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J.D. Class Discussion Acute Kidney Injury J.D. was driving home late one evening when she lost...

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?

Homework Answers

Answer #1

1.The information provided describes that the patient is having right femur fracture due to RTA.

2.The lab indicates that there is increased level of BUN and creatinine, decreased GFR and specific gravity which indicates the patient is experiencing acute renal failure or acute kidney failure .

3.ATN stands for acute tubular necrosis so diagnosis will be tested to fluid volume and not related to the bone fracture

Excess fluid volume R/T failure of kidney to eliminate excess body fluids

4.The fluid has been ordered to increase the urine output has the urine output was just 28ml/hr.This can help the kidney to recover and aide in elimination process .

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