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Vasopressin may be given IM or SC to treat diabetes insipidus. The injection solution may also be administered intranasally on cotton pledgets, by nasal spray, or dropper. When given parenterally 5 to 10 units administered two to three times daily is usually sufficient. To prevent or relieve abdominal distension, 5 units of the drug is administered initially and may increase to 10 units every 3 or 4 hours IM. When the drug is administered before abdominal roentgenography, the nurse administers 2 injections of 10 units each. The first dose is given 2 hours before x-ray examination and the second dose V2 hour before the testing. An enema may be given before the first dose.

Lypressin is administered intranasally by spraying 1 or 2 sprays in one or both nostrils usually four times per day or when the frequency of urination increases or significant thirst develops. Dosages greater than 10 sprays in each nostril every 3 to 4 hours are not recommended. Patients learn to regulate their dosage based on the frequency of urination and increase of thirst. The nurse instructs the patient to hold the bottle upright with the head in a vertical position when administering the drug.

Desmopressin may be given orally, intranasally, SC, or IV. The oral dose must be determined for each individual patient and adjusted according to the patient's response to therapy. When the drug is administered nasally, a nasal tube is used for administration. The nasal tube delivery system comes with a flexible calibrated plastic tube called a rhinyle. The solution is drawn into the rhinyle. One end is inserted into the nostril and the patient (if condition allows) blows the other end to deposit solution deep into the nasal cavity. A nasal spray pump may also be used. Most adults require 0.2 mL daily in two divided doses to control diabetes insipidus. The drug may also be administered via the SC route or direct IV injection.

MANAGING FLUID VOLUME. The symptoms of diabetes insipidus include the voiding of a large volume of urine at frequent intervals during the day and throughout the night. Accompanied by frequent urination is the need to drink large volumes of fluid because these patients are continually thirsty. Patients must be supplied with large amounts of drinking water. The nurse is careful to refill the water container at frequent intervals. This is especially important when the patient has limited ambulatory activities. Until controlled by a drug, the symptoms of frequent urination and excessive thirst may cause a great deal of anxiety. The nurse reassures the patient that with the proper drug therapy, these symptoms will most likely be reduced or eliminated.

When the patient has diabetes insipidus, the nurse measures the fluid intake and output accurately and observes the patient for signs of dehydration (dry mucous membranes, concentrated urine, poor skin turgor, flushed dry skin, confusion). This is especially important early in treatment and until such time as the optimum dosage is determined and symptoms have diminished. If the patient's output greatly exceeds intake, the nurse notifies the primary health care provider. In some instances, the primary health care provider may order specific gravity and volume measurements of each voiding or at hourly intervals. The nurse records these results in the chart to aid the primary health care provider in adjusting the dosage to the patient's needs.

MANAGING ABDOMINAL DISTENTION. If the patient is receiving vasopressin for abdominal distention, the nurse explains in detail the method of treating this problem and the necessity of monitoring drug effectiveness (ie, auscultation of the abdomen for bowel sounds, insertion of a rectal tube, measurement of the abdomen).

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After administration of vasopressin for abdominal distention, a rectal tube may be ordered. The lubricated end of the tube is inserted past the anal sphincter and taped in place. The tube is left in place for 1 hour or as prescribed by the primary health care provider. The nurse auscultates the abdomen every 15 to 30 minutes and measures the abdominal girth every hour, or as ordered by the primary health care provider.

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Supplements For Diabetics

Supplements For Diabetics

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