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: Encouraging increased oral intake is inappropriate for SIADH, as it exacerbates water retention caused by excessive ADH. This would worsen dilutional hyponatremia and fluid overload, potentially leading to severe complications like cerebral edema, making fluid restriction the preferred approach to manage this condition.

Choice B reason: Infusing IV fluids rapidly is contraindicated in SIADH, as it increases fluid overload. Excessive ADH already causes water retention, diluting serum sodium. Rapid IV fluid administration could worsen hyponatremia and lead to neurological complications, such as seizures, due to further dilution of electrolytes.

Choice C reason: Administering glucose-containing IV fluids is not appropriate for SIADH, as it adds to the fluid volume, worsening water retention and hyponatremia. Glucose fluids do not address the underlying ADH excess and may exacerbate dilutional effects, increasing the risk of cerebral edema or other complications.

Choice D reason: Restricting fluids is the appropriate intervention for SIADH, as excessive ADH causes water retention, leading to hyponatremia. Limiting fluid intake helps correct the dilutional effect, increasing serum sodium concentration and reducing the risk of complications like cerebral edema, aligning with the goal of restoring fluid balance.

Reasoning:

Choice A reason: Hyperthermia is not a primary risk in SIADH. This condition involves excessive ADH, leading to water retention and hyponatremia, not temperature dysregulation. Hyperthermia may occur in infections or neurological conditions, but it is not directly related to the fluid overload characteristic of SIADH pathophysiology.

Choice B reason: Peripheral neurovascular dysfunction is not a primary concern in SIADH. The condition causes water retention, leading to dilutional hyponatremia and potential cerebral edema, not vascular or nerve issues in the extremities. Peripheral dysfunction is more associated with conditions like diabetes mellitus or vascular disease.

Choice C reason: Ineffective airway clearance is not directly linked to SIADH. While severe hyponatremia could cause neurological symptoms like seizures, airway clearance issues are more typical in respiratory conditions. SIADH primarily affects fluid balance, leading to water overload, not mucus production or airway obstruction risks.

Choice D reason: Excess fluid volume is the primary risk in SIADH due to excessive ADH, which promotes water reabsorption in the kidneys, leading to fluid overload and dilutional hyponatremia. This can cause symptoms like edema, hypertension, and, in severe cases, cerebral edema, making it the most critical concern.