Question

Chapter 46 Acute Kidney Injury Disease

Acute Kidney Injury

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. A.S. has to have a 24-hour urine collection performed, as she is not urinating a lot. Describe in steps the collection procedure by the nurse.
• 2. What is your interpretation of A.S.'s BUN, Cr, and BNP?

BUN (10 -20 mg/dL)

Cr (<1.2 mg/dL for women <1.4 mg/dL for men)

BNP (<100 pg/mL):

3. Should you be concerned about A.S..'s potassium level of 5.2 meq/L? (Yes/No)

List two treatment types that the health care provider might prescribe if deciding to treat A. S. hyperkalemia.

1.

2.

• 4. Based on A.S.’s presentation, what nursing assessments, interventions, and monitoring skills need to be performed by you the registered nurse? Student must list at least six:
• 5. 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.

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

8. 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:

Answer 1

Answer : For collecting 24 hours urine specimen nurse should 1) explain the patient about the test, purpose and instructions( collect the urine after cleaning the genital area . 2) start collecting urine afterthe patient void once . 3) Record the starting time and collect all the urine from the starting time to end time (24 hrs ) on the jar . 4) Clearly label patient name, inpatient number ,starting and ending time of urine collection ). Elevated creatinine, BUN and BNP level indicates acute renal failures . 1) Inj : Calcium gluconate 10 ml IV slow over 3 to 5 minutes 2)Regular insulin 10 units with 25 ml of dextrose (25%) IV over 20 minutes. 3) in severe cases, doctors advise dialysis also. 1) Nurses should monitor vital signs (including rhythm ) and spo2 continuously . 2) Monitor intake and output chart strictly . 3)Assess the rhythm continuously because there is chances to get arrhythmias . 4) keep oxygen mask and ventilatior stand by because patient has shortness of breath. 5) check signs for shock because Hb level is low. 6 )Administer medications at correct time especially stat medications . Medications : 1)  Diuretics such as Lasix :  This medications helps  to eliminate extra Water from the body and also reduce blood pressure. 2) hemodialysis : for removing extra toxins from the body. 3 ) replacement of calcium 4)  ferrous sulfate 5) Antibiotics such as penicillin 6) calcium channel blockers . Lack of taking proper medications at correct time, risks factors such as diabetes ,hypertension and heart failure also the major contributing factors for her present condition. 1) if she followed Taking medication at correct time 2) ,diet control and exercise ,she would had prevented this condition from occurring . When kidneys are diseased or damaged,  they do not make enough EPO .As a result, bone marrow make fewer  red blood cells ,causing anemia . Instructions : 1) Importance of taking proper medications and control hypertension ,diabetes , CKD 2) Advise about adopting a daily exercise regimen 3) diet control including low sodium and high protein diet 4) follow fluid restrictions according to doctors advise 5) follow regular health checkup. Health care professionals : 1) Psychological comfort 2) frequent checking of creatinine, HR ,BUN and electrolytes . 3) checking of weight regularly 4) check the vital signs and spo2 . 5 ) plan a diet chart for the patient.