A 20-year-old male patient with a known history of hemophilia A is brought to the emergency department with swelling and pain in his right knee after a minor fall. Which of the following is the most appropriate initial nursing intervention?

Choice A Reason:

Weight loss is not typically associated with acromegaly. Acromegaly is characterized by excessive growth hormone production, leading to the enlargement of bones and tissues. Patients often experience weight gain rather than loss due to increased bone and soft tissue mass.

Choice B Reason:

Exophthalmos, or bulging eyes, is not a common manifestation of acromegaly. This symptom is more commonly associated with Graves’ disease, a thyroid disorder. Acromegaly primarily affects the bones and soft tissues, leading to changes in facial features and extremities.

Choice C Reason:

Thin and fragile hair is not a typical symptom of acromegaly. While hormonal imbalances can affect hair quality, acromegaly is more commonly associated with changes in bone and soft tissue structure. Symptoms like coarse, oily skin and excessive sweating are more characteristic of this condition.

Choice D Reason:

Enlarged hands and feet are hallmark signs of acromegaly. The excessive production of growth hormone leads to the enlargement of bones in the hands, feet, and face. Patients may notice that their rings no longer fit and that their shoe size has increased. This symptom is a key indicator of acromegaly and is often used in the diagnosis of the condition.

Choice A Reason:

Administering diuretics to increase urine output is not appropriate in this scenario. Diuretics would exacerbate dehydration and further increase serum sodium levels by promoting additional water loss. This approach would worsen the patient’s condition rather than improve it.

Choice B Reason:

Administering desmopressin is a suitable intervention for this patient. Desmopressin is a synthetic analog of vasopressin (antidiuretic hormone) and is used to treat conditions like diabetes insipidus, which can cause symptoms such as excessive thirst, frequent urination, and dehydration. Desmopressin helps to reduce urine output and correct the imbalance of fluids and electrolytes.

Choice C Reason:

Administering intravenous hypotonic saline is appropriate for managing high serum sodium levels and dehydration. Hypotonic saline helps to lower serum sodium levels by diluting the blood and rehydrating the patient. This intervention addresses both the dehydration and the electrolyte imbalance effectively.

Choice D Reason:

Restricting fluid intake to reduce urine output is not appropriate in this case. Fluid restriction would worsen dehydration and could lead to further complications. The patient needs adequate fluid replacement to correct the dehydration and normalize serum sodium levels.

Choice E Reason:

Administering hypertonic saline is not suitable for this patient. Hypertonic saline would increase serum sodium levels further, exacerbating the hypernatremia. This intervention would be counterproductive and could lead to severe complications.