K.B. Case Study 2023

K.B. Case Study 2023 K.B. is a 32-year-old woman being admitted to the medical floor for complaints of fatigue and dehydration. While taking her history, you discover that she has diabetes mellitus (DM) and has been insulin dependent since the age of 8. She has undergone hemodialysis (HD) for the past 2 years because of end-stage renal disease (ESRD). Your initial assessment of K.B. reveals a pale, thin, slightly drowsy woman. Her skin is warm and dry to the touch with poor skin turgor, and her mucous membranes are dry. Her vital signs are 140/88, 116, 18 99.9 F (37.7 C). She tells you she has been nauseated for 2 days so she has not been eating or drinking. She reports severe diarrhea. The following blood chemistry results are back. Sodium 145 mEq/L Potassium 6.0 mEq/L Chloride 93 mEq/L Bicarbonate 27 mEq/L BUN 48 mg/dL Creatinine 5.0 mg/dL Glucose 238 mg/dL What aspects of your assessment support her admitting diagnosis of dehydration - ANS The patient's history supports an admitting diagnosis of dehydration because she told you she has not been drinking for 2 days and reports severe diarrhea. Her skin is warm and dry with poor skin turgor and dry mucous membranes, all of which can be physical assessment findings of a patient with dehydration. Fluid is restricted when the person is on dialysis. Although most of her laboratory findings are elevated, lab values are not a good indicator of dehydration in patients on HD.;What is an AV Fistula? Why does K.B. have one? - ANS Fistula is a term used to describe the connection of two separate body parts. She has an AV fistula. This fistula is surgically created by connecting an artery with a vein and allows access for HD.;What steps do you take to assess K.B.'s AV fistula, and what physical findings are expected? Explain. - ANS You would use observation, palpation and auscultation. Observe for any signs of bleeding or infection. AQ functioning AV fistula has a "thrill" evident by palpation and a bruit present with auscultation.