Discuss what is happening on a cellular level with the disease process. Be careful to realize that patients have co-morbidities and you may need to discuss the other diseases impact on the pathophysiology and care of the patient. Three (3) resources after 2008 are required along with APA format.
Renal Failure
Patient Profile:
J.M. is a 37-year-old woman transferred to a large medical center from a small rural hospital for further evaluation of lower abdominal pain, nausea, vomiting, and progressive deterioration of urinary output.
Subjective Data:
-Long history of ETOH Abuse with a drinking binge two days ago
-Arthritis with heavy use of ibuprofen
-HTN for three years, treated with hydrochlorothiazide and a calcium channel blocker
-Borderline NIDDM for three years, does not want to take medications and has been trying
to lose weight and “watch her sugar intake.”
Objective Data:
B/P: 160/110 K: 6.3 mEq/L Urinary output: <15ml/hr Na: 149 mEq/L Lethargic Hgb A1C: 9.2%
Creatinine: 9.6 mg/dL BUN: 121 mg/dL
CRITICAL THINKING QUESTIONS…
- Address how the various factors in her past medical history could have contributed to her present renal problem.
- Is her acute renal failure likely to be prerenal, intrarenal, postrenal, or a combination? Why?
- Discuss each of the laboratory values and how they reflect the pathophysiology that occurs in renal failure. What is the significance of her Hgb A1C level?
- What are the specific priorities of treatment for J.M.?
- Explain the types of dialysis available, their indications, and their advantages/ disadvantages. What type of dialysis will most likely be used for J.M?
- After two weeks of intensive support and dialysis, J.M’s urinary output returns. Explain the diuretic phase of recovery in Acute Renal Failure, and what complications can occur.
- Do you think she needs intervention for her diabetes? What guidelines did you consult? How would you start in treating a patient with newly diagnosed Type 2 diabetes? Which medication(s) might you want to start first? What patient education issues would you emphasize in the initial period?
Full Answer Section
- Inflammation: Inflammation can damage the kidneys. This can be caused by infections, autoimmune diseases, or other medical conditions.
CKD
CKD can be caused by a number of factors, including:
- Diabetes: Diabetes is a leading cause of CKD. High blood sugar levels can damage the kidneys over time.
- High blood pressure: High blood pressure can damage the kidneys over time.
- Glomerulonephritis: Glomerulonephritis is an inflammation of the glomeruli, which are the filtering units of the kidneys.
- Polycystic kidney disease: Polycystic kidney disease is a genetic disorder that causes cysts to form in the kidneys. These cysts can damage the kidneys over time.
Cellular Mechanisms of Renal Failure
At the cellular level, renal failure is characterized by damage to the nephrons. Nephrons are the functional units of the kidneys. They are responsible for filtering blood and producing urine.
When nephrons are damaged, they are unable to filter blood effectively. This leads to a build-up of waste products in the blood. These waste products can be toxic to the body and can lead to a variety of health problems, including heart failure, seizures, and coma.
Co-Morbidities
The patient in the case study has a number of co-morbidities that can impact the pathophysiology and care of renal failure.
- Alcohol use disorder: Alcohol use disorder can damage the kidneys over time. It can also lead to dehydration, which can worsen renal failure.
- Arthritis: Arthritis can lead to inflammation, which can damage the kidneys. It can also lead to the use of medications, such as ibuprofen, which can be nephrotoxic.
- Hypertension: Hypertension can damage the kidneys over time. It can also lead to heart failure, which can cause ischemia and AKI.
- Borderline NIDDM: Borderline NIDDM (non-insulin-dependent diabetes mellitus) is a risk factor for CKD. High blood sugar levels can damage the kidneys over time.
Care of the Patient
The care of the patient will focus on stabilizing her condition and preventing further damage to her kidneys. This may involve:
- Intravenous fluids: Intravenous fluids can help to hydrate the patient and improve kidney function.
- Medications: Medications may be used to control the patient's blood pressure, blood sugar levels, and other medical conditions.
- Dialysis: If the patient's kidney function does not improve, she may need dialysis. Dialysis is a procedure that filters the blood and removes waste products.
Conclusion
Renal failure is a serious condition that can be fatal if not treated. Early diagnosis and treatment are essential for preventing further kidney damage and improving patient outcomes.
Sample Answer
Cellular Level
Renal failure is a condition in which the kidneys are no longer able to filter blood effectively. This can lead to a build-up of waste products in the blood, which can be fatal if not treated.
There are two main types of renal failure: acute kidney injury (AKI) and chronic kidney disease (CKD). AKI is a sudden loss of kidney function, while CKD is a gradual loss of kidney function over time.
AKI
AKI can be caused by a number of factors, including:
- Ischemia: Ischemia is a lack of blood flow to the kidneys. This can be caused by shock, heart failure, or blood clots.