Renal case study PDF

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ANNA KOTENKO Ms. Barkley is a thin, frail 64-year-old female presenting from a nursing home for acute abdominal pain, nausea, and vomiting x 2 days. She receives a CT scan with IV contrast. Findings show no acute bleeding, but a possible small bowel obstruction. She is admitted for bowel rest, with the following written orders from the provider:  Continuous Telemetry  Strict I&O measurements  Keep SpO > 92%  Keep NPO (strict)  Hydrocodone/Acetaminophen 5-325 mg PO q6h PRN moderate to severe pain  Ondansetron 4mg PRN nausea 2

She is admitted to the unit at the beginning of shift, and the UAP reports the following vital signs: HR 103 RR 16 BP 118/68 SpO 96% Pain 6/10 2

Which order would you question or request clarification for? Why? The Ondansetron has no directions or route of administration. What additional nursing assessments need to be performed? The nurse needs to assess the patient’s abdomen by inspecting, auscultating, palpating, and percussing. Since the patient is there for abdominal pain, nausea, and vomiting the nurse must make sure no masses are felt and to look for guarding. Listen to the heart and lungs to see if they are affected by the client’s condition. Assess the patients pain through detailed assessment and lastly asses the patients skin for dehydration. . At the end of the 12-hour shift, vital signs are as follows: HR 96 RR 22 BP 147/80 SpO 93% Pain 3/10 2

The nurse recognizes that the patient has not voided all day and assists the patient to the bathroom. The patient voids 200 mL dark, concentrated urine.

What nursing action(s) should be implemented at this time? Who should this information be passed on to?

The nurse must document the patients output as well as contact the doctor to let them know that the urine volume has decreased. The nurse must also make sure that she include all of this information in the report (SBAR) to the nurse who will be taking over so she can check the patients I & O. Provider orders a 500 mL bolus of Normal Saline (0.9%) IV over 1 hour and a renal function panel, which is drawn promptly by the nurse. After 6 hours, Ms. Barkley still has had no further urine output. A bladder scan shows approximately 60 mL of urine in the bladder. A head-to-toe assessment now reveals crackles in Ms. Barkley’s lungs and her SpO is 89% 2

The renal function panel has resulted: BUN 56 mg/dL Na 132 mg/dL Cr 3.6 mg/dL Ca 7.7 mg/dL GFR 47 mL/min/m Phos 4.8 mg/dL K 5.5 mEq/L Mg 1.4 mg/dL 2

What nursing action(s) should be implemented at this time? Since the clients SpO has gone down to 89% the first thing the nurse needs to do is to administer O2 to the patient starting at 2L through a nasal cannula. The patient should have SpO2 higher than 92%. Also the clients renal function panel is off and the doctor must be notified due to the abnormal values in BUN, Cr, GFR, and Potassium. These are indicators for some renal problems. What is going on physiologically with Ms. Barkley at this time? Explain what contributed to the development of this condition Ms. Barkley has possibly developed what seems to be acute kidney injury or possible failure (since the medical history is unknown). What has contributed in this possible physiological state it the dehydration due to vomiting along with the IV contrast. The order of NPO 12 hours plus and no IV fluids. Due to this the patient is in a low state of kidneys as well and possible damage to the kidneys. Please provide a nursing diagnosis for the patients plan of care? Risk of Dehydration due to vomiting. Impaired urine elimination. Risk of renal failure.

The provider orders to give 1L bolus of Normal Saline (0.9%) over 1 hour, then 125 mL/hr of Normal Saline continuously. The provider also orders a one-time dose of 40 mg Furosemide IV

push and to re-check the Renal Function Panel in 6 hours. Ms. Barkley diuresis approximately 600 mL in 2 hours and her lungs now sound clear to auscultation. Over the next two days, Ms. Barkley’s hourly urine output begins to improve and her BUN, Creatinine, and GFR return to normal ranges. Her small bowel obstruction resolves on its own and she is able to begin taking PO food and fluids....