In caring for a postoperative adrenalectomy client, which finding should the nurse specifically monitor?

• A. Peripheral edema
• B. Bilateral exophthalmos
• C. Signs and symptoms of hypocalcemia
• D. Signs and symptoms of hypovolemia

Answer: (D)

After removing the adrenal glands, the body loses aldosterone, which normally helps the kidneys retain sodium and water. Without it, sodium and water are wasted in the urine, decreasing intravascular volume. The most important thing to monitor is signs of hypovolemia because this can lead to hypotension and shock if not addressed. Watch blood pressure and pulse trends, urine output, and mental status, and assess for dizziness, dry mucous membranes, cool extremities, and orthostatic changes. Labs may show hyponatremia and hyperkalemia as the kidney’s handling of electrolytes is disrupted. Maintain fluid status as prescribed and monitor for the need for hormone replacement therapy.

Peripheral edema would suggest fluid excess, not the immediate postoperative risk. Exophthalmos points to thyroid disease (not adrenal), and signs of hypocalcemia relate to parathyroid function, which isn’t the primary concern after adrenalectomy.