Question

UNFOLDING CASE STUDY 1- KIMBERLY

Kimberly is a 35-year-old patient who was admitted to the hospital with a complaint of nausea for 1 week with minimal abdominal pain. She rated her pain a 3 on a numeric scale of 0 to 10, with 10 being the highest. Today, she has experienced vomiting, and stated, “I just feel really bad.” Kimberly also stated, “I have not had an appetite.” Her medical history is significant for hypertension for 5 years, anemia, and a hysterectomy. Kimberly’s vital signs are temperature 98.9°F, pulse of 108, respirations of 22, and a blood pressure of 150/90, and 2+ pitting edema in ankles. Her home medications include Norvasc 10 mg once a day, metoprolol 100 mg once a day, and ferrous sulfate 325 mg once a day. The doctor has examined Kimberly and has ordered a metabolic panel. The results are shown in Table 1:

Table 1:Blood results

Blood Lab Value. Patient Value. Normal Range

Sodium 150. 145 mEq/L

Potassium. 5.93. 5–5.0 mEq/L

Chloride. 119. 97–107 mEq/L

Glucose. 130 6.0 –110 mg/dL

Calcium. 7.3. 8.5–10.5 mg/dL

CO2. 14.0. 20–30 mEq/L

Phosphorus. 10.4. 2.3–4.3 mg/dL

Blood pH. 7.3. 7.38–7.42

BUN 59. 7–24 mg/dL

Creatinine. 10.0. 0.6–1.2 mg/dL

EXERCISE 1:

1. Based on Kimberly’s signs/symptoms and metabolic results, the nurse

is concerned about what pathophysiological process? _____________________________.

2. According to the metabolic results, what two lab values reflect the ability of the kidney

to excrete waste?

A. Sodium and chloride

B. Potassium and BUN

C. BUN and creatinine

D. Creatinine and sodium

Answer 1

1. The signs and symptoms and the metabolic parameters are indicating the pathiphysiology of Acute Kindney Injury or Acute renal failure.

In acute kidney injury, is a condition characterized by the sudden loss of kidneys ability to perform its normal excretory function which is characterized by certain clinical manifestations such as sudden abdominal pain, nausea, decreased urine output etc. Prolonged Hypertension is a major risk factor for the development of acute kidney injury. Here the patient is a known case of hypertension since 5 years and she is on Tab. Norvasc 10 mg/OD.

The laboratory data shows that patient had elevated Serum Sodium 150 (Normal is 135-145 mEq/L),elevated Potassium 5.93 (normal 5–5.0 mEq/L), elevated Chloride levels.(Normal value is 119. 97–107 mEq/L) and elevated serum Phosphorus 10.4. (Normal value 2.3–4.3 mg/dL).

Usually in Acute kidney injury, hyperkalemia develops due to inability of the kidney to excrete the high potassium levels.Hypernatremia usually develops in the diuretic phase of Acute kidney injury, where because if incresed diuresis action more and more water is loss and sodium retention will take place.

Because of the accumulation of metabolic waste the Blood pH become acidic.here the patients blood PH is 7.3 which is acidic in nature. Apart from that BUN 59 (Normal is 7–24 mg/dL) and Creatinine 10.0(Normal value 0.6–1.2 mg/dL) also starts to elevate. Creatinine is the waste product develops from muscle metabolism and it is removed by the kidneys, but when kidneys fails to function the creatinine level start to rise.the same way Urea and nitrogenous waste are excreted bythe kidneys.But when kidneys fails to function the urea and nitrogen in the blood also rises.Thats why the patient is having elevated BUN and creatinine levels.

2. Here the right option is Option C is correct. ie,BUN and creatinine.

Creatinine is the waste product develops from muscle metabolism and it is removed by the kidneys, but when kidneys fails to function the creatinine level start to rise.the same way Urea and nitrogenous waste are excreted bythe kidneys.But when kidneys fails to function the urea and nitrogen in the blood also rises.Thats why the patient is having elevated BUN and creatinine levels.

These are the metabolic waste to be eliminated from the body. And it is usually carried out by kidneys. When kidneys fails to do this Azotemia will develop in the body. It is the accumulation of Nitrogenous waste products in body due to renal failure. So usually based on these 2 lab values, the diagnosis of renal failure is made.