A. Summary: Carolyn Yucha, RN describes the case of David, a 22 year old male victim of posttraumatic Diabetes Insipidus (DI), an endocrine disorder marked by inadequate ADH production, secretion and/or release. Inadequate ADH results in the production of excess dilute urine, since the hormone is not available to promote H2O reabsorption by the kidneys. It may also lead to life threatening dehydration, electrolyte upset and inappropriate fluid distribution between body compartments. David’s case is complicated by adipsia, a condition marked by an absence of thirst sensation, which further complicates DI. The article describes the pathophysiology and treatment of DI, and stresses the importance of educating the patient and family to promote self motivation and compliance with a treatment plan that must continue throughout David’s life. A nursing careplan, with appropriately prioritized nursing diagnoses, assessments, interventions and discharge planning is also provided.
B. Critique: The article is well written, concise, and focused. Its organization provides an orderly flow through causes, treatment, assessment, and careplanning for the patient with DI. It identifies the critical role of the nurse in the development and implementation of an effective careplan, thus reinforcing the nursing process. Inserts and diagrams on "understanding the ebb and flow of fluid balance" provide helpful visual and written reinforcement of the important relationship between thirst and ADH in the maintenance of fluid equilibrium. A boxed insert on "How to administer Desmopressin" is helpful in reinforcing the pharmacologic aspect of the therapeutic plan of care.
C. Physiologic principles: Osmosis and Facilitated diffusion in the maintenance of fluid equilibrium; Receptor-Ligand interaction (specifically ADH acting on specific targets, namely distal and collecting ducts of kidney tubules).
D. System Related to: Endocrine