Question

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:

*	Hemoglobin	8 g/dL
*	Hematocrit	23.8%
*	RBC	2.57 million/mm3
*	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

Case Study Questions

1. 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.

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

3. 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

1. The contributing factors for A.S current situation may be :

• Uncontrolled blood pressure.
• Uncontrolled blood sugar.
• Improper medication intake secondary to forgetfulness.

All these factors have caused acute kidney injury resulting in signs and symptoms of anemia , increased blood pressure, headache, fatigue, dizziness.

Evidence based preventive health care provisions/ programs that could prevent A.S condition :

• Regular monitoring of blood pressure and adjusting of dosage ofanti hypertensive. Inclusion of diuretics if BP is high along edema.
• Regular monitoring of blood sugar levels and monitoring the diet intake along with physical activities.
• Home care nurse allocation for medication administration A.S suffers from forgetfulness.

2. A.S is suffering from Acute kidney injury . Kidney helps in production of erythrpoietin hormone which inturn stimulates the production and maintenance of red blood cells. Therefore, A.S is experiencing significant decrease in haemoglobin and hematocrit values.

3. Discharge teaching for A.S :

• Regular monitoring of blood pressure and blood sugar levels.
• Regular intake of medication. Include family members in medication intake or allot a home nurse as A.S suffers from forgetfulness.
• Mild physical activities like walking near home.
• Include nutritionist and follow her advice.
• Include physiotherapy to prevent blood clot complications.

Thank you.