NR 507 Week 4: Alterations in Renal Function - Discussion Part Two

Week 4: Alterations in Renal Function - Discussion Part Two Loading... Discussion This week's graded topics relate to the following Course Outcomes (COs). 1 Analyze pathophysiologic mechanisms associated with selected disease states. (PO 1) 2 Differentiate the epidemiology, etiology, developmental considerations, pathogenesis, and clinical and laboratory manifestations of specific disease processes. (PO 1) 3 Examine the way in which homeostatic, adaptive, and compensatory physiological mechanisms can be supported and/or altered through specific therapeutic interventions. (PO 1, 7) 4 Distinguish risk factors associated with selected disease states. (PO 1) 5 Describe outcomes of disruptive or alterations in specific physiologic processes. (PO 1) 6 Distinguish risk factors associated with selected disease states. (PO 1) 7 Explore age-specific and developmental alterations in physiologic and disease states. (PO 1, 4) Discussion Part Two (graded) Responses Lorna Durfee 5/23/2016 1:47:48 PM Discussion Part Two Dr. Brown and Class: What is your differential diagnosis? Urinary Calculi. Nephrolithiasis A 56-year-old female comes into the clinic complaining of intermittent severe pain that radiates from the flank to the groin and sometimes to the inner thigh. Upon further questioning, she tells you that she has an urge always to go to the restroom and that she sometimes sweats and feels nauseous. A urinalysis provides traces of blood, a few white blood cells, and no bacteria. Tests: Urinalysis shows few white blood cells, trace blood = hematuria or microhematuria and no bacteria. Patients with nephrolithiasis can have macroscopic or microscopic hematuria, but the urine may be normal. There can be pyuria without bacteria. If there is pyuria and foul-smelling urine and fever, there can be an infection. If there is suspicion of crystalline substances in the sediment, further testing will be necessary (Preminger, 2014). X-ray: Slightly dilated ureter. Discuss in detail the pathophysiology of each item in your differential and how it might fit in describing this case. Pathophysiology of following items: Flank to groin pain into the thigh, severe and intermittent, urgency, sweats, nausea. Preminger (2014) relates that calculi can remain in the renal parenchyma or renal pelvis or passed to the ureter or bladder. An abrasion from a stone passing and trauma in the ureter and bladder walls can cause pain. Calculi, when lodged in the ureter, can cause obstruction and decreased urine flow. They can cause hydroureter or dilation of the ureter, and hydronephrosis, or a swelling in the kidney due to the build-up of urine (Preminger, 2014). Common areas of that stones get lodged are in the ureteropelvic junction and the distal ureter. Calculi that have a diameter of greater than 5 mm can be lodged in the ureteropelvic junction. Any calculi that are smaller are likely to pass through the system. When there is an obstruction, there is a decrease in the filtration of the glomeruli. With swelling in the kidney there is an increased glomerular pressure and decline in blood flow and then renal function (Preminger, 2014). Preminger (2014) tells us that stone remaining in the renal pelvis are not symptomatic until they cause obstruction and/or infection. The signs and symptoms that accompany this condition are severe pain that is accompanied by nausea. There can also be vomiting that usually occurs when calculi pass into the ureter or cause obstruction. The feeling of pain is due to renal colic that is excruciating and is intermittent. The pain continues in a cycle. When there is pain in the flank or