Nursing: A Case study 2022

Running head: NURSING A CASE STUDY 1
Nursing: Case study
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NURSING A CASE STUDY 2
Part 1
1.1 Basics of renal anatomy and physiology
A kidney is composed of renal cortex, a space between outer capsule and medulla. The renal
medulla is composed of nephrons, the prime functional component of kidneys. A kidney is
said to be composed of approximately 1 million nephrons. Each nephron is composed of two
parts tubule and glomerulus. The function of the glomerulus is to filter the blood free out of
proteins and cells through the use of afferent and efferent arteriole. The glomerulus works on
producing ultra-filtrate composed of several smaller circulating elements. The ultra-filtrate
enters the tubule that is segmented into specialised parts for producing the final urine. The
final urine is formed by removing substance from the tubular fluid (reabsorption) or adding to
the tubular fluid (secretion). Filtration, secretion and even reabsorption keep the organism in
terms of minerals, electrolytes and even toxic substances produced by the body. The prime
functional work of kidney that influence the blood pressure, red blood cell production and
even calcium metabolism. The prime functional component of the kidney filters blood from
the fluid. The renal pelvis is seen to connect kidney with the nervous and circulatory systems
for the rest of the body parts (Chalmers, 2019)
1.2 Pathophysiology of chronic renal failure with risk and treatment options
Pathophysiology of chronic renal failure are as follows Malek and Nematbakhsh (2015)
 Irrespective of the main cause of nephron loss some individuals usually survive or
even less than severely damaged
 The infected nephrons then enlarge and clearance per nephron is highly increased
 If the initiating process is diffuse, severe and even sudden, such in patient with
crescentic glomerulonephritis are subjected to acute or even subacute renal failure

NURSING A CASE STUDY 3
 In case of Melanie, the progression of disease is gradual and adaptation of nephron is
possible.
 Focal glomerulosclerosis is seen to develop within the affected glomeruli and they
eventually start to lose their function.
 Simultaneously, focal glomerulosclerosis can lead to development of proteinuria that
thereby causes the worsening of systematic hypertension
 The process of nephron adaption can be termed as “final common path”
 The adapted nephron can work on enhancing the ability of the kidney to delay the
incident of uremia. However, it should be noted that the untimely process of
adaptation can lead to death of nephrons.
 Adapted nephron are not only equipped with enhanced level of glomerular filtrate
rate, but also better tubular functions in terms of proton and even potassium secretion
Pathophysiology and Clinical manifestation
The condition of Melanie is seen to degrade, a normal phenomenon for individuals suffering
from progressive renal failure. In case of Melanie and even the other cases, patients are often
seen to exhibit constancy of the internal environment of kidney until there is a loss of 75% of
renal capability. Individuals with uremic manifestation can have different complications that
can happen in other body parts. All CRF patients with those except medullary cystic kidney
disease is seen to have fixed levels of proteinuria (Bernal et al. 2015). The syndrome of
Melanie came into attention due to high levels of creatinine, 90 umol/L. The progressive
metabolic acidosis can be termed as one of the leading cause that leads to failure of the
kidneys. As pointed out by Bernal et al. (2015), a prime cause of failure to excrete excess
levels of acid is reduced renal ammonia excretion and even production.
However, it would be fair enough to state that major metabolic acidosis of renal failure is
often referred to as anion gap acidosis, the gap does not reveal until there is an increase in the