A nurse is providing care for a 71-year-old client who has diabetes insipidus (DI) and is receiving treatment with desmopressin. Which of the following lab values is most important for the nurse to monitor?

Choice A Reason:

Dietary and fluid restrictions are crucial for managing heart failure. Patients with heart failure often experience fluid retention, which can exacerbate symptoms such as swelling, shortness of breath, and fatigue. By restricting fluid intake, patients can help prevent fluid overload. Additionally, dietary modifications, such as reducing sodium intake, can help manage blood pressure and reduce the risk of fluid retention. Sodium causes the body to retain water, which can increase the workload on the heart. Therefore, a low-sodium diet is often recommended for heart failure patients. These restrictions are essential to prevent the worsening of heart failure symptoms and to improve the patient’s quality of life.

Choice B Reason:

Encouraging increased mobility is generally beneficial for overall health, but it must be approached cautiously in heart failure patients. While regular physical activity can help improve cardiovascular health and overall well-being, it is important to tailor the exercise regimen to the patient’s condition. Overexertion can lead to worsening symptoms or complications. Therefore, while increased mobility can be part of the management plan, it should be done under medical supervision and is not the primary lifestyle modification for heart failure management.

Choice C Reason:

Cessation of hormonal supplements may be relevant for some patients, particularly if the supplements are contributing to fluid retention or other adverse effects. However, this is not a standard recommendation for all heart failure patients. The decision to stop hormonal supplements would depend on the individual patient’s medical history and the specific supplements they are taking. It is not a general lifestyle modification for heart failure management.

Choice D Reason:

Cessation of intravenous (IV) drug use is important for patients who may be using IV drugs, as this can lead to infections, endocarditis, and other complications that can worsen heart failure. However, this recommendation is specific to patients with a history of IV drug use and is not a general lifestyle modification for all heart failure patients. The primary focus for most heart failure patients would be on managing fluid and dietary intake.

Choice A reason: Acetone Breath

Acetone breath is typically associated with diabetic ketoacidosis (DKA), not hyperosmolar hyperglycemic syndrome (HHS). In DKA, the body produces high levels of ketones, leading to a fruity or acetone-like breath odor. HHS, on the other hand, does not usually involve significant ketone production, so acetone breath is not a characteristic feature of HHS.

Choice B reason: Fever

Fever can be a clinical manifestation of HHS, often indicating an underlying infection, which is a common precipitating factor for HHS. Infections can exacerbate hyperglycemia and contribute to the development of HHS, making fever a relevant symptom to consider.

Choice C reason: 68 Years of Age

While age itself is not a clinical manifestation, HHS predominantly affects older adults, particularly those with type 2 diabetes. Therefore, being 68 years old is consistent with the typical demographic affected by HHS, but it is not a direct clinical manifestation.

Choice D reason: Serum Glucose 800 mg/dL

A serum glucose level of 800 mg/dL is significantly elevated and is a hallmark of HHS2. Normal serum glucose levels range from 74 to 106 mg/dL. Such high levels of glucose are indicative of severe hyperglycemia, which is a defining characteristic of HHS.

Choice E reason: Serum Bicarbonate 15 mEq/L

A serum bicarbonate level of 15 mEq/L is below the normal range of 21 to 28 mEq/L. This indicates metabolic acidosis, which can occur in HHS due to severe dehydration and impaired renal function. Although metabolic acidosis is more pronounced in DKA, it can still be present in HHS.

Choice F reason: Insidious Onset

HHS typically has an insidious onset, developing slowly over days to weeks. This gradual progression contrasts with the rapid onset of DKA and is a key feature in the clinical presentation of HHS.