Nursing Care Plan For Peds Diabetes Insipidus 1r6c1b

Ruth Vasquez Nursing Care Plan Priority Nursing Diagnosis Deficient fluid volume related to compromised endocrine regulatory mechanism as evidence by hypernatremia of 155 mEq/L. Goals Patient will experience normal fluid volume by normal serum sodium level between 133-145 mEq/L in 72 hours. Outcome Criteria Interventions Scientific Rationale Evaluation Patient will have an intake of 1.5 Monitor patient’s fluid intake Q 4 H. Fluid intake helps the body NOT MET liters a day in 24 hours. maintain hydration to properly Patient had a total fluid intake of 670cc (PO balance the electrolytes in the 270cc and IV parenteral 400cc). blood. The more water in the body system the more diluted the blood concentration becomes resolving high concentrations of sodium serum. Patient will have a urinary output of Monitor patient’s urine output Q 2 H. Too much excretion of urine can MET 264cc per 12-hour shift in 48 hours. interfere with balancing of Patient had a total urine output of 277cc in a (Following the 2cc/kg/hr rule of electrolytes, the same with the 12-hour shift. thumb) retention of fluids in the body. Monitoring urine output can help demonstrate fluid status of the body. Patient will have a decreased thirst Monitor for increased thirst (polydipsia) of Polydipsia is a good indicator of a MET sensation in 24 hours. patient Q shift. fluid imbalance because there is a Patient had a decreased desire to drink fluid desire to drink to replenish a PO (270cc in a 12-our shift). hydrated state.

Outcome Criteria Patient’s weight will maintain at 10.8 kg in 72 hours. Patient’s urine specific gravity will be between 1.001-1.030 in 48 hours. Patient’s serum and urine osmolality will be with in 500-800 mosm/kg in 48 hours Patient’s serum sodium levels will be between 133-145 mEq/L in 48 hours. Patient’s serum potassium levels will be between 3.3-5.1 mEq/L in 48 hours.

Interventions Obtain patient’s weight on the same scale Q day. Obtain patient’s urine specific gravity Q shift. Obtain patient’s serum and urine osmolality Q shift. Obtain patient’s serum sodium levels Q shift. Obtain patient’s serum potassium levels Q shift.

Scientific Rationale Weight loss could occur with excessive fluid loss. A urine specific gravity of a child that is more than 1.030 indicates a dehydration status or solute content that is too high in the urine. Increased urine osmolality is an indicator of dehydration, hypernatremia, or adrenal insufficiency. Decreased urine osmolality is an indictor of diabetes insipidus, excess fluid intake, or renal insufficiency. Hypernatremia indicates a high concentration of sodium that is caused by a decrease in total body water relative to electrolyte content. Hypokalemia may result from increase of urinary output of potassium.

Evaluation MET Patient’s weight remained at 10.8 kg. NOT MET A urine specific gravity analysis was not obtained. NOT MET Urine analysis was not obtained. NOT MET Patient’s sodium serum was 155 mEq/L. MET Patient’s serum potassium level was 4.5 mEq/L.

Outcome Criteria Patient’s heart rate will be between 70-110 beats/minute in 24 hours. Patient’s breathing rate will be between 20-30 breaths per minute in 24 hours. Patient’s palpable blood pressure will be between 55/0 -90/0 in 24 hours. Patient’s temperature will be between 34.7-37.3°C in 24 hours. Patient will have easy access to fluid source in one hour.

Interventions Monitor patient’s heart rate Q 4 hours. Monitor patient’s breathing rate Q 4 hours. Monitor patient’s palpable blood pressure Q 4 hours. Monitor patient’s temperature Q 4 hours. Provide an easily accessible fluid source by bedside Q 2 hours.

Scientific Rationale Frequent assessment of heart rate, breathing rate, blood pressure, and temperature can detect changes early for rapid intervention. Polyuria causes decreased circulatory blood volume and increases the risk for hypovolemic shock. “ “ “ “ “ “ This will allow the patient to have its thirst intact by maintaining adequate hydration to compensate the amount urinated.

Evaluation NOT MET Patient’s heart rate was 120. MET Patient’s breathing rate was 30 breaths per minute. NOT MET Patient’s palpable blood pressure was 100/0. MET Patient’s temperature was 36.8°C. MET Fluids were kept at bedside.

Outcome Criteria Patient will have parenteral fluid replacement per order. Patient will take prescribed diuretic per order.

Interventions ister D5 0.2% NaCl infusion at the rate of 40 ml/hr via IV continuous. ister DIURIL 250mg/5ml suspension 40 mg PO BID.

Scientific Rationale Hypotonic IV fluids provide free water and help lower serum sodium levels gradually. This diuretic can help cause a decrease in urine volume through a series of mechanisms that increase water reabsorption in the distal tubules.

Evaluation MET Patient received fluid replacement via IV. MET Patient received DIURIL as prescribed.