NRNP 6566 Week 10 Knowledge Check (100% Correct) Verified Answers

WEEK 10 QUESTION 1 Describe the different etiology of pre-renal, intra-renal, and post-renal acute kidney injury and provide examples of clinical conditions that cause each. Pre-Renal: Would be any condition that woul ...

WEEK 10 QUESTION 1 Describe the different etiology of pre-renal, intra-renal, and post-renal acute kidney injury and provide examples of clinical conditions that cause each. Pre-Renal: Would be any condition that would disturb blood flow to the kidneys. Ex: CHF, Renal Artery stenosis, hypotension, hypovolemia, decreased cardiac output. Intra-Renal: Would be any condition that would occur within the kidney itself effecting the tubules, glomerulus, collecting tubules. Ex: Medications effecting the kidneys (Antibiotics, NSAIDs, Ace Inhibitors), Acute Tubular Necrosis, kidney tumors, pyelonephritis, polycystic kidney disease. Post-Renal: Would be issues involving the ureters, bladder or urethra. Ex: Obstruction, kidney stones, enlarged prostate, cervical cancer, any tumors effecting these structures, urinary tract infection. QUESTION 2 Using the Cockcroft and Gault formula, calculate the estimated GFR for the following patient. 52 year old female weighting 177 pounds. Plasma creatinine is 3.3 I found a calculator for this on the National Kidney Foundation Website. I plugged in the information provided and got the answer of : Estimated GFR is 25 mm per minute. This was extra information that was provided: Creatinine Clearance= ((140-Age)x Weight) / (72 x Serum Creatinine) x 0.85 (If Female) QUESTION 3 The NP is admitting a 55 year old septic patient to the ICU. What IV fluid and dose would you prescribe for the initial fluid bolus? 30 ml/kg of IV crystalloid fluid within the first 3 hours. QUESTION 4 How would you calculate the fractional excretion of sodium? What does this calculation tell you about the patient’s acute kidney injury? FENa = ([Na] Urine/[Na] Plasma) / ([Cr] Urine / [Cr] Plasma) this number then X 100 Pre-Renal would be <1%, Intrinsic (Renal) would be >1% and Post Renal would be >2%-4%. This calculation would be able to tell you whether or not the patients acute kidney failure is due to a pre-renal issue, Intrinsic (renal) issue or a Post Renal issue. QUESTION 5 A 25 year old man with schizophrenia is admitted to the psych unit for medication stabilization. The patient is responsive but sleepy. Vital signs are within normal limits and muscle tone is normal. The patient has a large container of sweet iced tea which is nearly empty. His admission labs include: -Sodium 122 history is unremarkable. He was placed in the nursing home due to his age and inability to care for himself at home. His family states that he is usually quite alert and interactive. The patient is widowed and has been at the nursing home for about 2 months. He has no routine medications but several PRN mediations including haloperidol, valium, and milk of magnesia. BP 100/53 T 98.3 HR 88 RR 14 Mucous membranes are dry. Pulmonary, cardiovascular, abdominal, and extremity examinations are normal. Chest x-ray shows no infiltrate and voided urine shows no evidenced of UTI. LAB DATA: -Sodium 162 -Potassium 3.4 -Chloride 130 -Bicarbonate 23 -BUN 38 -Creatinine 1.8 -Glucose 97 -Calcium 10.3 What is your working diagnosis for this patient? How would you treat it? My working diagnosis would be hypernatremia related to dehydration. I would initiate an IV infusion of D5W because his sodium is greater than 160 and he is showing to only be mildly volume depleted and he is not showing any signs of bleeding or any other reason for volume loss. Once this patient is more alert I would discontinue the infusion and encourage PO intake as this type of free water fluid replacement is best. QUESTION 9 A 65 year old man is admitted with left lobar pneumonia. His symptoms on admission included productive cough, fever, dyspnea, confusion, nausea vomiting, constipation, and weakness. He has a 45 pack year history of smoking. He admits to losing 35 pounds over the past 4 months but his wife says he thought that was because of his poor appetite, feeling bad, and no energy. Medications include Advair, an albuterol rescue inhaler, Lisinopril, and HCTZ. The physical examination shows a somewhat emaciated man with a blood pressure of 123/72. There are decreased breath sound throughout the left lung field and normal cardiovascular, abdominal, and extremity examinations. His sputum is green with some blood streaks. Review of his chest x-ray shows lower lobe consolidation. There are also some white spots in the lower lobe which are concerning. He has been started on antibiotics and seems better but is still confused, weak, and complaining of nausea. His repeat labs from today show: -Sodium 133 -Potassium 4.4 -Chloride 98 -Bicarbonate 31 -BUN 15 -Creatinine 1.0 -Glucose 112 -Calcium 17.7 -What is the most likely diagnosis and how would you treat it? Working diagnosis is hypotonic hyponatremia related to dehydration, nausea/vomiting and diuretic use. I would discontinue his use of HCTZ and start him on an infusion of 9% NSS to correct his volume depletion and slowly correct his hyponatremia. I would also want to correct his constipation, nausea/vomiting and treat him for his pneumonia. The fluids will help with constipation, Zofran will help with nausea/vomiting and I would collect bold and sputum cultures and then treat him with empiric antibiotics for his pneumonia until the cultures came back and the antibiotic treatment could be more specific based on the organism causing the pneumonia.