Question

44085 BANK Scenario-Renal/Urinary Disorder or K.B. is a 32 year old woman who recently visited her primary care physician a couple days ago for a for a urinary tract infection (UTI) and obtained a prescription for azithromycin. She reports that she has finished 3 of the 7 days treatment. int is now She now presents to the hospital with complaints of fatigue and dehydration and is being admitted to the medial floor with AKI from dehydration. While taking her history, you discover that she has diabetes mellitus (DM) and has been insulin-dependent since the age of 8. Your initial assessment of K.B. reveals a pale, thin, slightly drowsy woman. Her skin is warm and dry to the touch with poor skin turgor, and her mucous membranes are dry. Her vital signs are: 140/88 mm Hg, 116, 18, 96%, 100.9 degrees. She tells you she has been nauseated for 2 days so she has not been eating or drinking. She also reports not having to void very often. She reports severe diarrhea. Her provider orders 1 gram vancomycin IV to be given STAT. Laboratory results are pending jority 4. What aspects of your assessment support her admitting diagnosis of dehydration? (3 points) 5. Discuss the pathophysiology of acute kidney infection (including pre-renal, intra-renal, and post-renal). (8 points) and K.B.'s laboratory results have come back. Chart View/Laboratory Test results Sodium Potassium Chloride Bicarbonate BUN Creatinine Glucose Phosphorous ABGS 145 mEq/L 6.0 mEq/L 93 mEq/L 27 mEq/L 48 mg/dL 5.0 mg/dL 238 mg/dL 6.0 mg/dL pH 7.28; PaCO2 38; HCO3 18; PaO2 82 7. Explain any lab results that might be of concern. Discuss at least one nursing assessment and one nursing intervention for each abnormal lab result. (6 points)

Answer 1

4) Assessment findings of dehydration are :-

- pale

- poor skin turgor

- dry mucous membrane

- drowsiness

Also she had diarrhea , was not eating anything and also her urine output was decreased

5) Pathophysiology of AKI :-

3 categories of AKI :-

prerenal, intrarenal, postrenal

Prerenal AKI: definition

Caused by impaired blood flow to the kidneys

what can cause pre renal AKI

gun shot with hemorrhage, septic shock, extensive burns, MI with subsequent heart failure

intrarenal AKI: definition:-

caused by a condition that actually damages the rental tissue. this leads to malfunctioning nephrons, aka acute tubular necrosis

what can cause intrarental aki

nephrotoxic substances, prolonged prerenal conditions, acute glomerular nephritis, and prolonged post renal conditions

postrenal AKI : definition :-

can be caused by obstruction of the kidneys, calculi, tumor, ureteral stricture

7) Abnormal lab values and interventions :

- Hight potassium

Intervention :-

Administer I.V. calcium and insulin along with inhaled beta-adrenergic blockers as initial treatment to stabilize the patient; give calcium slowly over 20 to 30 minutes. Once stabilized, administer sodium polystyrene sulfonate and diuretics to help reduce total body potassium

- High BUN and creatinine

Intervention :-

Assess hydration status look for a deficit or excess

Assess dietary intake (protein)

Treat the cause

Monitor urine output. (I&O)

Look for diuretics , nephrotoxic drugs (affect BUN

Daily weight

Monitor daily lab values

- High glucose

Interventions :-

Follow doctors orders for insulin therapy

Re-hydrate

Monitor blood glucose per order

-can be up to every 5 minutes

Neurological assessment

Monitor for hypoglycemia

- Metabolic acidosis

Interventions :-

*Monitoring ventilatory status, including lung sounds, work of breathing, and oxygen saturation

Administering oxygen as per protocol or as ordered

*Monitoring heart and lung sounds

*Monitoring central venous pressure if indicated

*Administering intravenous fluids as ordered

*Administering medications, including diuretics and bicarbonate, as ordered

*Monitoring circulatory status, including blood pressure, urine output, presence of edema, daily weight, peripheral pulses, and capillary refill time

*Monitoring the ECG pattern for dysrhythmias and changes characteristic of hyperkalemia and notifying the heathcare provider of any such changes

*Monitoring neurologic function, including mental status, level of consciousness, and muscle strength

*Monitoring arterial blood gases, serum electrolytes, and renal function studies

*Using safety precautions as necessary

*Orienting the client to time, place, and circumstances as necessary.

10) The abnormal CBC values are :-

RBC - low

HB - low

HCT - low