In the diuretic phase fluid retained during the oliguric phase is excreted and may reach 3 to 5 liters daily, hypovolemia may occur and fluids should be replaced. The diuretic stage usually lasts for 1-2 weeks but can persist longer. In this stage, an increase in urine output is noted and uremia begins to resolve as the kidney continues to heal.

Option B: The client is already experiencing renal failure. In the initiating stage, which begins when the kidney is injured and lasts from hours to days, signs of renal impairment are present such as altered BUN and creatinine levels and decreased urine output. During this phase, the cause of acute renal failure is sought and treatment is initiated.
Option C: Metabolic acidosis is caused by a build-up of too many acids in the blood. Differentiating between pre-renal azotemia and ATN can be difficult. In prerenal azotemia, urine output is diminished. In ATN, urine output may or may not be diminished. In pre-renal assaults, the urinalysis will show normal urinary sediment with hyaline or granular casts, high specific gravity, high osmolality, low urinary sodium and urea, and normal urine creatinine.
Option D: People with chronic kidney disease have a high risk for hyperkalemia, due in part to the effects of kidney dysfunction on potassium homeostasis. Other complications can include cardiac arrest from hyperkalemia due to the decrease in urine output, elevated phosphorus levels due to impaired renal regulation of calcium and phosphates, metabolic acidosis due to decreases in excretion hydrogen ions, GI bleeding, and decreased nutritional status. In treating hyperkalemia, all sources of dietary potassium should be stopped and a low potassium diet prescribed.

The constituents of CSF are similar to those of blood plasma. An examination for glucose content is done to determine whether a body fluid is a mucus or a CSF. A CSF normally contains glucose. A true normal range cannot be given for CSF glucose. As a general rule, CSF glucose is about two thirds of the serum glucose measured during the preceding two to four hours in a normal adult. This ratio decreases with increasing serum glucose levels. CSF glucose levels generally do not go above 300 mg per dL (16.7 mmol per L) regardless of serum levels.

Option A: Testing for protein would not differentiate mucus from CSF because CSF does not contain protein. CSF protein concentration is one of the most sensitive indicators of pathology within the CNS. Newborn patients have up to 150 mg per dL (1.5 g per L) of protein. The adult range of 18 to 58 mg per dL (0.18 to 0.58 g per L) is reached between six and 12 months of age.
Option B: The specific gravity of CSF at normal body temperature remains between 1.004 and 1.003. Cerebrospinal fluid is alleged to have markedly varied readings: extravagant differences are quoted-1.004 to 1.012, and even greater diversities. If such estimates were arrived at by some form of small hydrometer, or there was delay in testing, or no account was taken of the temperature of the fluid at the moment, then such computed answers were inevitable.
Option D: If microorganisms are found in CSF, this might suggest an infection. Normal CSF may contain up to 5 WBCs per mm3 in adults and 20 WBCs per mm3 in newborns. Eighty-seven percent of patients with bacterial meningitis will have a WBC count higher than 1,000 per mm,3 while 99 percent will have more than 100 per mm3. Having less than 100 WBCs per mm3 is more common in patients with viral meningitis.

Trauma is one of the primary causes of brain damage and seizure activity in adults. Other common causes of seizure activity in adults include neoplasms, withdrawal from drugs and alcohol, and vascular disease. Common causes of emergency department visits after seizures are alcohol and drugs, head injury, and epilepsy.

Option A: Decreased sodium in the blood is a rare cause of seizures, especially among adults. Acute symptomatic seizures- secondary to ischemic or hemorrhagic strokes, extra-axial hemorrhage, traumatic brain injury, hypoxic-ischemic injury, acute medical illness, metabolic derangements, substance abuse- can manifest as tonic-clonic seizures without the inherent tendency to recurrent seizures, whereas epileptic seizures recur without proximate provoking factors.
Option C: The most common cause of seizure is epilepsy. However, not every person who has a seizure has epilepsy. The etiology of most of the generalized tonic-clonic seizures is underlying epilepsy from genetic causes (previously categorized as idiopathic). Besides genetic generalized epilepsy, tonic-clonic seizures can be secondary to epilepsy due to structural, infectious, metabolic, or immune-related pathologies.
Option D: Congenital defects do not cause seizures among adults. Seizures account for 1 to 2 percent of all emergency visits in the U.S. Seizures are reported to occur about 11% of people in the United States during their lifetime. Acute symptomatic seizures tend to occur more frequently in males than females in a ratio of 1.85 to 1, with a lifetime risk of 5.0% in males and 2.7% in females.

It is crucial to monitor the pupil size and pupillary response to indicate changes around the cranial nerves. Pupil reactions are regulated by the oculomotor (III) cranial nerve and are useful in determining whether the brain stem is intact. Pupil size and equality is determined by balance between parasympathetic and sympathetic innervation. Response to light reflects the combined function of the optic (II) and oculomotor (III) cranial nerves.

Option B: The cholesterol levels may be monitored after the client has been cleared from imminent danger. Closely assess and monitor neurological status frequently and compare with baseline. Closely assess and monitor neurological status frequently and compare with baseline.
Option C: Echocardiogram can be done once the patient has been stabilized. Assess heart rate and rhythm, and assess for murmurs. Changes in rate, especially bradycardia, can occur because of the brain damage. Dysrhythmias and murmurs may reflect cardiac disease, which may have precipitated CVA (stroke after MI or from valve dysfunction).
Option D: Assessing the bowel sound is unnecessary for clients undergoing CVA. Assess higher functions, including speech, if the patient is alert. Changes in cognition and speech content are an indicator of location and degree of cerebral involvement and may indicate deterioration or increased ICP.

The nurse’s most positive approach is to encourage the client with multiple sclerosis to stay active, use stress reduction techniques and avoid fatigue because it is important to support the immune system while remaining active. Recommend participation in groups involved in fitness or exercise and/or the Multiple Sclerosis Society. Can help the patient to stay motivated to remain active within the limits of the disability or condition. Group activities need to be selected carefully to meet the patient’s needs and prevent discouragement or anxiety.

Option A: Individuals with MS may experience loss of balance, muscle spasms, problems in moving arms or legs, double vision, or loss of vision. Mechanical aids may come in handy once these symptoms occur, but the client should be taught not to depend on these devices. Mobility aids can decrease fatigue, enhancing independence and comfort, as well as safety. However, individuals may display poor judgment about the ability to safely engage in an activity.
Option B: Multiple sclerosis is a disorder that is chronic and has no cure. However, following good health habits would benefit the client. Anticipate hygienic needs and calmly assist as necessary with the care of nails, skin, and hair; mouth care; shaving. Caregiver’s example can set a matter-of-fact tone for acceptance of handling mundane needs that may be embarrassing to the patient and repugnant to SO.
Option D: Most people with MS continue to function normally for 20 years after diagnosis or more. Keeping active would be very beneficial to the client’s health and in maintaining a high quality of life. Plan care consistent rest periods between activities. Encourage afternoon naps. Reduces fatigue, aggravation of muscle weakness.