When assessing a patient with increased extracellular fluid (ECF) osmolality, the priority assessment for the nurse to obtain is

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Changes in ECF osmolality lead to swelling or shrinking of cells in the central nervous system, initially causing confusion, which may progress to coma or seizures. Although skin turgor, capillary refill, and heart sounds also may be affected by ECF osmolality changes and resultant fluid shifts, these are signs that occur later and do not have as immediate an impact on patient outcomes.

When Assessing a Patient with Increased Extracellular Fluid (ECF) Osmolality