Question

Chapter 46 Acute Kidney Injury Disease

Acute Kidney Injury Week 14 Case Study #10

Approx 60 min

Patient Profile

A.S. is a 70-year-old white woman who presented to the emergency department because of a 4-day history of increased shortness of breath and generalized weakness. A.S. stated that she has been able to do her daily chores at home independently, but for the past few days, it was getting difficult for her to get around and that she needed to take frequent breaks because she was short of breath and had no energy. She has a long history of heart failure, type 2 diabetes, and hypertension. She is admitted with a tentative diagnosis of acute kidney injury (AKI).

Subjective Data

• Has been having headaches on and off, with nausea and dizziness

• Reported that she had not been taking her medications regularly at home because of “forgetfulness”

• Has not been urinating a lot

• Feels “puffy” in her legs and hands

Objective Data

Physical Examination

• Blood pressure 178/96, pulse 110, temperature 98.9°F, respirations 24, and an oxygenation of 93% on room air

• Alert and oriented to person, place, and time

• Mild jugular venous distention

• Fine crackles in bilateral lower lobes

• Heart rate regular, no murmurs

• Bowel sounds normoactive and present in all four quadrants

• 2+ edema bilateral lower extremities and hands

Diagnostic Studies

• Echocardiogram shows decreased left ventricular function

• Urinalysis: Urine dark yellow and cloudy, protein 28 mg/dL, negative for glucose and ketones, positive for casts, red blood cells and white blood cells

• 24-hour urine output = 380 mL

• Laboratory Tests:

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Hemoglobin

8 g/dL

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Hematocrit

23.8%

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RBC

2.57 million/mm3

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WBC

4.7 mm3

*

Sodium

132 mEq/L

*

Potassium

5.2 mEq/L

*

Calcium

9 mg/dL

*

BUN

36 mg/dL

*

Creatinine

4.9 mg/dL

*

BNP

182 pg/mL

5. What orders do you as the nurse, anticipate the physician will order? Student must list at least six (frequencies not necessary to list; only what you think the physician will order):

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•

•

•

•

•

6. Explain what might have contributed to A.S.’s present condition as described above? What are two evidence-based preventive health care provisions/programs that if put in place early might have prevented this from occurring?

Explain what might have contributed to A.S.’s present condition:

Evidence-based Preventive Health Care Provisions/Programs:

1.

2.

7. What is the significance of A.S.’s Hemoglobin, Hematocrit, and RBC levels being significantly decreased?

8. You are planning discharge for A.S. What would you include in your discharge instructions/teachings and what other interdisciplinaries/health professionals would you include? Student must list at least five each:

Nursing Teaching/Instructions​​ Other Health Professionals

1. ​​​ ​1.

2. ​ ​​​2.

3. ​​​​3.

4. ​​​​4.

5. ​​​​ 5.

Answer 1

5) The physician will order antihypertensive drugs, diuretics, nebuliser, saline, may order dialysis, blood unit.

6) She forgets to take medicines. So she forgot to take diabetes pills which resulted in load over the kidney resulting in damage. This led to edema due to accumulation of fluid in the body due to kidney inactivity. Forgot to take antihypertensive that led to rise in bp.

Evidence based prevention could have been done if previously a family member was informed about the medications properly. She could have been given a checklist to check for medicine taking on daily basis. Follow up check could have been prescribed.

7) This is because kidney is unable to produce enough Erythropoietin necessary for the formation of these.

8) Proper checklist of daily medications, inform the family members, advice and date to be given for regular checkup, nutrition guidelines, to drink water properly and urinate time to time.