Question

You are a Practice Nurse in a small rural medical centre.

Mr Stuart Murray is a 48-year-old Indigenous man living with his family in a small rural town in NSW. Mr Murray has a medical history of type 2 diabetes, obesity and hypertension. Mr Murray drinks at least five schooners of beer and smokes up to 20 cigarettes daily. He is currently suffering from tiredness, breathlessness on exertion, swollen ankles, nausea, itchy skin and aching bones and joints. He passes about 400 mL of urine in 24 hours.

Mr Murray presents to his local medical centre saying he was not feeling well. Mr Murray’s regular medications are metformin and ramipril. You assess Mr Murray and reviews the pathology tests the doctor ordered.

• His blood pressure is 167/95mmHg, pulse 92bpm, respiration rate 24.
• Blood biochemistry reveals: Sodium 132 mmol/L, Chloride 92 mmol/L, Potassium 5.7 mmol/L
• Bicarbonate 20 mmol/L, Urea 27.6 mmol/L, Creatinine 428 umol/L, Hb 82g/L, eGFR 20   
• HbA1c 8.6%

Question 11. Maximum word limit 20 words. (1 mark)

You are concerned that Mr Murray is at risk of, or is, developing Chronic Kidney Disease (CKD). Based on the scenario above, list the risk factors for CKD that are applicable to Mr Murray.

Question 12. Maximum word limit 20 words. (1 mark)

List the three recommend tests that form the kidney health check, to determine if Mr Murray is developing CKD.

Question 13. Maximum word limit 10 words. (1 mark)

Based on the physical assessment and the pathology test results, what stage of CKD is Mr Murray currently experiencing?

Question 14. Maximum word limit 300 words.

Mr Murray’s doctor prescribes the following dietary modifications and additional medications.  

• Sodium bicarbonate tablet 500mg tds
• Calcium carbonate tablets 600mg tds
• Erythropoietin injection 40,000 units SC weekly   
• 1500 mL fluid restriction
• Low potassium and 70-gram protein diet

As the Practice Nurse in the medical centre, you explain to Mr Murray how each of these treatments are related to his failing kidney function, how they will improve his health, and how he should take them. Outline your explanation for each.

Question 15. Maximum word limit 150 words.

The doctor tells Mr Murray that he will need to go to the nearest large town for a specialist consultation and treatment. Mr Murray is not sure that he wants to go.

1. What cultural concerns may be raised for Mr Murray by this possibility?
2. Briefly describe strategies that could be implemented to help maintain Mr Murray’s autonomy.
3. Briefly describe strategies that could be implemented to help maintain Mr Murray’s cultural safety.

Answer 1

11.The risk factors applicable to Mr .Murray to develop CKD are

• Type 2 diabetes or diabetes
• Obesity
• Hypertension
• Smoking
• Alcoholism

12.The recommended test to determine CKD are

• Glomerular filteration rate less than 30ml /hr
• Elevated sr.creatinine ,BUN ,urea level
• Altered renal function test

13.The patient is in stage 4 level of CKD .The urine output is 400 ml/day which means approximately 16 _17 ml/hr which falls in stage 4 of CKD (GFR is around 15_29ml/hr)

14.As the renal function decreases the bicarbonate level in the blood decreases which can lead to electrolyte imbalance,acid base imbalance like acidosis .In order to prevent this bicarbonate has to be administered externally. This can be balanced by giving sodium bicarbonate tablets.

In CKD patient the risk for deposition or retention of phosphorus is high in order to prevent this calcium carbonate is administered.They bind with the phosphorus and prevent excess phosphate in the blood .

The kidney plays a vital role in the red blood cell production. In CKD the erythropoietin levels are decreased because of decreased erythropoietic metabolism.This can lead to anemia.In order to prevent this erythropoietin injection is administered once a week and maintain normal hemoglobin levels.

As the GFR rate is decreased excess fluid cannot be eliminated resulting in fluid retention in order to prevent this fluid restrictions has to be followed

The potassium levels can increase brvause of altered renal function so diet should be low in potassium to prevent hyperkalemia.Along with this the protein has to be restricted because the end products contains ammonia products which can increase the urea,creatinine,BUN and waste products causing further problems.Ib order to prevent this low potassium and recommended protein intake is a must.