Med Surg Case Study 15
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Nurse's Note
Ms. A.R., a 32-year-old female, was admitted to the nephrology unit complaining of sudden onset of swelling in her face and lower extremities, accompanied by decreased urine output over the past week. She reports experiencing malaise, fatigue, and intermittent dull flank pain. The patient denies any history of recent infections or medication changes. However, she has had problems getting her medication due to financial difficulties. Upon assessment, edema was noted in the face and legs, and her blood pressure was elevated at 160/100 mmHg. The patient appeared fatigued but oriented to time, place, and person.
Medical History
Ms. A.R. has a past medical history significant for hypertension for the past three years, for which she takes amlodipine. She has no known allergies and has not been previously diagnosed with kidney disease. Family history is non-contributory.
Vital Signs
Temperature: 98.6°F (37°C)
Heart Rate: 88 bpm
Respiratory Rate: 18 bpm
Blood Pressure: 160/100 mmHg
Lab Values
Blood Urea Nitrogen (BUN): 28 mg/dL
Serum Creatinine: 2.5 mg/dL
Urinalysis: Presence of proteinuria, hematuria, and red blood cell casts
Serum Albumin: 3.2 g/dL
Question 1: What could be the possible diagnosis for Ms. A.R. condition?
Question 2: What potential risk factors might have contributed to the development of this patient's diagnosis?
Question 3: What potential complications should the nurse monitor for with this diagnosis?
Answers to Questions Below
Answers
Question 1: What could be the possible diagnosis for Ms. A.R. condition?
Based on the clinical presentation and laboratory findings, the possible diagnosis for Ms. A.R.'s condition could be acute glomerulonephritis. Glomerulonephritis is characterized by inflammation of the glomeruli in the kidneys, leading to symptoms such as swelling (particularly in the face and lower extremities), decreased urine output, fatigue, flank pain, and elevated blood pressure. The presence of proteinuria, hematuria, and red blood cell casts in the urine along with elevated BUN, serum creatinine, and abnormal serum albumin levels supports the suspicion of glomerulonephritis.
Question 2: What potential risk factors might have contributed to the development of this patient's diagnosis?
The patient's history of long-standing hypertension could predispose her to glomerulonephritis. Hypertension can lead to endothelial damage in renal blood vessels, contributing to the development of glomerular injury and subsequent kidney dysfunction
Question 3: What potential complications should the nurse monitor for with this diagnosis?
Complications to monitor for include acute kidney injury (AKI), electrolyte imbalances (e.g., hyperkalemia, metabolic acidosis), and nephrotic syndrome. Additionally, vigilant monitoring for signs of infection, especially since glomerulonephritis can be triggered by previous infections, is crucial.
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