Question 2 10 pts Case Study Progress George is admitted to a medsurg/telemetry

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Question 2 10 pts Case Study Progress George is admitted to a medsurg/telemetry unit. Labs are collected and the patient has a renal ultrasound completed. Chart View – Labs and Diagnostics Sodium 133 Potassium 6.2 Chloride 100 Total CO2 15 BUN 170 Creatinine 16.0 GFR 28 ml./min Calcium 7.2 Phosphorus 10.5 Alkaline Phosphatase 306 Parathyroid Hormone 895 Hemoglobin 8.6 Hematocrit 27.4 Mean corpuscular volume 88 HbA1C 9.0 Urinalysis pH 6.0 Specific gravity 1.010 Protein 1+ Glucose negative Acetone negative Occult blood negative Bile negative Waxy casts 24-hour Urinalysis Volume 350 ml Protein 600 mg/dl Creatinine 180 mg/dl Renal Ultrasound Right kidney 9 x 6.0 cm, Left kidney 9.2 x 5.8 cm No hydronephrosis. After receiving the reports the nurse reviews the results before notifying the health care provider on call. Which labs and diagnostics are of concern? Why?

Explanation / Answer

The nurse has to report the abnormal changes in values which indicates an emergency. ( please find the bold)

Sodium 133: normal range is 135-145 mEq/L

Potassium 6.2 : normal range is 3.5 - 5.0 milliEquivalents/liter (mEq/L) , patients value is slightly elevated

Chloride 100: normal range is 95-105 mmol/L, so patient’s finding is not significant

Total CO2 15: normal range is 22-29 mEq/ L,

BUN 170: normal range is 8-21 mg/dL, significant increase indicates a renal emergency.

Creatinine 16.0 : Normal range is 0.8-1.3 mg/dL, Patients value is 16.0 indicative of renal damage or failure.

GFR 28 ml./min: GFR normal is 90-120 ml/ min. The patient’s value is significantly low. Report immediately to the physician.

Calcium 7.2 : normal range is < 6.2 mmol/d

Phosphorus 10.5 : normal range is 3-4.5 mg/dL or 1.8-2.3 mEq/L

Alkaline Phosphatase 306: normal value is 40-160 U/ L. The increased serum levels of alkaline phosphatase is seen Chronic Kidney Disease (CKD). The elevated serum alkaline phosphatase level can be an indication of inflammation due to its association with elevated levels of CRP.

Parathyroid Hormone 895: normal range is 10-65 pg/ mL. Secondary hyperparathyroidism is seen in CKD

Hemoglobin 8.6: normal range is 14.0-18.0 g/d. Decreased value is seen in CKD along with increased creatinine levels.

Hematocrit 27.4: expected range is 40-54%

Mean corpuscular volume 88: normal range is 76-100 ?m3

HbA1C 9.0: High HbA1c or glycosylated hemoglobin indicates poorer control of diabetes.

Urinalysis pH 6.0: PH is acidic, is normal

Specific gravity 1.010

Protein 1+: is 30 mg/dL in urine indicates protein loss through kidneys

Glucose negative

Acetone negative

Occult blood negative

Bile negative

Waxy casts: Presence of Waxy casts indicates chronic renal failure or acute and chronic renal allograft rejection. The broad waxy casts are known as renal failure casts due to its association with kidney failure.

24-hour Urinalysis

Volume 350 ml: the abnormally low volume indicates renal failure

Protein 600 mg/ dl: normal range is <300 mg/24 hours, increase indicates renal pathology

Creatinine 180 mg/dl: The urine creatinine excretion per 24 hours is expected to be 13-29 mg/kg of body weight/24 hours in males.

Renal Ultrasound

Right kidney 9 x 6.0 cm, Left kidney 9.2 x 5.8 cm

No hydronephrosis.

Total CO2 15: normal range is 22-29 mEq/ L,

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