A client is seen in the emergency department with severe pain related to a sickle cell crisis. What does the nurse understand is occurring with this client?

Reasoning:

Choice A reason: Recent blood donation is not a primary cause of secondary polycythemia, which results from chronic hypoxia or erythropoietin excess, not blood loss. Donation may temporarily reduce red blood cell count, but it does not drive the increased erythropoiesis seen in secondary polycythemia, making it less relevant.

Choice B reason: A history of venous thromboembolism is a consequence, not a cause, of secondary polycythemia. Increased red blood cell mass elevates blood viscosity, raising clotting risk, but thromboembolism does not trigger polycythemia. The nurse should assess for underlying causes like hypoxia, not its complications.

Choice C reason: Evidence of lung disease is critical to assess, as secondary polycythemia is often caused by chronic hypoxia from conditions like chronic obstructive pulmonary disease. Low oxygen levels stimulate erythropoietin production, increasing red blood cell mass to enhance oxygen delivery, making lung disease a primary factor to evaluate.

Choice D reason: Impaired renal function is not a primary cause of secondary polycythemia. While kidneys produce erythropoietin, renal disease typically causes anemia due to reduced erythropoietin. Rarely, renal tumors may increase erythropoietin, but lung disease is a more common driver of secondary polycythemia in clinical practice.

Reasoning:

Choice A reason: A blood pressure reading of 120/85 mm Hg is normal but not specific to SIADH. While fluid overload in SIADH may elevate blood pressure, this reading is not diagnostic. Hypertension is possible but not a consistent finding, as fluid retention primarily causes hyponatremia and other symptoms.

Choice B reason: Pitting edema in the lower extremities is uncommon in SIADH, as fluid retention is primarily intravascular, leading to dilutional hyponatremia rather than extravascular edema. Edema is more typical in conditions like heart failure or nephrotic syndrome, not the water retention mechanism of SIADH.

Choice C reason: Normal skin turgor is not typical in SIADH, as water retention can cause slight fluid overload, potentially leading to subtle tissue swelling. While not as pronounced as edema, skin turgor may be slightly increased due to excess fluid, making “normal” less accurate than moist mucous membranes.

Choice D reason: Moist mucous membranes are expected in SIADH due to excessive water retention from ADH overactivity. This leads to fluid overload, keeping mucosal tissues hydrated and moist, unlike the dehydration seen in diabetes insipidus, which causes dry mucous membranes due to water loss.