in.
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Okay, so if you remember from the SIADH pathophysiology video, SIADH is when there is too much antidiuretic hormone being released, which tells the kidneys to hold onto water. So again, this causes 2 problems:
- There is excess water, causing fluid overload
- There is a relative decrease in sodium, because the extra water is diluting the sodium
Alright, so now that we remember the pathophysiology behind SIADH, lets take it one step further and learn about why we are going to do these interventions and treatments let’s dive into critical thinking about SIADH.
So these are really the 2 main problems we want to correct, so here’s what you’ll need to do:
- Continue to monitor and assess them (of course!), especially watching for increased intracranial pressure and seizures
- Check their sodium lab values
- Do daily weight checks
- Track intake and output
- Give prescribed medications and IV fluids
- Do IV care
- Educate them on the importance of following the plan of care, especially when it comes to a fluid restriction
Again, lets go back to what is happening in SIADH. There is too much antidiuretic hormone being released, which tells the kidneys to hold onto water. This excess water dilutes the sodium levels making them decrease. So as you can probably see already, all of these nursing interventions really do have something to do with either fixing or tracking fluid volume or their sodium level.
So, the first thing I want you to be aware of is increased intracranial pressure and seizures. Because SIADH keeps the body retaining too much water, there can be too much fluid shifting into the neurological system, along with a decrease in sodium because it’s so diluted, from all the excess water.
These 2 factors can have a HUGE impact on nervous system function. So you must be watching out for signs of increased intracranial pressure, like headaches, confusion, vomiting, weakness, lethargy, and other mental status changes. Really, be aware of anything that seems off or isn’t quite normal for your patient. So if your patient was really coherent before, and you come back later and they are sleepy, or can’t find the right words, or not really tracking what you’re saying very well, that’s a HUGE clue that something isn’t right.
Be on the lookout for seizures and implement seizure precautions. The body, especially the neurological system, LOVES balance. And when the neurological system get’s out of balance it can cause some pretty acute changes. So make sure you have all the equipment set up in the room that you would need in an emergency, such as oxygen tubing and a mask, and all of the suction equipment, along with an Ambu bag or manual resuscitator, keep their bed lowered, pad the side rails and keep all of the rails up, and make sure they have their call light at all times. And if possible, keep them in a room that’s close to the nurses station or a room that can be video monitored, so that you can catch a seizure quickly it it happens.
Now again, we know that there is too much ADH being released, so the body is holding onto fluid, and it is decreasing the sodium level through dilution. So along with assessing for increased intracranial pressure and seizures, you’ll need to monitor them for the common signs and symptoms of SIADH.
These symptoms are going to go along the lines of too much water, and decreased sodium levels, because that is what is happening inside the body with SIADH. Symptoms such as
- Weight gain
- Increased blood pressure
- Increased heart rate and a bounding pulse
- Decreased urine output
- Concentrated urine
- GI disturbances (like nausea, vomiting, and a loss of appetite)
- Decreased deep tendon reflexes
- Neurological or mental status changes (like headaches, lethargy, confusion, seizures and coma)
- Low body temperature (or hypothermia)
We talked about these more in depth in the last video where we broke down the pathophysiology and signs and symptoms, going step by step through the critical thinking behind SIADH.
So if you haven’t watched that video yet, be sure to catch it so you can fully understand the critical thinking behind SIADH for your nursing school exams. Trust me, they won’t be testing you with a list of interventions, they will want to know why you are doing those interventions and treatments. And that is exactly what we are here to do. Break them down for you, step by step, so you can critically think through them for your nursing school exams.
Now since there is excess ADH being secreted, and the fluid volume is increased, we know that the sodium level is diluted from all the extra fluid, or decreased. So on top of those assessments, you’ll also need to monitor their sodium level by drawing labs.
A normal sodium level is between 135-145 mili Equivalents per liter, so anything less than 135 is considered low sodium or hyponatremia. You’ll need an accurate sodium level for the healthcare team to decide what medications to give, so drawing labs is really important.
Make sure to do daily weight checks to monitor their fluid status. Weight is the most sensitive indicator for fluid status, so monitoring their weight will alert you to if they are holding onto too much fluid because again, there is too much ADH being secreted, so the body is holding onto too much fluid. Doing daily weight checks helps us make sure their weight is trending downward and they aren’t continuing to hold onto more fluid. So to do daily weight checks, you’ll check their weight at the same time of day, with them wearing the same clothes, and using the same scale. That’s the standard for daily weight checks to make sure you get an accurate a read as possible.
And along those same lines of monitoring their fluid status, you’ll need to make sure you are accurately measuring and recording their intake and output to track their fluid. Measure the amount of urine that’s produced, along with all of the fluids they are getting (including IVs and all the fluids they are drinking). Monitoring these things will help you notice if they’re holding onto too much fluid and if you need to switch up your nursing interventions to help offload more fluid. We want to make sure we get their fluid volume balanced again, so we need to make sure we are monitoring their intake and output accurately.
The doctor might prescribe fluids or other medications, such as diuretics to help the kidneys get rid of some of the fluid, demeclocycline (which tells the kidneys not to respond to ADH, therefore, helping them get rid of more fluid), and possibly IV fluids such as hypertonic or isotonic solutions.
It is SUPER important that you CLOSELY monitor your patient when giving IV fluids, because fluid overload can happen fast and the consequences are serious, such as increased intracranial pressure.
Of course, your patient will need a working IV, and it’s important to make sure they have one at all time just in case of an emergency as well. You always want to make sure you have direct IV access in order to provide life saving medications.
And now this is really important – you’ll need to do a lot of teaching with them to make sure they know what’s going on and what the plan of care is. Especially, when it comes to a fluid restriction. Because this patient is holding onto too much fluid, because they were inappropriately secreting too much anti diuretic hormone, or ADH, it’s likely that they’ll need to decrease their fluid intake to help bring the body back to a balanced state. So you’ll need to educate them on the purpose of this, the fluid restriction parameters that the doctor has ordered, and encourage them to adhere to it.
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