Question

Question 9

A nurse is assigned to care for the following four patients on a medical floor. Which patient does the nurse know should be assessed first?

		The client with a pituitary tumor who has developed diabetes insipidus (DI) and has an intake of 1500 mls and an output of 1600 mls in the last eight (8) hours.
		The client with syndrome of inappropriate antidiuretic hormone (SIADH) who is having muscle twitching.
		The client with syndrome of inappropriate antidiuretic hormone (SIADH) who has a wt. gain of 1.5 lbs since yesterday.
		The client with diabetes insipidus (DI) who is c/o feeling tired after having to get up at night

Answer 1

ANSWER:

The nurse should be assessed first for the client with syndrome of inappropriate antidiuretic hormone (SIADH) who is having muscle twitching.

REASON:

SIADH leads to an abundance of Anti-diuretic hormone in the body. The anti-diuretic hormone raises the water by reabsorbing the urine. It preserves the water and prevents the loss of fluid from the body. Due to plenty of fluid in the body for the patient with SIADH, it ends in DILUTIONAL HYPONATREMIA (that is low sodium level).

Due to the low sodium level, the patient gets muscle twitching, spell, agitation and laziness. When analysing to the other options patients having muscle twitching should be assessed first. Because muscle twitching will creates pain and discomfort.

The client with SIADH who has a weight gain of 1.5lbs since yesterday should also be assessed following muscle twitching. Due to enhanced Anti-diuretic hormone, plenty of fluid accumulation will produce oedema. Due to oedema increased weight gain will occur. Average weight addition of an adult is 1 to 2 pounds a week. whereas in case of SIADH it might be more than normal.

The client with a pituitary tumour who has evolved diabetes insipidus and has an intake of 1500mls and an output of 1600mls in the last eight hours. Usually, a client with diabetes insipidus had enhanced urine output due to reduction of Anti-diuretic hormone. It occurs in increased urinary output. Increased urinary output is an anticipated one for the patient with diabetes insipidus and should not exceed more than the intake value.

It is common for the client who felt tired after having to get up at night. It should also be treated but not necessary to assessed first.