SIADH (syndrome of inappropriate antidiuretic hormone) happens when the body releases too much ADH and holds on to water. The extra water dilutes the blood and lowers sodium, which can cause confusion and seizures. Your priorities are fluid restriction, safe sodium correction, and seizure precautions.
A · AssessmentD · DiagnosisP · PlanningI · InterventionE · Evaluation
Each care plan below follows the nursing process (ADPIE).
CARE PLAN 1 · NURSING DIAGNOSIS
PLANNING · EXPECTED OUTCOMES
ASSESSMENT
Excess Fluid Volume
Related to
- Too much ADH causing water retention
As evidenced by
- Serum sodium below 135 mEq/L
- Weight gain without edema
- Low urine output with concentrated urine
- High urine specific gravity
Short-term goals
- Client follows the fluid restriction each day
- Weight decreases toward baseline within 48 to 72 hours
Long-term goals
- Sodium returns to the normal range of 135 to 145 mEq/L
- Daily weight
- Strict intake and output
- Serum sodium and urine specific gravity
- Lung sounds
| INTERVENTION | RATIONALE |
|---|---|
| Restrict fluids as ordered, often 800 to 1,000 mL a day | Less water lets sodium rise back toward normal. |
| Give hypertonic saline slowly as ordered and monitor sodium closely | Raising sodium too fast can cause osmotic demyelination, a serious brain injury. |
| Give medications such as tolvaptan or loop diuretics as ordered | These help the body get rid of extra water. |
| Offer ice chips and hard candy within the fluid limit and provide mouth care | These ease thirst and dry mouth. |
EVALUATION
- Weight is decreasing
- Sodium is rising slowly toward normal
- Client stays within the fluid limit
CARE PLAN 2 · NURSING DIAGNOSIS
ASSESSMENT
Risk for Injury
Risk factors
PLANNING · EXPECTED OUTCOMES- Low sodium affecting brain function
- Confusion and risk for seizures
Short-term goals
- Client stays free of falls and seizures during the hospital stay
Long-term goals
- Client returns to baseline mental status
- Neuro checks and level of consciousness
- Headache, nausea, or muscle cramps
- Sodium trend
| INTERVENTION | RATIONALE |
|---|---|
| Start seizure precautions per protocol | Low sodium can trigger seizures. |
| Do frequent neuro checks and report changes right away | New confusion can mean sodium is falling or changing too fast. |
| Keep the bed low and the call light in reach | These lower fall risk in a confused client. |
| Reorient the client as needed | Orientation lowers anxiety and keeps the client safe. |
EVALUATION
- Client is free of falls and seizures
- Client is alert and oriented
Quick answers
What lab finding is expected in SIADH?
Low serum sodium with concentrated urine and a high urine specific gravity. The body holds water, which dilutes the blood.
What is the main nursing intervention for SIADH?
Fluid restriction, along with daily weights and close sodium monitoring.
For learning only. Individualize every care plan to your client, and follow your program, current guidelines, provider orders, and facility policy.