Acute/ Chronic Renal Failure

[nochka22]

Hi guys,

just took my test (school test), and there was a question that I kept going back and forth and could not make up my mind which one to pick as an answer. The question was asking about. which patient does the RN need to see first after receiving the change of shift report. I eliminated 2 asnwers, and 2 were left: 1.) ESRD patient who started experiencing a new frequent oncet of early ventricular contractions, 2.) ARF patient who was Kussmauling with the rate of 26 breaths/ min, HR 100. They both are important, first one I thought was leading towards V-Fib? and the second one was in met. acidosis? So, which one you would assess 1st, correct me if I'm wrong and if someone could explain the rationals would really appreciate. Thank you guys!!!

[Esme12, ASN, BSN, RN]

Think about your answer. Would you see the End Stage Renal Disease patient having some PVCs or the ACUTE renal failure patient with kussmaul. In real life I would do both simultaneously. I'd call lab for stat lytes, I'd call respiratory for stat Abgs for the other. I run past their rooms and see who,looked worse. I would probably go to the ARF first and do a quick 1,2,3 and be sure this isn't acute then I'd go to the ESRD for treatment and intervention will take time.

Now to the world of TEST questions...the ARF may be with a resp rate of 26 for a while and is just compensating for the acidosis that accompanies ARF and 26 isn't that fast. The other question specifically mentions that the PVC's are NEW and FREQUENT....my guess would be ESRD first for the new, potentially life threatening arrythmia.

[ckh23, BSN, RN]

I second that.

[reginakrys]

I would go with the ESRD patient too. Frequent PVC's can lead to V-Fib, a fatal circulatory problem. Kussmaul's respiration is a compensatory mechanism to balance the acidosis. So, between potential V-Fib and metabolic acidosis, I'd see the former first.

[mindlor]

I am firmly in the Esme12 camp.