The nurse in the medical unit is caring for a 68-year-old female client.
0730:Admitted for persistent euvolemic hyponatremia associated with syndrome of inappropriate antidiuretic hormone secretion (SIADH). Alert, follows directions and asks for water when thirsty. A fluid-restriction order from admission remains on the record. Oral tolvaptan 15 mg daily was prescribed this morning.
0800:First tolvaptan dose given. Urine output over the preceding 2 hours was 120 mL.
1000:Reports thirst and a dry mouth. Urine output since 0800 is 680 mL. No headache, vomiting, confusion or weakness. Requests more water. Skin turgor normal; no edema. Client asks about going home this afternoon.
The nurse is reviewing the client's assessment data to prepare the client's plan of care.
Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.
Action to TakeAction to Take
Condition Most Likely ExperiencingParameter to MonitorParameter to Monitor
Actions to Take
Keep fluids restricted.
Arrange discharge after the dose.
Clarify the fluid restriction order.
Continue monitoring in the hospital.
Give an extra dose to raise sodium faster.
Potential Conditions
hypoglycemia
acute water intoxication
tolvaptan-related water diuresis
worsening dilutional hyponatremia
Parameters to Monitor
serum sodium
urine output
serum calcium
white blood cell count
pulse oximetry reading