- Decreased Cardiac Output related to Increased antidiuretic hormone release and
Aggravating fluid overload as evidenced by Shortness of breath and Palpitations - Deficient Knowledge related to Misinformation and Inadequate interest in learning as evidenced by Inaccurate follow-through of instructions and development of symptoms
- Excess Fluid Volume related to excessive fluid intake and compromised regulatory mechanism as evidenced by Intake exceeds output and Concentrated urine
| Assessment | Nursing Diagnosis | Planning/Outcomes | Intervention | Evaluation |
| Subjective data: Verbalizes Chest tightness Objective data: -Shortness of breath -Chest pain -Palpitations -Anorexia -Fatigue -Orthopnea -Alteration in mentation -Crackles | Decreased Cardiac Output related to Increased antidiuretic hormone release and Aggravating fluid overload as evidenced by Shortness of breath and Palpitations | Patient will manifest adequate cardiac output as evidenced by the following: Blood pressure: Systolic BP >90 to <140; Diastolic BP >60 to <90 Heart rate: 60 to 100 beats/min with a regular rhythm Respiratory rate: 12 to 20 breaths/min Strong peripheral pulses Absence of chest pain/discomfort Patient will not experience any changes in mentation. Patient will be normovolemic, as evidenced by the following: Urine output 0.5 to 1.5 cc/kg/hour Balanced intake and output Stable weight Maintained absence or reduction of edema | 1. Restrict free water. Patients with heart failure and SIADH should restrict their water intake as first-line therapy. Guidelines recommend restricting water intake to 500-1500 mL/day. 2. Administer diuretics as prescribed. Loop diuretics such as furosemide aid in eliminating excess water. Patients with heart failure and signs of fluid overload are treated with loop diuretics to reduce morbidity and mortality. 3. Consider vasopressin V2-receptor antagonists. Tolvaptan is shown to be beneficial for patients with hyponatremia associated with CHF and SIADH. This medication is indicated for patients who are hypervolemic with less severe hyponatremia but who haven’t responded to fluid restriction. 4. Educate the patient about the therapeutic regimen and the association between SIADH and cardiac disease. A thorough understanding of the therapeutic regimen and the nature of the disease aids in increasing adherence to the plan of care. Patients must understand the connection between fluid overload, sodium, symptoms, and cardiac workload. | Absence of chest pain/discomfort Patient did not experience any changes in mentation. Patient normovolemic, as evidenced by the following: Urine output 0.5 to 1.5 cc/kg/hour Balanced intake and output Stable weight Maintained absence or reduction of edema |
| Subjective data: -Verbalizes poor understanding -Seeks additional information Objective data: -Inaccurate demonstration or teach-back of instructions -Inability to recall instructions -Exhibiting aggression or irritability regarding teaching follow-up -Poor adherence to recommended treatment or worsening medical condition | Deficient Knowledge related to Misinformation and Inadequate interest in learning as evidenced by Inaccurate follow-through of instructions and development of symptoms | Patient will verbalize an understanding of the disease, prognosis, and treatments. Patient will not develop preventable complications. | 1. Educate the patient about the condition, symptoms, and treatments. Provide accurate information about the condition, symptoms, and treatments in layperson’s terms that the patient can understand. 2. Teach the patient about fluid restriction and its relation to SIADH. Fluid restriction is a priority in the management of SIADH, as the main issue with this disease is fluid excess and hyponatremia. 3. Educate the patient about medications and their uses. Providing accurate information about medications and how they work as part of the SIADH treatment regimen to ensure better adherence. 4. Involve the support system. The patient may require the assistance of a support person in managing this condition, monitoring for symptoms, and communicating with the healthcare team. | Patient verbalized an understanding of the disease, prognosis, and treatments. Patient not developed preventable complications. |
| Subjective data: Difficulty breathing Anxiety Weight gain or swelling Objective data: -Shortness of breath -Adventitious breath sounds -Abnormal electrolyte levels -Restlessness -Tachycardia -Pulmonary congestion/edema | Excess Fluid Volume related to excessive fluid intake and compromised regulatory mechanism as evidenced by Intake exceeds output and Concentrated urine | Patient will maintain electrolytes within acceptable ranges. Patient will maintain balanced intake and output. | 1. Monitor urine output. Urinalysis is often ordered to measure the patient’s urine concentration, sodium, and osmolality levels. Water retention may cause poor urine output. 2. Restrict fluids. Fluid restriction is vital in SIADH as this can prevent further fluid retention in the body. 3. Administer medications as indicated. Vasopressin antagonist medications like tolvaptan and conivaptan are given to block the action of ADH. 4. Administer diuretics as ordered. Furosemide can be given to decrease urine concentration and increase water excretion. | Patient maintained electrolytes within acceptable ranges. Patient maintained balanced intake and output. |