Nursing homework help
Week 7 Renal System Case Study (read instructions below carefully!!!)
Instructions: Upload a word document with answers. Must have APA resource and rationale with each answer for full-credit.
Case #1 (8 Questions Total)
The patient is a 46 year-old male who has a longstanding history of uncontrolled hypertension and diabetes Type II, presents with a complaint of pruritis, lethargy, lower extremity edema, nausea and emesis. He denies any other medical illnesses.
On physical exam the patient is a well-developed, well-nourished male in moderate distress. Blood pressure 180/110, pulse 80, respirations 24 and he was afebrile. Body weight 76.5 kg. Head/Ear/Neck/Throat (HEENT) exam was remarkable for fundoscopic findings of A-V nicking and copper wire changes consistent with hypertensive injury. Cardiac exam had an S1, S2 and S4 heart sounds. The remainder of the exam was remarkable for 2+ lower extremity edema and superficial excoriations of his skin from scratching. Nursing homework help
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Laboratory Data
| Chemistry | Results | Normal Values | Urinalysis |
| Sodium | 133 | 136-146 mmol/L | pH 6.0 Specific gravity 1.010 Protein 1+ Glucose negative Acetone negative Occult blood negative Bile negative Waxy casts
|
| Potassium | 6.2 | 3.5-5.3 mmol/L | |
| Chloride | 100 | 98-108 mmol/L | |
| Total CO2 | 15 | 23-27 mmol/L | |
| BUN | 170 | 7-22 mg/dl | |
| Creatinine | 16.0 | 0.7-1.5 mg/dl | |
| Glucose | 108 | 70-110 mg/dl | |
| Calcium | 7.2 | 8.9-10.3 mg/dl | |
| Phosphorus | 10.5 | 2.6-6.4 mg/dl | |
| Alkaline Phosphatase | 306 | 30-110 IU/L | |
| Parathyroid Hormone | 895 | 10-65 pg/ml | |
| Hemoglobin | 8.6 | 14-17 gm/dl | |
| Hematocrit | 27.4 | 40-54 % | |
| Mean cell volume (MCV) | 88 | 85-95 FL |
24-hour urine protein and creatinine – volume 850 ml, protein 600 mg/dl and creatinine 180 mg/dl
Renal ultrasound- Right kidney 9 x 6.0 cm, Left kidney 9.2 x 5.8 cm
Both kidneys illustrate hyperechogenicity and no hydronephrosis.
Case #1 Questions
- “Presents with a complaint of pruritis, lethargy, lower extremity edema, nausea and emesis.” what does the symptoms suggest to you?
- What is the significance of the finding ” superficial excoriations of his skin from scratching.” ?
- What does S4 signify? What cardiac findings will you expect to find in a hypertensive?
- What are the possibilities for his 2+ lower extremity edema?
- What evidence in renal ultrasound, will suggest obstruction?
- Is the cause of this patient’s renal failure acute or chronic? How did you arrive at that conclusion?
- Should this patient be started on dialysis? What are the indications for dialysis?
- What is the most likely diagnosis for his renal disease? How did you arrive at that conclusion? Nursing homework help
