A patient, on day seven of treatment for a traumatic brain injury, begins to demonstrate large amounts of urine output and an elevated serum sodium level. Which of the following does this assessment finding suggest to the nurse?
1. syndrome of inappropriate antidiuretic hormone
2. cerebral salt wasting
3. diabetes insipidus
4. renal failure
3
Rationale: The time of onset for diabetes insipidus is 5 to 10 days after the initial injury. The earliest sign of this disorder is large amounts of clear water-like urine with an associated increase in serum sodium levels. In the syndrome of inappropriate antiduretic hormone, there is a decrease in urine output with a decrease in serum sodium level. In cerebral salt wasting, there is a high urine output but a low serum sodium level. There is not enough information to support the idea that the patient might be in renal failure.
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