Assignment
Case Study
The nurse in the renal clinic is caring for a 65-year-old male client who had a peritoneal catheter inserted 2 weeks ago for peritoneal dialysis treatment. The nurse reviews the client's medical record from hospital discharge 2 weeks ago and notes the following.
Health History:
This 65-year-old male client has a long-term history of type 1 diabetes mellitus. He has a long-term history of poor control of his diabetes and his HbA1C levels have consistently been greater than 10%. He also has a history of hypertension, hyperlipidemia, and peripheral vascular disease.
He admits that he has not taken care of himself over the years and eats whatever he wants and drinks alcohol socially. He does report that he "faithfully takes his Toujeo insulin every day along with his weekly Ozempic" but admits that he does not check his blood glucose levels and doesn't take his regular insulin before meals as prescribed. He finds this regular insulin regimen to be a bother.
Over the past several months he has experienced nocturia, proteinuria, straw-colored urine with occasional blood streaks and reports that the amount is less than normal. He reports swelling in his hands and feet and some muscle weakness and cramping.
Current Medications:
Lisinopril 2.5 mg oral daily
Furosemide 40 mg oral daily
Atorvastatin 40 mg oral daily
Semaglutide 1 mg subcutaneous weekly
Insulin glargine 60 units daily
Regular insulin per sliding scale before meals
Laboratory results have revealed consistent changes over the past 3 months and on admission revealed:
GFR at 29 mL/min
BUN 60 mg/dL (21.1 mmol/L)
Creatinine 4.8 mg/dL (424 mcmol/L)
Potassium 4.5 mEq/L (4.5 mmol/L)
Sodium 150 mEq/L (150 mmol/L)
Hemoglobin 10.2 g/dL (102 g/L)
Total cholesterol 275 mg/dL (6.87 mmol/L)
The client is scheduled to receive his first peritoneal dialysis treatment today. The nurse assesses the client, assesses the morning laboratory results, and documents the following in the nurses' notes at 0900:
Alert and oriented. Reports ate breakfast at 0700 prior to coming to the clinic. Vital signs: temperature: 101° F (38.3° C), heart rate (HR): 100 beats per minute, respirations 22 breaths per minute, blood pressure 190/120 mm Hg, O2 saturation: 94% room air, pain at peritoneal catheter site 2/10. Complains of a throbbing headache.
Height 5' 10", weight 240 lb (108.8 kg).
Blood glucose postprandial 132 mg/dL (7.4 mmol/L).
Client reports being confused about his first dialysis treatment.
1+ edema in lower legs and feet bilaterally.
Denies chest pain, lung sounds clear, had BM last evening, abdomen soft.
Reports approximately 20 mL urine output during the night.
ECG rate of 100 regular, tall peaked T waves, flat P waves, widened QRS, prolonged PR interval.
A. Which findings of the above Nurse's note requires immediate follow up by the nurse? (write down your answer)
The client is scheduled to receive his first peritoneal dialysis treatment today. The nurse assesses the client, assesses the morning laboratory results, and documents the following in the nurses' notes at 0900:
Laboratory Results
BUN 64 mg/dL (23 mmol/L)
Creatinine 5.1 mg/dL (450.5 mcmol/L)
Potassium 6.5 mEq/L (6.5 mmol/L)
Sodium 155 mEq/L (155 mmol/L)
Hemoglobin 10.2 g/dL (102 g/L)
B. Which findings of the above Lab results require immediate follow up by the nurse? (write down your answer)
C. Which findings in the Nurse's 0900 notes require immediate follow up by the nurse? Briefly explain your rationale.
D. Which findings in the 0900 Lab results require immediate follow up by the nurse? Briefly explain your rationale.