Care Scenario #11: Miguel The patient is a 41 year-old Hispa
Care Scenario #11: Miguel The patient is a 41 year-old Hispanic… Care Scenario #11: MiguelThe patient is a 41 year-old Hispanic male who has a longstanding history of hypertension and diabetes and presents with a complaint of pruritus, lethargy, lower extremity edema, nausea, and emesis. He denies any other medical illnesses.On physical exam Miguel is a well-developed, well-nourished male in moderate distress. BP: 180/110, P: 80, R: 24 and he was afebrile. Body weight 76.5 kg. Cardiac exam had an S1, S2 and S4. The remainder of the exam was unremarkable except for the 2+ bilateral pitting edema to mid- tibial level and superficial excoriations of his skin from scratching.Laboratory data (all in mmol/L unless otherwise stated):Na: 133 K: 6.8Urea: 60.7 Cr: 1385 µmol/LParathyroid Hormone (PTH): 95 pmol/LHb: 86 x1012/L Hct: 27.4%Urinalysis (done 2 months ago): pH 6.0, Specific gravity 1.010, Protein 1+, Glucose negative,MCV 88 FL Ketone negative, Blood negative, Waxy castsCl: 100 Ca: 1.87 Phos: 3.58 Glucose: 5.9He is diagnosed with uremia and due to his non-existent urine output, the decision is made to start hemodialysis with a new dialysis catheter inserted in the right subclavian vein. As the dialysis RN, you arrive to start his first treatment. The orders state High-flux dialyzer x 2 hours; 2K bath; Blood flow (Qb) 200-300 cc/min; Dialysate Flow (Qd) 500cc/min, Heparin 50,000 U bolus followed by 400 U Q1H while on dialysis; aim for 1.5-2L ultrafiltration.Suggested ObjectivesLinking this to the care scenario, students should examine:1. The risk factors and pathophysiology of renal failure2. The clinical manifestations of uremia and its complications3. Review the stages of chronic kidney disease and based on his eGFR decide which category he is in.4. Review the required orders to perform dialysis and the significance of each5. Review the types of medications Miguel will most likely need6. Patient education re: hemodialysis and potential complications Health Science Science Nursing HTHSCI 2C06
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