The nurse assumes care of a postoperative adult client with type 2 diabetes mellitus and learns that the client has a current blood glucose level of 750 mg/dL (42 mmol/L). When assessing the client, which is the priority?
Reference Range: Glucose [Reference Range:74 to 106 mg/dL (4.1 to 5.9 mmol/L)]

Rationale for Correct Choices:

• Hyponatremia: The client shows signs of neurological impairment (confusion and altered LOC), which are common symptoms of hyponatremia. The significant, concentrated urine output despite normal IV fluid intake suggests water retention and sodium dilution.
• Syndrome of inappropriate antidiuretic hormone (SIADH): A hypothalamic tumor can disrupt normal ADH regulation, leading to SIADH. In SIADH, excessive ADH causes water retention without sodium retention, resulting in dilutional hyponatremia. The high urine output relative to intake further supports inappropriate ADH secretion.

Rationale for Incorrect Choices:

• Hypernatremia: This condition is associated with dehydration, increased serum osmolality, and symptoms like thirst and dry mucous membranes, not confusion with preserved fluid intake and high urine output seen here.
• Hypokalemia: This typically presents with muscle weakness, cramping, or arrhythmias. It does not account for the client’s confusion or link directly to hypothalamic tumors and fluid imbalance.
• Diabetes insipidus: Although linked to hypothalamic or pituitary damage, diabetes insipidus causes hypernatremia due to water loss and low urine osmolality, not confusion from fluid retention and hyponatremia.
• Addison’s disease: Addison’s typically presents with hypotension, hyperkalemia, and fatigue. It is an adrenal insufficiency condition, not primarily linked to hypothalamic tumors or SIADH-like fluid handling.

Rationale for Correct Choices

• 4 to 8 weeks: Sertraline, an SSRI, typically requires 4 to 8 weeks to reach its full therapeutic effect. This time frame allows for sufficient serotonin modulation, necessary for symptom improvement in conditions like PTSD and depression.
• Eye movement desensitization: Eye Movement Desensitization and Reprocessing (EMDR) is specifically recommended for PTSD. It involves guided eye movements that help the brain reprocess traumatic events and reduce emotional disturbance.
• Deep breathing: Deep breathing promotes parasympathetic nervous system activation, helping reduce anxiety and hyperarousal. It is a simple, accessible coping strategy to complement therapy and medication.

Rationale for Incorrect Choices

• 1 to 2 days: This timeframe is too short for an SSRI to have significant therapeutic effects. Any changes in mood or anxiety within this period are typically not due to the medication’s primary mechanism of action.
• 10 to 14 days: Although some mild improvement may begin, full therapeutic benefits of sertraline are not typically seen within this period. Clients are advised to continue consistent use for several weeks.
• Cognitive behavioural therapy: CBT is effective for many mental health disorders, including PTSD, but it does not involve the “reprocessing” component referenced.
• Prolonged exposure therapy: Prolonged exposure is used for PTSD treatment but focuses on gradually confronting trauma-related memories. It lacks the reprocessing element emphasized in the question.
• Progressive muscle relaxation: While useful for anxiety reduction, it is more complex and less immediate than deep breathing. It also requires a quiet space and more time, which may limit spontaneous use.
• Guided imagery: Guided imagery can reduce anxiety but involves visualization, which may not be suitable for individuals with intrusive trauma-related images. Deep breathing is simpler and more universally applicable.