The nurse is caring for a client with an exacerbation of sickle cell disease (SCD). Which finding indicates to the nurse that the client is experiencing a liver complication from this condition?

Reasoning:

Choice A reason: Monitoring weight is essential in Cushing’s syndrome, as excess cortisol promotes fat redistribution and weight gain. Regular weight checks help assess disease progression or treatment response, as weight gain in the trunk and face is a hallmark, and changes may indicate fluid retention or metabolic shifts.

Choice B reason: Administering prescribed diuretics is appropriate in Cushing’s syndrome when fluid retention causes edema or hypertension. Diuretics reduce excess fluid volume due to cortisol’s mineralocorticoid effects, which increase sodium and water retention, helping manage symptoms like swelling and elevated blood pressure effectively.

Choice C reason: A high sodium diet is contraindicated in Cushing’s syndrome, as cortisol’s mineralocorticoid activity causes sodium retention, leading to fluid overload and hypertension. A low-sodium diet is typically recommended to mitigate these effects and reduce the risk of edema and cardiovascular complications.

Choice D reason: Reporting blood pressure above 139/89 mm Hg is critical, as Cushing’s syndrome often causes hypertension due to cortisol’s effects on sodium retention and vascular tone. Elevated blood pressure increases cardiovascular risk, and prompt reporting ensures timely intervention to prevent complications like stroke or heart failure.

Choice E reason: Examining extremities for pitting edema is important, as cortisol’s mineralocorticoid effects cause sodium and water retention, leading to edema. Regular assessment helps detect fluid overload early, guiding diuretic therapy and fluid management to prevent complications like heart failure in clients with Cushing’s syndrome.

Reasoning:

Choice A reason: Systolic blood pressure above 70 mm Hg is a goal in hypovolemia but is not the most specific outcome for DIC-related bleeding. While low blood pressure reflects fluid loss, addressing bleeding directly prevents further volume depletion, making reduced bleeding a more targeted and measurable outcome.

Choice B reason: A stable level of consciousness is important but not directly tied to deficient fluid volume from bleeding in DIC. Altered consciousness may result from cerebral ischemia or hyponatremia, but reducing bleeding is the primary goal to stabilize fluid volume and prevent further hemodynamic compromise.

Choice C reason: Urine output of 30 mL/hour or more indicates adequate renal perfusion but is a secondary outcome in DIC-related bleeding. While it reflects fluid status, directly addressing bleeding through interventions like transfusions or clotting factor replacement is more specific to correcting the underlying fluid volume deficit.

Choice D reason: Decreased bleeding is the most appropriate outcome for deficient fluid volume in DIC, as bleeding from mucosal and venipuncture sites directly causes volume loss. Reducing hemorrhage through platelet or factor replacement stabilizes fluid volume, preventing hypovolemia and its complications, making this the most measurable and relevant outcome.