Allison Mei R.

Bialba 3nur 1 RLE 4

October 28, 2014
Genitourinary Tract Case Discussion
1. What are the renal problems in this case?
Based on the laboratory studies, there is acute renal failure with elevated serum
potassium, elevated serum BUN and serum creatinine, elevated WBC as evident
sign of infection. There is also low Hgb level that signifies anemia. There is also
proteinuria, hypoalbuminemia and hyperlipidemia. There is also urinary tract
infection and albuminuria.
2. Compute for the estimated creatinine clearance using the serum
creatinine of 8.7 mg/dL.
140-58 x 85
X 1 (male) = 11.13mg/dL
72
3. What are the present stages of chronic kidney disease of the
patient?
The patient has Stage 5 or end stage chronic renal failure which is very severely
reduced kidney function (end stage or ESRF/ESRD), less than 15% (GFR less than 15
ml/min). The patient has changes or loss of appetite, nausea and vomiting,
headache, easy fatigability, making little or no urine, swelling/edema, and tingling
sensation which are common manifestations at this stage. Additional symptoms
include increased skin pigmentation, changes in skin color, and muscle cramps. The
kidneys fail to function and are not able to remove waste and fluids from the body
leading to toxins building up in the blood, causing an overall ill feeling. Kidneys also
have other functions they are no longer able to perform such as regulating blood
pressure, producing the hormone that helps make red blood cells and activating
vitamin D for healthy bones.
4. What are the underlying causes of Renal Failure?
There are many causes of renal failure but the leading causes are diabetes
(about two thirds of cases) and hypertension (about one third of cases). Other
underlying causes include impaired blood flow to the kidneys like in heart disease,
infection, liver failure and anaphylaxis; damage to the kidneys like in
glomerulonephritis, hemolytic uremic syndrome, lupus, multiple myeloma,
scleroderma, blood clots in the veins and arteries around the vein and arteries of
the kidneys & vasculitis; and urine blockage in the kidneys including bladder cancer,

cervical cancer, colon cancer, enlarged prostate, kidney stones and nerve damage
involving the nerves that control the bladder.
5. Explain the laboratory/ancillary results of the patient.
The kidneys may fail to function for many different reasons. Either directly
reduced blood flow into the kidney or inflammation and necrosis of the tubules
cause obstruction and back pressure. Due to the functions that the kidneys fail to
fulfill, it might not produce enough erythropoietin (EPO) which is a glycoprotein
hormone responsible for the regulation of red blood cell production. When EPO
decreases, there would be less production of red blood cells and less protein
hemoglobin that would facilitate the delivery of oxygen to the bodys organs.
Decreased red blood cell count results in anemia. This is also manifested by low
hemoglobin and hematocrit count which is manifested by malaise, dizziness and
shortness of breath. Elevated creatinine and blood urea nitrogen (BUN) levels that
are revealed in the blood chemistry are likely evidence of decreased kidney
function. Creatinine and urea nitrogen are waste products that the kidneys normally
remove from the blood. If the kidneys are not working properly, these substances
may build up in the blood. Another laboratory test is the HbA1C or glycosylated
hemoglobin which shows the average blood sugar over the past 2-3 months. For
people without diabetes, the normal range for the hemoglobin A1c test is between
4% and 5.6%. Hemoglobin A1c levels between 5.7% and 6.4% indicate increased
risk of diabetes, and levels of 6.5% or higher indicate diabetes and in this case, the
patient has 9% which indicates diabetes. Fasting Blood Sugar test (FBS) measures
blood glucose after fasting to check for diabetes due to the lack of insulin that
causes the rates to rise.
As for the electrolytes, hyperkalemia, hyponatremia, hyperphosphatemia, and
hypocalcemia were noted. The kidneys help to control the levels of potassium in the
body and hyperkalemia may be caused by the impaired functioning of the kidneys
due to renal failure. Hyponatremia also occurred due to impaired sodium excretion
which is the factor leading to the patients edema and recurrent hypertension.

Regulation of phosphorus excretion by the kidney is the key mechanism of

maintaining phosphate balance in normal day to day life. Kidney injury
impairs the ability of the body to maintain phosphorus balance, and in
chronic kidney disease, phosphorus homeostasis is lost and positive
phosphate balance occurs in the later stages (4 and 5) of kidney diseases.
Loss of phosphorus homeostasis due to excretion failure in chronic kidney
disease results in hyperphosphatemia. The body also produces low levels of
calcium that causes the parathyroid hormone to move calcium out of the
bones, causing hypocalcemia. And if this continues, the bone would become
brittle and will break easily.
The results also show high levels of LDL. This indicates a possible
cardiovascular problem including hypertension that is already manifested by
the patient. Low albumin is caused by increased oncotic pressure resulting in
edema and is affected by high LDL levels. This leads to hyperlipidemia and
hypoalbuminemia.

Albuminuria was also noted in the urinalysis. Albuminuria means that the
kidney has some damage and is starting to spill some albumin into the
urine. Some causes of this includes hypertension, heart failure or kidney
damage.
6. Enumerate Nursing diagnosis and Nursing Intervention.
Alteration in fluid volume
Decreased glomerular filtration rate and/or obstruction to urinary output
results in oliguria, fluid overload and electrolyte imbalance.
INTERVENTIONS
1) Assess fluid status of the patient and maintain intake-output records meticulously
2) Weigh the patient daily at the same time, scale and clothing
3) Observe for skin turgor and mucous membranes
4) Note orthostatic changes in blood pressure, pulse, and respiratory rate
5) Monitor vital signs
6) Monitor urine specific gravity
7) Monitor serum electrolytes
Alteration in nutrition
INTERVENTIONS
1) Maintain accurate record of dietary intake
2) Assess response to prescribed diet therapy: appetite, daily weight, muscle mass
and strength, wound healing
3) Frequent mouth care to prevent stomatitis and promote salivation
Potential for injury secondary to infection
INTERVENTIONS
1) Monitor vital signs especially temperature
2) Check for lab results especially leukocyte count and differential
3) Inspect skin for breaks in integrity: redress wounds using aseptic techniques, use
aseptic technique during insertion and daily dressing changes of IV cannulas
4) Provide oral hygiene
5) Provide assistance when needed

Risk for decreased cardiac output

Risk factors may include fluid overload (kidney dysfunction/failure,
overzealous fluid replacement), fluid shifts, fluid deficit (excessive losses),
electrolyte imbalance (potassium, calcium); severe acidosis, and uremic effects on
cardiac muscle/oxygenation

INTERVENTIONS
1) Monitor for the blood pressure and heart rate
2) Assess skin integrity and mucous membranes
3) Monitor ECG changes
4) Maintain bed rest or encourage adequate
rest and provide assistance when needed
5) Monitor laboratory
studies on electrolytes (K, Na, Ca, P, Mg)

7. Whats the complete diagnosis?

Uremia, congestion secondary to Chronic Kidney Disease type V secondary to
Diabetes Mellitus Nephropathy, Diabetes Mellitus type 2 poorly controlled, s/p ray
amputation 5th digit left foot