Question 1 Interpret Mrs. Davies’s laboratory test results and describe their significance. Question 2 What is the most likely cause of Mrs. Davies’s AKI? Question 3 What additional tests, if needed, could be done to determine the cause of AKI? Question 4 What are the priority nursing diagnoses to address the concern of fluid retention? Question 5 What are the priority nursing interventions for these nursing diagnoses?

Question 1: Interpret Mrs. Davies’s laboratory test results and describe their significance.

Mrs. Davies’s laboratory test results provide valuable information in understanding her condition. The following test results are significant:

1. Serum Creatinine: Mrs. Davies’s serum creatinine levels are elevated at 3.2 mg/dL. Elevated serum creatinine is one of the diagnostic criteria for acute kidney injury (AKI). It indicates impaired kidney function, as the kidneys play a crucial role in eliminating creatinine from the body. The higher the serum creatinine, the more severe the impairment of kidney function.

2. Blood Urea Nitrogen (BUN): Mrs. Davies’s BUN levels are elevated at 35 mg/dL. Like serum creatinine, elevated BUN levels are indicative of impaired kidney function. BUN is a waste product that is normally filtered out by the kidneys. When the kidneys are not functioning properly, BUN accumulates in the blood.

3. Urine Output: Mrs. Davies has decreased urine output at 200 mL over 24 hours. Decreased urine output is a common symptom of AKI. It indicates reduced kidney filtration and the inability to eliminate waste products effectively. Monitoring urine output is an important measure in assessing kidney function and determining the severity of AKI.

4. Urinalysis: Mrs. Davies’s urinalysis shows the presence of red blood cells (RBCs) and proteinuria. RBCs in the urine may suggest glomerular injury or damage to the kidney’s filtering units. Proteinuria indicates leakage of protein into the urine, which is also a sign of kidney dysfunction. These findings further support the diagnosis of AKI and suggest underlying kidney damage.

Question 2: What is the most likely cause of Mrs. Davies’s AKI?

The most likely cause of Mrs. Davies’s AKI can be attributed to prerenal factors. Prerenal AKI refers to a condition where decreased blood perfusion to the kidneys results in impaired renal function. In Mrs. Davies’s case, the following factors support the prerenal etiology:

1. Hypovolemia: Mrs. Davies’s history of persistent diarrhea points to a potential cause of dehydration. Dehydration can decrease blood volume, leading to decreased renal perfusion and subsequent AKI.

2. Hypotension: Mrs. Davies’s BP reading of 90/60 mmHg indicates low blood pressure. Hypotension can reduce the blood flow to the kidneys, compromising their ability to filter waste products effectively.

3. Pre-existing renal artery stenosis: Mrs. Davies’s history of renal artery stenosis can further exacerbate prerenal perfusion impairment. Renal artery stenosis narrows the blood vessels supplying the kidneys, resulting in reduced blood flow and increased susceptibility to prerenal AKI.

4. Medication use: NSAIDs, diuretics, and ACE inhibitors are known to affect renal blood flow. Mrs. Davies’s use of these medications may have contributed to her prerenal AKI. NSAIDs, in particular, can cause renal vasoconstriction and reduce renal blood flow, leading to AKI.

Question 3: What additional tests, if needed, could be done to determine the cause of AKI?

To determine the underlying cause of Mrs. Davies’s AKI, additional tests may be required. These tests can provide more specific information about the etiology of AKI. Potential additional tests include:

1. Renal ultrasound: A renal ultrasound can assess the size, structure, and blood flow to the kidneys. It can identify any structural abnormalities, such as kidney stones or obstruction, which may contribute to AKI.

2. Renal artery Doppler study: This study utilizes ultrasound to assess the blood flow through the renal arteries. It can help identify any significant stenosis or obstruction in the renal arteries, which could further support the diagnosis of prerenal AKI.

3. Urine sediment analysis: A more detailed analysis of the urine sediment can provide additional information about the underlying cause of AKI. It can help identify specific types of renal injury, such as glomerulonephritis or tubular injury.

4. Imaging studies: Depending on the clinical context, further imaging studies such as a CT scan or MRI may be warranted to identify any anatomical abnormalities or assess the presence of kidney masses or tumors.

These additional tests can help to determine the specific cause of Mrs. Davies’s AKI, assisting in guiding appropriate management strategies.