https://nursingpaperspros.com/wp-content/uploads/2020/05/logo-nursing--300x60.png 0 0 Hector https://nursingpaperspros.com/wp-content/uploads/2020/05/logo-nursing--300x60.png Hector2020-06-07 20:05:462020-06-07 20:05:46acute poststreptococcal glomerulonephritis
Case Study N.G. is a 21-year-old year-old college student who is admitted to the hospital with a diagnosis acute poststreptococcal glomerulonephritis. He was seen at the college’s student neam center because of swelling around his eyes and rusty-colored urine. His history based on medical records from the student health center indicates that he had a sore throat several weeks ago that he ignored because it resolved in 4 to 5 days. His past medical history positive for type 1 diabetes mellitus since the age of 7. However, he has maintained excellent control of his serum glucose levels via intensive insulin therapy. Before caring for N.G., you review his admission laboratory findings, which reveal gross hematuria, moderate proteinuria, and red blood cell (RBC) casts in the urine, a blood urea nitrogen (BUN) of 28 mg/dL (10 mmol/L), a creatinine of 1.4 mg/dL (123.8 mmol/L), a serum glucose level of 131 mg/dl, and decreased C3 and CH50 complement levels. An ASO (antistreptolysin O) titer was 240 Todd units. During the morning assessment of N.G., has vital signs are as follows: BP 154/98 mm Hg, heart rate 86 beats/min, respiratory rate 16 breaths/min, and temperature 98.8°F (37.1°C). He has periorbital edema and 3+ pitting edema of his ankles, and he denies any pain. His urinary output from the previous 8 hours was 200 ml 1. You recognize that N.G. has a decreased glomerular filtration rate based on the findings of a. hematuria. b. proteinuria. c. elevated BUN and creatinine. d. periorbital and peripheral edema. 2. When planning care for N.G.. you consider the interprofessional care indicated for patients with acute poststreptococcal glomerulonephritis. Select all the interventions that are indicated in the management of N.G. There are 8 correct answers. a. Administration of antibiotics b. Administration of antihypertensive agents c. Administration of corticosteroids d. Administration of diuretics e. Administration of insulin 1 Capillary blood glucose monitoring before meals and at bedtime g. Daily weights h. Intake and output 1. High protein diet Rest k. Sodium and fluid restriction
3. You plan to promote rest for N.G. during his hospitalization, but when entering his room later, you find him pacing around the room, fretting because he is missing classes. He asks you how long it will be until he can go back to school. Your best response to him is that he a. should be able to go back to school within a few days. b. should just be glad he isn’t feeling bad and not worry about school. c. has the right to sign himself out of the hospital in order to prioritize his schoolwork. d. needs to take it easy until his BP returns to normal and his edema subsides. 4. pressure rises to 182/102. His BUN and creatinine increase to 42 mg/dL (15 mmol/L) and 1.8 mg/dL (159.1 mmol/L.), respectively, and he continues to have marked hematuria and proteinuria. He is placed on strict bed rest, and antihypertensive drugs are started in addition to corticosteroids and increased diuretic dosages. His health care provider is concerned that he may be developing rapidly progressive glomerulonephritis and orders a creatinine clearance test. You understand that the creatinine clearance test a. requires the collection of a urine specimen every 6 hours for 24 hours. b. reflects the glomerular filtration rate and indicates the amount of functioning renal tissue. c. is a 24-hour collection of urine used to evaluate the kidneys’ ability to concentrate urine. d. is a measurement of urea and creatinine in the blood at hourly intervals after administration of a measured amount of protein. 5. Question: N.G’s kidney function continues to deteriorate. You recognize that his clinical manifestations are related to the effects of Aki on other body systems. Match the pathophysiologic effect of AKI to the appropriate clinical finding. Failure of excretory ability of kidneys High urea content of the blood Fluid retention Decreased renal concentrating ability depression a. Asterixis b. Hyperkalemia c. Hypertension d. Metabolic acidosis e. General central nervous system (CNS) 1. Fixed urine-specific gravity
6. N.G.’s latest lab results include BUN 84 mg/dL (30 mmol/L), creatinine 4.2 mg/dL (371.3 mmol/L), Hgb 9.2 g/dL (92 g/L), K+ 6.0 mEq/L (6.0 mmol/L), Na+ 142 mEq/L (142 mmol/L), glucose 122 mg/dL, Ca++ 6.5 mg/dL (1.62 mmol/L), and phosphate 7.2 mg/dL (2.3 mmol/L). His urine output is less than 400 ml/day, and his blood pressure ranges from 104/90 to 168/104 mm Hg. Based on these data, select the nursing diagnoses that you would anticipate to be appropriate for N.G. There are 6 correct answers. a. Anxiety related to disease processes, therapeutic interventions, and uncertainty of prognosis b. Activity intolerance related to anemia resulting from uremia c. Constipation related to hyperkalemia d. Excess fluid volume related to kidney failure and fluid retention e. Fatique related to anemia, metabolic acidosis, and uremic toxins 1. Deficient fluid volume related to elevated plasma sodium levels g. Risk for impaired skin integrity related to peripheral edema h. Risk for infection related to uremic toxins and altered immune responses 7. Because of N.G.’s elevated serum potassium levels, you monitor him closely for which complication of AKI? Question: Because of N.G.’s elevated serum potassium levels, you monitor him closely for which complication of AKI? a. Gastrointestinal (GI) bleeding b. Dysrhythmias c. Seizure activity d. Pulmonary embolism Question. You recognize that dietary modifications are necessary in the management of N.G.’s renal dysfunction. Based on N.G.’s most recent lab results and his diagnosis of AKI. identify substances that would be restricted and substances that would be supplemented in his dietary management. a. Essential amino acids b. Dietary fat c. Phosphorus d. Potassium e. Sodium f. Water
9.N.G. insists on drinking diet cola despite his dietary restrictions. Which nursing intervention best applies evidence-based practice in response to N.G.’s action? a. Allow N.G. to drink the diet cola of his choice. b. Teach N.G. that cola is high in sodium and phosphorous and thus not allowed. c. Collaborate with the dietitian to find a soda with the least amount of sodium and phosphorus d. Ask N.G.’s health care provider to prescribe diuretics to counteract N.G.’s intake of diet cola. 10.Calcium carbonate is ordered for N.G. to be taken with each meal. You explain to him that this medication is used to a. prevent osteoporosis. b. inactivate potassium in the GI tract. c. decrease his risk of gastric ulcer formation. d. bind phosphorus in the bowel, preventing its absorption. 11. The health care provider determines that hemodialysis is necessary for N.G. when he fails to respond to conservative treatment. A temporary vascular access catheter, exiting from his chest wall and tunneled subcutaneously to the internal jugular vein, is placed for immediate use with hemodialysis. During the initial hemodialysis treatment, your priority assessment focuses on N.G.’s a. intake and output. b. capillary blood glucose. c. emotional response to dialysis. d. blood pressure and cardiac rhythm. 12.Question: While you are closely monitoring N.G. during hemodialysis, which activities could you appropriately delegate to the unlicensed assistive personnel (UAP) (select all that apply)? a. Provide skin care for N.G. b. Administer insulin based on N.G.’s blood glucose results. c. Document vital signs on the computerized patient record. d. Empty and measure wound drainage on your other patient. e. Monitor N.G. for any signs of bleeding or hemorrhage.
The 13. N.G.’s condition stabilizes with the use of hemodialysis. You take the time to teach N.G. about AKI, explaining that there are three typical phases of this dysfunction. The first phase is the phase, which N.G. is currently experiencing. phase is manifested by a gradual in urine output. Although the kidneys are regaining the ability to excrete wastes during this phase, they cannot yet concentrate urine, putting the patient at risk for hypovolemia and – The phase begins when the glomerular filtration rate increases, allowing the BUN and serum creatinine to normalize. 14.Knowing that N.G. is at risk for chronic kidney disease (CKD) as a complication of his diabetes and this AKI episode, N.G.’s parents ask you questions about different types of dialysis. In response to their request, you review the characteristics of hemodialysis and peritoneal dialysis with them. Match the characteristics of hemodialysis and peritoneal dialysis to the correct category. Ti a. Contributes to anemia b. Effective and rapid clearance of potassium and creatinine c. Extensive equipment necessary d. Less cardiovascular stress Pe. Less complicated f. Less protein loss g. Lowers serum triglycerides h. May lead to high blood glucose levels P g. Provides more flexibility with portable system h. Rapid fluid removal P I. Requires fewer dietary restrictions HP J. Requires surgical placement of vascular access P K. Risk for tunnel and excit-site infections 15. Question: N.G.’s mother also asks about the possibility of donating one of her kidneys for a transplant if N.G. would need that in the future. Your best response to her comment is that A. as a living related donor, the chances that she would be a good donor are high b. talk of a transplant is premature because N.G. has not tried a course of dialysis yet. c. a transplant should be carefully considered because if the kidney is rejected, there is no alternative treatment. d. before any decision is made about a transplant, extensive evaluation of N.G.’s medical and psychosocial status would need to be made.
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