The client has a history of cardiovascular disease. The nurse will prioritize the assessment of: Question 1of 10 history of cardiovascular disease.The nurse will prioritize the assessment of: A nurse is caring for a 70-year-old client who is taking desmopressin (DDAVP). The client has a
The Correct Answer and Explanation is:
When caring for a 70-year-old client who is taking desmopressin (DDAVP) and has a history of cardiovascular disease, the nurse should prioritize the assessment of fluid balance and electrolyte levels, particularly sodium levels.
Desmopressin is a synthetic analogue of the antidiuretic hormone vasopressin, which is used primarily to treat conditions like diabetes insipidus, nocturnal enuresis, and bleeding disorders (e.g., hemophilia). One of the main actions of desmopressin is to promote water reabsorption in the kidneys, which can result in fluid retention. This fluid retention, in turn, can lead to hyponatremia (low sodium levels), which is a serious and potentially life-threatening complication.
Why fluid balance and electrolyte levels are important:
- Fluid Retention and Cardiovascular Risk: Desmopressin can increase water retention in the body, which may exacerbate cardiovascular conditions such as hypertension, heart failure, or coronary artery disease. Given the client’s history of cardiovascular disease, this is a crucial area for assessment because excessive fluid retention can put additional strain on the heart, leading to complications like pulmonary edema or heart failure exacerbation.
- Hyponatremia: One of the most significant risks with desmopressin therapy is the development of hyponatremia due to overhydration, which can occur when excessive amounts of water are retained in the kidneys without a corresponding increase in sodium levels. Symptoms of hyponatremia include headache, nausea, vomiting, confusion, and in severe cases, seizures or coma.
- Cardiovascular Complications: For a client with a cardiovascular history, the risk of fluid overload is amplified. The nurse should monitor for signs of fluid overload, such as edema (swelling in the legs, feet, or abdomen), increased blood pressure, and difficulty breathing (indicative of pulmonary congestion).
Nursing Actions:
- Monitor vital signs regularly, particularly blood pressure and heart rate.
- Assess for signs of fluid overload like edema and dyspnea.
- Evaluate laboratory values including sodium levels, renal function (creatinine and BUN), and electrolytes.
- Educate the client to report any signs of fluid retention (e.g., swelling, shortness of breath).
In summary, the nurse should prioritize the assessment of fluid balance, electrolytes, and cardiovascular status to prevent complications such as hyponatremia and fluid overload, which are particularly concerning for clients with cardiovascular disease.
