QLexNursing

🌊 Monitor for Pulmonary Edema

🔷 Explanation: The client’s elevated cortisol and sodium levels indicate fluid retention, a hallmark of Cushing’s syndrome or hypercortisolism.

🔷 Mechanism: Excess cortisol promotes sodium and water retention, leading to increased intravascular volume and blood pressure.

🔷 Clinical Concern: Rapid fluid accumulation can result in pulmonary edema, manifesting as dyspnea, crackles, and decreased oxygen saturation.

🔷 Nursing Action: The nurse should auscultate lung sounds regularly, monitor for shortness of breath, and track oxygen saturation for early detection.

🔷 Goal: Early identification prevents respiratory compromise and reduces the risk of acute heart failure secondary to fluid overload.

⚖️ Report Weight Change

💠 Explanation: The client’s weight increased by 1 kg (2.2 lb) in 24 hours, indicating fluid retention rather than fat gain.

💠 Significance: In patients with elevated cortisol, even small daily weight gains can signal worsening edema or fluid overload.

💠 Clinical Importance: Reporting these changes promptly allows providers to adjust diuretic therapy or investigate underlying fluid imbalance.

💠 Nursing Monitoring: Accurate daily weights should be taken at the same time each day, using the same scale, and with consistent clothing.

💠 Goal: Maintain fluid balance and prevent complications such as hypertension or pulmonary congestion.

🧂 Place the Client on a Low-Sodium Diet

💎 Explanation: Elevated sodium levels (155 mEq/L) reflect hypernatremia, often due to cortisol-induced sodium retention.

💎 Rationale: A low-sodium diet helps reduce fluid retention and blood pressure, decreasing the workload on the cardiovascular system.

💎 Teaching Point: The client should be educated to avoid processed foods, canned soups, and salted snacks, which are high in sodium.

💎 Expected Outcome: Limiting sodium supports blood pressure control and reduces the risk of edema and heart complications.

💎 Goal: Promote fluid homeostasis and prevent worsening hypertension or fluid overload.

❤️ Monitor for Dysrhythmias

💠 Explanation: The client’s potassium level (3 mEq/L) indicates hypokalemia, which can disrupt cardiac electrical conduction.

💠 Risk Factor: Low potassium increases the risk of ventricular dysrhythmias, especially when coupled with hypertension and fluid overload.

💠 Monitoring: Continuous ECG monitoring or frequent apical pulse checks help detect arrhythmias early.

💠 Nursing Priority: Notify the provider of irregular heart rhythms or palpitations, and anticipate potassium replacement therapy.

💠 Goal: Maintain normal cardiac rhythm and prevent life-threatening ventricular arrhythmias.

💉 Monitor Blood Pressure

🔶 Explanation: The client’s persistent hypertension (172/90 → 178/92 mm Hg) reflects the mineralocorticoid effect of cortisol, which enhances sodium and water retention.

🔶 Complications: Uncontrolled blood pressure increases the risk of stroke, heart failure, and renal impairment.

🔶 Nursing Action: Frequent vital sign monitoring is essential to detect worsening hypertension or response to treatment.

🔶 Interventions: Encourage dietary modification, stress reduction, and medication adherence as ordered.

🔶 Goal: Maintain stable blood pressure to protect target organs and prevent cardiovascular complications.