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Chronic Kidney Disease (CKD) Case Study (45 min)

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Mr. Stinson is a 52-year-old male with a history of HTN, DM Type II, CKD, and CHF. He presented to the Emergency Department (ED) complaining of severe itching, nausea, and vomiting.  He appeared pale and is lethargic. He reported shortness of breath and the nurse notes crackles in his lungs. He has now been admitted to your unit.

Critical Thinking Check
Bloom's Taxonomy: Application

What additional nursing assessments should be performed?

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Critical Thinking Check
Bloom's Taxonomy: Analysis

What diagnostic or lab tests would you expect the provider to order?

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Upon further questioning, the patient reports he normally gets dialysis Monday, Wednesday, Friday, but that he skipped dialysis yesterday because he was “not feeling well”. He has +2 pitting edema in his legs. Vital signs are as follows:

HR 102 RR 24

BP 153/97 SpO2 90%

 

The patient’s labs result and show the following:

BUN 62 mg/dL Na 134 mg/dL

Cr 3.9 mg/dL Ca 7.8 mg/dL

GFR 13 mL/min/m2 Phos 5.0 mg/dL

K 6.3 mEq/L Mg 1.6 mg/dL

Gluc 224 mg/dL H/H 8.2 / 30%

pH 7.32 pCO2 32 HCO3 16

BNP 247 pg/mL

Critical Thinking Check
Bloom's Taxonomy: Analysis

Interpret these lab results and explain their meaning.

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Critical Thinking Check
Bloom's Taxonomy: Analysis

What is going on with Mr. Stinson physiologically?

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The nephrologist is consulted and determines that the patient needs hemodialysis. As soon as possible.  The charge nurse of the dialysis unit is working to create a bed for him and will call back as soon as one is available, hopefully within the hour.

Critical Thinking Check
Bloom's Taxonomy: Analysis

What do you, the nurse, need to consider and assess for Mr. Stinson PRIOR to sending him to dialysis?

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Mr. Stinson goes to hemodialysis, where they are able to pull of 3 L of fluid. He tolerates the procedure well and returns to his room.  

Critical Thinking Check
Bloom's Taxonomy: Analysis

What would you need to assess for Mr. Stinson AFTER he returns from Dialysis?

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Critical Thinking Check
Bloom's Taxonomy: Application

What are some important patient education topics for Mr. Stinson before discharge?

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