Assessment What is a case study?

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Assessment 1: Case scenario one
Shift handover:
Identify: Mr Michael Blue, HRN: 123456, DOB: 26/01/1945
Situation:
Michael is a 75 year old Caucasian man from Darwin. He has been
admitted to the CDU medical ward with Acute Kidney Injury (AKI)
secondary to dehydration. He has a 2/7 history of confusion,
fatigue, decreased urine output, and decreased skin turgor. He has
now been transferred to the CDU Medical ward for continuing care.
Background:
Michael lives in an aged care facility. His daughter lives close by
and visits him occasionally. He needs assistance with his ADL’s,
including feeding and showering.
He has an extensive past medical history including:
T2DM (on insulin), HTN, Hyperlipidaemia, chronic kidney disease
stage 3 (Baseline eGFR 40 ml/min/1.73m2), previous R) sided
stroke with mild L) sided hemiparesis, anxiety. No known drug
allergies (NKDA).
He is obese (BMI 30) and drinks 1 glass of wine every night.
Assessment: Airway: Own, patent
Breathing: RR 22, O2 Sats 94% on RA.
Circulation: HR 96 bpm, BP 105/65 mmHg.
Disability: GCS 14/15, feels tired and ‘a bit worried’.
Exposure: Temp 37.2 oC
Michael looks unwell. He is restless and pleasantly confused. His
urine is dark in colour and offensive smelling. He has urinated 50
ml into a urine bottle in 8 hours. He had 2 x IVC’s inserted to both
ACF’s and is tolerating a diabetic diet. He last opened his bowels
this morning.

Pathology (on admission)
WBC 11.0 x 109/L (4.0-11.0)
Urea 14 mmol/L (3.0-8.0)
Serum
creatinine
213 μmol/L (60-
100)
eGFR 30 mL/min/1.73 m2 (90-120)
Recommendatio
ns/Read
back:
Medical orders
• Routine ward assessments and observations
• Strict fluid monitoring
• Administer Intravenous fluids as prescribed
• MSU for MC & S
• Diabetic diet and fluids as tolerated
• TED stockings and DVT prophylaxis
IV Fluid orders
• Intravenous compound sodium lactate (CSL) 500mls over
2 hours followed by:
• Intravenous sodium chloride 1000mls/8 hourly.
Medication orders
• Furosemide 10mg BD (IV)
• Ramipril 10mg OD (PO)
• Insulin Glargine 30 Units OD (s/c)
Nursing orders
• Devise a plan of care for your patient

Task 1:
Chronic kidney disease (CKD) in elderly people is a very serious health
concern which is correlated with elevated morbidity which death (Levey et al.,
2011). As life expectancy continues to increase worldwide, this demographic is
witnessing a growing incidence of comorbidities and risk factors such as
hypertension and diabetes predisposing to a heavy burden of CKD. As per the
case study, post the handover of the shift, the nursing assessments were
performed to evaluate the condition of the patient. On checking the assessment
table the three diagnoses that can be inferred include, firstly it can be observed
in the chart that Mr. Michael Blue had shown signs of feeling tired and had been
in a confused state. With renal failure, the patient is expected to feel exhaustion,
muscle weakening and nausea and vomiting as the rates of creatinine and BUN
begin to increase. The individual may have impaired mental function like
somnolence and uncertainty. To provide appropriate treatment, the nurse
(Wong, Chow & Chan, 2010) will examine each individual with an elevated
creatinine and BUN's cognitive and physical capacities. Many of the fatigue
(Bonner, Wellard & Caltabiano, 2010) complications faced by Mr. Blue with renal
failure are attributed to anaemia, because the weakened kidneys cannot
generate adequate hormone erythropoietin to induce red blood cell output by
the bone marrow. In cases of renal failure, severe distress and distress may pose
somatic symptoms such as breathlessness, palpitations, chest pain, sweating
and fear of dying. These signs are sometimes not correlated with any causes,
and may appear spontaneously. On the other side, there are also explanations
for the fear happening. Secondly, it can be observed that Mr Blue also had
displayed signs of decrease in skin turgor, which is mainly caused due to
potential deficiency of fluid volume in the body. Dehydration is one important
cause for a rise in BUN. The nurse will find the BUN amount as possible

indications of dehydration together with the patient's vital signs, intake and
discharge, weight, and skin turgor. Since an elevated BUN may also be induced
by something that induces impaired renal perfusion or renal impairment, it is
crucial for the particular patient to look at the BUN in relation to the pathological
cycle. If the BUN is related to inadequate renal perfusion, the priority should be
on the blood supply to the renal. When an elevated BUN indicates real renal
injury, depending on the course of acute renal impairment, fluids can need to be
limited or supplemented. Thirdly, Mr Blue condition as a stage Three Chronic
Kidney Disease patient seem to have degraded, which is why his situation
worsen and he was hospitalised on an urgent basis. The eGFR is recorded to be
30 mL/min/1.73 m2, which indicates the degradation of the condition to Stage 3B.
Fluid Volume Overload (FVE), or hypervolemia, refers to an isotonic ECF
expansion attributed to a rise in the overall sodium content of the body and an
improvement in the total body temperature. This fluid excess typically stems
from impaired sodium and water control systems as demonstrated in congestive
heart failure (CHF), renal failure and hepatic failure. Often known sources of FVE
are improper sodium consumption from meats, drugs, IV solutions or medical
dyes. Haemodialysis, peritoneal dialysis and myocardial infarction are other
medical problems which may lead to FVE. Existing factors that lead to the degree
of fluid retention, I&O the fluid equilibrium will also take into account the findings
of clinical testing when recording Mr. Blue's documents.