Question

Milton Owens is a 70 year old male admitted with complaints of severe generalized weakness. He has a heart rate of 50 and BP of 86/40. He has a history of End Stage Renal Failure (ESRD). The patient is anuric and receives hemodialysis 3 times/week. BUN 72; Cr 4.1. 1. What electrolyte imbalance do you suspect? 2. What other clinical manifestations will you anticipate as you proceed with the physical assessment of this patient? 3. What lab and diagnostic tests do you anticipate will be ordered for this patient? 5. What acid-base imbalance do you suspect for this patient who has renal failure and his current symptoms? 6. The lab calls with a critical electrolyte value. Your preceptor takes the value by phone and reports to you that the potassium level is 6.8 mEq/l. What type of medical orders do you anticipate as the nurse to treat this critical value? 7. What is your priority nursing diagnosis? 8. Your preceptor has a couple more questions for you before the shift ends! She asks you what electrolyte imbalance you would see in renal failure, hypophosphatemia or hyperphosphatemia? And why? How would hyperphosphatemia be treated in this patient?

Answer 1

1. In this case, the nurse should suspect Hyperkalemia and hypernatremia.

It's because Milton Owens is in End-Stage Renal Failure and he is anuric so, there is no way to remove potassium and sodium.

2. Clinical manifestation associated with  End-Stage Renal Failure includes

- Generalized edema (Due to extra fluid deposition)

- Pulmonary edema

- Shortness of breath

- Fatigue and drowsiness

- dry and itchy skin

- Weight loss

3.

lab and diagnostic tests nurse anticipate will be ordered includes

- Serum electrolytes (To know the value of sodium and potassium)

- Kidney function test (Serum urea and creatinine)

- Arterial blood gas (To know acid-base imbalance)

4.

The patient may have metabolic acidosis (pH < 7.35)

It's because of the low bicarbonate level in blood due to fluid retention and Dyselectrolytemia.