Question

K. B. is a 32-year old woman who is being admitted to the medical floor for complaints of fatigue and dehydration. While taking your nursing history you discover that she has diabetes and has been insulin-dependent since the age of 8. She has been in chronic renal failure (CRF) and undergoing hemodialysis for the past 3 years. Your initial assessment of K. B. reveals a pale, thin, lethargic woman in no acute distress. Her admitting chemistries are Na 145 mEq/L, K 5.5 mEq/L, Cl 93 mEq/L, HCO₃ 27 mEq/L, BUN 40 mg/dL, creatinine 3.0 mg/dL, glucose 238 mg/dL. Her skin is warm and dry to touch with poor skin turgor, and her mucous membranes are dry. Her VS are 140/88, 116, 18, 99.9^oF. She tells you she has been nauseated for 2 days so she has not been eating or drinking. She denies vomiting.

1. What aspects of your assessment support her admitting diagnosis of dehydration?
2. Identify 2 possibilities for K. B.’s low-grade fever?

The rest of K. B.’s physical assessment is within normal limits. She tells you she has an AV fistula in her left arm.

3. What is a fistula? Why does K. B. have one?
4. In assessment of an AV fistula, what physical findings would you expect during auscultation and palpation? Why?

Over the next 24 hours, K. B.’s nausea subsides, and she is able to eat normally. Her physician believes she experienced a viral illness because there was no other etiology found for her nausea. While you are in helping her with her AM care she confides in you that she never really understood what “diet I’m supposed to be on anyway.”

5. What information would you seek from K. B. now?
6. Because K. B. is on chronic hemodialysis, what are her special nutritional needs?

K. B.’s complete blood count yields the following results: WBC 7.6 mm³, RBC 3.4 mm³, Hgb 8.1 g/dL. Hct 24.3%, and platelets 333 mm³.

7. Are these values normal? If not, what are the abnormalities?
8. K. B.’s physician notes that she is anemic and this is most likely the cause of her increasing fatigue. Why is K. B. anemic?

The following day K. B. is discharged feeling much better and with a good understanding of her dietary restrictions. Her iron stores have been evaluated and found to be adequate. Her physician has instructed her to continue her same medications before her admission except for the addition of recombinant human erythropoietin 50 units/kg 3 times a week with dialysis.

9. What information would you tell K. B. about her new medication?

Answer 1

Patient is having dehydration symptoms like pale skin, lethargic, the skin is warm, and dry, and poor skin turgor. patient high blood pressure indicate patient is with chronic dehydration, because when body cells lack water pituitary gland secret vasopressin that constricts blood vessels that cause hypertension. high heart rate due to strain in the heart due to blood volume decrease and it make the heart beat faster. patient Na and K levels are high and low chloride level, BUN and creatinine level elevated because dehydration results loss of electrolytes so the concentration of sodium in the blood will be high. due to excess loss of water from the body tissue, it causes imbalance Na, potassium, chloride, and electrolytes.
Low-grade fever due to dehydration, when your body not getting enough fluids it can not maintain regular body temperature. patient chronic renal failure causes low-grade fever due to infection.
fistula is an abnormal connection between two body parts. patient AV fistula is an atrioventricular fistula that blood vessels made wider and stronger to handle the needles that allow blood to flow out to and return from the dialysis machine. it is useful for the patient for hemodialysis.
In assessment of AV fistula during palpation there will be thrill and evaluation of pulse. it identifies the function and dysfunction of the vessels. the thrill is a palpable vibration that is soft and continuous. palpation of AV access followed by auscultation that is done through listening and recognizing changes in the normal bruit and detecting abnormal ones. a bruit is an auditory assessment of thrill. it has two types of normal background(stenosis). it has systolic and diastolic components that is low pitched, soft, machinery like sound.