Medical Surgical Hyperaldosteronism #5

Question

Which priority assessment finding would the nurse immediately report on a 48-hour adrenalectomy client?

Answers

  1. Temperature reading of 99.5 F (37.5 C) and 99.6 F (37.6 C)
    • Rationale:

      This answer is not correct because this is not a reportable finding. The temperature reading of 99.5 F (37.5 C) and 99.6 F (37.6 C) is a low-grade fever that is expected soon after major surgery due to tissue removal. Unless the client exhibits other symptoms of infection, such as increased white blood cells or infection symptoms at the surgery site, this is not something the nurse needs to report immediately.

  2. Blood pressure readings of 92/60 and 88/58 mm Hg
    • Rationale:

      This answer is correct because blood pressure readings of 92/60 and 88/58 mm Hg are consistent and trending towards hypotension. Hypotension is a symptom of adrenal crisis or Addison’s crisis, therefore, this should be reported immediately.

  3. Surgical site with slight redness, edema, well-approximated
    • Rationale:

      This answer is not correct because this is not a situation that indicates it needs to be reported. Surgical site with slight redness, edema, well-approximated is an expected finding shortly after surgery. Unless there is drainage that is yellow or excessive, this finding is expected.

  4. PaCO2 44 mm Hg, HCO3 22 mEq/L, PaO2 80 mmHg, pH of 7.35
    • Rationale:

      This answer is not correct because PaCO2 44 mm Hg, HCO3 22 mEq/L, PaO2 80 mmHg, pH of 7.35 is within normal range. The client with hyperaldosteronism generally has metabolic alkalosis, so these are good ABG numbers.

Overview

The priority assessment finding the nurse should report for a 48-hour postoperative adrenalectomy client is the blood pressure of 90/60 and 88/58 mm Hg which indicates hypotension. This is concerning especially after an adrenalectomy because there is not enough cortisol to maintain an adequate blood pressure so the client can go into adrenal or Addison’s crisis.

Explanation

Learning Outcomes

Treatment for aldosteronism is an adrenalectomy or removal of the adrenal gland. Adrenal or Addison’s crisis is a life-threatening consequence of adrenalectomy. When an adrenal gland is removed, there is not enough cortisol to maintain an adequate blood pressure so the client can go into adrenal or Addison’s crisis. Therefore, low blood pressure should be reported immediately. Other symptoms of adrenal or Addison’s crisis include extreme weakness, confusion, dizziness, bradykinesia, fatigue, dehydration, high fever, nausea, and vomiting.

Test Taking Tip

Understanding clinical manifestations of adrenal or Addison’s crisis associated with an adrenalectomy is important to answer these questions. Know what are expected findings and normal ABGs to answer this question correctly.

Video Rationale