In the epidemiologic triangle, what do the following mean? (a) Agent, (b) Host, and (c) Environment

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:

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

A 50 year old truck driver has been diabetic and has required insulin therapy for the past 20 years. Diabetic neuropathy has led to several complications, including end stage renal disease, which he developed two years ago. He now receives hemodialysis 3 times a week and has an AV fistula in his left forearm. Yesterday, C.S presented in the ER with respiratory infection and was hospitalized with pneumonia, hypertension, and fluid overload. He will receive dialysis while on your nursing unit.

1. List 3 nursing diagnosis, interventions, and patient teachings.

Scenario 1: You are treating your patient with acute UTI with the aminoglycoside antibiotic gentamicin. While the patient is taking gentamicin, acute tubular necrosis (epithelial cells in the renal tubules of the kidney) develops that requires intermittent dialysis before recovery.

Scenario 2: You prescribe the recently approved drug aliskiren (Tekturna), a direct renin inhibitor, for hypertension in your patient. One week after starting the drug, your patient reports edema involving the face and hands; no clear respiratory symptoms can be elicited.

For each scenario-

1. Should any of these incidents be reported to the US Food and Drug Administration (FDA)? If so, how is this done?
2. What are the benefits to you the provider, or to the public if this information is reported?
3. What are the requirements of the manufacturer to report to the FDA instances of these events?

Thinking about the current outbreak situation with COVID-19 and parallels with Yellow Fever Outbreaks in Paraguay.

What are our thoughts on when vaccination may become available to the general public and if a massive vaccination program will get established worldwide?

What are some challenges researchers and health professionals face communicating with the media?

1. Mary is a primipara who is breastfeeding. "Why am I experiencing so many painful cramps in my uterus? I thought this happens only in woman who have had babies before.

2. Marion is 1 day postpartum. "It seems like I am urinating all the time; do you think that I have a bladder infection?"

3. Alice, a primiparous, bottle-feeding woman, is concerned. She states, "My mother told me that I should be getting a drug to dry up my breasts like she got after birth. How will my breasts ever stop making milk and get back to normal?"

4. June is a primapara. "My friend who had a baby last year, said she had a flow for 6 weeks. Isn't that a long time to bleed after having a baby?"

5. Joan is a primpara, who is breastfeeding her baby. "My friend told me that I cannot gert pregnant as long as I contiue to breastfeed. This is great because I do not like to use birth control.

the surgical puncture of the chest wall for removal of fluid

Sylvester Brown is 5' 11" (180.3 cm) tall he weighs 152 Lb (68.9 kg) and his current BMI is 17.4. On arrival at the hospital he appears weak. He says he realizes he should eat, but he does not have the energy or the appetite, and he has developed pain in his mouth. He is complaining of a headache that does not seem to go away. He is known to be living with HIV which was diagnosed twelve years ago. He has been taking anti-retroviral (ART) medication but, he admits he has not been consistent in taking them. A year ago, he was treated for tuberculosis and recovered. Brain MRI shows a brain lesion suggestive of an abscess. Describe in details the stage of HIV infection that Sylvester will belong to, indicating what in the case prompted you to choose that stage. What organism is most likely to be causing the abscess? What is the reservoir for that organism and in what class of microorganism does it belong to?

Explain with examples, how infectious diseases are transmitted through (a) direct contact and (b) Indired contact

1. Janice Q., blood bank tech, is working in evening shift. As she normally do, she search for the transfusion patient history, and patient has no previous ABO and Rh. She obtained the ABO and Rh results below.

Janice repeated the testing, but results are still the same. She decided investigate further and look up the patient medical records on file. She found out that the patient has multiple myeloma, and the patient is currently in the hospital due to septicemia.

1. Which part of typing is discrepant? Is it the forward or reverse typing?

2. Explain your answer in #1.

3. What should be the next step to resolve the discrepancy?

4. What causes this ABO discrepancy?

5. Describe the step-by-step procedure on how to resolve this ABO discrepancy.

What steps are cited as to how one can prevent foodborne diseases?