Question

1 THE DIGESTIVE AND URINARY SYSTEMS Client Profile Mr. P, a 64-year-old retiree, is 4'10' and weighs 170 pounds. He shares a private home with his younger brother, who transported him to the emergency department (ED) of the hospital. On arrival, he complains of having had a headache for the past two hours. His vital signs are: Blood pressure: 200/150 Pulse: 110 Respirations: 30 Temperature: 08.6°F He is alert and oriented but is slow to respond to questions. He denies chest pain but reports nausea and feels he will vomit at anytime. Double-lum nogastric tube Case Study Mr. P was diagnosed a year ago with end stage renal failure secondary to hyperten- sion, requiring treatment with hemodialysis. He is dialyzed at the clinic three times per week and is restricted to 1000 mL of fluid.cach day. He has a primary arteriove- nous (AV) fistula in his left forearm (he is right handed). He reports current med ications as Folic acid: 0.1 mg PO daily Ferrous sulfate: 325 mg three times per day Aluminum hydroxide: gel 500 mg PO twice Erythropoietin alpha: self medicates with 50 units SC three times per week Nifedipine: 30 mg PO three times per day Mr. P reports not feeling his usual self, feeling tired on awakening this morning, and having difficulty getting out of bed. He is triaged and transferred to the med- ical intensive care (MICU), where an electrocardiogram (EKG) is done and shows sinus tachycardia, and occasional unifocal premature ventricular contractions Physical assessment reveals rales at the bases of the lungs and pitting edema of the lower extremities. Serum laboratory reports reveal: Creatinine: 12 mg/dL 1 Blood urea nitrogen (BUN): 40 mg/dl. Sodium (Na): 150 mEq/L Chloride: 100 mEq/ L N Potassium (K+): 7.8 mEq/L

Answer 1

Pathophysiology of & Renal chronic Failure el psychosocial, sedentary due to etiological life style, energy come causes food, genetic factors, adenovirus infection etc. v nephron neember adaptive hyperfifltration at glomerulus M glomerular permeability RAAS Hypertensions Proteinurial in filtration of proteins and macromolecu Dyslipidemia i Nephrotoxic inflammation /remodelling Tubulointestitial fibron's Renal failure & Activation & uit D VGER Impaired ca absorbtion & Poy excretion 1 serum ca Osteitis fibrosa L APTH Osteomalacia & Bone domineralization SerumPou yrascular and soft an ott & serumca, perum tissue calcification

estimated 2 million Incidence-In - In united state united states almost almost 750,000 peope are affected with ESRD and estimated 20 - patient world wild affected with ESRD. eralence-ESRD prevalence is expect to between 2700 and 35ooper millio RD prevalonce is expeated to increase so and 35ooper million, an increare of 297. - 68% over the 2015 prevalonce / 2087 per million. Etiologies & ESRD - Researches shows that diabetes is a major cause of ESRD (94%). High blood pressure or hypertension - 29% Polycystic kidney disease. 16% Glomerular diseane -7% In diabetes high level of blood glucose damages nephromo In hypertension the increased pressure on the small resels ing kidneys leads to damage. The damage prevents blood vessels from performing blood tittering properly, other causes are Kidney stone enlarged prostate resicoureteral reflux congenital abnormalities, Atpart syndrome, interstitial nephritis pyelonephritis certain autoimmune conditions, such Do

patient not working, so the 3. Mrip was dialyzed soon after he was tramterred to the micu because a.- he was having sinus trachycardia. This is - because of renal failure and nemodialysis related disorders overlap. b. Rales at the bore of ungs may be because of exces truid in the airway. a. pitting edema & lower extremities due to freed overload. di pH - 7.32 means acidic. That meana kidney is not working, soth was sended for dialysis. 4. The best type of long term access for dialysis is an Av tistula, surgeon connects an arlery to an nein usually in arm to create an AV tistula This mainly done in radial artery to basilic rein, brachial artery to cophalic rein or the brachial artery to bañlic rein. purpose'- The Av fistula is made by surgeon to make the blood resel wider and stronger to handle the needles that allow blood to flow out to and return from a dialysis machine Here one needle remove the blood and sends if to the machine, where it is tiltrered. The second needle allows the blood to be sefely return to the body.

3. In patient with chronic kidney diseare causes & me fabolic acidosis are - impaired ammonia excretion. - decreared tubular reabsorption ? bicarbonate - insufficient production of bicarbonate m relation to the amount of acid synthesised in the body and ingested with food. Ba Angladea 6. In CRD damaged kidneys and abnormal harman levels causes calcium and phosphorus levels in blood to be out of balance. • In CKD calcitriol stop activating. The low loves of calcitriol in the body create an imbalanced calcium in the body, In CKD shosphorus is not remoned from the Blod properly, so phosphorus levels rise in the blod. the The extra phosphorus pulls calcium out bones, ceuring them to weahh CKD & activation & GFR calcitriol di phosphasan & serem ca excretin Lucre a serum phospher pulls calciumout 1 from bn p serum ca.

a. Fleed volume excess related to decreared glomerulan tillration rate and sodium retention as enidoned by rales at ung bone , pitting edema. b. Risk foor infection related to Av fistula, dialyn's, c. Imbalanced nutrition less than body requirements related to restricted tood, prescribed dietary n as enidoncod by weakness, verbalizatia d. Impaired urinary elimination related to renal failure , & GFR as enidenced by less wrine out put. e. Risk of congested heart failure related to fluid over load secondary to renal tailer. 8. oln hemodialysis blood is promped out of the body to an artificial kidney machine, and returned to body by tuber that connect to the machine, • In peritoneal dialysis the inside lining of the person's own belly acts as a matural filter: As. My P is as end stage renal disean hemodialysis is going on.. 2. folic acid-To treate anemia or make new blood cells Ferrous sulfate - to treate iron deficiency anemia, Furosemide - 100$ diuretic, to treat thuid relention. Mifedipine - calcium channel blockor to treat high blood preon 1o. adverse effects are - Kidney damage, AKI, accelerated kidney function less, ESKD et.

( a. Cliend is educated to modifie protein intake. cuuth logm/k/ dous for normal GFR. b. client is aduised to do mild exercise daily, c. client is advised to maintain freeid restriction. a client is instructed to reduce weigu e client is aduised not to smoke and consume alcohol.