Which endocrine disorder causes the client to have dilutional hyponatremia?

Reasoning:

Choice A reason: Impaired physical mobility is a concern in Addisonian crisis due to weakness from cortisol deficiency, but it is not the highest priority. Acute crisis causes severe hypovolemia and hypotension, which threaten cardiac output and organ perfusion, making mobility a secondary issue compared to life-threatening cardiovascular instability.

Choice B reason: Imbalanced nutrition is relevant in chronic Addison’s disease due to weight loss and poor appetite, but in acute crisis, it is not the priority. Severe hypotension and electrolyte imbalances from adrenal insufficiency pose immediate threats to life, requiring urgent correction before addressing nutritional deficits.

Choice C reason: Risk for infection is a concern in Addison’s disease due to cortisol’s role in immune function, but it is not the primary issue in acute crisis. Hypovolemia, hypotension, and electrolyte imbalances drive life-threatening cardiovascular collapse, making infection risk secondary to stabilizing cardiac output and fluid status.

Choice D reason: Decreased cardiac output is the highest priority in Addisonian crisis, as adrenal insufficiency causes severe hypotension and hypovolemia due to aldosterone and cortisol deficiencies. This leads to reduced cardiac preload and shock, requiring urgent fluid and steroid replacement to restore perfusion and prevent organ failure.

Reasoning:

Choice A reason: Diabetes insipidus is likely due to the client’s symptoms of polyuria, thirst, and weight loss following a head injury. Trauma can disrupt the posterior pituitary, reducing ADH secretion, leading to excessive dilute urine output, dehydration, and subsequent thirst and weight loss from fluid depletion, consistent with central DI.

Choice B reason: A pituitary tumor may cause diabetes insipidus but is not the condition itself. Tumors can disrupt ADH production, but the symptoms described—polyuria, thirst, and weight loss—point directly to diabetes insipidus as the primary condition, with a tumor being a potential underlying cause requiring further investigation.

Choice C reason: Hypothyroidism, caused by thyroid hormone deficiency, leads to symptoms like fatigue and weight gain, not polyuria or weight loss. It is unrelated to head injury or ADH dysfunction, making it an unlikely diagnosis for the client’s symptoms of excessive urine output and dehydration.

Choice D reason: SIADH causes water retention, leading to concentrated urine, hyponatremia, and potential weight gain, opposite to the client’s symptoms of dilute urine, weight loss, and thirst. Head injury may cause SIADH, but the clinical presentation aligns with diabetes insipidus, not water retention.