Question

A male patient who has possible cerebral edema has a serum sodium level of 116 mEq/L (116 mmol/L) and a decreasing level of consciousness (LOC). He is now complaining of a headache. Which prescribed interventions should the nurse implement first?

a. Administer IV 5% hypertonic saline.
b. Draw blood for arterial blood gases (ABGs).
c. Send patient for computed tomography (CT).
d. Administer acetaminophen (Tylenol) 650 mg orally.

Answer 1

The most urgent intervention for a patient with hyponatremia and symptoms of cerebral edema is to administer IV 5% hypertonic saline to quickly address the swelling of brain cells and prevent further damage.

Step-by-step explanation:

The patient is presenting with symptoms consistent with hyponatremia, which is a lower-than-normal concentration of sodium in the bloodstream, often related to excess water accumulation in the body. This excess water can lead to cerebral edema, wherein the brain cells swell due to the osmotic difference across cell membranes. Given this situation and the decreasing level of consciousness (LOC), the priority is to stabilize the patient's sodium levels.

Considering the emergent nature of cerebral edema and potential brain damage, the nurse should first administer IV 5% hypertonic saline to increase the serum sodium concentration. This hypertonic solution acts rapidly to pull water out of the cells, reducing swelling, and helping stabilize the LOC in the patient. This intervention should take precedence over the other options provided, which while important in their respective contexts, do not address the immediate life-threatening condition of cerebral edema.