Renal Case Studies by 85JaGD


									Renal Case Studies

 Nursing 2904
 Carol Isaac MacKusick, MSN, RN, CNN

   Maria is a 38 year old female,
    admitted to the hospital via the ED
    after being involved in a serious MVA.
   At the scene, EMTs noted the
    – BP 76/42
    – Tight belly, hypoactive bowel sounds
    – Pt c/o abdominal pain

   It is revealed that rescue of the client
    from the auto took approximately 45
    minutes. It is assumed that help
    arrived on the scene 30 – 45 minutes
    after the accident occurred
   Upon exam in the ED, it was noted
    that her spleen was ruptured;
    immediate surgery was performed

   Family members state that there is no
    significant medical history with Maria
   She is a Hispanic female, slightly
    overweight at 146 pounds, height is 5
    foot 3 inches
   She is a first grade teacher
   She is a practicing Catholic
   She is single

   After surgery, Maria is transferred to the
    ICU of the hospital
   2 days post surgery, you notice that urine
    output has decreased to approximately 25
    ml / hour times 2 hours
   Maria is relatively well controlled for pain at
    this point, and she is alert and oriented

   After initial injury, how did Maria’s
    body respond to the low blood
    pressure she was experiencing?
    – Osmoreceptors inhibit ADH production
    – Stretch receptors vasoconstrict peripheral
    – Chemoreceptors stimulate production of
    – Baroreceptors stimulate ADH production

   Which type of ARF is Maria most at
    risk for developing?
    – ATN
    – Postrenal
    – Prerenal
    – intrarenal

   Five days have passed since the
    accident. Maria’s urine output has
    fallen to 350 ml / 24 hours. Her MD
    orders a diuretic challenge, and no
    response is noted. Her BP is 165/94.
    Maria appears anxious, edematous,
    and c/o shortness of breath. Her
    weight has increased 2.1 kgs since

   What is happening to Maria?
    – Prerenal failure
    – ATN
    – Postrenal failure
    – Intrarenal failure

   Maria’s BUN is 100 mg / dl. She is
    confused and drowsy. She has a
    diagnosis of ARF secondary to acute
    tubular necrosis. Her urine output has
    remained at ~350 ml / day for the
    last 3 days.

   What stage of ARF is Maria in?
    – Oliguric / anuric
    – Onset
    – Early diuresis
    – Late diuresis

   Maria c/o extreme thirst. Together
    with the dietitian, you compute her
    daily fluid allowance to be:
    – As tolerated
    – 200 ml / hour
    – 2000 ml / day
    – 850 ml / day

   One week has passed. Maria’s urine
    output has increased slightly, and is
    now 450 ml / 24 hours. Her BUN and
    CrS have stabilized.

   According to the latest data, which of
    the following stages of ARF is Maria
    – Oliguric / anuric
    – Late diuresis
    – Onset
    – Early diuresis

   Maria is experiencing what you believe
    to be uremic syndrome. She is
    complaining of tingling and numbness
    of her hands and feet. She is easily
    bruised, and has a slight urine odor to
    her skin.

   The tingling and numbness are most
    likely caused by
    – Hyperkalemia
    – Hypocalcemia
    – Stimulated stretch receptors
    – Peripheral neuropathy

   Skin bruising in ARF is secondary to
    the effects of
    – Her EPO injections
    – Decreased NH4 levels
    – Severe hypocalcemia
    – Uremic toxins affecting platelet

   Maria’s PO4 level is elevated. Why?
    – Hypermagnesemia
    – Hypocalcemia
    – Hypomagnesemia
    – hypercalcemia

   You know that Maria is at risk for
    development of metabolic acidosis
    primarily due to
    – Decreased excretion of K
    – Increased excretion of hydrogen ions
    – Increased excretion of K
    – Decreased excretion of hydrogen ions

   Maria has an order to receive
    emergent dialysis. She is
    hemodynamically stable, and she is 8
    days post abdominal surgery. She has
    generalized edema, and severe
    electrolyte abnormalities.

   What type of dialysis therapy should
    Maria most likely receive?
    – Hemodialysis
    – Peritoneal dialysis
    – SCUF
    – CVVHD

   Maria’s urinary output returns to
    normal. Her BUN and CrS are stable,
    as are all other major electrolytes.
    Her GFR is computed at 90 ml / min.
    She is to be discharged home for
    further recovery.

   Maria asks how long her kidneys will not
    work at 100%. You reply
    – Your kidneys will never be the same
    – You should continue to see improvement over
      the next year
    – Things will actually get worse for you over the
      next 6 – 12 months, and you should plan on
      scheduling regular dialysis treatments
    – This is a normal kidney function

   How long will Maria remain in the
    convalescent phase of ARF?
    – 3 – 4 weeks
    – Three months
    – 6 – 12 months
    – Forever

   During the convalescent phase, it is
    important for Maria to avoid:
    – Fatty foods
    – NSAIDs and OTC herbals and cold
    – High protein diets
    – Contrast dye

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