Question

Chapter 46 Acute Kidney Injury Disease

Acute Kidney Injury

Approx 60 min

Patient Profile

A.S. is a 70-year-old white woman who presented to the emergency department because of a 4-day history of increased shortness of breath and generalized weakness. A.S. stated that she has been able to do her daily chores at home independently, but for the past few days, it was getting difficult for her to get around and that she needed to take frequent breaks because she was short of breath and had no energy. She has a long history of heart failure, type 2 diabetes, and hypertension. She is admitted with a tentative diagnosis of acute kidney injury (AKI).

Subjective Data

• Has been having headaches on and off, with nausea and dizziness
• Reported that she had not been taking her medications regularly at home because of “forgetfulness”
• Has not been urinating a lot
• Feels “puffy” in her legs and hands

Objective Data

Physical Examination

• Blood pressure 178/96, pulse 110, temperature 98.9°F, respirations 24, and an oxygenation of 93% on room air
• Alert and oriented to person, place, and time
• Mild jugular venous distention
• Fine crackles in bilateral lower lobes
• Heart rate regular, no murmurs
• Bowel sounds normoactive and present in all four quadrants
• 2+ edema bilateral lower extremities and hands

Diagnostic Studies

• Echocardiogram shows decreased left ventricular function
• Urinalysis: Urine dark yellow and cloudy, protein 28 mg/dL, negative for glucose and ketones, positive for casts, red blood cells and white blood cells
• 24-hour urine output = 380 mL
• Laboratory Tests:

*	Hemoglobin	8 g/dL
*	Hematocrit	23.8%
*	RBC	2.57 million/mm3
*	WBC	4.7 mm3
*	Sodium	132 mEq/L
*	Potassium	5.2 mEq/L
*	Calcium	9 mg/dL
*	BUN	36 mg/dL
*	Creatinine	4.9 mg/dL
*	BNP	182 pg/mL

Case Study Questions

• 1. What orders do you as the nurse, anticipate the physician will order? Student must list at least six (frequencies not necessary to list; only what you think the physician will order):

6. Explain what might have contributed to A.S.’s present condition as described above? What are two evidence-based preventive health care provisions/programs that if put in place early might have prevented this from occurring?

Explain what might have contributed to A.S.’s present condition:

Evidence-based Preventive Health Care Provisions/Programs:

1.

2.

1. 3. What is the significance of A.S.’s Hemoglobin, Hematocrit, and RBC levels being significantly decreased?

1. 4. You are planning discharge for A.S. What would you include in your discharge instructions/teachings and what other interdisciplinaries/health professionals would you include? Student must list at least five each:

Nursing Teaching/Instructions                    Other Health Professionals

1.                                                                 1.
2.                                                                 2.
3.                                                                 3.
4.                                                                 4.
5.                                                                 5.

Reference: (Lewis, S. M., Bucher, L., Heitkemper, M. M. L., Harding, M., Kwong, J., & Roberts, D. (2017). Medical-Surgical Nursing: Assessment and Management of Clinical Problems. St. Louis: Elsevier

Answer 1

1) The orders anticipated by the nurse are :-

- Antihypertensives

- Loop diuretics

- Weight monitoring

- Input /output monitoring

- Potassium binders

- The antibiotic trimethoprim-sulfamethoxazole and the H2-blocker cimetidine to decrease the secretion of creatinine.

2) The cause which have contributed to her condition is non compliance to medication which has resulted in kidney failure and hence the present condition

Two evidence-based preventive health care provisions/programs :-

Health education

Regular follow ups to the physician

3) The significance of A.S.’s Hemoglobin, Hematocrit, and RBC levels being significantly decreased is due to the failure of kidney. Production of RBC's is one of the main functions of kidney .

4) Discharge teaching :-

- Proper rest

- Monitor fluid intake (as prescribed ) and output

- Compliance to all medications( Antihypertensives , diuretics etc )

- Avoid potassium rich diet

- Take diet as prescribed by dietician

- weight monitoring

- regular follow up with physician

Other healthcare professionals to be included are :-

- Dietician

- Counselor

- Nephrologist

- Medical Assistant