Mrs. G. is a 74-year-old woman with a history of diabetes and hypertension. Two years ago she was diagnosed with an abdominal aortic aneurysm (AAA). Four days ago she was admitted to the cardiovascular intensive care unit postoperatively for repair of her AAA. Immediate postoperative data are as follows: temperature, 97.3° F (36.3°C); pulse rate, 120 beats/min; blood pressure, 87/50 mm Hg; respiratory rate, 18 breaths/min; and oxygen saturation by pulse oximetry (SpO 2 ), 98% (on 50% fraction of inspired oxygen [FiO 2 ]). Laboratory test on admission included Na + , 130 mEq/L; K + , 3.5 mEq/L; Cl – , 100 mEq/L; CO 2 , 18 mmol/L; blood urea nitrogen, 28 mg/dL; creatinine, 1.4 mg/dL; and glucose, 162 mg/dL. This morning, the data included temperature, 101.5° F (38.5°C); pulse rate, 80 beats/minute; blood pressure, 127/85 mm Hg; respiratory rate, 16 breaths/min; oxygen saturation by pulse oximetry (SpO 2 ), 96% (on 2 L/min by nasal cannula); Na + , 132 mEq/L; K + , 4.5 mEq/L; Cl , 105 mEq/L; CO 2 , 17 mmol/L; blood urea nitrogen, 45 mg/dL; creatinine, 2.1 mg/dL; and glucose, 122 mg/dL.

1.   Explain the pathophysiologic basis of the changes in Mrs. G.’s blood urea nitrogen and creatinine values before and after surgery.

2.   What are Mrs. G.’s risk factors for developing acute kidney injury?

3.   What are some of the nursing care priorities for Mrs. G.? What treatments could you anticipate for her?

4.   It is postoperative day 3 and Mrs. G. has developed acute kidney injury, with lab values now as follows: Na + , 138 mEq/L; K + , 5.2 mEq/L; Cl – , 1,109 mEq/L; CO 2 , 15 mmol/L; blood urea nitrogen, 67 mg/dL; creatinine, 3.9 mg/dL; and glucose, 154 mg/dL. What is the pathophysiologic basis for the change in Mrs. G’s CO 2 ? Her potassium?

5.   An arterial blood gas has been requested. What do you suspect the results will demonstrate?

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