The nurse is speaking to a client who takes desmopressin nasal spray for diabetes insipidus. Which statement by the client is most important for the nurse to report to the health care provider?

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Desmopressin is a medication often used to treat central diabetes insipidus, a disease characterized by reduced antidiuretic hormone (ADH) levels that may result in dehydration and hypernatremia. Desmopressin mimics the effects of naturally occurring ADH, which increases renal water resorption and concentrates urine. However, this effect also increases the risk for water intoxication from decreased urine output. Clients receiving desmopressin must have their fluid and electrolyte status closely monitored for symptoms of water intoxication/hyponatremia (eg, headache, mental status changes, weakness). The nurse should immediately notify the health care provider (HCP) of client reports of water intoxication symptoms, as severe hyponatremia may progress to seizure, neurologic damage, or death (Option D). (Option A) Clients on desmopressin are often on fluid restriction as part of therapy. Frequent reinforcement may be necessary. (Option B) Rhinitis and upper respiratory infection (eg, a cold) can decrease the effectiveness of desmopressin nasal spray therapy and may require dosage adjustments by the HCP. However, dosage adjustments can be addressed after symptoms of water intoxication. (Option C) Side effects of desmopressin nasal spray include nasal irritation, congestion, and pain. If the client cannot tolerate side effects of nasal spray, oral dosing may be prescribed by the HCP. Educational objective: Clients taking desmopressin for diabetes insipidus are at risk for water intoxication and hyponatremia. Client reports of headache, mental status change, and/or muscle weakness may indicate hyponatremia from water intoxication and should be reported to the health care provider immediately.

The Nurse Is Speaking to a Client Who Takes Desmopressin