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Case Study 101: Abdominal Aortic Aneurysm With Acute Kidney Injury
Case Study 101: Abdominal Aortic Aneurysm With Acute Kidney Injury
1. T.A. has questions about his surgery. He asks you, “I was fine before surgery.
I'd still be fine now if I hadn't been operated on, wouldn't I?” Based on your
knowledge of AAA, what will your response be?
My response to T.A would be although he did not feel the symptoms or did not
feel ill before the surgery, any type of aneurysm have a very high risk of mortality
rate. The one T.A is suffering is the most dangerous type of aneurysm. T.A’s AAA
measured at 8cm diameter, the risk of rupture greatly increases which is
recommended for surgery. Without the procedure, chances of survival would be
very slim.
3. You are performing your initial assessment of T.A.'s legs. What should you
include?
In performing initial assessment for T.A’s legs, the following should be included:
5. Four hours after his admission to your floor, you note that T.A. has had a total
urinary output of 75mL of dark amber urine. Why are you concerned?
I am concerned about this because having a total urinary output of 75mL of dark
amber urine means the kidneys are failing to produce adequate amounts of urine.
The perfusion to the kidneys could be compromised. With an inadequate amount
of urine being produced, the toxins within the body could begin to build up
leading to more issues, or the kidneys could be retaining urine.
6. You examine the urinary catheter and tubing for obstructions, and find none.
What other assessments do you need to gather?
T.A has an increased level of potassium, glucose, BUN, creatinine. While sodium
level has increased. T.A is at high risk for cardiac dysrhythmias due to the increase
in potassium. The increased result of BUN and creatinine indicates that there is a
current kidney injury, but it does not identify if it is a chronic or an acute problem
that is occurring. An increased glucose result within the urine indicates that the
kidneys are failing to absorb the blood sugar back into the blood vessel as it
passes through them.
8. Indicate the expected outcome for T.A. that is associated with each of the
medications he is receiving. Be specific. Include the type of medication it is,
class, etc.
My options are to use the subclavian vein, or other line. However, these two are
not compatible. I would probably start a new line to infuse the antibiotic, this is to
continue dopamine infusion.
10. T.A. is placed on a fluid restriction and a renal diet. T.A. asks how much he is
going to be able to drink. What is your reply?
The more the severe the condition, the less fluids that T.A should intake. This
depends on the severity of the stage of the complication. I will tell T.A that it will
depend on how much fluid T.A is releasing from the body. Common range for
restrictions would be 300-700 ounces of fluid/day.
11. Briefly describe a renal diet. What referral may be needed and why?
A renal diet typically consists of a high carbohydrate and low protein diet. Foods
such as quinoa, oats, bananas, and sweet potatoes examples of foods that are
high in carbs. Meat, poultry, and fish are a few examples of foods that are high in
protein so they should be avoided by any pt. on a renal diet. A nutritionist should
be able to help the T.A. identify the foods that he would enjoy eating but still
remains within the category of a renal diet. T.A should receive all the proper
information and gets all his questions answered.
12. What are some interventions you can use to help T.A. be more comfortable
while on a fluid restriction?
Some interventions I can use to help T.A be more comfortable while on a fluid
restriction are the following:
• Let T.A take small sips of water to stretch out the amount of water throughout
the day instead of drinking an entire amount at once
• Let T.A suck on sugar free candy help with dry mouth
• Give T.A frequent oral care to prevent dry mouth
13. As you plan your care of T.A. for the remainder of the shift, identify which
aspects of his care you can delegate to the UAP? Select all that apply.
14. You note that T.A.'s blood glucose levels have ranged from 62 to 387mg/dL
over the past 3 days. He comments, “That's funny, you're giving me almost
twice the amount of insulin that I give myself at home. I don't understand why
it's not working.” How should you respond?
I would respond by telling T.A that currently his body is experiencing a lot of
stress from both the surgery and the kidney injury. When the human body is
experiences a lot of stress, the glucose levels tend to rise which is what is
happening in your body right now. Additionally, his kidneys are not
processing/filtering your bodies waste properly, leading to an increase in glucose
as well.
15. Explain the relationship between his blood glucose readings and wound
healing.
I would explain to T.A that the time it takes for wounds to heal is greatly extended
because the nutrients in the body such as oxygen and proteins are being used to
break down the protein, rather than healing wounds. The higher the glucose
levels remain, the longer it takes for wounds to heal.
Due to this being T.A. first dialysis treatment, it is vital to monitor for any adverse
reactions to the treatment. Although headaches and nausea are fairly common
side effects of dialysis, the restlessness and acute confusion is what beings to
worry me. Additionally, hypotension is the common reaction to dialysis not
hypertension like T.A. is experiencing. With this mixture of symptoms, T.A. is most
likely experiencing dialysis disequilibrium syndrome. This syndrome is classified by
the presentation neurological signs shortly after receiving dialysis. The neurologic
symptoms are attributed to cerebral edema and increased intracranial pressure,
although the precise cause remains unknown.
17. You page the physician. What will you do while waiting for the physician to
return your call?
I will maintain calm. I would not allow visitors. But if there are family members
around, I would kindly ask them to leave the patient to let him rest and let them
go the waiting area to ensure that T.A is not bothered. Also, I would anticipate
infusing hypertonic decrease solution to the patient, and make sure that I have
patient IV access to start infusion as soon as possible and administer medication
to decrease ICP.
18. While waiting for the physician, T.A. begins to vomit severely. During the
episode, he complains of something “not feeling right” in his abdomen. What is
your immediate concern and why?
The care that I would render would be to dawn sterile gloves and apply a wet
sterile saline dressing directly on the tissue. It is beyond important to make sure
that the dressing is moist because you want the intestine tissue to remain as
moist as possible. It is important to cover the tissue as soon as possible to
decrease the exposure to harmful organisms. I would not leave T.A’s side because
deterioration of his condition can occur rapidly.