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; his pupils are equal and reactive to light and accommodation. 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 low 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 likely has a traumatic brain injury, lacks antidiuretic hormone (ADH), and needs vasopressin.
C) The man is experiencing symptoms of heart failure and is releasing atrial natriuretic peptide that results in decreased urine output.
D) The man 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 causing the lower urine output. The man urinating prior to his arrival to the ED is unlikely; the fall and hip injury would make his ability to urinate difficult. No assessment information indicates he has a head injury or heart failure.
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