A nurse cares for a client who possibly has syndrome of inappropriate antidiuretic hormone (SIADH). The client's serum sodium level is 114 mEq/L. Which action should the nurse take first?
a. Consult with the dietitian about increased dietary sodium.
b. Restrict the client's fluid intake to 600 mL/day.
c. Handle the client gently by using turn sheets for re-positioning.
d. Instruct unlicensed assistive personnel to measure intake and output.
ANS: B
With SIADH, clients often have dilutional hyponatremia. The client needs a fluid restriction, sometimes to as little as 500 to 600 mL/24 hr. Adding sodium to the client's diet will not help if he or she is retaining fluid and diluting the sodium. The client is not at increased risk for fracture, so gentle handling is not an issue. The client should be on intake and output; however, this will monitor only the client's intake, so it is not the best answer. Reducing intake will help increase the client's sodium.
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