A client with Cushing syndrome as a result of a pituitary tumor has been admitted for a transsphenoidal hypophysectomy. What would be most important for the nurse to monitor before, during, and after surgery?

Reasoning:

Choice A reason: Dry mucous membranes support diabetes insipidus, as excessive water loss from polyuria due to ADH deficiency causes dehydration. This reduces moisture in mucosal tissues, leading to dryness in the mouth and throat, a common physical finding in dehydrated states associated with uncontrolled diabetes insipidus.

Choice B reason: Weight gain is not consistent with diabetes insipidus, which causes water loss through polyuria, leading to dehydration and potential weight loss. Weight gain is more typical of conditions like SIADH, where water retention increases body fluid volume, diluting sodium and causing hyponatremia.

Choice C reason: Poor skin turgor is a sign of dehydration, supporting diabetes insipidus. ADH deficiency leads to excessive dilute urine output, reducing body water content. This causes skin to lose elasticity, as subcutaneous tissues become dehydrated, making poor skin turgor a key physical finding in this condition.

Choice D reason: Hypotension is a clinical sign of diabetes insipidus due to hypovolemia from excessive water loss. Reduced blood volume decreases blood pressure, as the cardiovascular system struggles to maintain perfusion. This finding supports the nurse’s suspicion, as dehydration from polyuria is a hallmark of the condition.

Choice E reason: Decreased heart rate, or bradycardia, is not typical in diabetes insipidus. Dehydration from polyuria typically causes tachycardia as the heart compensates for reduced blood volume. A decreased heart rate may indicate another condition but does not support the diagnosis of diabetes insipidus in this context.

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.