...posterior pituitary gland RAAS will be activated Increase release of ADH Increase aldosterone level Peripheral vacoconstriction Na and water retention s/sx: increased BP Nephrotoxicity /Nephropathy Increase water reabsorption by renal tubule Dilation and enlargement of heart chambers Stretching of muscle fibers of the heart Increase contraction (Frank-starling law) Increase O2 requirement to perform work Presence in the skin/skin changes Tissue Hypoperfusion s/sx: Weakness, fatigue, pallor. Pale nail beds and lips Increase cardiac workload, leading to overworked heart Heart failure Increased Fluid backup into the lungs Increased Pulmonary Pressure Impaired Gas exchange s/sx; dry Cough, Fatigue, Orthopnea, Irritability, Crackles Legend: pathophysiology signs/symptoms lab result diagnosis Kidney hypoperfusion Decrease glomerular filtration rate Decrease nephron function Heart failure Renal Failure (impaired renal excretory ability) Increase...
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...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 fluid and sodium which will cause the production of a concentrated urine. This stage of failure is reversible if the pressure and perfusion are restored quickly, but if it continues the pre-renal renal failure will occur. Ryan Chavez Patho 2 4. The labs that should be monitored to assess P.W.’s renal function are serum BUN, creatinine, potassium, and serum sodium. A increase in these...
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...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 the kidneys suddenly become unable to filter waste products from your blood. When the kidneys lose their filtering ability dangerous levels of wastes can accumulate and the body’s chemical makeup may get out of balance. * It is clear that he is still in acute renal failure because his BUN (blood urea nitrogen) and creatinine chemistry results were nearly four times...
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...very little assistance. Mrs. C is morbidly obese which makes it difficult to get out of bed without assistance but for the most part, she can ambulate and walk around on her own once she is out of the bed with the assistance of a walker. Because of her obesity, Ms. C has several skin folds throughout her body, which make a great medium for fungal infections. The area underneath her skin folds is red and irritated. Ms. C has had oliguria for the past several days and is outputting very little to no urine. A foley catheter has been placed in order to remove any urinary retention. However, very minimal urine seems to be coming out of foley. The doctors have requested labs to be drawn on a regular basis to check her kidney function and to also monitor her electrolytes. Her admitting diagnosis is Acute Renal Failure. Past Medical History: o Essential Hypertension o Hyperlipidemia o Diabetes Mellitus Type 2 o Stage 3 Diabetic Chronic Kidney Disease o Severe Obesity Present Medical History: o Severe abdominal pain o Dehydration o Oliguria o Uncontrolled Diabetes o Chronic Kidney Disease o Hypertension o Obesity Active Orders: o Foley Catheter o Oxygen 2 L NC o Blood Sugar Monitoring AC and HS o Insulin Regular o Insulin NPH 10 units in AM o Insulin NPH 5 units before bed time o Flucanozole 100 mg IV o D5W 1000 mL with Sodium Bicarb 100 mEq IV solution running at 75 ml/hr o Albuterol 2.5 mg/0.5 mL Nebulizer 2.5 mg o Morphine Inj Syg 2mg PRN Q4H ...
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...to glomerulonephritis. The injured and defective glomeruli in the kidneys lead to the release of too much protein in the urine resulting in nephrosis. 2. Use JH’s laboratory values to determine if he is still experiencing nephrosis or if his condition is progressing to renal failure. JH’s lab values indicate that the PaCO2, HCO3-, and Hct, and Na levels are all below normal limits. His potassium level was increased at 5.4 mEq/L. There was also an increase in JH’s BUN (58 mg/dl), creatinine (3.9 mg/dl), and albumin (2.0 g/dl) levels. Traces of protein were found in his urine suggesting that JH’s condition is progressing to renal failure. 3. What additional physical or laboratory findings would be helpful in determining JH’s degree of renal impairment? Creatinine clearance is helpful in determining general kidney function. A level above 1.2 is reduced and indicates renal impairment. The kidneys' ability to handle creatinine is called the creatinine clearance rate, which helps to estimate the glomerular filtration rate (GFR). This rate will give a general overview of how the kidney is functioning. Physical assessment findings of joint pain, tenderness, redness and swelling are all indicative of renal impairment from hyperuremia. Skin nodules, generalized itching/pruritus may be present upon assessment of the integument. Patient may also complain of flank pain. Decrease in urine...
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...Abstract: Renal failure can take its toll on those affected patient and family. At the end of 2009, there were 572,569 U.S. resident under treat for End-stage Renal Disease (ESRD). Among the U.S resident with ESRD, there were 150.5 deaths per 1,000 patient totaling 88,620 deaths in all patients undergoing ESRD treatment. With so many experiencing the disease, understanding how it occurs and progresses might prove useful. Table of Contents Introduction…………………………………………..…………………………………..4 Mechanisms of Fluid Regulation………………………………………..7 Discussion……………………………………………………………………………….8 Etiology/Cause……………………………………….………….............8 Clinical Manifestations…………………………………………………11 Labs and Diagnostic Tests……………….……………………………..11 Treatment……………………………………………………………………………......13 Pharmacological…………………………………………………..……15 Nutritional………………………………………………..…………….15 Dialysis…………………………………………………………………16 Introduction The kidneys are bean shaped organs that are approximately 12cm long, 6cm wide and 2.5 cm thick. They are highly vascular, receiving 25% of cardiac output. The kidneys efficiently separate the excess of fluids, electrolytes, and metabolic by-products to produce urine. The kidneys’ location is described as retroperitoneal which means they are located outside and posterior to the abdominal cavity but lateral and anterior to the lumbar spine. Both kidneys are protected by the posterior rib cage; with the right kidney slightly lower then the left because of liver...
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...1.Describe process of referral and management of renal dialysis patients. Nephrology referral is especially indicated when there is a rapid decline in kidney function, and elevated albumin and creatinine in stage four of chronic kidney disease. Also, when the kidney function is severely reduced. 2. Discuss the nursing role in care and management of clients in renal dialysis center. The nursing role in nursing care and management of clients in renal dialysis center: assess vital signs including blood pressure, respirations, apical pulse, and lung sounds. Record weight before and after treatment, assess vascular access site for a palpable pulsation or vibration and an audible bruit. Also, alert all personal to avoid using the extremity with...
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...hypothalamic heat-regulating center to cause 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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...Nursing 344 Week 1: Report Writing & GFHP Report Writing Pt records are sometimes called in evidence before a court of law in order to establish events that may have contributed to a pt’s death or injury. They may also be required as evidence for an inquiry or hearing by 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...
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...Collaborative Approach to End Stage Renal Disease Patient Care Chronic kidney disease (CKD) affected 15.1% of the U.S. population in 1999-2000. During the fifth stage of kidney disease, kidney failure occurs. This is known as end-stage renal disease (ESRD). As of 2006, 25% of the Medicare budget was being used for the treatments for CKD and ESRD patients. As the baby boomers age, these numbers are expected to rise as well. An innovative and collaborative approach, such as a patient-centered medical home (PCMH), to ESRD treatment will provide higher quality patient care while reducing cost (Odum &Whaley-Connell, 2012). A case study using the PCMH approach will be conducted. Case Description Natalie is a 53-year-old African American woman. She...
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...Critical Pathway: Case Study of Chronic Renal Failure Advanced Pathophysiology NURS 5104 October 4, 2013 Critical Pathway: Case Study of Chronic Renal Failure I. Introduction Mr. P. J., a 38-year-old African American male, presented to the Emergency Department by the rescue squad team, with a six day old complaint of increased swelling of the bilateral lower extremities, unusual weight gain, and a feeling of ‘I can not breathe’ per patient. Patient was sent as a direct admit to the Intensive Care Unit (ICU) and placed on 2 liters NC with hydration and adult special care monitoring. Vital signs were taken by the paramedic enroute revealing the following: Ambulance Vitals: * BP 202/112 * Pulse 101 * Respirations 20 * O2 86% before O2 * Temp. 98.4 * Height 5’10 Patient stating * Weight 222 lbs. Patient stating (weighed the day before) The paramedic started a 20 gauge IV into Mr. J’s right antecubital and started him on 2 liters nasal cannula; due to the “presence of crackles no Procardia was administered” (J. Madden, personal communication, August 14, 2013). The paramedic monitored the vitals and reported to medical control the situation and estimated time of their arrival in five minutes. Mr. P. J. has been married to K for twenty years and they have one child, a twelve-year-old daughter. Mr. P. J. has worked in construction for twenty years; Mr. J stated working on his feet all day he noticed the swelling six days ago...
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...Nursing Assessment & Diagnosis | Planning & patient centered goals | Nursing Interventions | Scientific Rationale | Evaluation | 1) Diagnosis: Excess fluid volume r/t decreased urinary output Assessment: B.K is an 88 year-old female presented with acute renal failure with urinary retention. Patient was admitted into Lehigh Regional on July 5th, 2013.Previous history: Diabetes, HTN, UTI, skin cancer, TIA. Subjective: Patient states, “I feel a bit fatigued in the evenings. My doctor said it is a side effect of my dialysis sessions. I don’t like going to dialysis but I know that I have to”.Objective: Patient alert and oriented x4. Vitals signs: BP: 119/72, Temperature: 98.9, Pulse: 82 bpm, respiratory rate: 18, and displays no pain at this time. Breath sounds clear, gag and cough reflexes intact. Bowel sounds present in all four quadrants. Eyes: PERRLA. Skin integrity is not intact; stage 1 pressure ulcer located in right posterior upper thigh, below buttock. Minor bruising on both upper extremities, No signs of DVT. Patient PICC line placement in right upper arm. Patient is easily fatigued primarily after dialysis sessions. Chooses to ambulate by wheelchair due to occasional dizziness. 1 assist when walking.Diagnostic test: Recent CBC done on 07/11/13 showed an elevated WBC count with a result of 14.0.Progress notes: “ Patient readmitted to facility due to noncompliance with dialysis sessions. Experiencing fatigue and occasional anxiety between dialysis sessions. Recent...
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...doctor and the responsible for patients and the subordinates –doctors, nurses and workers-. This department one of the most famous oldest unit in Egypt, in which renal transplantation done successfully and legally. The unit has: * 8 renal dialysis machines, * 2 outpatient clinics, * 20 inpatient beds, * 3 professors, * 1 senior doctor, * 5 doctors, * 3 head nurses, * 5 nurses, * 4 assistances, * 2 workers. Situation analysis: Current service: - AlSalam nephrology department, responsible for many services, like: * Renal transplantation, * Follow up renal-transplanted patients, * Renal dialysis for chronic renal failure patients, * Outpatient clinic for kidney diseases; and * Teaching and practicing place for new doctors who care with nephrology. - The unit in AlSalam hospital, which present in ElMohandseen area in Giza, Egypt, which is a famous, commercial, crowded, rich area. - The hospital accredited with ISO 9001 in 2004. -Background information -Date of opening the unit: 1983 -Average No. of outpatient/Day: 60 patients - No. renal failure patients/Day: 20 patients -Costs /outpatient: 40 LE -Revenue /out patient: 120 LE -Net profit /outpatient: - 80 LE, which is good. -Costs / renal failure patients: 200 LE -Revenue / renal failure patients: 250 LE -Net profit / renal failure patients: 50 LE, which is very low. - My unit is the only private unit all over the country, which produce services 24 h/7 d. - My unit has two types...
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...HBSP Product Number TCG 5 rP os t THE CRIMSON PRESS CURRICULUM CENTER THE CRIMSON GROUP, INC. Lakeside Hospital A hospital just can’t afford to operate a department at 50 percent capacity. If we average 20 dialysis patients, it costs us $425 per treatment, and we’re only paid $250. If a department can’t cover its costs, including a fair share of overhead, it isn’t self-sufficient and I don’t think we should carry it. op yo Peter Lawrence, M.D., Director of Specialty Services at Lakeside Hospital, was addressing James Newell, M.D., Chief Nephrologist of Lakeside’s Renal Division, concerning a change in Medicare’s payment policies for hemodialysis treatments. Recently, Medicare had begun paying independent dialysis clinics for standard dialysis treatments, and the change in policy had caused patient volume in Lakeside’s dialysis unit to decrease to about 50 percent of capacity, producing a corresponding increase in per-treatment costs. By February of the current fiscal year, Dr. Lawrence and Lakeside’s Medical Director were considering closing the hospital’s dialysis unit. Dr. Newell, who had been Chief Nephrologist since he’d helped establish the unit, was opposed to closing it. Although he was impressed by the quality of care that independent centers offered, he was convinced that Lakeside’s unit was necessary for providing back-up and emergency services for the outpatient centers, as well as for treatment for some of the hospital’s seriously ill inpatients. Furthermore...
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...Disease Prevention Paper HCS/436 April 29, 2014 Maria Libano Disease Prevention and description about the kidneys There is a common saying that “the body is a one way street”, therefore any alteration can hinder the flow and may cause damage to vital body systems and organs. The kidneys which are bean-shaped structure primary function are elimination of waste and toxins out of the body and blood filtration. Each kidney contains almost one million nephrons, which is a major aspect of the functional unit of the kidney which filters blood and urine production through the network of capillaries tubules in the glomerulus. The tubules ensure that the glomerulus filters the substances that are essential including protein and that waste exit to the bladder to the urethra. The kidneys participate in different life-sustaining duties of the body including removal of waste and any excess fluid in the body, maintenance of salt and minerals in the blood, blood pressure regulation, producing of erythropoietin through renin by stimulating red blood cells, and can also aid in the production of vitamin D. When the glomerulus is not able to meet the daily demand from the kidneys by the human body as a result of damaged, it can hinder the function causing protein and blood loss in the urine, accumulation of waste product because it can no longer filter, which will then lead to edema in the extremities, fatigue, and elevated blood pressure as a result of inflammation is named...
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