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Medicine General ddce8284

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
High-Yield Explanation
Urine output of 300 ml/hr may indicate diabetes insipidus, which is a failure of the pituitary to produce the anti-diuretic 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. Option C: Providing emollients to prevent skin breakdown is important, but doesn’t need to be performed immediately. Option D: Slowing the rate of IV fluid would contribute to dehydration when polyuria is present.

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