Physiological Adaptation Q 176

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Which of the following symptoms might a client with right-sided heart failure exhibit?

  

     A. Adequate urine output

     B. Polyuria

     C. Oliguria

     D. Polydipsia

    

    

Correct Answer: C. Oliguria

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Inadequate deactivation of aldosterone by the liver after right-sided heart failure leads to fluid retention, which causes oliguria. Oliguria is a late finding in heart failure, and it is found in patients with markedly reduced cardiac output from severely reduced LV function.

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Option A: An adequate urine output indicates that the client does not have fluid retention. The activation of the RAAS leads to salt and water retention, resulting in increased preload and further increases in myocardial energy expenditure. This results in an increase in angiotensin II (Ang II) levels and, in turn, aldosterone levels, causing stimulation of the release of aldosterone. Ang II, along with ET-1, is crucial in maintaining effective intravascular homeostasis as mediated by vasoconstriction and aldosterone-induced salt and water retention.

Option B: Polyuria is possible in a weak heart due to heart failure. A weak heart cannot pump blood efficiently, causing fluids to build up in the body. The kidneys work to rid the body of excess fluid, causing frequent urination.

Option D: Polydipsia is usually associated with diabetes mellitus. In people with diabetes, polydipsia is caused by increased blood glucose levels. When blood glucose levels get high, the kidneys produce more urine in an effort to remove the extra glucose from the body. Meanwhile, because the body is losing fluids, the brain tells you to drink more in order to replace them.

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