J.D. Class Discussion Acute Kidney Injury
J.D. was driving home late one evening when she lost control
of her car. Her car struck a tree and rolled into a deep ditch
beside the road, out of sight of passing cars. Her wreck was not
discovered until 2 hours later. On arrival at the accident scene,
the paramedics found M.D. She was alert and in severe pain, with a
fractured right femur. After immobilizing M.D.’s neck the
paramedics applied a traction splint and to her leg and assessed
her vital signs: B/P 90/60, P 120, RR 24, and transported her to
the local hospital.
1) What does this information tell you?
On M.D.’s admission to the ICU, you obtain a nursing history.
M.D. indicates that she has been healthy, no hospitalizations, and
KNDA. Physical assessment reveals multiple scrapes and cuts, and
bruises to her chest and abdomen from the seatbelt. Her V.S are
P100, RR 18, B/P 124/68, T. 97.4. Skin dry pale and cool. All other
findings are WNL except for skeletal traction to the right leg. One
unit of whole blood was infused before ICU admission and a second
unit is currently infusing. An indwelling urinary catheter and NG
tube are in place. After a few hours you note M.D.’s urine output
has dropped from 55ml/hr to 45 ml/hr to 28ml/hr of clear yellow
urine.
The physician orders a 500ml fluid challenge, STAT UA, BUN,
and serum creatinine.
The fluid challenge elicits only a slight increase in urine
output.
UA results:
specific gravity-1.01 (Normal 1.005 to 1.025)
and the presence of WBC’s , Red and white cast cells, and
tubular epithelial cells in the sediment.
BUN 28mg/dl (Normal 10-20 mg/dL)
Creatinine is 1.5mg/dl (Normal 0.6-1.1)
GFR- 70mL/min (Normal GFR is 90 to 120 mL/min)
The physician orders Aluminum hydroxide 10ml every 2 hrs. via
NG
Ranitidine 50mg IV every 8 hrs. & Furosemide 40 mg IV
once.
2) What do the labs indicate?
3) Which of these nursing diagnoses would be appropriate to
for this patient with ATN? Why?
Activity intolerance R/T broken femur
Excess fluid volume R/T failure of kidneys to eliminate excess
body fluid
4) Why did the physician order a fluid challenge?
5) Why did the physician order furosemide?
6) Why did the physician order aluminum hydroxide?
7) What should we do as nurses for this patient?