ms case analyis

8/9/2019 MS case analyis

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Allison Mei R. Bialba 3nur 1 RLE 4October 28, 2014

Genitourinary Tract ase !iscussion

1. "#at are t#e renal $roble%s in t#is case&

Based on the laboratory studies, there is acute renal failure with elevated serum

potassium, elevated serum BUN and serum creatinine, elevated WBC as evident

sign of infection. There is also low Hgb level that signies anemia. There is also

proteinuria, hypoalbuminemia and hyperlipidemia. There is also urinary tract

infection and albuminuria.

2. o%$ute 'or t#e esti%ate( creatinine clearance usin) t#e seru%creatinine o' 8.* %)+(L.

!"#$%& ' &% ( ! )male* + 11.13%)+(L

-

3. "#at are t#e $resent sta)es o' c#ronic i(ney (isease o' t#e$atient&

The patient has tage % or end stage chronic renal failure which is very severely

reduced /idney function )end stage or 0123014*, less than !%5 )621 less than !%

ml3min*. The patient has changes or loss of appetite, nausea and vomiting,

headache, easy fatigability, ma/ing little or no urine, swelling3edema, and tinglingsensation which are common manifestations at this stage. 7dditional symptoms

include increased s/in pigmentation, changes in s/in color, and muscle cramps. The

/idneys fail to function and are not able to remove waste and 8uids from the body

leading to to'ins building up in the blood, causing an overall ill feeling. 9idneys also

have other functions they are no longer able to perform such as regulating blood

pressure, producing the hormone that helps ma/e red blood cells and activating

vitamin 4 for healthy bones.

4. "#at are t#e un(erlyin) causes o' Renal -ailure&

There are many causes of renal failure but the leading causes are diabetes)about two thirds of cases* and hypertension )about one third of cases*. :therunderlying causes include impaired blood 8ow to the /idneys li/e in heart disease,infection, liver failure and anaphyla'is; damage to the /idneys li/e inglomerulonephritis, hemolytic uremic syndrome, lupus, multiple myeloma,scleroderma, blood clots in the veins and arteries around the vein and arteries of the /idneys < vasculitis; and urine bloc/age in the /idneys including bladder cancer,


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cervical cancer, colon cancer, enlarged prostate, /idney stones and nerve damageinvolving the nerves that control the bladder.

. E/$lain t#e laboratory+ancillary results o' t#e $atient.

The /idneys may fail to function for many di=erent reasons. 0ither directly

reduced blood 8ow into the /idney or in8ammation and necrosis of the tubulescause obstruction and bac/ pressure. 4ue to the functions that the /idneys fail tofulll, it might not produce enough erythropoietin )0>:* which is a glycoproteinhormone responsible for the regulation of red blood cell production. When 0>:decreases, there would be less production of red blood cells and less proteinhemoglobin that would facilitate the delivery of o'ygen to the body?s organs.4ecreased red blood cell count results in anemia. This is also manifested by lowhemoglobin and hematocrit count which is manifested by malaise, di@@iness andshortness of breath. 0levated creatinine and blood urea nitrogen )BUN* levels thatare revealed in the blood chemistry are li/ely evidence of decreased /idneyfunction. Creatinine and urea nitrogen are waste products that the /idneys normallyremove from the blood. Af the /idneys are not wor/ing properly, these substances

may build up in the blood. 7nother laboratory test is the Hb7!C or glycosylatedhemoglobin which shows the average blood sugar over the past -$ months. 2orpeople without diabetes, the normal range for the hemoglobin 7!c test is between"5 and %.5. Hemoglobin 7!c levels between %.5 and ."5 indicate increasedris/ of diabetes, and levels of .%5 or higher indicate diabetes and in this case, thepatient has D5 which indicates diabetes. 2asting Blood ugar test )2B* measuresblood glucose after fasting to chec/ for diabetes due to the lac/ of insulin thatcauses the rates to rise.

7s for the electrolytes, hyper/alemia, hyponatremia, hyperphosphatemia, andhypocalcemia were noted. The /idneys help to control the levels of potassium in thebody and hyper/alemia may be caused by the impaired functioning of the /idneys

due to renal failure. Hyponatremia also occurred due to impaired sodium e'cretionwhich is the factor leading to the patient?s edema and recurrent hypertension.1egulation of phosphorus e'cretion by the /idney is the /ey mechanism of maintaining phosphate balance in normal day to day life. 9idney inEuryimpairs the ability of the body to maintain phosphorus balance, and inchronic /idney disease, phosphorus homeostasis is lost and positivephosphate balance occurs in the later stages )" and %* of /idney diseases.Foss of phosphorus homeostasis due to e'cretion failure in chronic /idneydisease results in hyperphosphatemia. The body also produces low levels of calcium that causes the parathyroid hormone to move calcium out of thebones, causing hypocalcemia. 7nd if this continues, the bone would becomebrittle and will brea/ easily.

The results also show high levels of F4F. This indicates a possiblecardiovascular problem including hypertension that is already manifested bythe patient. Fow albumin is caused by increased oncotic pressure resulting inedema and is a=ected by high F4F levels. This leads to hyperlipidemia andhypoalbuminemia.


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7lbuminuria was also noted in the urinalysis. 7lbuminuria means that the/idney has some damage and is starting to spill some albumin into theurine. ome causes of this includes hypertension, heart failure or /idneydamage.

. Enu%erate ursin) (ia)nosis an( ursin) nterention.

7lteration in 8uid volume4ecreased glomerular ltration rate and3or obstruction to urinary output

results in oliguria, 8uid overload and electrolyte imbalance.

ANT01G0NTA:N!* 7ssess 8uid status of the patient and maintain inta/e$output records meticulously-* Weigh the patient daily at the same time, scale and clothing* :bserve for s/in turgor and mucous membranes"* Note orthostatic changes in blood pressure, pulse, and respiratory rate

%* onitor vital signs* onitor urine specic gravity* onitor serum electrolytes

7lteration in nutrition

ANT01G0NTA:N!* aintain accurate record of dietary inta/e-* 7ssess response to prescribed diet therapyI appetite, daily weight, muscle massand strength, wound healing* 2reJuent mouth care to prevent stomatitis and promote salivation

>otential for inEury secondary to infection

ANT01G0NTA:N!* onitor vital signs especially temperature-* Chec/ for lab results especially leu/ocyte count and di=erential* Anspect s/in for brea/s in integrityI redress wounds using aseptic techniJues, useaseptic techniJue during insertion and daily dressing changes of AG cannulas"* >rovide oral hygiene%* >rovide assistance when needed

1is/ for decreased cardiac output1is/ factors may include 8uid overload )/idney dysfunction3failure,

over@ealous 8uid replacement*, 8uid shifts, 8uid decit )e'cessive losses*,

electrolyte imbalance )potassium, calcium*; severe acidosis, and uremic e=ects on

cardiac muscle3o'ygenation


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ANT01G0NTA:N

!* onitor for the blood pressure and heart rate

-* 7ssess s/in integrity and mucous membranes

* onitor 0C6 changes

"* aintain bed rest or encourage adeJuate

rest and provide assistance when needed %* onitor laboratorystudies on electrolytes )9, Na, Ca, >, g*

*. "#ats t#e co%$lete (ia)nosis&

Uremia, congestion secondary to Chronic 9idney 4isease type G secondary to

4iabetes ellitus Nephropathy, 4iabetes ellitus type - poorly controlled, s3p ray

amputation %th digit left foot

ms case analyis

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