...Unit 4 Case Study A 45-year old man presented to the hospital with alcohol withdrawal. After drinking a pint of brandy daily for the past 5-6 years, he decided to stop drinking 4 days ago. he experienced tremors and then visual and auditory hallucinations. On arrival at the hospital, he was diaphoretic and tachycardiac, with a pulse rate of 102. His chemistry results are shown below: Na+ | 130 mmol/L | K+ | 3.7 mmol/L | Cl- | 90 mmol/L | CO2 | 20 mmol/L | BUN | 81 mg/dL | Creatinine | 4.0 mg/dL | Magnesium | 1.4 mg/dL | Alcohol | Negative | Total Protein | 7.1 g/dL | Albumin | 3.7 g/dL | Medical history included arthritis, hypertension, depression, and alcoholism. He had been taking an anti-inflammatory medication for arthritis and an antidepressant. Overnight, he became agitated and required increasing doses of a benzodiazepine, together with physical restraints for behavior control. The next morning, he was transferred to the ICU where he was evaluated for acute renal failure. The patient was rehydrated and his arthritis and antidepressant medication were withheld. Lab test results are listed below: Na+ | 139 mmol/L | K+ | 3.5 mmol/L | Cl- | 107 mmol/L | CO2 | 23 mmol/L | BUN | 16 mg/dL | Creatinine | 1.4 mg/dL | Discussion Questions: 1.) Is the patient still in acute renal failure? Explain your answer. * Yes, the patient is still in acute renal failure. Acute renal failure, also called acute kidney failure, is when...
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...An Overview of Renal Failure and Its Treatment Option Renal failure can affect any population in society with no discrimination to age or race. There are several different types of renal failure and a multitude of treatment options depending on the severity or complexity of the disease process. With a change in healthcare on the horizon an examination into the area and the current school of thought is a must. While renal failure is just one small area of the healthcare sector, it is rapidly growing and affecting more and more every day. According to the data from the CDC more than 4.4 million Americans are diagnosed with some form of kidney disease (CDC). Renal Failure is best defined when the kidneys no longer work properly. Now one might ask, what do the kidneys do? The kidney’s simply remove metabolic waste and water from the human body and maintain homeostasis. Without the kidneys functioning properly the body will no longer make urine and dangerous electrolyte abnormalities can occur. One must realize there are several categories of renal failure. The two main classifications are Acute and Chronic Renal Failure. Acute Renal Failure is best defined as rapid and new onset renal failure sometimes reversible when treated appropriately while Chronic Renal Failure long term and irreversible unless treated via transplant. Now that a basic foundation definition of Renal Failure has been established, one must gain knowledge of what causes Renal Failure. Now that there...
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...Pathophysiology: Neoplasia and Renal System School of Nursing 1. Cancer Staging Cancer staging describes the severity of a person’s cancer based on the person’s initial tumor, and whether or not the cancer has metastasized (American Cancer Society, 2012, www.cancer.org). Knowledge of the stage is very important in that is can be used to explain prognosis to the patient, and can be used by the doctor and the patient to plan treatment. Staging of cancer is based on knowledge of the way in which cancer progresses in the body. Malignant cells grow and reproduce without any control or order, and they do not die when they should. In most cases the cancer cells will form a mass called a tumor. As the tumor grows it can invade tissues and organs that are close to it. The malignant cells can also break away from the tumor and enter the bloodstream (Lemone, 2004, p. 284). There are five common elements considered in most staging systems: site of the primary tumor, tumor size and number, lymph node involvement, cell type, and the presence or absence of metastasis. A common staging system is called TNM, which stands for Tumor, lymph Nodes, and Metastasis. When staging a number is added to each letter to indicate the size of the primary tumor and the extent of the cancer spread. (Lemone, 2004, p. 284) Infection, immunity and inflammation in cancer patients are all interrelated. They form what could be...
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...------------------------------------------------- Hypertensive emergency From Wikipedia, the free encyclopedia A hypertensive emergency is severe hypertension (high blood pressure) with acute impairment of an organ system (especially the central nervous system, cardiovascular system and/or the renal system) and the possibility of irreversible organ-damage. In case of a hypertensive emergency, the blood pressure should be substantially lowered over minutes to hours with an antihypertensive agent. Contents [hide] * 1 Treatment * 2 Incidence * 3 Definition * 3.1 Hypertensive emergency as a generic term * 4 Pathophysiology * 5 Mortality * 6 Clinical history * 7 References * 8 See also | ------------------------------------------------- [edit]Treatment Several classes of antihypertensive agents are recommended and the choice for the antihypertensive agent depends on the cause for the hypertensive crisis, the severity of elevated blood pressure and the patient's usual blood pressure before the hypertensive crisis. In most cases, the administration of an intravenous sodium nitroprusside injection which has an almost immediate antihypertensiveeffect is suitable but in many cases not readily available. In less urgent cases, oral agents like captopril, clonidine, labetalol, prazosin, which all have a delayed onset of action by several minutes compared to sodium nitroprusside, can also be used. It is also important that the blood pressure is lowered not too...
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...ACUTE GLOMERULONEPHRITIS DISCLOSED _________________________ A Case Study Presented to The Clinical Instructors AUP College of Nursing Adventist University of the Philippines __________________________ In Partial Fulfillment of the Requirements for the Course NMCN 244, Care of Mother, Child, Family and Population at Risk ___________________________ TABLE OF CONTENTS I. Introduction Significance of the Study II. Patient DataBase A. Demographic Data B. Nursing History 1. Developmental Tasks 2. Health History 3. Medical Diagnosis & Chief Complaints III. The Disease Entity A. Review of Normal Physiology B. Theoretical Background C. Statistical Report D. Risk/Aggravating Factors E. Pathophysiology Narrative w/ Documentation F. Pathophysiology Diagram G. Prognosis of Disease IV. Assessment A. Gordon’s or Head to Toe Assessment B. Book Picture vs Patient’s Manifestations V. The Management A. Diagnostic Test Result and Significant B. Therapeutic/Medical Interventions 1. Surgeries/Treatment 2. Drugs C. Nursing Initiated Interventions 1. Nursing Care Plan 2. Discharge Plan VI. General Evaluation of the Study A. Summary B. Recommendation VII. Bibliography I. Introduction Acute glomerulonephritis is a disease that affects glomerular capillaries. Etiologic factors are many and varied; they include immunologic reactions, vascular injury, metabolic...
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...Ryan Chavez Patho 2 Case study 7 Case1 1. Due to D.K.’s signs and symptoms she probably has a urinary tract infection or urinary cystitis. 2. Since E. coli is the most common cause of urinary treat infections, antibiotics are an appropriate treatment for D.K. because she is symptomatic with frequency, urgency and burning upon urination. 3. The factors that predispose the development of a UTI are sexually active women,the us of a diaphragm, failure to void after intercourse, improper hygiene, female anatomy, low estrogen levels in postmenopausal women, catheters or a foreign object placed in the urinary tract for a long period time, pregnancy, and diabetes mellitus. 4. The strategies that D.K can take to avoid the recurrence of a UTI would be clean perineal hygiene, stay well hydrated, wear cotton crotched underwear, void after intercourse, avoid feminine hygiene deodorants, avoid harsh toilet paper, and avoid tight fitting pant. Case 2 1. Due to the loss of blood P.W is at risk for pre-renal acute renal failure and it may lead to poor renal perfusion. 2. The best type of treatment to prevent renal failure would be adequate fluid volume replacement with blood or any isotonic solution maintain proper blood volume circulation and to maintain adequate blood pressure and perfusion to the kidneys. 3. P.W. is in the stage of pre-renal oliguria. This means that the kidneys are functioning as the should if blood volume and pressure are low. The kidneys will conserve...
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...eMedicine article/238798 MeSH D007676 Chronic kidney disease (CKD), also known as chronic renal disease (CRD), is a progressive loss in renal function over a period of months or years. The symptoms of worsening kidney function are non-specific, and might include feeling generally unwell and experiencing a reduced appetite. Often, chronic kidney disease is diagnosed as a result of screening of people known to be at risk of kidney problems, such as those with high blood pressure or diabetes and those with a blood relative with chronic kidney disease. Chronic kidney disease may also be identified when it leads to one of its recognized complications, such as cardiovascular disease, anemia or pericarditis.[1] It is differentiated from acute kidney disease in that the reduction in kidney function must be present for over 3 months. Chronic kidney disease is identified by a blood test for creatinine. Higher levels of creatinine indicate a lower glomerular filtration rate and as a result a decreased capability of the kidneys to excrete waste products. Creatinine levels may be normal in the early stages of CKD, and the condition is discovered if urinalysis (testing of a urine sample) shows that the kidney is allowing the loss of protein or red blood cells into the urine. To fully investigate the underlying cause of kidney damage, various forms of medical imaging, blood tests and often renal biopsy (removing a small...
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...City College of Medical Technology Acute Glomerulonephritis In partial fulfillment of RLE Researchers: Valdez, Shiela Mae A. Alonzo, Krizzel Marie M. Sevilla, Rica Allona N. Flores, Ma. Cristina D. Mangulabnan, Kimberly M. March 2015 I. INTRODUCTION Glomerulonephritis literally means inflammation of the glomerulus or the clusters of microscopic blood vessels in the kidney that filter wastes and fluids from the blood. It includes a number of disorders that affect the structure and function of the glomerulus without any prominent inflammation. It is therefore also referred to as glomerular disease or glomerulopathy. In glomerulonephritis, various known and unknown causes trigger immune activity against the glomeruli which damages it. It is characterized by body tissue swelling (edema), high blood pressure, decreased protein in the blood (anemia), and the presence of red blood cells (hematuria) or protein (proteinuria) in the urine. (Christian Nordqvist, Medical News Today, 2009) Collin, Rull, and Huins (2012) articulated that glomerulonephritis results from a variety of immune and inflammatory mechanisms. It is often described as primary, when it arises on its own and originated on the kidney, or secondary, when glomerular involvement is part of a systemic disease like systemic lupus erythematosus (SLE), and polyarteritis nodosa. Furthermore, glomerulonephritis can be classified as acute or chronic. In acute glomerulonephritis, the condition starts...
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...Central University of Technology, Bloemfontein Early detection and prevention of Chronic Kidney Disease Contents page Definition of key terms used in the assignment Abbreviations used in the assignment Introduction Chronic Kidney Disease, a condition characterised by a gradual loss of kidney function. CKD is often misdiagnosed owing to the lack of knowledge about the disease. With early detection and prevention of the progression of the disease CKD patients can still enjoy life to the fullest while they manage their disease, however if the healthcare professionals fail to identify the disease on time the patient can suffer dire consequences. Besides the financial implications associated with the disease, there are the emotional implications together with physical and psychological. This assignment seeks to explore such implications in an effort to highlight the importance of early detection and prevention of kidney disease, with the best interest of the patient at heart Background Normal kidney anatomy http://doctorstock.photoshelter.com/image/I000096SqkYwaLhE The bean-shaped kidneys lie in retroperitoneal position in the superior lumbar region. Extending approximately from T12 to L3, the kidneys receive some form of protection from the lower part of the rib cage (E.N. Marieb, K Hoehn, 2010) The kidneys functions can be divided into two, non-excretory functions and excretory functions. Under excretory we have Glomerular filtration, Tubule...
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...Case Study 7 Case 1 D.K. is being seen in the clinic for complaints of urinary frequency, urgency, and burning. She reports that her urine appears cloudy and smells abnormal. A urine culture is obtained, and D.K. is given a prescription for antibiotics. 1) What is the most likely cause of D.K.’s signs and symptoms? The most likely cause of the signs and symptoms is a urinary tract infection. 2) Was antibiotic therapy the appropriate treatment? What organism should the antibiotic be effective against since it is the most common cause of this disorder? Yes, antibiotics are indicated for symptomatic urinary tract infection. E. Coli causes about 80% of UTIs. 3) What factors predispose to development of this urinary tract disorder? Factors that predispose the development of a UTI are: sexually active women, failure to void after intercourse, incorrect hygiene (i.e. wiping from front to back), female anatomy, low estrogen in postmenopausal women, catheters, tubes or foreign objects placed in the urinary tract, pregnancy and diabetes mellitus. 4) What strategies could be suggested to help D.K. avoid recurrence of this problem? Strategies that will help to avoid the recurrence of an UTI: If sexually active void after intercourse, wipe perineal area from front to back, wear cotton crotch underwear, drink six to eight glasses of water a day, avoid bubble baths and highly perfumed soaps, avoid douches and feminine hygiene deodorants. Case 2 P.W. was...
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...III - Vascular Access Vascular Access Chapter 6 - Establishing Venous Access Chapter 7 - The Indwelling Vascular Catheter Section IV - Hemodynamic Monitoring Hemodynamic Monitoring Chapter 8 - Arterial Blood Pressure Chapter 9 - The Pulmonary Artery Catheter Chapter 10 - Central Venous Pressure and Wedge Pressure Chapter 11 - Tissue Oxygenation Section V - Disorders of Circulatory Flow Disorders of Circulatory Flow Chapter 12 - Hemorrhage and Hypovolemia Chapter 13 - Colloid and Crystalloid Resuscitation Chapter 14 - Acute Heart Failure Syndromes Chapter 15 - Cardiac Arrest Chapter 16 - Hemodynamic Drug Infusions Section VI - Critical Care Cardiology Critical Care Cardiology Chapter 17 - Early Management of Acute Coronary Syndromes Chapter 18 - Tachyarrhythmias Section VII - Acute Respiratory Failure Acute Respiratory Failure Chapter 19 - Hypoxemia and Hypercapnia Chapter 20 - Oximetry and Capnography Chapter 21 - Oxygen Inhalation Therapy Chapter 22 - Acute Respiratory Distress Syndrome Chapter 23 - Severe Airflow Obstruction Section VIII - Mechanical Ventilation Mechanical Ventilation Chapter 24 - Principles of Mechanical Ventilation Chapter 25 - Modes of Assisted Ventilation Chapter 26 - The Ventilator-Dependent Patient Chapter 27 -...
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...vasodilation and sweating, which helps dissipate heat.Carvedilol causes vasodilation by blocking the activity of α-blockers, mainly at alpha-1 receptors. It exerts antihypertensive effect partly by reducing total peripheral resistance and vasodilation. It is used in patients with renal impairment, NIDDM or IDDM.Promotes incorporation of water into stool, resulting in softer fecal mass, may also promote electrolyte and water secretion into the colon. It increases the amount of water and fat absorbed by the feces, softening the stool and making it easier to pass.Inhibits the reabsorption of sodium and chloride from the loop of Henle and distal renal tubule. Increases renal excretion of water, sodium, chloride, magnesium, potassium, and calcium. | Contraindicated with allergy to acetaminophen. Use cautiously with impaired hepatic function, chronic alcoholism, pregnancy, lactation. Adverse effects CNS: Headache CV: Chest pain, dyspnea, myocardial damage when doses of 5–8 g/day are ingested daily for several weeks or when doses of 4 g/day are ingested for 1 yr GI: Hepatic toxicity and failure, jaundice GU: Acute kidney failure, renal tubular necrosis Contraindications Hypersensitivity; severe chronic heart failure, bronchial asthma or related bronchospastic conditions; severe hepatic impairment. Adverse effects Bradycardia, AV...
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...the NMB of NSW. ▪ Frequency of documentation relies on: - physical/ mental status of the pt. - the type of care provided (self care v. intensive care) - requirements of health care agency - any legal or other obligations that the health record must meet ▪ Content of documentation needs to be: - relevant - appropriate - accurate - requirements will vary according to pt acuity - content may be guided by framework (assessment, intervention, response) ▪ Documentation framework: - assessment: conclusions reached utilising subjective and objective data - intervention: reflects the action taken - response: reflects the pt’s response to the intervention ▪ Example of using framework to case: Mrs Pat Martin, a 28y/o lady has been admitted overnight via Casualty accompanied by husband. She is 16 wks pregnant and has been diagnosed with appendicitis by Dr Chan. At the moment she is only experiencing mild pain and has a low grade fever of 37.7. IMI Pethidine 50mgs was given at 2am, and may be repeated PRN. Shes been added to the theatre list at 9.30am. She remains NMB and has IV normal saline running over 10hrs. IV Keflin QID commenced, is next due 12md. Her husband remains at bedside. It is now 630am and Mrs Martin is resting, however she has not had much sleep overnight. Her 6am vital signs are: BP: 120/80 Respirations: 16, Ward urinalysis shows no abnormalities Temp: 37.7. Pulse: 80 (reg). ASSESSMENT: - Mrs Martin aged 28 ...
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...Definitions of systemic inflammatory response syndrome (SIRS), sepsis, septic shock, and multiple organ dysfunction syndrome Systemic inflammatory response syndrome Two or more of the following clinical signs of systemic response to endothelial inflammation: • Temperature > 38°C or < 36°C x Heart rate > 90 beats/min • Tachypnoea (respiratory rate > 20 breaths/min or hyperventilation (Paco2 < 4.25 kPa)) • White blood cell count > 12 ⋅ 109/l or < 4 ⋅ 109/l or the presence of more than 10% immature neutrophils In the setting (or strong suspicion) of a known cause of endothelial inflammation such as: • Infection (bacteria, viruses, fungi, parasites, yeasts, or other organisms) • Pancreatitis x Ischaemia x Multiple trauma and tissue injury x Haemorrhagic shock x Immune mediated organ injury x Absence of any other known cause for such clinical abnormalities Sepsis Systemic response to infection manifested by two or more of the following: • Temperature > 38°C or < 36°C x Raised heart rate > 90/min • Tachypnoea (respiratory rate > 20 breaths/min or hyperventilation (Paco2 < 4.25 kPa)) • White blood cell count > 12 × 109/l or < 4 × 109/l or the presence of more than 10% immature neutrophils Septic shock Sepsis induced hypotension (systolic blood pressure < 90 mm Hg or a reduction of >40 mm Hg from baseline) despite adequate fluid resuscitation Multiple organ dysfunction syndrome Presence of altered organ...
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...Structural and Functional Parameters Are IndependentPredictors of Renal Function at 3 Months | 202(111 biopsied) | | A donor preimplantation biopsy with sufficient material forevaluation was available in 111 cases. Mean global glomerularsclerosis was 1.2% _ 3.5% and in seven cases globalglomerular sclerosis was greater than 10%. Mean donorchronic damage score was 0 in 77 cases; 1 in 15 cases; 2 in13 cases; and _3 in five cases(LOW PERCENTAGE OF GLOMEROSCLEROSIS) | | Histopathologic Evaluation of Pretransplant Biopsy as a Factor InfluencingGraft Function After Kidney Transplantation: A 1-Year Observation | 92 | We observed a significant correlation between immediate graft function (IGF)and lack of ATN in the pre-0 biopsy. We observed no correlation between renal functionand arterial hyalinization and fibrosis, inflammatory infiltration, tubular atrophy. In thepostoperative period, we observed a significant correlation between IGF and lack ofinterstitial fibrosis with significantly lower levels of creatinine, urea, and potassium andhigher urine output early after transplantation. IGF and better function of the right kidneywas correlated with shorter time to reach a creatinine level of 2 mg%. In the postoperativeperiods, we also observed a difference between renal function depending on gender. Thepresence of acute tubular necrosis, arterial fibrosis, lack of inflammatory infiltration in thepre-0 biopsy correlated with worse late renal function. Among explantation biopsies 65.5%showed signs of CAN...
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