A client is diagnosed with a right-sided stroke. The client is now experiencing hemianopsia. How can the nurse help the client manage potential sensory and perceptual difficulties?

Reasoning:

Choice A reason: Aspiration precautions are important in head injury to prevent pneumonia, particularly if consciousness is impaired, but they are not specific seizure prophylactic measures. Seizures require anticonvulsants to prevent neuronal hyperexcitability, making aspiration precautions a secondary concern unrelated to seizure prevention.

Choice B reason: Anticonvulsant medications, initiated early (e.g., day two), are standard for seizure prophylaxis in head injury. Trauma can cause cortical irritation, increasing seizure risk. Drugs like levetiracetam stabilize neuronal activity, preventing seizures, which could worsen brain injury or ICP, making this the primary measure.

Choice C reason: Intubation and ventilator support are used for severe head injuries with compromised airway or breathing but are not seizure prophylaxis. Seizures are managed with anticonvulsants, as mechanical ventilation does not address neuronal excitability, making this inappropriate for seizure prevention.

Choice D reason: Antiemetic medications manage nausea but are not seizure prophylactic measures. While vomiting may occur post-head injury, it does not prevent seizures, which result from cortical irritability. Anticonvulsants directly target seizure risk, making antiemetics irrelevant to this specific intervention goal.

Reasoning:

Choice A reason: Impaired physical mobility is a concern in Addisonian crisis due to weakness from cortisol deficiency, but it is not the highest priority. Acute crisis causes severe hypovolemia and hypotension, which threaten cardiac output and organ perfusion, making mobility a secondary issue compared to life-threatening cardiovascular instability.

Choice B reason: Imbalanced nutrition is relevant in chronic Addison’s disease due to weight loss and poor appetite, but in acute crisis, it is not the priority. Severe hypotension and electrolyte imbalances from adrenal insufficiency pose immediate threats to life, requiring urgent correction before addressing nutritional deficits.

Choice C reason: Risk for infection is a concern in Addison’s disease due to cortisol’s role in immune function, but it is not the primary issue in acute crisis. Hypovolemia, hypotension, and electrolyte imbalances drive life-threatening cardiovascular collapse, making infection risk secondary to stabilizing cardiac output and fluid status.

Choice D reason: Decreased cardiac output is the highest priority in Addisonian crisis, as adrenal insufficiency causes severe hypotension and hypovolemia due to aldosterone and cortisol deficiencies. This leads to reduced cardiac preload and shock, requiring urgent fluid and steroid replacement to restore perfusion and prevent organ failure.