The laboratory report of a pregnant client shows increased adrenocorticotropic hormone, salivary cortisol, and blood glucose levels. What should the primary healthcare provider instruct the nurse to include in the plan of care for the client to help reduce the risk of death in the client?

The laboratory report of a pregnant client shows increased adrenocorticotropic hormone, salivary cortisol, and blood glucose levels. What should the primary healthcare provider instruct the nurse to include in the plan of care for the client to help reduce the risk of death in the client?

• A. Monitoring weight
• B. Administering mifepristone
• C. Monitoring fluid overload at every 6 hours
• D. Including 5 g of sodium in the diet everyday

Answer: (A)

When the lab results show high ACTH and cortisol with hyperglycemia in pregnancy, the body is in a state of excess cortisol that can lead to fluid retention, hypertension, and glucose intolerance. The most practical way to reduce the risk of death is to closely monitor the patient’s weight. Rapid or excessive weight gain signals fluid shifts and edema, which can indicate worsening fluid overload, preeclampsia, or heart strain. Detecting these changes early through daily weight tracking allows timely interventions (such as adjusting fluids, nutrition, or coordinating with obstetrics for further evaluation) to prevent life-threatening complications for both mother and fetus. Administering mifepristone is not appropriate during pregnancy, as it is used to terminate pregnancy or is not a safe treatment for hypercortisolism in this context. Monitoring fluid overload every 6 hours is more intensive than usually required and weight monitoring already provides a reliable, noninvasive gauge of fluid balance. Increasing sodium intake would tend to worsen edema and hypertension, contrary to the goal of reducing risk.

When the lab results show high ACTH and cortisol with hyperglycemia in pregnancy, the body is in a state of excess cortisol that can lead to fluid retention, hypertension, and glucose intolerance. The most practical way to reduce the risk of death is to closely monitor the patient’s weight. Rapid or excessive weight gain signals fluid shifts and edema, which can indicate worsening fluid overload, preeclampsia, or heart strain. Detecting these changes early through daily weight tracking allows timely interventions (such as adjusting fluids, nutrition, or coordinating with obstetrics for further evaluation) to prevent life-threatening complications for both mother and fetus.

Administering mifepristone is not appropriate during pregnancy, as it is used to terminate pregnancy or is not a safe treatment for hypercortisolism in this context. Monitoring fluid overload every 6 hours is more intensive than usually required and weight monitoring already provides a reliable, noninvasive gauge of fluid balance. Increasing sodium intake would tend to worsen edema and hypertension, contrary to the goal of reducing risk.