Med Surg Case Study #40: Jeana Sanders

Jeana Sanders | 28 years old

Chief Complaint: Jeana Sanders presents to the emergency department with complaints of cola-colored urine, swelling in her face and ankles, and a headache. She reports feeling generally unwell for the past week.

Medical History:

Jeana has a recent history of a sore throat two weeks ago, which she attributed to a cold. She has no significant past medical history, and she is not on any medications. Jeana denies any allergies or chronic conditions.

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Nurse's Note:

• Patient presents with noticeable facial and ankle edema, and she reports dark-colored urine over the past few days. She also complains of a persistent headache and general malaise. Jeana’s blood pressure is elevated, and she appears anxious about her symptoms. She denies any recent infections or illnesses, other than a sore throat two weeks ago. Urinalysis has been ordered.

  
  

Vital Signs:

• Blood pressure: 156/92 mmHg

• Heart rate: 88 bpm

• Respiratory rate: 18 breaths/min

• Temperature: 98.6°F (37°C)

• SpO2: 99% on room air

Provider's Orders:

• Admit to the medical unit for further evaluation and management.

• Obtain a complete blood count (CBC), basic metabolic panel (BMP), and serum creatinine.

• Complete urinalysis and 24-hour urine collection.

• Administer Labetalol 100 mg PO for hypertension.

• Start IV fluids: Normal Saline at 50 mL/hr.

• Monitor intake and output (I&O) closely.

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 Jeana has been admitted to the medical unit. Her urinalysis shows significant proteinuria, hematuria, and RBC casts. Lab results show elevated BUN and creatinine levels, indicating impaired renal function.

Nurse's Note:

Patient's blood pressure remains elevated despite the administration of Labetalol. She continues to complain of a headache and reports some flank pain. Patient appears fatigued but is alert and oriented. She has been placed on a sodium-restricted diet.

Vital Signs

• Blood pressure: 150/90 mmHg

• Heart rate: 84 bpm

• Respiratory rate: 18 breaths/min

• Temperature: 98.5°F (36.9°C)

• SpO2: 98% on room air

Provider's Orders:

• Administer Furosemide 40 mg IV

• Restrict sodium intake to 2 grams per day.

• Administer Acetaminophen 650 mg PO for headache relief.

• Prepare the patient for a kidney biopsy to confirm the diagnosis.

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Jeana’s kidney biopsy was completed without complications. She remains on bed rest with close monitoring of her vital signs and urinary output.

Nurses Note: Patient's blood pressure has stabilized slightly but remains elevated. She reports that her headache has improved slightly after receiving Acetaminophen. She is anxious about the biopsy results and potential complications of her condition.

Vital Signs:

• Blood pressure: 148/88 mmHg

• Heart rate: 80 bpm

• Respiratory rate: 16 breaths/min

• Temperature: 98.4°F (36.9°C)

• SpO2: 98% on room air

Provider's Orders:

• Administer Prednisone 40 mg PO daily

• Continue sodium restriction and educate the patient on the importance of limiting fluid intake.

• Monitor for signs of infection following the biopsy.

• Schedule a follow-up with nephrology to discuss biopsy results and long-term management.

Follow Up Questions:

Question 1: What is the significance of the cola-colored urine in Jeana's case?

Question 2: Why was a kidney biopsy ordered for Jeana?

Question 3: What is the purpose of administering Prednisone in Jeana's treatment?

Question 4: Why is sodium restriction important in the management of acute nephritic syndrome?

Answers to Questions Below

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Answers

Question 1: What is the significance of the cola-colored urine in Jeana's case?

The cola-colored urine indicates the presence of hematuria, which is a common symptom of acute nephritic syndrome due to glomerular inflammation and injury. Hematuria occurs when red blood cells leak into the urine through the damaged glomeruli, and it is often one of the first signs of glomerulonephritis.

Question 2: Why was a kidney biopsy ordered for Jeana?

A kidney biopsy was ordered to confirm the diagnosis of acute nephritic syndrome and to determine the specific type of glomerulonephritis. A biopsy provides a definitive diagnosis by allowing direct examination of kidney tissue, helping to guide appropriate treatment.

Question 3: What is the purpose of administering IV fluids to Joseph?

Prednisone is administered to reduce inflammation in the glomeruli and to help control the immune response that is causing the kidney damage. Also potentially slowing disease progression.

Question 4: Why is sodium restriction important in the management of acute nephritic syndrome?

Sodium restriction is important to help control hypertension and reduce edema, which are common complications of acute nephritic syndrome. Excess sodium can exacerbate fluid retention and hypertension, worsening the symptoms and complications associated with kidney inflammation

Med Surg Case Study #40: Jeana Sanders