A nurse is caring for a client who reports increased anxiety, nervousness, heat intolerance, and unintentional weight loss. Blood testing reveals decreased thyroid-stimulating hormone (TSH), elevated thyroxine (T4), and elevated triiodothyronine (T3). Which of the following vital sign abnormalities does the nurse anticipate?

 

Choice A Reason:

Monitoring blood glucose levels is crucial for managing diabetes, but in the context of hyperosmolar hyperglycemic syndrome (HHS), recognizing the signs and symptoms is more critical. HHS is a serious condition characterized by extremely high blood sugar levels without significant ketoacidosis. Early recognition of symptoms such as extreme thirst, frequent urination, confusion, and weakness can prevent complications and prompt timely medical intervention.

Choice B Reason:

Recognizing signs and symptoms of HHS is the most important topic to prioritize. HHS can develop gradually and may be life-threatening if not identified and treated promptly. Patients and caregivers need to be aware of the warning signs to seek immediate medical attention. Symptoms include severe dehydration, altered mental status, and very high blood glucose levels. Educating patients on these signs ensures they can act quickly to prevent severe outcomes.

Choice C Reason:

Administering insulin correctly is essential for managing diabetes, but it is not the top priority in the context of HHS education. While proper insulin administration helps control blood glucose levels, the immediate concern in HHS is recognizing the condition’s onset. Once HHS is identified, insulin administration becomes part of the treatment plan, but early detection is key to preventing severe complications.

Choice D Reason:

Understanding the importance of hydration is important because dehydration is a significant component of HHS. Patients with HHS often experience severe dehydration due to high blood glucose levels leading to osmotic diuresis. Educating patients on maintaining adequate hydration can help manage their condition and prevent the onset of HHS. However, recognizing the symptoms of HHS remains the top priority.

Choice E Reason:

Managing diet and nutrition is a fundamental aspect of diabetes care, but it is not the primary focus when dealing with HHS. While a balanced diet helps maintain stable blood glucose levels, the immediate concern in HHS is identifying and responding to the condition’s symptoms. Once HHS is recognized and treated, dietary management becomes part of the long-term care plan.

Choice A Reason:

A urine specific gravity of 1.010 falls within the normal range of 1.005 to 1.0301. This value does not indicate hyponatremia. In SIADH, urine is often more concentrated due to the retention of water, leading to higher specific gravity values.

Choice B Reason:

Respiratory alkalosis is not a typical manifestation of hyponatremia. It is usually associated with conditions that cause hyperventilation, such as anxiety or high altitude. SIADH typically does not cause respiratory alkalosis.

Choice C Reason:

Diarrhea is not a direct manifestation of hyponatremia. While diarrhea can lead to electrolyte imbalances, including hyponatremia, it is not a symptom caused by SIADH5. SIADH leads to water retention and dilutional hyponatremia, not diarrhea.

Choice D Reason:

Diminished reflexes are a manifestation of hyponatremia. Low sodium levels affect neuromuscular function, leading to symptoms such as muscle weakness, cramps, and diminished reflexes7. This is a direct result of the electrolyte imbalance caused by SIADH.