You call the hospitalist regarding the labs above and the following orders are placed: Decrease the IV fluids, D/C insulin drip, Start insulin sliding scale with glucometer readings every 2 hours

________Case Study Part 3: Renal Failure_

Clinical Course Day 2: You call the hospitalist regarding the labs above and the following orders are placed: Decrease the IV fluids, D/C insulin drip, Start insulin sliding scale with glucometer readings every 2 hours, increases oxygen to 4 Liters O2 per NC with titration to maintain SpO2 >92%, Lasix 40mg IV x 1 now. You inform him that the newest vital signs are: T:100.9; HR: 114; R: 32; B/P: 122/64. Urine output 45cc/hr.

Basic Metabolic Profile, CBC, UA, ABG and BNP ordered:

Labs and Diagnostics:

Na 134 meq/L K 3.5 meq/L Cl 109 meq/L HCO3 17 meq/L BUN 66 mg/dL Cr 3.0 mg/dL

eGFR 36 cc/min WBC 16.8 x 10³/mm3 Hb 11.6 g/dl / Hct 37% Glucose 180 mg/dL

URINALYSIS

Clear, dark yellow urine; Microscopy was negative for cells, casts, pigments, and crystals

SG 1.032 (-) bacteria (+) glucose (-) protein (-) Nitrate (-) RBC (-) WBC

Urine sodium 8 mEq/L. FeNa <1%

BNP 975 pg/ml Troponin I High Sens. 15 pg/ml

ABG: pH= 7.30; PaCo2=12; PaO2= 88; HCO3: 18 BE: 1 ___________________________________________________________________________________

Answer the following questions based on the information above:

10) The patient is noted to have acute kidney injury (AKI) and nephrology is consulted. Based on the patient’s diagnosis of CHF, physical findings and labs, is the patient exhibiting pre-renal, intra-renal or post renal failure? (1point). Explain your decision (3 points)

11) Oliguria occurs in AKI whether the cause is pre-renal or intrarenal. What are three mechanisms which account for the decrease in urine output? ( 3 points)

12) Describe the key differences in the pathophysiology between pre-renal and intrarenal failure.(4 points) As the nurse, what would you look for on your assessment of the patient who is in pre-renal failure? (2 points)

13) Comorbidities such as hypertension and diabetes can affect kidney function over and above this patient’s diagnosis of CHF. List five teaching points and expected outcomes on her diagnoses at discharge to prevent a reoccurrence and readmission ? (5 points)

APA 1 point Scholarly Work 1 point Total points 20

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