HCR 240 Case Study 30 - Acute Renal Failure

HCR 240 Case Study 30 - Acute Renal Failure Case Study 30 - Acute Renal Failure 1. Based on the information provided above, which two types of acute renal failure are most likely? Based on the information provided above, the two types of acute renal failure that are most likely include prerenal acute renal failure and intrarenal acute renal failure. 2. List four major risk factors that are likely to be contributing to the patient’s kidney failure. Four major risk factors that are likely to be contributing to the patient’s kidney failure include history of heart failure, vomiting, diarrhea, and hypertension. 3. What is the significance of (a) poor skin turgor and (b) an absence of itching? The significance of poor skin turgor is that it’s consistent with dehydration and an absence of itching indicates that toxins have not yet build up in the patient’s blood and that his renal failure has not reached a server level. 4. What is the importance of the absence of JVD and HJR? The importance of the absence of JVD and HJR is that there is no indication that this patient’s renal failure has progressed to a significant degree. 5. What is the significance of the “faint S3” cardiac sound? The significance of the “faint S3” cardiac sound is that it has some ventricular dysfunction which may be a sign of heart failure that can lead to prerenal acute failure. 6. What is the significance of the absence of pulmonary crackles? The significance of the absence of pulmonary crackles is that there is no fluid in the lungs (edema) so no indication of left heart failure. 7. What is the significance of the neurological findings in this patient? The significance of the neurological findings in this patient is that everything seemed to be intact and normal, indicating that his renal failure has not progressed to an extreme level. 8. Do serum potassium, phosphate, calcium, and magnesium concentrations suggest that intrarenal acute failure has developed? The serum potassium, phosphate, calcium, and magnesium concentrations do not suggest that intrarenal acute failure has developed. Kidneys help regulate levels of blood ions. If these concentration appear normal, which they do, it indicates that intrarenal acute failure has not happened. 9. Why may the serum glucose levels be abnormal? The serum glucose levels may be abnormal due to them being taken at a random time and not after a period of fasting. 10. Would you suspect echocardiogram abnormalities in this patient? Why or why not? No, I would not suspect echocardiogram abnormalities in this patient since he is not experiencing hypercalcemia or other heart related problems. 11. If acute renal failure progresses to chronic renal failure, hemoglobin and hematocrit may decrease significantly and a peripheral blood smear may indicate a normocytic, normochromic anemia. Suggest two pathophysiological mechanisms that explain the abnormal hemoglobin level, hematocrit, and peripheral blood smear. Two pathophysiological mechanisms that explain the abnormal hemoglobin level, hematocrit, and peripheral blood smear are if kidneys can no longer produce enough erythropoietin then this will lead to abnormalities. If toxins build up in the blood then red blood cells are destroyed and this can also explain the hemoglobin, hematocrit, and blood smear abnormalities. 12. What laboratory data suggest that the infection is probably viral not bacterial? The laboratory data that suggest that the infection is probably viral and not bacterial is the increased lymphocytes. The laboratory tests show that this patient has a high lymphocyte count of 66%. 13. Why is it appropriate that a serum creatinine phosphokinase assay was not ordered? It is appropriate that a serum creatinine phosphokinase assay was not ordered because this is used to look at muscles and heart tissue and the patient does not present with any problems there so it is not needed. 14. Which urinalysis information suggests that acute renal failure in this patient is not the result of glomerular disease? The urinalysis information that suggests that acute renal failure in this patient is not the result of glomerular disease includes the absence of cells, casts, crystals, bacteria, and proteins in the urine. 15. Do the urinary microscopic analysis, specific gravity, sodium concentration, and osmolality suggest prerenal acute renal failure or intrarenal acute renal failure associated with acute tubular necrosis? The urinary microscopic analysis, specific gravity, sodium concentration, and osmolality suggest prerenal acute renal failure (lack of blood supply). 16. Calculate the plasma BUN/creatinine ratio and suggest whether the calculated value is consistent with prerenal acute renal failure or acute tubular necrosis. The plasma BUN/creatinine ratio is 21.9. This value is consistent with prerenal acute renal failure. 17. If the patient's fractional excretion of sodium is 0.87%, calculate the patient’s urine creatinine concentration. The patient’s urine creatinine concentration is 29.1. 18. Why do you expect that an ultrasound study of the patient’s urinary tract was not conducted? I expect that an ultrasound study of the patient’s urinary tract was not conducted because the patient had no signs of blockage, kidney stones, or postrenal acute renal failure. 19. Which therapeutic measures should be considered “first and foremost” and may be very beneficial in reversing the signs of acute renal failure? The therapeutic measure that should be considered “first and foremost” and may be very beneficial in reversing the signs of acute renal failure is rapid I.V fluid therapy. This will help resolve the dehydration the patient has been experiencing along with other problems. Treating the patient's viral infection is another thing that should be looked at immediately. 20. Would dialysis be appropriate treatment for this patient at this time? No, dialysis would not be appropriate treatment for this patient at this time. 21. Should sodium polystyrene sulfonate therapy be initiated in this patient? No, sodium polystyrene sulfonate therapy should not be initiated since the patient is not experiencing high levels of potassium in the blood.