A 73-year-old man comes into the emergency department (ED) by ambulance after slipping on a small carpet in his home
The patient fell on his hip with a resultant fracture. He is alert and oriented; PERLA is intact. His heart rate is elevated, he is anxious and thirsty, a Foley catheter is placed, and 40 mL of urine is present. What is the nurse's most likely explanation for the urine output?
A) The man urinated prior to his arrival to the ED and will probably not need to have the Foley catheter kept in place.
B) The man has a brain injury, lacks ADH, and needs vasopressin.
C) The man is in heart failure and is releasing atrial natriuretic peptide that results in decreased urine output.
D) He is having a sympathetic reaction, which has stimulated the renin-angiotensin-aldosterone system that results in diminished urine output.
Ans: D
Feedback: Renin is released by the juxtaglomerular cells of the kidneys in response to decreased renal perfusion. Angiotensin-converting enzyme converts angiotensin I to angiotensin II. Angiotensin II, with its vasoconstrictor properties, increases arterial perfusion pressure and stimulates thirst. As the sympathetic nervous system is stimulated, aldosterone is released in response to an increased release of renin, which decreases urine production. Based on the nursing assessment and mechanism of injury, this is the most likely cause of the lower urine output. Option A is incorrect; the man urinating prior to his arrival to the ED is unlikely; the fall and hip injury would make his ability to urinate difficult. Options B and C are incorrect; there is no assessment information that indicates he has a head injury or heart failure.
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