To prevent autonomic dysreflexia, which nursing action would the home health nurse include in the plan of care for a patient who has paraplegia at the T4 level?

Choice A reason: Increased serum chloride is not a typical finding associated with syndrome of inappropriate antidiuretic hormone (SIADH). In SIADH, the body's regulation of water is impaired, leading to water retention and dilutional hyponatremia. Serum chloride levels might not be significantly affected and are not the primary laboratory indicator for this condition.
Choice B reason: Elevated hematocrit is not directly related to SIADH. Hematocrit levels reflect the proportion of red blood cells in the blood. In SIADH, the main issue is water retention leading to dilutional hyponatremia, rather than changes in red blood cell concentration. Therefore, hematocrit levels are not a key laboratory finding in this disorder.
Choice C reason: Decreased serum sodium, or hyponatremia, is a hallmark finding in SIADH. The excessive release of antidiuretic hormone (ADH) leads to water retention, diluting the sodium in the blood and resulting in low serum sodium levels. This hyponatremia can cause symptoms such as disorientation, headache, and muscle cramps, as seen in the patient. Monitoring and correcting serum sodium levels is crucial in the management of SIADH.
Choice D reason: Low urine specific gravity is not expected in SIADH. In fact, patients with SIADH typically have a high urine specific gravity due to the excessive release of ADH, which causes the kidneys to reabsorb water and concentrate the urine. This concentrated urine reflects the body's attempt to reduce water excretion in response to elevated ADH levels. Therefore, low urine specific gravity would not be an initial laboratory finding in this condition.

Choice A reason: Observing for signs of hypotension is not typically a primary concern for patients with Cushing syndrome. These patients are more likely to experience hypertension due to increased cortisol levels, which cause sodium and water retention, rather than hypotension. Therefore, while monitoring blood pressure is important, focusing specifically on hypotension is not relevant to the typical presentation of Cushing syndrome.
Choice B reason: Monitoring blood glucose levels is a crucial intervention for patients with Cushing syndrome. Increased cortisol levels lead to hyperglycemia and glucose intolerance. Patients may develop diabetes mellitus as a result of chronic hypercortisolism. Regular monitoring of blood glucose levels helps in managing and controlling hyperglycemia and adjusting medication as necessary to maintain stable glucose levels.
Choice C reason: Protecting the patient from exposure to infection is essential in caring for patients with Cushing syndrome. Elevated cortisol levels suppress the immune system, making patients more susceptible to infections. Implementing infection control measures, such as hand hygiene, using personal protective equipment, and monitoring for signs of infection, are vital to prevent complications and ensure patient safety.
Choice D reason: Restricting protein intake is not a recommended intervention for patients with Cushing syndrome. In fact, these patients often require a diet high in protein to counteract the muscle wasting and weakness caused by excessive cortisol levels. Adequate protein intake helps in maintaining muscle mass and overall health, making restriction counterproductive.