1. Discuss the treatment and prevention of Contrast Induced Nephropathy
2. Identify the characteristic symptoms and signs of your patient with oliguria
3. Identify the cause of Prerenal, post-renal, and intrarenal AKI
4. Identify which patient would be a candidate for hemodialysis treatment
5. Identify the normal and abnormal findings on a urinalysis screen
6. Describe the associated care for the patient receiving lactulose
7. Identify the purpose of the LeVeen shunt
8. Identify the significance of ascites in your patient
9. Discuss the concept of hepato-renal syndrome
10. Discuss the differences in acute, chronic, and hyperacute transplant rejections
11. Discuss the differences with HHNS and DKA
12. Identify the signs and symptoms associated with kidney transplant rejection
13. Identify the symptoms, lab values, and pharmacological options associated with thyroid disorders

 

1. Discuss the treatment and prevention of Contrast Induced Nephropathy

Contrast Induced Nephropathy is term used to refer to the impairment of renal function which occurs within 48 hours of administration of contrast media as a result of relative increase in serum creatinine after being exposed to a contrast agent compared to baseline serum creatinine values.

Treatment of Contrast Induced Nephropathy involves the administration of contrast agents containing the ACIST contrast delivery system, in combination with contemporary hydration procedures which are associated with lowering the CIN.

Prevention of CIN involves the following;

Discontinuation of potentially nephrotoxic drugs such as metformin before radiographic procedure. Aminoglycosides should be administered daily as a single dose but not multiple dose.

Administering adequate water to the patient ,it is important to drink more water because this helps in cleaning the kidneys and keeping it safe from CIN.

Usage of contrast media in lowest amount possible in dosage. This is because use of large doses for contrast agents facilitates the formation of CIN.

Patients undergoing radiographic procedure, their renal function should be monitored by measuring serum creatinine before and once daily for 5days after the contrast medium injection.

 

2.Identify the characteristic symptoms and signs of your patient with oliguria

Oliguria is a disorder which is mainly characterized by production of reduced amount of urine than the normal. It is mainly caused by dehydration or health issues such as kidney failure.

Signs and symptoms of a patient suffering from oliguria include the following;

The colour of the urine produced is darker than normal, it is usually deeper yellow.

Urinating less frequently and also producing smaller amount of urine than usual which may result from the inability of the kidney to regulate fluids.

The patient may experience rapid heartbeat.

The skin of the patent is likely to dry, this results from dehydration which is the reduction of water level in the body system.

 

3. Identify the cause of Prerenal, post-renal, and intrarenal AKI

Prerenal AKI is a condition that occurs when there is a sudden reduction of blood flow to the kidney resulting to loss of kidney function. This condition is caused by;

Severe dehydration resulting from excessive loss of fluids from the body.

Taking of medicine that interfere with the supply of blood to the kidneys. Such medicine include ACE inhibitors they mainly cause prerenal AKI to the people living with kidney problems.

Severe loss of blood and low blood pressure which may be as a result of abdominal surgery or severe infection.

Postrenal AKI is a condition that occurs when an obstruction in the urinary tract below the kidneys results to building up of waste in the kidneys. It is caused by;

Enlarged prostate gland which may put pressure on the urethra causing the urine to go back to the bladder.

Clotting of blood in the urethra blocking the urine from getting out from the bladder.

Prostate, cervix or colon cancer.

Kidney stones which block the urethra or the ureter.

Malfunctioning of the bladder making it not to empty the urine properly. This may be as a result of nervous system disorders or spinal cord injuries.

Liver diseases such as cirrhosis and pancreatitis that cause reduced level of fluids in the abdomen.

Intrarenal AKI is a condition that occurs when kidneys are damaged directly resulting to sudden loss in the functioning of the kidney. It is caused by;

Excessive intake of drugs that are poisonous to the kidney that result to it's damage.

Kidney stones which after staying for long in the kidney causes damage.

Bladder cancer which can seriously damage the kidney.

 

4.Identify which patient would be a candidate for hemodialysis treatment

Hemodialysis treatment involves filtering wastes and water from blood, serving the function of the kidney. It is called artificial kidney.

A patient who would be a candidate for hemodialysis treatment is the one who has lost 85 to 90 percentage of their kidney function, whereby the kidney has been damaged. Therefore, it can not carry out the function of filtering waste and water from blood, thus waste accumulates in the blood. This kind of a person has to undergo hemodialysis treatment.

 

5.Identify the normal and abnormal findings on a urinalysis screen

Urinalysis is the process of urine test.

Normal findings on a urinalysis screen include the following;

Yellow (pale or light) colour.

The urine should be clear or cloudy.

Yeast, bacteria and ketones should show none.

Nitrites, leukocyte esterase and bilirubin should test negative.

Crystals should appear occasionally, protein of about 150mg/d, Read blood cells of about 2RBCs/hpf and White blood cells of about 2-5WBCs/hpf.

Abnormal findings on a urinalysis screen include;

Presence of protein ,this can be as a result of the malfunctioning of the kidney.

Glucose which may result from high sugar content a sign of diabetes.

Acidity or pH, abnormal acid levels may result from kidney stones.

Blood in the urine may be a sign of infection.

 

6.Describe the associated care for the patient receiving lactulose

Lactulose is a drug taken for the purpose of treating constipation. Therefore, the associated care for a patient suffering from constipation involves the following;

Providing food that is rich in fibre such as fresh vegetables and fruits which aides in digestion by increasing the weight of the stool and speeds up the process of egestion.

Encouraging the patient to take part in physical activity which increases muscle activity in the intestines.

 

7. Identify the purpose of the LeVeen shunt

LeVeen shunt is a device useful in relieving ascites and reversing protein loss in a patient. It is also known as peritoneovenous shunt. It is useful in draining peritoneal fluid from the peritoneum into veins which is usually the internal jugular vein or the superior vena cava. It is also useful to patients with refractory ascites. It is a long tube with non return valve running from the peritoneum to the internal jugular vein in the neck and it's known for allowing ascitic fluid to flow into the systemic circulation.

 

8. Identify the significance of ascites in your patient

Ascites is a term used to refer to a condition that causes fluids to build up in the abdomen that is in the space around the organs. This condition is mainly caused by the problems associated with the liver that is when the liver becomes damaged and starts to leak ascitic fluid into the abdominal space.

It's significance in a patient is through the following;

Accumulation of extra fluids in the abdomen which may result to pressure on the surrounding organs which may cause problem in breathing.

Rapid weight gain in the patient which lead to the lack of appetite, nausea and vomiting.

 

9. Discuss the concept of hepato-renal syndrome

The term hepato-renal syndrome is used to refer to a type of kidney failure found in the people with severe liver damage and in most cases it is caused by cirrhosis. When the kidney stops functioning, it leads to accumulation of toxins in the body. It eventually results to liver failure. This condition is said to be very dangerous. Some of the symptoms include; swollen abdomen, dark coloured urine, decreased urine output, vomiting, nausea and weight gain.

 

10.Discuss the differences in acute, chronic, and hyperacute transplant rejection

The start for the acute transplant rejections is between weeks to months of the transplant, the beginning for hyperacute occurs almost immediately and is usually evident while you are still in surgery on the other hand, chronic transplant occurs months to years after the transplant.

The type of hypersensitivity in hyperacute transplant rejections is type II and it results in thrombosis and occlusion of graft vessels. In acute transplant rejections the type of hypersensitivity is type IV and it results in leucocyte infiltration of grant vessels. While on the other hand, chronic transplant rejections has III and IV type of hypersensitivity resulting to intimal thickening and fibrosis of graft.

 

11. Discuss the differences with HHNS and DKA

In HHNS there is little or no ketoacidosis and the serum glucose concentration exceeds 1000mg/dl while on the other hand in DKA metabolic acidosis is often the major finding and the serum glucose is below 800mg/dl.

HHS usually evolves over a period of time several day while on the other hand DKA usually evolves rapidly.

 

12. Identify the signs and symptoms associated with kidney transplant rejection

Fatigue

Weight gain

Decreased urine output

Pain or tenderness as a result of the transplant

Fever

Flue-like symptoms

 

13. Identify the symptoms, lab values, and pharmacological options associated with thyroid disorders

The symptoms associated with thyroid disorders include ;

Increased sweating

Unintentional weight loss

Fatigue

Increase in bowel movements

Tremor

Nervousness

 

The lab values showing thyroid disorders may include:

Thyroid stimulating hormone and thyroid antibody tests.

High levels of thyroxine and low or non existent amount TSH indicate an overactive thyroid.

 

Pharmacological options associated with thyroid disorders include:

Hormone replacement therapy such as Synthroid.

An anti-thyroid drug like tapazole can be used for hyperthyroidism.