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Order ID 932888, RENAL COMPONENT ASSESSMENT (IN ITU) Pages:9 Language Style: English (U.K.) Style: Harvard Degree Grade Project description 90 year old lady Past Medical History: *Hypertension *Cataracts *Previous rectal prolapse Initially Presented to Accident and Emergency three days prior to ITU admission with abdominal pain, treated for urinary tract infection with Trimethoprim and sent home. Presented on day of admission with nausea, distended abdomen.Anuric for 3 days.Showing ventricular ectopic beats on ECG. Bloods: Creatinine 984, Urea 54.8, Potassium 8.7, CK 227, CRP 177. PERFORMANCE CRITERIA: 1. Can assess, plan, implement and evaluate care efficiently and effectively for patients suffering with renal dysfunction. 2. Demonstrates advanced knowledge of renal anatomy and physiology. 3. Demonstrates advanced understanding of renal conditions (e.g. acute renal failure) and therapeutic interventions for them. 4. Evaluates the effects of the renal system on other body systems (e.g. cardiovascular, respiratory). 5.Demonstrates ability to link SIRS/sepsis/MODS with renal system. 6. Demonstrates advanced understanding of filtration techniques and related therapies (e.g. treat of hyperkalaemia). Please can you follow this criteria and make sure that it is written in UK Standard English. source..

Renal dysfunction
The ITU admission case study
Renal dysfunction
This paper focuses on discussing renal dysfunction. The first part discusses a case study presented to ITU. Evaluation of the case study helps understand connections between symptoms that may lead to kidney failure. The paper describes how a patient suffering from renal dysfunction can assess, plan, implement and evaluate care efficiently and effectively. The paper also demonstrates knowledge of renal conditions and therapeutic interventions for them. The paper demonstrates links between SIRS, sepsis, and MODS to renal failure. It also evaluates effects of renal system failure to the cardiovascular system.
Case study analysis: The ITU admission case
The 90-year-old woman, (Mrs. Dodds) as per the medical history, is suffering from a urinary tract infection (ITU). Mrs. Dodds is not an actual name for the patient but it is used in this paper for confidentiality purposes according to NMC. Her past medical history shows that she suffers from hypertension, which is one of the causes that may lead to renal failure. She displays an eye disease (cataract) in which the clear lens of the eye becomes cloudy and at extreme cases opaque, causing a decrease in vision (Arora, 1999). There are other causes relating to the condition. Most of the causes are brought by changes of the proteins patterns forming the lens. Protein is arranged in a specific way that keeps the lens clear to allow light passage through to the retina surface. The change in protein pattern is a symptom of urinary tract infection that can lead to renal failure (Watt, Harris & show, 2010). She also has had a rectal prolapse. The rectal prolapse may have been partial, involving only the mucosa. It may have completed involving the entire wall of the rectum. It is a condition most observed in adults though it can occur in children too. It is occasionally connected to urinary tract infections that spread to other parts (Stengel, 2003).
Mrs. Dodds present symptoms that are suggestive she is suffering from a complete renal dysfunction. Nausea is caused by many factors including gallbladder disease, intense pain, medicines meant to induce vomiting, infections, gasttoparesis or slow stomach emptying (a condition often detected among diabetic patients), and urinary tract infections among other causes. She suffers from distended abdomen suggesting that she suffers from discrete mass or enlargement of an organ. Fluids (ascites) in the human body may cause this condition (Stengel, 2003). She presents anuric for 3 days meaning urine is not secreted as is supposed to in a normal functioning body. Anuria may be caused by kidney dysfunction, a decline in blood pressure below the required levels to maintain filtration pressure in the kidneys, or an obstruction in the urinary passages such as urinary tract infections. Dodds (2004) stipulates that when the body is not functioning well, a person may display premature ventricular complex.
In a case study analyzed by Armitage & Tomson (2003), the symptoms are suggestive that the elderly woman was suffering from kidney dysfunction. Her heartbeat is initiated by Purkinje fibers in the ventricles rather than by the sinoatrial node, the normal heartbeat initiator. Medical studies suggest that the above condition may be initiated by chemical (electrolyte) problems in the blood. The chemicals may also be associated with kidney diseases. Strong evidence suggesting the patient is suffering from kidney dysfunction is seen in blood creatinine ranging up to 984, urea up to 54.8, potassium 8.7, CK 227 and CRP (c-reactive protein) 177. The level of potassium is very high suggesting that the kidneys are not functioning well to excrete excess of it (Armitage & Tomson, 2003).When Mrs. Dodss is admitted at ITU, she is prescribed with actrapid, which is a medicine used by patients suffering from diabetes mellitus (Armitage & Tomson, 2003). Calcium gluconate injection is an oxidation product of glucose. It is used to prevent or treat low blood calcium levels or hypocalcemia. Mrs. Dodds bones are weak, and she suffers from decreased parathyroid gland activities. Salbutamol is used to relief bronchospasm in conditions such as asthma and chronic obstructive pulmonary disease (Armitage & Tomson, 2003). Furosemide infusion is administered to a patient to promote the production of urine. Diuretics are used to treat heart failure, liver cirrhosis, and hypertension and certain kidney diseases. The medicine helps to increase excretion of substances such as aspirin in cases of overdose or poisoning (Armitage & Tomson, 2003).
Renal dysfunction
Components of normal urinary systems are the kidneys, ureters, and the urinary bladder. Kidneys are responsible for filtering the blood in order to remove the waste products and excess fluids from the body and form the urine. The kidneys are made of close to a million small filtering units called glomeruli (Armitage & Tomson, 2003). Blood will flow through tiny tubes and intricate network of blood vessels within the kidneys to the glomeruli in order to undergo the filtration process. All the waste and excess water removed pass through the walls of the tube to form urine (John, Webb & young, 2004). For filtration to take place, certain conditions must be fulfilled, e.g. optimum body pressure must be met (Armitage & Tomson, 2003).
Renal failure is attributed to the failure of normal filtration functions of the kidneys. The kidneys fail to remove metabolic products from the blood and regulate the fluids, electrolyte, and pH balance of the extra cellular fluids. Underlying causes for the above condition may be renal disease, systemic disease, or urologic defects (John, Webb & young, 2004). Renal failure may take two shapes, acute and chronic (Walker & Edwards, 2009). Acute renal failure takes shape abruptly in onset and may be prevented from further encroachment if it is detected early. On the other hand, chronic defect occurs after the effects are beyond a reverse point. The damage done to the kidney is severe such that they cannot be restored back to their original functioning (Shihabi & Meltons, 2007).
Renal anatomy and physiology
Renal physiology is the study of all functions of the kidneys. These functions include reabsorption of glucose, amino acids, regulation of sodium, potassium, and other electrolytes, Regulation of fluid balance and blood pressure, maintenance of acid-base balance, production of various hormones including erythropoietin, and the acticvation of vitamin D (Walker & Edwards, 2009). For healthy kidneys, formation of urine begins with a passive ultra filtration process. Kidneys maintain the homeostasis of several important internal conditions by controlling excretion of substances out of the body (Shihabi & Meltons, 2007). Within the process, water, and associated dissolved small molecules is determined by hydrostatic and oncotic pressures. Glomerular capillaries are more permeable to water and crystalloid than muscle capillaries are (John, Webb & young, 2004). Plasma oncotic pressure rises due to movement of fluids along the capillaries. The movement is associated with a net loss of water into the Bowman's space (Dodds, 2004).
The typical glomerular filtration rate (GFR) is 180 liters per day, or 125ml/min. Out of this amount, 1-2 liters per day are excreted as urine (Shihabi & Meltons, 2007). This implies that almost 99% of the filtered volume is reabsorbed. The kidneys have an ability of secrete hydrogen ion and potassium ion (John, Webb & young, 2004). This capability is vital in regulation of pH. Sodium excretion is at an increase when the GFR increases and is decreased by reduced re-absorption levels and vice versa. On the other hand, GFR is controlled by changes in glomerular capillaries pressure. Kidneys control excretion of potassium, sodium, calcium, magnesium, phosphate, and chloride ions into the urine (Watt, Harris & show, 2010).
When the levels of these ions reach a higher level, kidneys increase their excretion out of the body to return them to normal and vice versa (Shihabi & Meltons, 2007). The kidneys are also responsible for the regulation of levels of hydrogen ions (H+) and bicarbonate ions in the blood to control blood pH (Watt, Harris & show, 2010). H+ ions are as a result of dietary metabolism of proteins and accumulated blood over time. Excess ions are excreted to the urine for elimination to from the body (Watt, Harris & show, 2010). Kidneys also conserve bicarbonate ions, which act as important pH buffer in the blood. Kidneys maintain the body osmotic balance to facilitate fluid and electrolyte balance. Kidneys filter the wastes of body metabolism such as urea from protein metabolism and uric acid from DNA breakdown (John, Webb & young, 2004).
According to Armitage and Tomson (2003), the kidneys decide which amount of waste to excrete as urine such that when a person is dehydrated resulting from any cause, the kidneys will hold onto as much water as possible, and the urine becomes very concentrated. If the body has retained adequate water, the kidneys will excrete dilute amounts of urine, which are clear on observation. The kidneys produce a hormone called renin that regulates the above procedure in their function of maintaining regular blood pressure in the body systems (Armitage & Tomson, 2003).
Kidney nephrology
Kidney nephrology is a branch of medical science that deals with diseases of the kidneys. Each nephron begins with a filtration component that filters blood entering the kidneys. The filtration then flows along the length of the nephron, which is a tubular structure lined by a single layer of specialized cells and surrounded by capillaries. The linings reabsorb water and small molecules from the filtration into the blood and secretion of wa...
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