Question

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1.Acute Kidney Injury

Patient Profile

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 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 98.9° F, respirations 24

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 ------------- abnormal result normal is 120-160 g/dl

Hematocrit      23.8%---------------

RBC                   2.57 million/mm^{3 ----------------}abnormal result …normal value is

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

Discussion Questions (total 12 marks)

1-Interpret A.S.’s laboratory test results and describe their significance. (2 marks)

2-What is the most likely cause of A.S.’s AKI? (1 mark)

3-Is this cause of AKI classified as prerenal, intrarenal, or postrenal? Explain your answer. (2 marks)

4 What phase of AKI is A.S. in? (1 mark)

5 What are the priority nursing diagnoses (there are to address the concern of fluid retention? (4 marks)

6- What are the priority nursing interventions for these nursing diagnoses? (2 marks)

Answer 1

Q1: lab results:

Reduced haemoglobin's, RBC, Hematocrit.

Indicates severe anemia,

Q2: Causes:

For this patient hypertension, Diabetes and hypertension.

Q3:

Pre renal:

Because of hypertension, diabetes nephropathy blood supply to the kidney is affected, this is a type of pretty renal cause.

Q4:

Oliguric phase

Patient will have urine output less than 400ml.

Patient will have signs and symptoms of fluid volume excess.

Q5:

1. Ineffective breathing pattern related to crackles in lung field.

2. Fluid volume excess related to water retention.

3. Impaired gas exchange related to pulmonary edema

Q6:

Nursing intervention:

1. High followers,position

2. Proper skin care.

3. Oxygen adminstration

4. Psychological support

5. fluid restrictions