Question

Dudley Wayne is a 62-year-old factory worker. Mr. Wayne makes an appointment with his primary care practitioner because he has lost 15 pounds in the last 2 months, and has recently noticed blood in his urine. He denies pain on urination. During the admission assessment, Mr. Wayne states that he is a two-pack-per-day smoker and just thought he was losing weight because of increased work stress. He also states that he worked 30 years in a building that was recently closed due to asbestosis contamination. Upon physical examination, Mr. Wayne complains of pain when the provider percusses and palpates his flank area. A CT scan is ordered along with an ultrasonogram; both reveal a mass in the renal pelvis. (Learning Objective 3) a. What risk factors for renal cancer does Mr. Wayne demonstrate? b. The diagnosis of renal cancer is made. What are the classic symptoms of this disease process? c. Upon further evaluation, metastatic renal carcinoma is diagnosed, and Mr. Wayne is scheduled for renal artery embolization. What is the rationale for this procedure? d. Mr. Wayne develops postinfarction syndrome. What clinical manifestations does the nurse correlate to this syndrome? How are these symptoms managed?

Answer 1

a Cigarette smoking is one of the significant factor for the development of renal cell carcinoma.Here the patient Mr Wayne smokes 2 packs of cigarettes per day.Another risk factor is the exposure to asbestos.the patient is also subjected to asbestos exposure as he have been working in a factory which has been recently shut off due to asbestos contamination.So that explains it.

b One of the unfortunate things is that there are no characteristic early symptoms and many patients with kidney diseases go undetected due to lack of symptoms.Many kidney diseases are diagnosed as incidental findings on imaging studies used to evaluate symptoms for often unrelated conditions.The most common presenting manifestations are hematuria,flank pain,and a palpable mass in the flank or abdomen.

c Renal artery embolization are used for the pretreatment of renal cell carcinomas prior to planned resection to decrease haemorrhagic complications intra-operatively.it is mainly used for combating potential haemorrhagic complications.

d The renal infarction which follows the procedure,the patient may experience severe flank pain nd fever leading to post infarction syndrome.