Lab tests revealed that patient Z’s [Na+] is 170 mEq/L. Which clinical manifestation would nurse Natty expect to assess?
A. Tented skin turgor and thirst
B. Muscle twitching and tetany
C. Fruity breath and Kussmaul's respirations
D. Muscle weakness and paresthesia
Correct Answer: A. Tented skin turgor and thirst
Hypernatremia refers to elevated serum sodium levels, usually above 145 mEq/L. Typically, the client exhibits tented skin turgor and thirst in conjunction with dry, sticky mucous membranes, lethargy, and restlessness. Most patients present with symptoms suggestive of fluid loss and clinical signs of dehydration. Symptoms and signs of hypernatremia are secondary to central nervous system dysfunction and are seen when serum sodium rises rapidly or is greater than 160 meq/L.
Option B: Muscle twitching and tetany may be seen with hypercalcemia or hyperphosphatemia. CNS features include delirium, coma, seizures, neuromuscular hyperexcitability, (Chvostek’s sign and Trousseau’s phenomenon), hyperreflexia, muscle cramping (e.g., carpopedal spasm), or tetany.
Option C: Fruity breath and Kussmaul’s respirations are associated with diabetic ketoacidosis. Kussmaul breathing, which is labored, deep, and tachypneic, may occur. Some providers may appreciate a fruity scent to the patient’s breath, indicative of the presence of acetone. Patients may have signs of dehydration, including poor capillary refill, skin turgor, and dry mucous membranes.
Option D: Muscle weakness and paresthesia are associated with hypokalemia. Significant muscle weakness occurs at serum potassium levels below 2.5 mmol/L but can occur at higher levels if the onset is acute. Similar to the weakness associated with hyperkalemia, the pattern is ascending in nature affecting the lower extremities, progressing to involve the trunk and upper extremities, and potentially advancing to paralysis.
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