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Difficulty: MediumPhysiological Adaptation

Following a transsphenoidal pituitary tumor resection 14 hours ago, a client develops a sudden, massive increase in urine output, voiding 2,100 mL of pale, odorless urine over a 3-hour period. The client is increasingly restless and reports extreme thirst. Assessment reveals a weak peripheral pulse of 118 beats per minute and a blood pressure reading of 88/50 mm Hg. Which of the following is the priority nursing action?

  1. Initiate an infusion of prescribed desmopressin acetateAnswer
  2. B
    Reduce the maintenance intravenous fluid rate to prevent circulatory overload
  3. C
    Position the client flat in bed with the lower extremities elevated
  4. D
    Perform a comprehensive evaluation of cranial nerve function

Answer

The priority action is to initiate an infusion of prescribed desmopressin acetate.
The client is exhibiting classic signs of central Diabetes Insipidus, a common complication of transsphenoidal pituitary surgery. The lack of antidiuretic hormone (ADH) leads to massive diuresis of dilute urine, which rapidly causes hypovolemic shock, as indicated by the tachycardia and hypotension. The priority is to administer desmopressin acetate, a synthetic form of ADH, to replace the deficient hormone, stop the excessive fluid loss, and stabilize the client's circulatory status.

Step-by-Step Solution

1
Analyze the client's postoperative timeframe, clinical symptoms, and vital signs.
The client has massive polyuria, restlessness, tachycardia, and hypotension 14 hours after pituitary surgery.
Identifying the pattern of symptoms is necessary to recognize the acute complication.
2
Correlate the findings with known surgical complications.
Transsphenoidal surgery can cause pituitary gland damage, leading to decreased antidiuretic hormone (ADH) and central Diabetes Insipidus.
Understanding the pathophysiology connects the polyuria directly to the hypotension.
3
Apply the ABCs (Airway, Breathing, Circulation) framework for prioritization.
The client is in hypovolemic shock (Circulation compromise) secondary to the massive fluid loss.
Airway and Breathing are intact, so stabilizing Circulation is the highest priority.
4
Determine the appropriate intervention for the circulatory compromise.
Administering desmopressin (a synthetic ADH analog) treats the underlying cause by promoting renal water reabsorption.
Stopping the fluid loss is essential to stabilize the client's hemodynamic status.

Key Concept

Recognizing and managing Diabetes Insipidus as a complication of pituitary surgery, prioritizing hemodynamic stability over secondary assessments.
Estimated Time:1m 30s
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Topics

Physiological Adaptation

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