A nurse is planning care for a client who has overhydration and hyponatremia. Which of the following actions should the nurse include in the plan? (Select all that apply.)

Choice A reason:

Decreased urine specific gravity indicates improvement in hydration status. Urine specific gravity is a measure of the concentration of solutes in the urine. It reflects the ability of the kidney to concentrate or dilute urine. A high urine specific gravity (>1.030) indicates concentrated urine, which can be caused by dehydration, reduced renal blood flow, or increased fluid loss. A low urine specific gravity (<1.010) indicates diluted urine, which can be caused by overhydration, diuretic use, or impaired renal function. A normal urine specific gravity ranges from 1.010 to 1.030.

Choice B reason:

Increased hematocrit level indicates worsening of dehydration. Hematocrit is the percentage of red blood cells in the total blood volume. It is affected by the plasma volume and the number of red blood cells. A high hematocrit (>47% for males and >42% for females) indicates hemoconcentration, which can be caused by dehydration, polycythemia, or hypoxia. A low hematocrit (<37% for males and <32% for females) indicates hemodilution, which can be caused by overhydration, anemia, or hemorrhage. A normal hematocrit ranges from 37% to 47% for males and 32% to 42% for females.

Choice C reason:

Decreased skin turgor indicates persistent dehydration. Skin turgor is the elasticity of the skin that reflects its hydration status. It is assessed by pinching a fold of skin on the chest, abdomen, or forearm and releasing it. Normally, the skin should return to its original position in less than 3 seconds. If the skin remains elevated or takes longer to return, it indicates poor skin turgor, which can be caused by dehydration, aging, or edema.

Choice D reason:

Increased serum osmolarity indicates worsening of dehydration. Serum osmolarity is a measure of the concentration of solutes in the blood plasma. It reflects the balance between water and electrolytes in the body fluids. A high serum osmolarity (>300 mOsm/kg) indicates hyperosmolarity, which can be caused by dehydration, hypernatremia, hyperglycemia, or mannitol infusion. A low serum osmolarity (<280 mOsm/kg) indicates hypoosmolarity, which can be caused by overhydration, hyponatremia, syndrome of inappropriate antidiuretic hormone secretion (SIADH), or diuretic use. A normal serum osmolarity ranges from 280 to 300 mOsm/kg.

Choice A reason:

Hypernatremia is not a likely complication of fluid therapy for diabetic ketoacidosis (DKA) Hypernatremia occurs when there is a loss of water or an excess of sodium in the body. Fluid therapy for DKA usually involves normal saline and dextrose, which do not cause hypernatremia. In fact, fluid therapy may help correct the dehydration and hyperosmolality that are associated with DKA.

Choice B reason:

Hyperkalemia is also not a likely complication of fluid therapy for DKA. Hyperkalemia occurs when there is an excess of potassium in the blood. Fluid therapy for DKA usually involves insulin infusion, which helps lower the potassium level by driving it into the cells. Insulin also helps lower the blood glucose level and reverse the acidosis that are characteristic of DKA.

Choice C reason:

Fluid volume deficit is a common manifestation of DKA, not a complication of fluid therapy. Fluid volume deficit occurs when there is a loss of fluid and electrolytes from the body due to osmotic diuresis, vomiting, and increased respiratory rate. Fluid therapy for DKA aims to restore the fluid volume and correct the electrolyte imbalances that result from fluid loss.

Choice D reason:

Cerebral edema is a potential complication of fluid therapy for DKA, especially in children and young adults. Cerebral edema occurs when there is an increase in intracranial pressure due to swelling of the brain tissue. Fluid therapy for DKA may cause cerebral edema by altering the osmotic gradient between the blood and the brain, leading to fluid shifts into the brain cells. Cerebral edema can cause neurological symptoms such as headache, confusion, seizures, and coma.