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Ms. Kim: Adult-Urinary Tract Infection, Acute Kidney Injury on Chronic Renal Fai
Ms. Kim: Adult-Urinary Tract Infection, Acute Kidney Injury on Chronic Renal Failure
Ms. Kim is a 39 y/o Korean American female with past medical history of Diabetes Mellitus Type 1 (DMT1), Hypertension (HTN), Chronic Kidney Disease (CKD) & is legally blind. She comes to the clinic today for a follow-up visit. You have not cared for her before, but a colleague, who is her Health Care Provider, is not working today & you are assigned to care her.
You review her chart before seeing her. She was seen in the Health Clinic 12 days ago & treated for a Urinary Tract Infection (UTI). She was prescribed levofloxacin (Levaquin) 750 mg PO BID for a 10 day course. She was instructed to return after completing the antibiotic for a follow-up urinalysis. She had no known drug allergies. Her home medications include: Lisinopril 20 mg PO daily, HCTZ 50 mg PO daily, Lantus 80 units SQ daily, Humalog Insulin 10 units SQ with each meal, & Multivitamin (MVI) daily.
Assessment today:
Vital Signs: BP 164/90, HR 94, RR 20, POX 93% RA, Temp 97.8
Physical Assessment: Neuro A& O x3; Lungs clear; Heart Sounds regular, S1, S2, no murmurs appreciated; Abd soft, nontender, nondistended, bowel sounds +; Extremities PP+, + pedal edema.
Labs & a urinalysis are sent & you ask Ms. Kim to wait for the results.
NA 149, K 6.1, BUN 68, Cr 4.8, Cr Clearance 36; glucose 156
WBC 6.2; Hgb 10.9; Hct 32.2; Plt 229
Urinalysis: no nitrates; no leukocyte esterase; specific gravity 1.430; bacteria none
Please respond to Questions by number & in order listed here. Scholarly references are required.
Her priority diagnoses is Acute Kidney Injury (AKI) on Chronic Renal Failure (CRF), specifically Acute Tubular Necrosis. Review the pathophysiology of Acute tubular Necrosis & AKI.
Support your reasons why this occurred. A clue is to review all her medications. Did they plan a role in this acute event?
Besides AKI what do you see as priority diagnoses now? They can be new diagnoses to the client. Why?
There are several abnormal lab findings. Explain why they are abnormal.
Which lab finding is the most life threatening. Why?
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