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:

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: (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

1)Sultana indicated that the baby “catch cold and we took him to the emergency.” She was referring to what is known as the “common cold.” What causes the “common cold”? What are its symptoms? How is it usually treated? Is the underlying cause of the illness treated or are only its symptoms treated?

2)The “common cold” and influenza (flu) are different. What causes influenza? What are its symptoms and how is it generally treated?

3)What is pneumonia? What causes it? What is its relationship to influenza and the common cold?

4)Explain how azithromycin works to treat pneumonia without harming us. In other words, explain the mode of action of azithromycin and the reason for its selective toxicity.

A 22 year old client comes in for evaluation of a skin rash. She think she may have psoriasis. For several years, she has completed of a white scaly rash that comes and goes.

1. When preforming an initial work up history, what questions would you ask the client regarding the skin rash?

2. The client asks you to explain what kind of disease psoriasis is and would like you to discuss how the scaly patches develop. What is your response?

3. The client is diagnosed with psoriasis and wants to know how to get rid of the rash and prevent if from coming back again. What methods do you suggest?

4. She has been prescribed to use coal tar shampoo along with topical steroids as a first line therapy on her skin. What other over the counter products would be useful for psoriasis?

Food insecurity during covid-19:

How would you conduct a nutrition assessment with these individuals- I.e. What tools would you use/incorporate, ABCDEFG?

Implications, if any on nutritional assessment in the future

Sensory Readiness Activity

Case Study #1: Cataract Surgery

Marcella is a 75-year-old single woman who has had progressive diminished vision and increased difficulty with night driving. Her health care provider suspects that Marcella has a cataract and does a complete eye examination and history.

1. During the health history, the nurse collects data that would indicate whether Marcella has any common factors that contribute to cataract development. What would some of these factors be?

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

2. Marcella informed the nurse of visual symptoms she has been having. Which symptoms would the nurse recognize as significant for cataracts?

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

3. It is determined that Marcella has cataracts, and she has agreed to have surgery to remove them. What is important for the nurse to include in the post-op teaching for this patient following her surgery?

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describe how you measure for knee and thigh high TEDs ?

Dr. William Halsted was a famous surgeon who was the professor of surgery at Johns Hopkins Hospital from 1893 to 1922. He contributed numerous ideas and concepts for Suturing Technique’s used today.

1. Identify his techniques and why they are so important when considering wound closure and wound healing. Your response for this question must be at least 150 words.
2. Identify at least 4 Surgical Staplers used in the past and/or still in use today. Identify when they were first used, why they are used and also a brief description of each stapler. Also include a brief paragraph why staplers are important for wound closure.

Case Study:

Martin, a practical nurse, works in a long-term care facility. He is often the nurse-in-charge of his unit and works with unregulated care providers (UCPs).

He has approached his manger with an idea to improve the care of the residents. This will require a change in the approach to care (model of care) that is currently being used and the UCPs will have added responsibilities. To implement this change, Martin is leading the group working on the new approach to care. He has also learned that some of the UCPs are angry about the proposed change.

1. One day, a small group of UCPs confronts Martin. They are angry and tell him that they are unhappy at work because of the stress they feel from the proposed changes. Martin recognizes that conflict is occurring.

Identify one model of conflict resolution and describe the components.

2. Apply the model to the case scenario and provide statement (verbatim) examples that Martin could apply to each component of the conflict resolution model.

what appropriate techniques that you would use to improve quality of clinical care in the nursing home

thank you

1. How can a public health nurse be involved in disaster preparation? Disaster care?

2. Describe communication challenges in a disaster. What are some solutions?

3. Why does care need to be coordinated in a disaster? What happens when it is not? (Give examples)

Neuro Case Study

Mrs. Greene is a 92-year-old woman who presents to the emergency room with an acute change in mental status and generalized weakness. Her past medical history is unremarkable. She has not had episodes of confusion in the past. Case Study It is determined that Mrs. Greene has a urinary tract infection (UTI) for which she is started on intravenous (IV) levofloxacin (Levaquin). Mrs. Greene’s confusion escalates to visual hallucinations, the pulling out of two IV sites, and restless nights of little sleep. Bilateral soft wrist restraints are prescribed to maintain her safety, the integrity of the IV site, and the Foley catheter. While the nurse is providing care for Mrs. Greene, Mrs. Greene’s son visits. He is very distraught over Mrs. Greene’s state of confusion and her inability to recognize him. Mrs. Greene is unable to answer her son’s questions appropriately and frequently states, “I told you I do not want to cook today.” Visibly upset and tearful, Mr. Greene states, “I don’t understand. She was perfectly normal three days ago. I stopped by to visit and she was outside working in her garden and her conversation with me made perfect sense.”

1. What do you suspect is the reason for Mrs. Greene’s confusion?
2. Would you describe Mrs. Greene’s confusion as delirium or dementia? Provide a rationale for your decision and explain the difference between delirium and dementia.
3. What are three appropriate nursing diagnoses that address Mrs. Greene’s change in mental status?
4. State at least three outcome goals that should be included in the plan of care for Mrs. Greene’s diagnosis of acute confusion
5. Provide five nursing interventions to include in the plan of care for Mrs. Greene’s diagnosis of acute confusion.
6. Briefly discuss strategies that help prevent the need for restraints. List five nursing interventions to include in Mrs. Greene’s plan of care now that she needs bilateral soft wrist restraints for her safety.