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In: Nursing

Sarah Getts, 77 yr-old, Dx- Chronic Renal Failure, admitted with hyperkalemia (5.9, Eq/L)/hyponatremia (128mEq/L). No known...

Sarah Getts, 77 yr-old, Dx- Chronic Renal Failure, admitted with hyperkalemia (5.9, Eq/L)/hyponatremia (128mEq/L). No known allergies (NKA). Vital signs -Temp 98.8, BP 102/76, P 102- irregular, RR 22, SaO2 90%, cardiovascular on telemetry with Sinus irregular rhythm. Disoriented to time and place, speech slurred. Pupils PERRLA, eyes clear. 20 ga. Hep-Lock in right forearm, skin warm and dry, generalized weakness with recent weight loss. 50% intake. High fall risk. Renal diet. Family in room with patient very concerned.

Diagnosis: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Pathophysiology: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Etiology and Risk Factors: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Manifestations: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Diagnostic Tests and Rationale (labs, radiology, etc) _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Treatment: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Expected Outcomes: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Possible Complications: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Possible Nursing Diagnoses: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Solutions

Expert Solution

Diagnosis

Chronic Renal Failure with ,Hyperkalemia, Hyponatremia

Pathophysiology

The etiological factors in the patient affects the renal function gradually .The functional units if kidneys are nephrons.It destroys the function of nephrons in the renal system. As a result in order to counteract it and normalise the renal function the glomerular filtration rate increases. So that wastes can be eliminated from the body. This alters the sodium and water balance in the body initially increasing the sodium retention in the body causing edema.  By this time the renin angiotensin hormones are stimulated this results in expulsion of sodium (causing hyponatremia) and retention of potassium the cells (hyperkalemia) This overtime gives symptom like disorientation and slurred speech ,reducing the blood pressure ,warm and dry skin. (due to hyponatremia) and generalized weakness, irregular heart beat ,tachycardia (due to high potassium and altered erythrocyte actions) Treatment has to be initiated in order to prevent further complications .If not treated this will lead to uremia ,metabolic acidosis followed by clinical symptoms .

Etiology and Risk factors

  • Diabetes
  • Hypertension
  • Polycystic renal disease
  • Acute renal failure
  • Family history

Manifestation

  • Irregular heart beat
  • Tachycardia
  • Hypertension
  • Decreased oxygen saturation
  • Generalized weakness
  • Slurred speech
  • Disorientation

Diagnostic tests and rationale

  • CBC: to rule out any infection and get basic blood counts
  • Renal function test: to assess the renal function
  • GFR: to assess the amount of urine filtered
  • Urine analysis :to assess any infection and the presence of any filtrates
  • Sr.creatinine and Sr .urea are increased
  • Sr.Electrolyte to assess for hyponatremia, hyperkalemia ,hypomagnesemia, hpocalcemia ,etc. ,

Treatments

  • Renal dialysis (to filter the wastes)
  • Medication to reduce symptoms
  • Diuretics to excrete excess body fluid wastes
  • Vitamin supplements to prevent deficiency
  • Erythropoietin injections to induce RBC production

Expected outcome

The outcomes or the prognosis is generally poor until a real transplantation is done

Possible complications

  • Metabolic acidosis
  • Hyperkalemia
  • Anemia
  • Bone loss

Nursing Diagnosis

Impaired fluid balance /Fluid volume excess related to decreased renal function as evidenced by increased potassium ,low sodium levels.

Nightingale answered 1 year ago
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