Renal/GU Progressive case study The nurse is admitting a 74-year-old female, KB, to the emergency
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Asked by afolabitoks
Renal/GU Progressive case study
The nurse is admitting a 74-year-old female, KB, to the emergency department. She has a 4-day-long history of non-localized abdominal pain, incontinence, new -onset mental confusion, and lethargy. Her most current vital signs are BP 82/38, HR 118 and irregular, RR 28, Temp 100.9 degrees, room air oxygen saturation 89%.
PMH:
Renal calculi
CHF with an EF of 28%
s/p MI with stent in 5/2020
Afib
HTN
DM 2
Height: 5’8″
Weight: 220 lbs
Allergies: Sulfa drugs, Codeine
Serum Lab review:
Bun 38 mg/dL
Creat 4.2 mg/dL
GFR: 25 ml/min/1.73m2
Sodium: 114 mEq/L
Potassium: 7.1 mEq/L
Glucose: 320 mg/dL
White Blood Cells: 15,000/mm3
Hct: 48%
Hgb: 18g/dL
Platelet: 180,000/mm3
Urinalysis:
Appearance: dark amber, cloudy with sediment
Ph 6.9
Specific Gravity: 1.026
Protein: Moderate
Nitrates: Positive
WBC’s: many
RBC’s: many
Current Medications:
Aspirin, 81mg PO, QD
Plavix, 75mg PO QD
Eliquis, 5mg, PO, QD
Digoxin, 0.25mg PO, QD
Atenolol, 100mg PO, BID
Lisinopril, 20mg PO, QD
Aldactone, 100mg PO, QD
Metformin, 500mg PO, BID
Sliding scale Regular Insulin AC
What are some medical problems that could be going on with KB, and what is the rationale?
What is your interpretation of the serum lab values, and why?
What is your interpretation of the urinalysis, and why?
Why do you think she is taking her current medication and why? Are there any medication you would expect to be changed at this time, on admission, why?
The health care provider (HCP) orders are as follows:
The health care provider (HCP) orders are as follows: What is the rationale for this order and is it appropriate/safe? Which are the top 3 priorities
Titrate O2 via NC to maintain O2 saturation greater than 92%
Morphine, 2mg IV push x1
NS @ 200ml/hr x 8 hours
Heparin IV drip: 850 units/hour
EKG
Regular insulin, 12 units, SC
KB had all orders implemented. She is admitted to the ICU. A KUB and CT scan were performed and a 4.5mm stone was located in the left kidney, a ECSL was performed. An indwelling Foley catheter was placed. Her BP continued to decline, and she was placed on blood pressure support medicine, intravenously. Her BUN/Creat continued to increase (BUN 48, Creat 4.9) and GFR continued to decrease (GFR 12). A decision was made to place temporary dialysis catheters in the subclavian.
What do you think is happening?
How do you know?
What other nursing interventions would be implemented, and why?
Forty-eight hours later, KB’s status is unchanged. She continues to feel lethargic and has been receiving hemodialysis daily. Below is the current report from the night shift, items in red are new results.
PMH:
Renal calculi
CHF with an EF of 28%
s/p MI with stent in 5/2020
Afib
HTN
DM 2
Height: 5’8″
AdmissionWeight: 220 lbs
Current weight: 250lbs
Allergies: Sulfa drugs, Codeine
Serum Lab review:
Bun 52 mg/dL
Creat 5.2 mg/dL
GFR: 18 ml/min/1.73m2
Sodium: 114 mEq/L
Potassium: 6.1 mEq/L
Glucose: 120 mg/dL
White Blood Cells: 8,000/mm3
Hct: 28%
Hgb: 8 g/dL
Platelet: 180,000/mm3
Urinalysis:
Appearance: yellow with slight sediment
Ph 5.9
Specific Gravity: 1.013
Protein: Moderate
Nitrates: negative
WBC’s: none
RBC’s: none
Current Medications:
Aspirin, 81mg PO, QD
Plavix, 75mg PO QD
Eliquis, 5mg, PO, QD
Digoxin, 0.25mg PO, QD
Atenolol, 100mg PO, BID
Lisinopril, 20mg PO, QD
Aldactone, 100mg PO, QD
Metformin, 500mg PO, BID
Sliding scale Regular Insulin AC
Heparin, IV drip, titrate per PTT sliding scale
Procrit 3,000 units/ml three times/week
Lasix, 40mg PO, BID
Aluminum hydroxide (Amphojel), 25mg PO, AC
NS @ 75ml/hr
Vancomycin, 1g, IV QD
Coumadin, 5mg, PO QD
Why are the lab values and current weight important?
Why do you think changes were made in the client’s medications?
KB remained in the hospital and slowly her status improved. Unfortunately, her kidneys will not recover. You are providing discharge teaching with the client and her daughter. You prepared a discharge teaching packet, knowing renal failure is a new diagnosis for her.
What do you include, and why?
Below are the discharge medications. Provide brief patient education on the 4 new medications.
Dischage Medications:
Aspirin, 81mg PO, QD
Plavix, 75mg PO QD
Digoxin, 0.25mg PO, QD
Atenolol, 100mg PO, BID
Metformin, 500mg PO, BID
Sliding scale Regular Insulin AC
Procrit 3,000 units/ml three times/week during dialysis
Lasix, 40mg PO, BID
Aluminum hydroxide (Amphojel), 25mg PO, AC
Coumadin, 5mg, PO QD
SCIENCE
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NURSING
NURSING 325
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