Neurological Disorders Q 68 - Gyan Darpan : Learning Portal
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Monday 18 April 2022

Neurological Disorders Q 68

A client with head trauma develops a urine output of 300 ml/hr, dry skin, and dry mucous membranes. Which of the following nursing interventions is the most appropriate to perform initially?
     A. Evaluate urine specific gravity.
     B. Anticipate treatment for renal failure.
     C. Provide emollients to the skin to prevent breakdown.
     D. Slow down the IV fluids and notify the physician.

Correct Answer: A. Evaluate urine specific gravity.

Urine output of 300 ml/hr may indicate diabetes insipidus, which is a failure of the pituitary to produce the antidiuretic hormone. This may occur with increased intracranial pressure and head trauma; the nurse evaluates for low urine specific gravity, increased serum osmolarity, and dehydration.

Option B: There’s no evidence that the client is experiencing renal failure. The most common findings in patients with diabetes insipidus are polydipsia, polyuria, and nocturia. Additional symptoms in patients with diabetes insipidus may include weakness, lethargy, fatigue, and myalgias.
Option C: Providing emollients to prevent skin breakdown is important, but doesn’t need to be performed immediately. Central diabetes insipidus is diagnosed when there is evidence of plasma hyperosmolality (greater than 300 mosm/l), urine hyperosmolarity (less than 300 mosm/l or urine/plasma osmolality less than 1), with polyuria (urinary volume greater than 4 mL/kg/hr to 5 mL/kg/hr for two consecutive hours after surgery).
Option D: Slowing the rate of IV fluid would contribute to dehydration when polyuria is present. In cases of nephrogenic diabetes insipidus, water deprivation suboptimally increases urine osmolality. DDAVP minimally increases urine osmolality in partial nephrogenic diabetes insipidus, with no increase in urine osmolality in complete nephrogenic diabetes insipidus.

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