A patient with multiple draining wounds is admitted for hypovolemia. Which assessment would be the most accurate way for the nurse to evaluate fluid balance?

Choice A reason: I will always need to take hydrocortisone pills is a correct statement. Hydrocortisone is a synthetic form of cortisol, a hormone that is normally produced by the adrenal glands. After a bilateral adrenalectomy, the patient will have no adrenal glands and will need to take hydrocortisone pills for life to replace the missing hormone.

Choice B reason: I have a way to inject hydrocortisone in case of emergency is also a correct statement. Hydrocortisone injections are used to treat acute adrenal crisis, a life-threatening condition that can occur when the patient has low cortisol levels due to stress, illness, injury, or surgery. The patient should have an emergency kit with hydrocortisone injections and instructions on how to use them.

Choice C reason: I will stop taking hydrocortisone when I feel better is an incorrect statement. This indicates a need for further education regarding medications after a bilateral adrenalectomy. The patient should never stop taking hydrocortisone without consulting their doctor, as this can cause severe symptoms of adrenal insufficiency, such as low blood pressure, low blood sugar, weakness, fatigue, and confusion.

Choice D reason: I have nausea or vomiting often is a statement that requires further assessment by the nurse. Nausea or vomiting can be signs of inadequate or excessive hydrocortisone dosage, or other complications after a bilateral adrenalectomy. The nurse should monitor the patient's vital signs, blood glucose, electrolytes, and weight, and report any abnormal findings to the doctor. The patient may need to adjust their hydrocortisone dose or take other medications to manage their symptoms.

Choice A reason: This statement is false. Acetaminophen (Tylenol) is not the best choice for the nurse to administer as an adjuvant to decrease the patient's pain, as acetaminophen is a mild analgesic that works by inhibiting the synthesis of prostaglandins, which are involved in inflammation and pain. Acetaminophen is not very effective for chronic, burning leg pain, which is likely caused by diabetic neuropathy, a nerve damage condition that affects the sensation and function of the legs.

Choice B reason: This statement is true. Gabapentin (Neurontin) is the best choice for the nurse to administer as an adjuvant to decrease the patient's pain, as gabapentin is an anticonvulsant that works by modulating the activity of calcium channels, which are involved in transmitting pain signals from the nerves to the brain. Gabapentin is effective for chronic, burning leg pain, as it can reduce the intensity and frequency of neuropathic pain.

Choice C reason: This statement is false. Hydrocodone-Acetaminophen (Norco) is not the best choice for the nurse to administer as an adjuvant to decrease the patient's pain, as hydrocodone-acetaminophen is a combination of an opioid analgesic and a mild analgesic that works by binding to opioid receptors in the brain and spinal cord, and by inhibiting the synthesis of prostaglandins, respectively. Hydrocodone-acetaminophen is not very effective for chronic, burning leg pain, as it can cause tolerance, dependence, and addiction, and can also interact with oxycodone, which the patient is already taking.

Choice D reason: This statement is false. Aspirin is not the best choice for the nurse to administer as an adjuvant to decrease the patient's pain, as aspirin is a nonsteroidal anti-inflammatory drug (NSAID) that works by inhibiting the synthesis of prostaglandins, which are involved in inflammation and pain. Aspirin is not very effective for chronic, burning leg pain, as it can cause gastrointestinal bleeding, ulcers, and kidney damage, and can also interact with other medications that the patient may be taking, such as anticoagulants or antiplatelets.