A client with a new diagnosis of ischemic stroke was treated in the ED with tissue plasminogen activator (t-PA) and then admitted to the ICU. In addition to closely monitoring the client’s cardiac and neurologic status, the nurse monitors the client for signs of what complication?

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.

Reasoning:

Choice A reason: Addison’s disease, due to adrenal insufficiency, reduces aldosterone and cortisol production, leading to sodium loss (hyponatremia) and potassium retention (hyperkalemia). These electrolyte abnormalities result from impaired renal sodium reabsorption and potassium excretion, making sodium and potassium monitoring critical for managing complications like hypotension and arrhythmias.

Choice B reason: Calcium and phosphorus abnormalities are not primary concerns in Addison’s disease. These electrolytes are more affected by parathyroid or renal disorders. Addison’s disease primarily disrupts sodium and potassium balance due to aldosterone deficiency, with calcium and phosphorus typically remaining within normal ranges unless other conditions coexist.

Choice C reason: Sodium abnormalities occur in Addison’s disease due to aldosterone deficiency, causing hyponatremia. However, chloride levels are not significantly altered, as chloride follows sodium passively. Potassium imbalances (hyperkalemia) are more critical alongside sodium, making this combination less comprehensive than sodium and potassium monitoring.

Choice D reason: Chloride and magnesium abnormalities are not hallmark features of Addison’s disease. While mild chloride changes may occur with sodium loss, magnesium is typically unaffected. The primary electrolyte disturbances involve sodium (hyponatremia) and potassium (hyperkalemia), making these the focus of monitoring in adrenal insufficiency.