Renal Case Study
ORDER CUSTOM, PLAGIARISM-FREE PAPERS ON Renal Case Study
Assignment Description: Assessment and management of the renal system is crucial to the outcome of the critically ill patient. Renal failure can be a primary or secondary threat to life. Renal failure is commonly caused by low perfusion states such as decreased cardiac output, hypovolemia, and altered peripheral vascular studies.
Assignment Directions:This week you will be completing a case study. You will each complete the case study independently. Download the Renal Case Study, complete it, and then attach it to this link. Be sure to fully answer questions and cite references.
See attachment for assignment and please fill out questions in attachment.
Unformatted Attachment Preview
Renal Case Study N 4080 Brief Patient History Ms. L is a 32-year-old, 85.3kg woman found down in the street near the hospital. No known medical history could be obtained. The patient was intubated for protection of airway and started on fentanyl and propofol for ventilation management. Clinical Assessment Ms. L is admitted to the intensive care unit with muscle pain and minimal dark urine output of 15ml/hr. Cardiovascular: ECG: Frequent PVC’s and peaked t-waves. Pulmonary: Pt is intubated and on pressure control 10/5, FiO2: 40% VT = 550, lung sounds are clear, but decreased in bases. Chest x-ray confirms ETT placement. Neurological: Patient is sedated and restrained with bilateral wrists restraints, pt responds to noxious stimuli and is a 2 on a Ryker-agitation-sedation scale. GI/GU: Bowel sounds are hypoactive in all quadrants: GU: Urine out is dark amber and has some sediment(red, white and tubular casts), a foley catheter has been inserted for monitoring. Some hematuria is noted. Renal Case Study
Integumentary: Pt is jaundiced Vascular: A failed AV fistula is noted in left arm. Pt has had a triple lumen central venous catheter inserted and a right radial arterial line. Laboratory Results Na+= 128 mEq/l K+ = 5.3 mEq/l Cl- = 92 mEq/l CO2= 18 mEq/l BUN: 40 mg/dl Serum Creatnine 3.2 mg/dl CPK: 40,400 U/L Serum myoglobin: 2.5 ng/L Urine myoglobin: 300 ng/L WBC: 16000 HCT: 31% HGB: 10.0 BUN: 40 mg/dl Serum Creatnine 3.2 mg/dl Ionized Calcium: Low Toxicology screen: positive for cocaine and opioids Edema 2+ to lower extremities Discussions for Case Studies 31-2 Baseline vital signs: blood pressure (BP), 77/55; heart rate (HR), 128 (sinus tachycardia with noted arrythmias); respiratory rate (RR), 18 (per ventilator); temperature (T), 103.3° F; O2 sat, 98%. Glasgow Coma Scale is 7. ABG: Ph 7.23, PO2= 85, PCO2 = 32, HCO3 = 17 Questions: 1. Identify the abnormalities in the lab results and briefly discuss the implications of each result. 2. You decide to calculate an anion gap. Calculate the anion gap and explain the results. 3. List at least three findings on the clinical assessment that indicate the patient may be suffering from renal failure? 4. Why might the patients CPK and myoglobin levels be elevated? What are the implications of these values? 5. Identify your top three priorites in the care of this patient. Why? Renal Case Study
The physician orders intravenous fluids and antibiotics for Ms. L. BP is now 90/60 and HR: 110 with occasional PVCs and peaked T waves. Use Figure 26.2 in your text to answer the following questions. 6. Interpret Ms. L’s ABG results. 7. Identify the type of IV fluids that would be appropriate for Ms. L. 8. What medications/interventions could be used to reduce Ms. L’s K level? 9. Identify three types of dialysis that might be instituted for this patient? List the indications and nursing care implications for each type of dialysis. Discussions for Case Studies 31-3 10. What type of renal failure does this patient have? (Pre, Intra or postrenal injury). Defend you answer. … Renal Case Study