Question

Read the following scenario:

K.B. is a 32-year-old woman being admitted to the medical floor for complaints of fatigue and dehydration. While taking her history, you discover that she has diabetes mellitus (DM) and has been insulin dependent since the age of 8. She has undergone hemodialysis (HD) for the past 2 years because of end-stage renal disease (ESRD). 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, 116, 18, 99.9 ° F (37.7 ° C). She tells you she has been nauseated for 2 days so she has not been eating or drinking. She reports severe diarrhea. The following blood chemistry results are back.

Laboratory Test Results:
Sodium 145 mEq/L
Potassium 6.0 mEq/L
Chloride 93 mEq/L
Bicarbonate 27 mEq/L
BUN 48 mg/dL
Creatinine 5.0 mg/dL
Glucose 238 mg/dL

Think through the following related to K.B.'s condition:

Etiology and pathophysiology

Risk factors

Signs and symptoms

Diagnostic procedures

Medication and treatment

Nursing interventions, including patient education

Potential complications

Complete a concept map

Answer 1

Etiology and Pathophysiology: (foto attached)

Risk factors:

Family history of diabetes mellitus

Hypertension

Chronic diseases like kidney stones, atherosclerosis, Polycystic kidney disease, SALE.

Glomerulonephritis

Genetic predisposition

Obstructive neuropathy

Smoking and recreational drugs

High HDL

Signs and symptoms

Loss of appetite

Nausea and vomiting

Fatigue and weight loss

Itchy skin

Confusion and trouble concentrating

Swelling throughout the body

Low urine output

Diarrhoea

Shortness of breath

Yellowish brownish skin tone

Frequent hiccups

Diagnostic procedures:

Physical examination

Lab tests showing increased blood urea nitrogen (BUN), increased creatinine level.

Presence of urine protein

Decreased glomerular filtration rate (GFR).

Treatment:

Periodic dialysis

Dietary restrictions and modifications - high calorie, low protein, low sodium and low potassium diet.

Kidney transplant.

Medications:

ACE inhibitors incase of hypertension

Anti-diabetic drugs in case of diabetes mellitus.

Vitamin supplements

Antibiotics which are not renal toxic.

NUrsing diagnosis:

1. Excess fluid volume related to decreased urine output and fluid retention.

2. Imbalanced nutrition related to nausea and vomiting.

3. Risk for disturbed sensory perception related to neuropathic changes.

4. Risk for infection related to poor nutritional status.

5. Activity intolerance related to fatigue, anaemia and waste retention.

6. Fluid volume deficit related to nausea and vomiting.

Nursing interventions:

1. Monitor vital signs.

2. Weigh daily if possible.

3. Monitor intake output chart. Limit to prescribed fluid intake.

4. Assist coping with discomforts due to fluid restriction.

5. Encourage high calorie, low protein, low sodium and low potassium diet.

6. Ask the client to avoid Bananas, tomatoes, oranges, chocolates, nuts, spinach and avocados.

7. Increased blood urea nitrogen and creatine may lead to mental changes in the client. So provide psychological support.

8. Assist the client in carrying out daily activities if required.