Question

D. RENAL FAILURE

A patient with uncontrolled Type 2 Diabetes consulted in the emergency department due to shortness of breath, bipedal edema, palpitation, and decreased urinary output during the past 2 days. The following laboratory test values are presented

Serum Creatinine –2.5 mg/dL
BUN level –30 mg/dL
Serum potassium –5.9 mEq/L
HBA1C –8%
A diagnosis of Acute Renal Failure secondary to DM Nephropathy was made by the doctor. Sodium polyesterene sulfonate (Kayexalate) was ordered to normalize potassium level. Oral hypoglycemic agents were revised, and insulin therapy was started to manage the blood sugar level. Urine output is closely monitored for possible hemodialysis.

Answer the following questions:
1. Explain the relationship of diabetes mellitus on the development of acute renal failure using a flow chart.

2. Identify three (3) nursing diagnoses pertinent to the patient’s condition and create hypothetical Nursing Care Plans (NCPs) for each nursing diagnosis.

3. Create a drug study for the medication: SODIUM POLYESTERENE SULFONATE specifying the following:

a. Drug classification
b. Mechanism of action
c. Indication (*for the case of the patient mentioned above)
d. Contraindication
e. Side effects
f. Nursing Considerations

Answer 1

1.Relationship of Diabetes Mellitus on the development of Acute Renal Falilure.

Diabetes mellitus is leading a main role in the formation of Acute Renal Failure,beacuse diabetes mellitus means increased blood sugar/glucose level.This high level of glucose can damage the millions of tiny filtering units which present within the kidney.If it is not treated well which can lead to Acute Renal Failure.

2.Nursing Care Plan

ASSESSMENT	NURSING DIAGNOSIS	GOAL	NURSING INTERVENSIONS	RATIOANLE	EVALUATION
Subjective Data: The patient complaints that he is not feeling to pass the urine and very tired Objective Data Dry skin and mucous membrane poor skin turger sudden weight loss	Fluid volume deficit related to increased osmotic diuresis secondary to hyperglycemia	Decrease the blood sugar level f the patient.	assess the baseline data Check the glucose level monitor intake and output chart Check the skin Prescribe the medications and IV fluids as per physiciand order	To know the baseline data To understand the glucose level of the patient To understand the estimate volume of the urine and to know the kidney function To know the level of dehydration To cure the probles as soon as possible	After 8 hours of nursing interventions the patient was able to demonstrate adequate hydration evidenced by stable vital signs,palpable periferal pulses,good skin turgor and capillary refil

ASSESSMENT	NURSING DIAGNOSIS	GOAL	NURSING INTERVENSIONS	RATINALE	EVALUATION
Subjective data The patient has verbalized that he is very tired,fatigue Objective data Sudden weight loss poormuscle tone	Imbalanced nutritional status less than body requirements related to abdominal pain secondary to acute renal failure	maintain a good balance nutritional status of the patient	Check the actual weight of the patient Chech the vital signs of the patient Maintain Intake and output chart Know the likes and dislikes of foofinf pattern of the patient	To know the sudden weight loss To understand the funfions of the vital organs Mainly to understand the funtions of the kidney Encourages the patient to have food	After 2 weeks of the nuesing intervensions the goal has met as evidenced by monitored weight and facial expression of the patient.

3.Drug Study for Sodium Polystrene Sulfonate

It is also knon as KAYEXALATE

Mechanism of action

• It is not absorbed from the gastrointestinal tract.
• As a resin passes through the gastro intestinal tract, the resin removes the pottasium by exchanging it for sodium irons.

Indication

It is indicated for the treatment of hyperkalemia

Contraindications

• Serum pottassium less than 5mmol/L
• History of hypersensitivity to polystyrene sulphonate resins
• Odstructive Bowel disease
• Pregnancy

Side effects

• Gastric irritation
• Anorexia
• Nausea
• Vomiting
• Constipation
• Fecal impaction in childrens
• Occasionally Diarrhea

Nursing Interventions

• Ensure that the right medication to right patient
• Check the expiary date
• Check the dose,route,freequency and amount to be administered.
• Check the adverse reacctions after administration
• Record it in the patient's chart