After surgical clipping of a cerebral aneurysm, what should the nurse monitor for as a manifestation of excessive ADH?

Monitoring for excessive antidiuretic hormone (ADH) secretion, also known as Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH), is critical after surgeries such as clipping of a cerebral aneurysm. In cases of excessive ADH, the body retains water, which leads to dilutional hyponatremia and a decrease in urine output.

When ADH levels are elevated, the kidneys reabsorb more water than normal, thus decreasing the volume of urine produced. Consequently, this results in the patient experiencing decreased urine output, which is a hallmark sign of excessive ADH activity.

Increased blood urea nitrogen (BUN) levels can indicate dehydration or renal impairment, while an increased serum sodium level suggests dehydration rather than retention, making these options inconsistent with excessive ADH. Lastly, decreased specific gravity indicates a dilute urine condition, which would not typically occur during times of excessive ADH, where urine would be more concentrated. Therefore, monitoring decreased urine output is a key indicator of excessive ADH post-surgery.