Question

Renal question

Olly is a 21 years old female who works as a teacher and leaves alone. Olly suspects she has developed food poisoning after consuming leftovers from a take away meal she had in her fridge from three days ago before she re-heated it for dinner. She has not been to work for 5 days due to severe vomiting, diarrhea and abdominal pain. Olly stated she has been feeling increasingly tired and weak and unable to tolerate oral fluids or diet. She also noticed that her urine output has been decreasing over the last two days and has not passed urine for the past 12 hours and is feeling severely unwell.

An assessment finding reveals the following on Olly

She has a sunken eyes, dry oral mucosa, and tongue, cracked lips, and is complaining of nausea, dizziness, and lethargy.

Vital signs and blood and urine test showed

Temp- 37.8, HR 110 bpm, RR 22 rpm, BP 90/50 mmhg, body weight 60kg

Blood test results reveal- Sodium 145mmol/L, Potassium 6.0mmol/L, Serum creatinine 400mmol/L, Blood Urea Nitrogen 14mmol/L

She is diagnosed with suspected gastroenteritis and acute kidney injury(AKI) and transferred to renal wards.

QUESTION

1, Describe how each of these aspects of the information presented above has led to the diagnosis of pre-renal AKI

2, Identify three priority nursing problems and provide a rationale for making each of these priorities

3, you are required to formulate a goal to address each priority nursing problem

Answer 1

1. Diagnosis of Pre renal AKI ( Acute Kidney Injury) :

Acute Kidney Injury is also called as Acute Kidney failure or Acute renal failure. Acute Kidney Injury is charecterised by the sudden episode of kidney failure or kidney become unable to do its function, filtering of blood. Pre renal AKI occurs due to sudden reduction in the blood flow to the kidney and there is no wrong with the kidney itself.

Here in this case , Ms. Olly had severe diarrhoea and vomiting, that led to the extensive loss of fluid and hypotension, resulting in depletion of blood volume or intravascular volume depletion and shock . This leads to the impairment of kidney perfusion , gradually this affects the kidney's ability to filter the blood and leads to acute kidney failure. Impairment of kidney function can leads to the accumulation of toxic products and fluid in the body , characterised by increased serum creatinine and Blood urea nitrogen. Ms. Olly had the symptoms of dehydration and Acute Kidney Injury like, sunken eyes, cracked lips, dry oral mucousa, dizziness, lethargy etc.

2 . Three priority nursing problems:

i) Decreased cardiac output related to electrolyte imbalance and fluid deficit as evidenced by low Blood pressure ( 90/50)

Rationale: As the patient had low Blood pressure, and sodium , potassium imbalance, it may lead to decreased cardiac output and may lead to severe complications.  

ii) Fluid volume deficit related abnormal loss of fluid due to severe diarrhoea and vomiting as evidenced by dry oral mucosa, sunken eyes and dry lips .

Rationale: Dehydration and fluid deficit can lead to the impairment of function of vital organs like , heart and kidney. It should be given the priority and should replace the fluids appropriately.

iii) Imbalanced nutrition less than body requirements related to food poisoning and related problems as evidenced by general weekness and tiredness.  

* Nutrition and adequate intake is essential fot the body to be healthy, and to prevent infections.  

3. Goals :

i)( Decresed cardiac output )

Patient demonstrates adequate cardiac output as evidenced by blood pressure and pulse rate within normal parameters .

ii) Fluid volume deficit

Patient is normovolemic as evidenced by systolic Blood pressure greater than or equal to 90 / 70 mm of Hg or Heart beat of 60 to 100 beats / minutes

iii)( Imbalanced nutrition)

Patient demonstrates adequate intake of food as evidenced by the weight gain .