Question

John Brown is a 72- year-old man (100kg) who has recently  returned to the general surgical war following a resection of part of his bowel. His past medical history includes smoking for 40years ( but not in the past 10 years ), hypertension, diabetes (type 2) that was diagnosed 5 years ago. His current medications includes ramipril 2.5mg and gliclazide 40mg twice daily. He also reports that he takes non-steroidal anti-inflammatory drugs (NSAIDs) regularly due to chronic back pain. Over all the surgery was uneventful although it was estimated that he sustained a 2- liter blood loss. He was transferred with 2 units of blood alongside other intravenous fluid. On return to the ward his condition appeared stable. He has two redivac drains in situ and there was minimal drainage noted in them. His vital signs were also within normal limits. Later that afternoon, however, the nursing staff noted that his urinary output had decreased to less 40ml/hr. They continued to monitor this for couple of hours and then informed the doctor when it showed no signs of improvement. Bloods were sent off to the laboratory as the doctor was concerned that John might be developing acute kidney injury (AKI).

• Understand and explain first line treatment for acute kidney injury.

• Understand and explain second line treatment for acute kidney injury. and why you would use

  second line treatment.

• Clearly explain the patient medication (minimum of 3-5 medication)

• Clearly explain the subclass of medication

• Clearly explain alternative therapies

• Clearly explain any Black Box warnings, contraindications, and nursing

  consideration for the medications

• Able to identify 3 -5 common side effects

• Identify any medication interactions

• Common indication for the prescribed medication

• Explain 2 challenges that might prevent them from taking medication as

  prescribed.

Answer 1

Assessing the haemodynamic status of the patient is an essential part of initial treatment and should correct hypovolemia and hypotension or hypertension, and other life saving management.If the fluid assessment is difficult ultrasound guided placement of an internal jugular catheter to measure central venous pressure is necessary.in first line therapy for hypertension mostly used drug is angiotensin converting enzyme inhibitors.it will dilate the blood vessels and reduce blood pressure. examples are Capoten,Zestril.

We should be use second line therapy for preventing further complications. examples of second line therapy is calcium channel blockers.it used to lower the bp.It work by slowing the movement of calcium in to the cells of the heart and blood vessels.eg: Amlodipine,Nicardipine,Diltiazem,Nefidipine,Verapamil.

Medication used for kidney failure :Dopamine_ To increase the renal function for critically ill patients.dose is about 1_3ug/kg/min. Diuretic_250 mg furosemide iv over 1hour and have to stop if oliguria present. Amlodipine:it help to relax blood vessels. mostly using in heart failure.Ace inhibitors:it help to dilate the blood vessels.

Subclass of medication: antimicrobial agents:pencilling, Ciprofloxacin,aciclovir.NSIDS:ibuprofen,Naproxen. Anticonvulsant:phynytoin.Antiulcer agents: Omeprazole.ACE inhibitors:Capoten,Zestril.

Alternative therapy for renal failure:Keep blood sugar in target range,blood pressure regulation,loss weight,don't drink soda,quit smoking, balance the blood ph.

Medications used for renal failure like dopamine not to be used in cardiac arrythemias like ventricular fibrillation, ventricular tachycardia. Should be correct hypovolemia before starting dopamine infusion.also monitor blood pressure, pulse,every 15 min.

Side effects of dopamine: Nausea, vomiting,headache,chills, shortness of breath.

Dopamine intraction: arrythemias, asthmatic, dehydration, ischemic heart disease.

Indications for dopamine:shock syndrome due to myocardial infraction,truma,open heart surgery.