Case Study, Chapter 54, Management of Patients With Kidney Disorders
Correction
James Bean, a patient 67 years of age, is three days postoperative after a coronary artery bypass graft operation. The patient has a history of hypertension, type 1 diabetes, coronary artery disease, and end-stage renal disease, which is treated with hemodialysis three times per week. The patient has a left atriovenous (AV) shunt. The patient is taking the following medications:
Sevelamer (Renagel): 2 capsules with each meal
Vitamin D, B12, and iron supplements with meals
Calcium carbonate (OS-Cal): 3 tablets with each meal
Procrit (epoetin alfa): 100 U/kg/dose subcutaneously every Monday, Wednesday, and Friday (dialysis days)70/30 NPH and regular insulin 30 U twice daily. (Fingerstick blood sugars are taken before meals and at bedtime and regular insulin given per sliding scale.)
Coreg (carvedilol): 12.5 mg twice daily
Lanoxin: 0.125 mg (every other day, on even days)
Acetaminophen with Codeine No. 3: 1 to 2 tablets every 6 hours
Diphenhydramine hydrochloride (Benadryl): 25 mg every 8 hours PRN for itching
Docusate sodium (Colace): 100 mg b.i.d.
(Learning Objective 6)
The patient is ordered to have daily dialysis. What is the rationale for this order?
The patient’s metabolic rate is always high when he has undergone surgery, as there is a need for quick healing. As a result, there is an increasing amount of metabolic wastes in the kidney. In this regard, the patient may have uremia symptoms, which require the dialysis process after three days to remove an increasing amount of wastes.
The patient is going to hemodialysis at 9 am on an odd day. Which medication or medications should the nurse hold before sending the patient?
Carvedilol (Coreg)
What should nursing management considerations be made for this patient?
The nurses must place a sign on the left bedside, which shows that “No BP or venipuncture in the left arm.”
The nurses should also be assessing the AV fistula after eight hours for patency and monitor any signs of infections, which should be reported to doctors.
The nurses should also be assessing vital signs. They have to report for hypotension promptly. Nurses need to increase the b.p as ordered so that the AV fistula doesn’t clot off.
In administering IV fluid, an infusion pump should be used. However, they have to ensure that the fluid has no potassium. The nurses should avoid using Lactated Ringer, which has potassium. Also, the assessment of medication is critical in ensuring that they do not have magnesium. Lastly, the nurses have to carry an assessment of crackles in the lungs, which may be signaling fluid overload.
Complications to monitor for include fluid overload, electrolyte imbalance, and respiratory complications
The nurses have to assess for Pericarditis-Low grade fever, pulses paradoxus, and pericardial friction. The assessment of the conditions is only possible through the use of a manual blood pressure cuff. As a result, they have to determine the signs of the progress of the perfusion. The heart sound will be muffled and appear at a distance. If there is the development of cardiac tamponade, the sound of the hart will not be audible. Also, the patient will exhibit breath shortness and hypotension.
Dudley Wayne Case
Dudley Wayne is a 62-year-old factory worker. Mr. Wayne makes an appointment with his primary care practitioner because he has lost 15 pounds in the last two months, and has recently noticed blood in his urine. He denies pain on urination. During the admission assessment, Mr. Wayne states that he is a two-pack-per-day smoker and just thought he was losing weight because of increased work stress. He also states that he worked 30 years in a building that was recently closed due to asbestosis contamination. Upon physical examination, Mr. Wayne complains of pain when the provider percusses and palpates his flank area. A CT scan is ordered along with an ultrasonogram; both reveal a mass in the renal pelvis. (Learning Objective 3)
What risk factors for renal cancer does Mr. Wayne demonstrate?
Exposure to contaminated environmental for more than 30 years; he was exposed to asbestos. Also, he smokes packets of cigarettes per day.
The diagnosis of renal cancer is made. What are the classic symptoms of this disease process?
The classic symptoms of renal cancer include anemic, hypercalcemia, dysfunction of the liver, imbalance in levels of hormones, HTN, and increased rate of sedimentation.
Upon further evaluation, metastatic renal carcinoma is diagnosed, and Mr. Wayne is scheduled for renal artery embolization. What is the rationale for this procedure?
Renal artery embolization is an invasive process that is critical during palliative care for metastatic cancer. As a result, the patient will be relieved from hematuria. Also, the patient level of pain is reduced when the tumor is removed.
Mr. Wayne develops postinfarction syndrome. What clinical manifestations does the nurse correlate to this syndrome? How are these symptoms managed?
The management of the symptoms will involve non-steroidal anti-inflammatory drugs (NSAIDs), which should be used with caution because it may delay the healing of myocardial.
References
Gansevoort, R. T., Arici, M., Benzing, T., Birn, H., Capasso, G., Covic, A., … & Knebelmann, B. (2016). Recommendations for the use of tolvaptan in autosomal dominant polycystic kidney disease: a position statement on behalf of the ERA-EDTA Working Groups on Inherited Kidney Disorders and European Renal Best Practice. Nephrology Dialysis Transplantation, 31(3), 337-348.
Medical-Surgical Nursing: Brunner & Suddarth’s 13th Edition