- Information
- AI Chat
Renal discussion
Med surg 2 (341)
Marian University
Preview text
Patient Profile A. 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. stated that she has been able to do her daily chores at home independently, but for the last 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, diabetes mellitus type 2, 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 hadn’t 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° F, respirations 2 4 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: o Hemoglobin 8 g/dL o Hematocrit 23% o RBC 2 million/mm 3 o WBC 4 mm 3 o Sodium 132 mEq/L o Potassium 5 mEq/L o Calcium 9 mg/dL o BUN 36 mg/dL o Creatinine 4 mg/dL o BNP 182 pg/mL
- Interpret A.’s laboratory test results and describe their significance.
o Hemoglobin 8 g/dL: Normal range 14-18 g/dL. The Hgb concentration is a measure of the total amount of Hgb in the peripheral blood, which reflects the number of blood cells in the blood count. Decreased levels indicate anemia (Pagana, 2017, p. 476). o Hematocrit 23%: Normal range 37%-47%. The test measures the percentage of the total blood volume that is made up by the red blood cells. Decreased levels indicate anemia (Pagana, 2017, p. 473). o RBC 2 million/mm^3: Normal range 4.2-5. This test counts the number of circulating red blood cells in a 1 mm^3 of peripheral venous blood. Low blood values are caused by decreased bone marrow production (Pagana, 2017, p. 752). o WBC 4 mm^3: Normal range 5000-10,000/mm^3. The total number of WBC in a 1 mm^3 of peripheral venous and has a differential component. This measures the percent of each type of leukocyte present. The major function of the WBC is to fight infection and react to foreign bodies or tissues. Decreased amounts of total WBC counts occurs in many forms of bone marrow failure (Pagana, 2017, p. 953-954). o Sodium 132 mEq/L: Normal range 135-145mEq/L. Sodium is a major cation in the extracellular space. The sodium content of the blood is a result of a balance between dietary sodium intake and renal secretion. A decreased amount of sodium may result from decrease sodium intake, increased sodium loss, third space losses of sodium, and increased free body water (Pagana, 2017, p. 815-816). o Potassium 5 mEq/L: Normal range 3.5-5. Potassium is the major cation within the cell. Potassium is excreted by the kidneys and not reabsorbed so adequate amounts need to be supplied by diet. Increase amounts may relate to medications, excessive dietary and IV intake, acute and chronic renal failure, injury to the head, transfusion, infections and dehydrations (Pagana, 2017, p. 707-709). o Calcium 9 mg/dL: Normal range 9-10 mg/dL. This test is used to evaluate parathyroid function and calcium metabolism by directly measuring the total amount of calcium in the blood (Pagana,2017, p. 186). o BUN 36 mg/dL: Normal range 10-20 mg/dL. This measures the amount of urea nitrogen in the blood. Urea is formed in the liver as the end product of protein metabolism. An increased amount could indicate dehydration, renal disease or failure (Pagana, 2017, p. 908-909). o Creatinine 4 mg/dL: Normal range 0.6-1 mg/dL. This measures the amount of catabolic product of creatine phosphate, which is used in skeletal muscle contraction, in the blood. This is excreted by the kidney and used to diagnosed with impaired renal function. Increased range could indicate urinary tract obstruction (Pagana, 2017, p. 293- 294). o BNP 182 pg/mL: Normal range is <100pg/mL. Natriuretic peptides are used to identify and stratify patients with congestive heart failure. BNP is released to in response to atrial and ventricular stretch. Correlates well to left ventricular pressures. Higher levels indicate CHF (Pagana, 2017, p. 622).
improves. If this is not effective in treating AKI, then renal replacement therapy is used (Lewis et al., 1074).
References
Lewis, S. L., Bucher, L., Heitkemper, M. M., & Harding, M. M. (2017). Medical-surgical nursing: Assessment and management of clinical problems (10th ed.). St. Louis, MO: Elsevier.
Pagana, K., Pagana, T. & Pagan, T. N. (2017). Mosby’s diagnostic & laboratory test reference. (13th ed.). St. Louis, Missouri: Elsevier.
National Institute of Health (NIH). (2018). Conservative management for kidney failure. Retrieved June 8, 2020, from niddk.nih/health-information/kidney-disease/kidney-failure/conservative- management
Renal discussion
Course: Med surg 2 (341)
University: Marian University
