Mr. K.G. is a thin 60-year-old man admitted to the hospital for cardiac catheterization for recurrent angina. Past medical history includes hypertension, type 2 diabetes mellitus, and a previous myocardial infarction 2 years ago. Current medications are metformin (Glucophage), glipizide (Glucotrol), entericcoated aspirin (Ecotrin), and lisinopril (Zestril). Laboratory tests on admission revealed the following: normal electrolyte levels; blood urea nitrogen (BUN), 40 mg/dL; and serum creatinine, 2.0 mg/dL. A complete blood cell count and urinalysis were unremarkable. Mr. K.G. receives intravenous fluids at 20 mL/hr on the morning of the procedure. He successfully undergoes the catheterization and returns to the telemetry unit. The day after the procedure, Mr. K.G.’s urine output decreases to less than 10 mL/hr. Mr. K.G. is given a fluid bolus of normal saline without any increase in urine output. Furosemide is administered intravenously, with a slight increase in urine output to 15 mL/hr for several hours. Laboratory studies reveal the following: potassium, 5.9 mEq/L; BUN, 70 mg/dL; serum creatinine, 7.1 mg/dL, and carbon dioxide total content, 16 mEq/L. The next day Mr. K.G. has 21 edema and basilar crackles, and he complains of feeling short of breath. A preliminary diagno sis of AKI is made.
Questions
1. What are possible factors predisposing Mr. K.G. for AKI?
2. What laboratory studies assist in the diagnosis of AKI? Describe expected results for a patient with acute tubular necrosis.
3. What medical interventions do you anticipate for Mr. K.G.?
4. What interventions could have been taken before Mr. K.G.’s cardiac catheterization to possibly prevent his AKI?
5. Discuss the advantages and disadvantages of using diuretic therapy in patients with AKI.
Acute kidney injury refers to as sudden episode of kidney failure that happens within a few hours or a few days. AKI results in buildup of waste product in the blood and make it hard for kidney to balance of fluid in the body. AKI can be cause by decreased blood flow, direct damage of kidney and blockage of urinary tract.
Possible factors of this condition are myocardial infarction, increased serum creatine, and decrease in urine.
Mr. K. G. is a thin 60-year-old man admitted to the hospital for cardiac catheterization for recurrent angina. Past medical history includes hypertension, type 2 diabetes mellitus, and a previous myocardial infarction 2 years ago. Current medications are metformin (Glucophage), glipizide (Glucotrol), enteric-coated aspirin (Ecotrin), and lisinopril (Zestril). Laboratory tests on admission revealed the following: normal electrolyte levels; blood urea nitrogen (BUN), 40 mg/dL; and serum creatinine, 2.0 mg/dL. A complete blood cell count and urinalysis were unremarkable. Mr. K....
hello there 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....
Brief Patient History: Mr. X is a 64-year-old male admitted to the unit with acute myocardial infarction (AMI) after emergent left (L)- sided heart catheterization/percutaneous coronary intervention (PCI). Past history includes diabetes mellitus type 2, heart failure, hypertension, and osteoarthritis. Home medications include furosemide Lasix), digoxin (Lanoxin), captopril (Capoten), carvedilol (Coreg), Byetta (exenatide), Glucophage (metformin), and Motrin (ibuprofen). Clinical Assessment: Twenty-four hours after admission to the unit, Mr. X is alert; oriented to person, place, and time; and pain free....
Brief Patient History: Mr. X is a 64-year-old male admitted to the unit with acute myocardial infarction (AMI) after emergent left (L)- sided heart catheterization/percutaneous coronary intervention (PCI). Past history includes diabetes mellitus type 2, heart failure, hypertension, and osteoarthritis. Home medications include furosemide Lasix), digoxin (Lanoxin), captopril (Capoten), carvedilol (Coreg), Byetta (exenatide), Glucophage (metformin), and Motrin (ibuprofen). Clinical Assessment: Twenty-four hours after admission to the unit, Mr. X is alert; oriented to person, place, and time; and pain free....
Brief Patient History: Mr. X is a 64-year-old male admitted to the unit with acute myocardial infarction (AMI) after emergent left (L)- sided heart catheterization/percutaneous coronary intervention (PCI). Past history includes diabetes mellitus type 2, heart failure, hypertension, and osteoarthritis. Home medications include furosemide Lasix), digoxin (Lanoxin), captopril (Capoten), carvedilol (Coreg), Byetta (exenatide), Glucophage (metformin), and Motrin (ibuprofen). Clinical Assessment: Twenty-four hours after admission to the unit, Mr. X is alert; oriented to person, place, and time; and pain free....
Brief Patient History: Mr. X is a 64-year-old male admitted to the unit with acute myocardial infarction (AMI) after emergent left (L)- sided heart catheterization/percutaneous coronary intervention (PCI). Past history includes diabetes mellitus type 2, heart failure, hypertension, and osteoarthritis. Home medications include furosemide Lasix), digoxin (Lanoxin), captopril (Capoten), carvedilol (Coreg), Byetta (exenatide), Glucophage (metformin), and Motrin (ibuprofen). Clinical Assessment: Twenty-four hours after admission to the unit, Mr. X is alert; oriented to person, place, and time; and pain free....
Mr. X., a 63-year-old white man, was admitted for ST elevation MI. He was in his normal state of health until 6 hours before admission, when he developed substernal chest pain (SSCP) with radiation to his left arm. Pain was accompanied by mild diaphoresis. After self-administering antacids without relief, he asked his wife to take him to the emergency department (ED). In the ED, he was found to be anxious and diaphoretic, and he complained of dyspnea and 9/10 SSCP....
Mr. P. F., a 68-year-old man, is admitted to the medical intensive care unit from the emergency department with respiratory failure and hypotension. His history is significant for type 2 diabetes mellitus, steroid-dependent chronic obstructive pulmonary disease, peripheral vascular disease, and cigarette and alcohol abuse. His medications at home include glipizide, prednisone, and Combivent. In the emergency department he received a single dose of ceftriaxone and etomidate for intubation. On medical examination he is intubated, on pressure-controlled ventilation, and receiving...
ADULT HEALTH NURSE II CASE STUDY IV: ACUTE RENAL FAILURE J.T. age 45 was admitted to the emergency room following a major automobile accident in which her husband was killed. She had a massive abdominal injuries and a fractured femur. She was taken immediately to surgery for repair of lacerated liver and perforated ileum. She had two units of blood during surgery and two units while in recovery room. On the day of surgery, her urine output declined to 10-20...
Pateints weight was 62 kg, and her BMI was 21 kg/m2 .Her fingerstick glucose on admission was 571 mg/dl, and subsequently measured serum glucose was 617 mg/dl. Testing revealed a sodium level of 133 mEq/l (normal 135–145), potassium of 4.0 mEq/l (normal 3.5–5.0), chloride of 99 mEq/l (normal 96–108), carbon dioxide of 25 mEq/l (normal 21–30), blood urea nitrogen (BUN) of 18 mg/dl (normal 7.0–20.0), and creatinine of 0.8 mg/ dl (normal 0.4–10). Serum acetone was positive at 1:2. Urinalysis...