Question

Questions 5-8

Concept Map- Renal Insufficiency You are working in the ICU of an acute care hospital and assume the care of Edith Bunker, a 78 year-old woman who is 3 days post inferior wall MI. Mrs. Bunker had been healthy before admission except for a longstanding history of arthritis treated with rofecoxib (Vioxx) 50mgm daily and longstanding hypertension treated with atenolol (Tenormin) On admission to the emergency room the patent had a blood pressure of 210/122 mm Hg, therefore thrombolytics were contraindicated. An IV was started with D5/ w at keep open rate and was taken directly to the cardiac catheterization lab for acute PTCA. Her angioplasty was successful, and she has been pain free since her PTCA. You are reviewing her lab work and note the following values: NA K Cl 142 4.6 100 26 CO2 BUN 60 Creatinine Glucose 3.8 158 1. Define thrombolytics and why this medication may not have been used for this patient. 2. Define PTCA 3. Describe how you would have prepared the patient for this procedure 4. Identify the abnormalities in Mrs. Bunker's lab work as well as what the normal values should have been 5. State the possible causes for the abnormalities in the laboratory studies. 6. List the causes of acute urinary retention mes You are given the results of Mrs. Bunker's lab work from today. The results are: Na 140 5.0 K Negative Outeome CI 104 CO2 24 BUN 68 Creatinine Glucose You have also noted that her urine output for the past 8 hours is 160 ml 4.0 Evaluation 104 7. Explain the lab values that have changed over the past 24 hours. 8. State the significance of the urine output. Revised 9/19

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Answer 1

5) The significant abnormalities in the laboratory study of the patient are high Blood urea nitrogen (BUN) and creatinine values. The possible causes for these abnormalities are :-

• Myocardial infarction (Heart attack)
• Congestive heart failure
• Dehydration
• Kidney diseases
• Stress
• Shock
• Gastrointestinal bleeding

6) The causes of acute urinary retention are :-

• ​​​​​​Bladder stones
• Bladder infections
• Urethral stricture
• Cystitis
• Weak bladder muscle
• Bladder cancer
• Faecal impaction
• In men : benign prostatic hyperplasia, prostate cancer, paraphimosis, phimosis, meatal stenosis,balanitis, prostatitis
• In women : Uterine prolapse, uterine fibroid, ovarian cyst, retroverted gravid uterus,vulvovaginitis.

7) Over the past 24 hours, Sodium value has slightly decreased from 142 to 140. Potassium value has slightly increased from 4.6 to 5.0. Chloride value has also slightly increased from 100 to 104. Carbon dioxide level has slightly decreased from 26 to 24. BUN value has increased significantly from 60 to 68. Creatinine value has also increased significantly 3.8 to 4.0. Glucose level has decreased from 158 to 104.

The most significant point to be noted is that patients urine output for the past 8 hours is 160 mL which is low. This could be the reason behind the significant changes in the above lab values.

8) The changes in the urine output in the body can indicate many abnormal conditions in the body such as dehydration, Kidney diseases, Congestive heart failures, Myocardial infarction, Bladder abnormalities, urinary retention, shock, multiple organ dysfunction syndrome, etc. It can give clues about the kidney failure.

This is the significance of urine output.

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