The patient was a male of 89 years old. He had a urostomy twenty years ago. The patient presented with a urinary tract infection. He also had leukocytosis and hyperkalemia. His glucose level was at 198, Sodium; 139, Magnesium: 2.2, Phosphorous: 3.2, Chloride: 117 and Potassium was 5.4. The patients’ Blood Urea Nitrogen (BUN) was at 33, Creatinie was1.23 and CO2 was 21. His total protein was at 6.9. To test for liver function, AST, Bilirubin and ALT were tested.
The patients’ bilirubin was at 0.9.His Aspartate aminotransferase level was at 79 while his Alanine aminotransferase was at 46.His triglycerides were at 128, the low-density lipoprotein was 84 mg/dL and the high density lipoprotein was 28 mg/dL. To rule out the possibility of thyroid problems the T4 was measured and was at 128. His white blood count was 26.4 and the neutrophil level was at 83.
Nursing Diagnosis
Possible Acute kidney failure caused by urinary tract infection manifested by high BUN, Creatinine, sodium, chloride and magnesium levels. Possible acute kidney failure due to liver damage indicated by elevated levels of glucose levels, Aspartate aminotransferase and Alanine aminotransferase.
The Term Paper on Patient Satisfaction
The good health of nations is a key to human development and economic growth and it is important to analyze health systems’ performance and to share what we knew with governments and the international community. Within all systems there are many highly skilled, dedicated people working at all levels to improve the health of their communities. To move towards higher quality care, more and better ...
Collaborative Planning
Clearance of the urinary tract infection Reversal of acute kidney failure as evidenced by clearance of the urinary tract infection, lowered levels of Urea Nitrogen (BUN) and Creatinine and reduced levels of sodium, chloride and magnesium levels. Normal liver functioning as evidenced by reduced levels of glucose, Aspartate aminotransferase and Alanine aminotransferase.
Collaborative Nursing Interventions Perform Hemofiltration until the kidneys return to normal function. Put the patient on antibiotics to clear the urinary tract infection. Teach the patient the necessary diet changes to ensure electrolyte balance.
Manage the high glucose levels
Significance of Laboratory Results The patients’ glucose level is at 198 mg/dL. The normal range of glucose after fasting is 70 – 110 mg/dL. This is indicative of possible diabetes mellitus which may occur due to liver failure (Levy et al., 1996).
Magnesium levels were also high at 2.2 mEq/L. This differed from the normal range for magnesium which is 1.5 – 2.0 mEq/L. The patient also had high chloride levels of 117mEq/L which differed form the normal range of 98 – 106 mEq/L. The patients’ potassium levels were also high at 5.4 mEq/L .Normal Potassium levels should be at 3.5 – 5.0 mEq/L. This was a predisposing factor to irregular heart beats. These high levels of electrolytes were indicative of a kidney problem because the kidney is responsible for electrolyte balance (Star, 1998).
The BUN and the Creatinine levels are usually indicative of the glomerular filtration rate. The Urea Nitrogen (BUN) levels in a patient with normal kidney functioning should be at 7 – 18 mg/dL. The patients’ levels of urea and nitrogen were very high at 33 mg/dL. BUN tests have been shown to be variable based on exogenous protein intake and with the catabolism of endogenous protein, even in healthy patients (Mendel & Chertow, 1997).
As a result the Creatinine test is recommended for suspected renal failure. The Creatinie levels were taken. The patient had Creatinine levels of 1.23 mg/dL.
The Essay on Objective structured clinical examination Assessment of Critically Ill Patient
This essay will critically analyse my performance throughout the Objective structured clinical examination (OSCE) assessment I completed, including the escalation strategy utilised by the Nation early warning scores (NEWS) (RCP, 2012) as a track and trigger tool (NICE, 2007). Based on the findings from the assessment interventions will be recommended and supported by evidence and formatted on the ...
This was significantly higher than the healthy ranges of 0.5 to 1.0 mg/dL. Carbon Dioxide Pressure in a healthy patient ranges between 35 – 45 mm Hg. The patient had CO2 at 21 mm Hg. This low carbon dioxide pressure was indicative of over ventilation. This can be due to overworked lungs in order to compensate for a metabolic disorder (Mendel & Chertow, 1997).
To test for liver problems the patients Aspartate aminotransferase levels were measured. He had an Aspartate aminotransferase level of 79 units/L. This was more elevated than the normal ranges of 5 to 40 units per liter of serum. His Alanine aminotransferase level was at 46 units/L. The normal ranges for Alanine aminotransferase is 1 – 21 units/L. High levels of Aspartate aminotransferase and Alanine aminotransferase are indicative of diabetes mellitus as a result of liver damage.
The high density lipoprotein should be at 60 mg/dL and above (Abuelo, 1999).
The patient had a high density lipoprotein of 28 mg/dL. These levels indicated that the patient was at high risk for heart disease. The thyroxine level which should range at 4.6-12 ug/dl was at 12.8ug/dl.This ruled out hypothyroidism as the cause of the elevated ALT and AST.
The patients’ white blood count was 26.4. The increased white blood cells indicated a response to the urinary tract infection. White blood cell count in healthy patients should be at 4.4-10.8 x 109/L. The patient had a white blood cell count of 26.4 x 109/L. This indicated acute infection and as a result neoplastic growth of white blood cells. The neutrophil level was at 83. Normal neutrophil range is between 2.0 – 8.0 x 10.09/L. Above 75% the neutrophil level is considered elevated. The elevated neutrophil count was suggestive of an infection (Knoll et al., 2001)
Recommended Diet
Once the electrolyte level is restored, the patient must take a diet with restricted fluids to prevent fluid build up which may cause overworked kidneys and prevent healing. Low salt intake will prevent fluid retention. To prevent irregular heartbeat and muscle weakness, the patient should avoid too much potassium in the diet. In addition the patient should regulate the levels of phosphorous to prevent decalcification of the bones (Thadhani et al., 1999).
The Essay on Care of a Patient in Acute Pain from a Total Knee Replacement Jahaira Melendez
Nursing care after a total knee replacement is very essential in promoting a speedy and safe recovery for a patient. In an attempt to replicate the knee’s natural ability to roll and glide as it bends by cutting away damaged bone and cartilage and replacing it with an artificial joint, acute pain following the procedure can be unbearable. In assisting the patient in controlling the pain would only ...
To bring the high glucose levels own, the patient should maintain a low sugar diet.
Treatment
The patient should be started on antibiotics to clear the urinary tract infection. These should not trigger renal failure (Knoll et al., 2001).
Lost fluids should be replaced to check and routine urinalysis conducted to check whether kidney function will be restored to normal (Andreucci & Federico, 2001).
This will restore electrolyte balance Hemofiltration should be used to control the acute kidney failure (Shusterman et al., 1997).
References
Abuelo JG (1999).
Diagnosing vascular causes of acute renal failure. Ann Intern Med, 123:600–614.
Andreucci, M., Federico, S., and Andreucci, V.E. (2001).”Edema and Acute Renal Failure.” Seminars in Nephrology, 21: 251-6.
Knoll, T., Schult, S., Birck, R., Braun, C., Michel, M.S., Bross, S., Juenemann, K.P., Kirchengast, M., and Rohmeiss, P. (2001).
“Therapeutic Administration of an Endothelin-A Receptor Antagonist After Acute Ischemic Renal Failure Dose-Dependently Improves Recovery of Renal Function.” Journal of Cardiovascular Pharmacology, 37: 483-8.
Levy EM, Viscoli CM, Horwitz RI. (1996).
The effect of acute renal failure on mortality. JAMA, 275:1489–1494.
Mendel JA, Chertow GM (1997).
A practical approach to acute renal failure.Med Clin North Am, 81:730–748.
Shusterman N, Strom BL & Murray TG (1997).
Risk factors and outcome of hospital-acquired acute renal failure. Am J Med, 83:63–71.
Star A. Robert. (1998).
Treatment of acute renal failure. Kidney Int, 54(6):1816-31.
Thadhani R, Pascual M, Bonventre J. (1999): Acute renal failure. New Engl J Med, 334:1442–1460.