Ms. S, a 78-year-old black female, is brought to the emergency room by her son w
ID: 166644 • Letter: M
Question
Ms. S, a 78-year-old black female, is brought to the emergency room by her son who reports that she has been vomiting violently for the past 24 hours. Her mucous membranes are dry and cracked. Her skin is warm and dry with tenting. Her temperature and heart rate are elevated, and her blood pressure is low.
1. What do these findings most likely indicate?
Upon further questioning Ms. S reports that she has had a urinary tract infection (UTI) that just will not go away because she is allergic to so many antibiotics.
2. What additional assessments and diagnostic testing would be pertinent at this time?
Ms. S is unable to void, so the nurse inserts a catheter with a return of less than 50 mL of amber, malodorous urine. The nurse receives the following results, which are significant from her lab work:
Urinalysis = + Protein; + RBCs; +WBCs, nitrates
BUN = 35
Creatinine = 3.5
GFR = 65
Na+ = 150
WBC = 12,000
3. How would the nurse explain these findings?
4. Describe the three types of renal dysfunction (prerenal, intrarenal, postrenal) .
5. Which dysfuction(s) does the nurse suspect with Ms.S? Is Ms. S at risk for acute kidney injury (AKI) as a result of Acute Tubular Necrosis, why or why not?
As the nurse is completing Ms. S’s health history, Ms. S mentions that she takes a pill for her “high blood,” and when she has a headache, she will take two because she knows her “pressure” is up. When her son brings in her medication bottle, the nurse notes that she is taking lisinopril.
6. What concerns does the nurse have based on the above information?
Ms. S received antiemetics, and her vomiting subsided. She was rehydrated with IV fluids, and the UTI was being adequately treated. As she was being discharged from her 3-day hospitalization, she said, “I was so afraid I was going to have to go on that machine that cleans the blood for the rest of my life like my cousin who has chronic kidney disease (CKD).”
7. What is CKD?
Explanation / Answer
1. The first and foremost indication is that Ms. is suffering from acute dehydration and loss of potassium after vomiting continuously for 24hrs. That is why her mucous membrane and skin is dry.
2. Her urine sample has to be taken for the test, possibly a urine culture should be done and her blood sample should be taken for WBC(White Blood Cell) counting.
3. Her bun is too high-35 which should be between 8-20 which proves her kidney has been infected. GFR is slightly higher than normal which should be 60. All the test show a higher range than from normal condition which proves that she suffers from CKD.
4. Prerenal kidney dysfunction occurs when there is inadequate blood flow to the kidney. Intrarenal renal dysfunction is the failure/damage/loss of function in one of the kidneys.Postrenal dysfunction is acute kidney injury.
5. Ms.S is at a suffers both from prerenal and intrarenal dysfunction and is at a risk of postrenal dysfunction.
6. An overdose of lisinopril will increase her headache, vomiting and skin rashes.
7. CKD is Chronic Kidney Disorder.
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