A client diagnosed with meningitis says, “I’m just so thirsty. I keep drinking and drinking, but I can’t seem to get enough. I’ve been urinating a lot, too.” The nurse checks the client’s urine specific gravity and finds it to be very dilute. The nurse suspects that the client may be developing diabetes insipidus. Which assessment finding(s) would support the nurse’s suspicion? (Select all that apply)

Reasoning:

Choice A reason: Decreased heart rate is a late sign in subdural hematoma, occurring with increased intracranial pressure (ICP) causing Cushing’s triad (bradycardia, hypertension, irregular breathing). Early manifestations like altered LOC appear first due to hematoma compression, making heart rate changes a secondary concern.

Choice B reason: Alteration in level of consciousness is the earliest manifestation of subdural hematoma. As the hematoma expands, it compresses brain tissue, impairing cerebral function, leading to confusion, lethargy, or reduced responsiveness. This precedes other signs like motor deficits or vital sign changes, making it the first to monitor.

Choice C reason: Slurred speech may occur in subdural hematoma if motor or speech areas are affected, but it is not the earliest sign. Altered LOC typically precedes focal neurological deficits, as hematoma compression globally impacts brain function before specific areas, making speech changes secondary.

Choice D reason: Bradycardia, like decreased heart rate, is a late sign in subdural hematoma, part of Cushing’s triad from severe ICP elevation. Early signs like altered LOC occur first due to initial brain compression, making bradycardia a later manifestation requiring urgent intervention.

Reasoning:

Choice A reason: Teaching coughing and deep breathing techniques prevents respiratory infections but is not the primary intervention for immune thrombocytopenia (ITP). ITP involves autoimmune platelet destruction, increasing bleeding risk. While infection prevention is important, maintaining platelet counts through transfusion is more critical to prevent hemorrhage in ITP.

Choice B reason: Giving aspirin to control temperature is contraindicated in ITP, as aspirin inhibits platelet function, worsening bleeding risk in clients with low platelet counts. Fever management should use alternative antipyretics like acetaminophen, making aspirin administration inappropriate and potentially harmful in this condition.

Choice C reason: Administering platelets, as ordered, is a key intervention in immune thrombocytopenia when bleeding risk is high. ITP causes autoimmune destruction of platelets, leading to thrombocytopenia. Platelet transfusions restore counts, reducing the risk of spontaneous bleeding, such as intracranial or gastrointestinal hemorrhage, a critical concern in severe cases.

Choice D reason: Administering stool softeners prevents straining, which could cause bleeding in ITP due to low platelets. While useful, it is secondary to platelet transfusion, which directly addresses the primary issue of thrombocytopenia and bleeding risk, making it less urgent than restoring platelet counts.