Question

Mr. H., age 68 years, has a long history of hypertension. He has had more headaches recently, his legs and feet are swollen, and he has noticed that more frequent voiding, both during the day and at night, is necessary. He constantly feels tired and does not feel hungry. Mr. Hs blood pressure is 170/110, his pulse is 94, and he has gained 12 pounds in the last 2 months. Diagnostic test findings related to the blood and urine include elevated serum creatinine and rea levels, low serum bicarbonate, low hemoglobin and hematocrit, and low serum sodium. The urine contains protein and has a very low specific gravity. The diagnosis is renal insufficiency or chronic renal failure due to nephrosclerosis. 2) Explain the cause of the edema and weight gain. 3) State three factors contributing to fatigue. 4) Explain why Mr. H.: a. Is voiding frequently b. Has very dilute urine 5) Explain why Mr. H. has: a. High blood pressure b. Anemia c. Metabolic acidosis 6) List the signs indicating that Mr. H. has progressed into uremia or end-stage renal failure. 7) List three reasons why development of pneumonia is a high risk for Mr. H

Answer 1

2) The causes are as follows:

# decreased albumin level in blood

# sodium retention

# medications

# retention of fluid due to altered excretion

3) The factors contributing to fatigue are:

# decreased hematocrit and hemoglobin

# renal insuffieciency

# excessive electrolyte and protein loos in urine.

4) Mr. H is voiding frequently due to increase in diuresis mechanism due to secretion of prostaglandin E2 which inhibits the cation reabsorption and stimulates diuresis.

B) the urine is Diluted due to progression of kidney disease as the kidney loses the ability to concentrate or dilute the urine.

5) Mr. H has high blood pressure due to deterioration of kidney function as renal is the organ which helps in the regulation of blood pressure. As the kidney disease reduces the blood flow... It blocks the tiny filtering units of kidney. Which results in retaining of electrolyte and abnormal excretion of waste which in turn increases the blood pressure.

B) Mr. H has anemia due to reduced hematocrit and hemoglobin, as kidneys are affected they do not make erythropoitin as a result it makes fewer rbc in bone marrow leading to anemia.

C) Metabolic acidosis occurs as the kidney will not be adequately moving the acid from the blood, because this happens by build up of too many acids in the blood.

6) the signs indicating Mr. H is in end stage renal failure are as follows :

# high blood pressure

# electrolyte imabalances

#anemia

# fatigue

#protienuria

# severe metabolic acidosis

# signs of gout

7) the reasons why pneumonia is at high risk it due to :

# reduction of oncotic pressure in the extra cellular fluid leading to respiratory edema and prone for infections

# immune suppression leading to low immunity

# hospitalisation