A nurse is caring for an 80-year-old patient who was admitted to the hospital wi
ID: 121797 • Letter: A
Question
A nurse is caring for an 80-year-old patient who was admitted to the hospital with a diagnosis of dehydration. The patient stated he had been vomiting for 2 days and had been unable to take food or fluids. He has been healthy and currently takes only a diuretic for his blood pressure. On physical examination, the nurse notes the patient's skin is dry with decreased turgor, oral mucous membranes are dry, heart rate is 100, and blood pressure is 90/60. The patient's urine is dark amber with a specific gravity of 1.028. His urine output was 30 cc/hour for the past 4 hours since admission. When reviewing the patient's laboratory results the nurse notes the BUN is 60 and a creatinine of 1.2. What type of renal failure is most often seen with dehydration? What signs and symptoms noted by the nurse are characteristic of renal failure? If the blood pressure continued to drop in this patient and the patient developed acute tubular necrosis, what would happen to the kidney tubule? What are the three phases of acute tubular necrosis? Identify two important nursing interventions for each phase.Explanation / Answer
BUN(Blood urea nitrogen) and creatinine are the most important indicators of the severity of kidney related ailments. Normal level of BUN is 7-20 mg/dL, and the given level of 60 suggests kidneys are not working well. On the other hand, normal creatinine for male is 0.6-1.2 and in the given level of 1.2 is alright. However, the elevated BUN should be carefully matched with other problems like dehydration, multiple drugs, GI bleeding ,and increased protein intake.
1. Hypovolemia due to specific gravity of 1.028 suggests reversible acute renal failure.
2. Hypotension,hypovolemia, dry skin with reduced turgor, elevated BUN,and dark amber urine with a specific gravity of 1.028.
3. Damage and death of tubular epithelial cells due to insufficient oxygen but the renewal of a tubular cell takes place. Here it is ichemic due to hypotension.
4. Initiation phase- Increased creatinine and elvated BUN. It is managed through monitoring of fluid and electrolyte balance along with reducing metabolic rate.
Maintenance phase- Severe reduction in the glomerular filtration rate and continued rise of BUN and creatinine. It is managed through promoting pulmonary function and preventing infection.
Recovery phase- Hypervolemia and decrease in BUN and creatinine and restoration of tubular function. Restoration of fluid balance and improving nutritional intake are the main management strategies.
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