Keola Akana is a 70-year-old male with a history of heart failure. He was admitted to the

Keola Akana is a 70-year-old male with a history of heart failure. He was admitted to the medical-surgical unit on Monday for medication adjustment, monitoring, and cardiac rehabilitation. On Thursday at 1400, Mr. Akana experiences confusion, decreased urinary output, and elevated blood urea nitrogen, creatinine, and potassium values. The client is sitting in bed with head of bed at 45 degrees and 3 pillows behind his back and head. He is complaining of difficulty breathing and is intermittently confused. Urine output has been below 30 mL per hour for the past 16 hours, and labs have just returned indicating elevated blood urea nitrogen (BUN), creatinine, and potassium. 3 pitting edema is present in his legs, and lung sounds are coarse. His wife Zoe is in the room. She is supportive and patient.  Past Medical History ? Hypertension ? High cholesterol ? Congestive heart failure  Physical examination findings Vital signs: BP 154/92 mmHg, Pulse 98/min irregular, RR 30/min and laboured, SaO2 91% on 3L O2 via nasal cannula, Temp 36.9 0C  Respiratory ? developed shortness of breath at rest ? use of accessory muscles. ? Chest with bibasilar coarse crackles on auscultation Cardiac ? heart sounds irregular Neurological ? Confused ? Keola asks, “Where am I? Who are you?” Abdomen ? no abdominal distention ? bowel sounds present Neck ? distended neck veins ? JVD with jugular venous pressure >4cm ? no bruits noted on auscultation Extremities ? 2 bilateral pre-tibial pitting edema and also in feet and ankles ? Palpable pedal pulses Integumentary ? Pale, cool and clammy ? Slightly diaphoretic  Urinalysis ? fixed specific gravity of 1.010 ? cell casts present. Diagnosis Mr. Akana was diagnosed with acute kidney injury (AKI) based on his clinical presentation. The following were ordered by the physician to manage Mr. Akana acute kidney injury: Furosemide 40 mg IV x 1 now Sodium polystyrene sulfonate 15 grams oral elixir x 1 now 12-lead ECG STAT   Q1. Mr. Akana has developed acute tubular necrosis (ATN) evident by tubular epithelial casts present in the urine. Provide the pathophysiological rationale for the development of ATN in this patient.  Arterial blood Gas (ABG) Results Normal value pH 7.32 PaCO2 31 HCO3- 12 PaO2 70 Laboratory Results Tests Results Normal value Red blood cell count 4.9 million/mm3 4.4 – 5.7 X 1012/L White blood cell count 11.0 × 109 /L 4.0-10.0 × 109 /L Troponin <0.01 µg/L < 0.01 µg/L B-type natriuretic peptide (BNP). >400 pg/ml HF very likely <100 pg/ml sodium 132 mmol/L 135-145 mmol/L potassium 6.0 mmol/L 3.5-5.0 mmol/L Blood urea nitrogen (BUN) 10.0 mmol/L 2.5 – 8.0 mmol/L Serum Creatinine 700 µmol/L 70 – 120 µmol/L eGFR <60 mL/min/1.73m2 > 90 mL/min/1.73m2  Health Science Science Nursing PATH 222 Share QuestionEmailCopy link Comments (0)

Our website has a team of professional writers who can help you write any of your homework. They will write your papers from scratch. We also have a team of editors just to make sure all papers are of HIGH QUALITY & PLAGIARISM FREE. To make an Order you only need to click Order Now and we will direct you to our Order Page at Litessays. Then fill Our Order Form with all your assignment instructions. Select your deadline and pay for your paper. You will get it few hours before your set deadline.