i need help for this Case study i have exam coming up soon

[slivairegie]

K.B. is a 32 y.o. woman who is being admitted to the medical floor for complaints of fatigue and dehydration. While taking your nursing history you discover that she has diabetes and has been insulin dependent since the age of eight. She has been in chronic renal failure (CRF) and undergoing hemodialysis for the past 3 years. Your initial assessment of K.B. reveals a pale, thin, lethargic woman in no acute distress. Her admitting chemistries are Na 145 mEq/L, K 5.5 mEq/L, Cl 93 mEq/L, HCO3 27 mEq/L BUN 40 mg/dl, creatinine 3.0 mg/dl, glucose 238 mg/dl. Her skin is warm and dry to touch with poor skin turgor, and her mucous membranes are very dry. Her VS are 140/88, 116. 18. 99.9F. She tells you she has been nauseated for 2 days so she has not been eating or drinking. She denies vomiting. The rest of K.B.'s physical assessment is within normal limits. She tells you she has an AV fistula in her left arm.

1. What aspects or your assessment support her admitting diagnosis of dehydration?

2. Identify 2 possibilities for K.B.'s low-grade fever.

3. What is a fistula? Why does K.B. have one?

4. In assessment of an AV fistula, what physical findings would you expect during auscultation and palpation? Why?

[JustBeachyNurse, LPN]

Ok so what do you need help with?

[slivairegie]

for answers of the case study. thank you.

[slivairegie]

with the Case sudy, i'm new from this website. thanks in advance..:)

[JustBeachyNurse, LPN]

What do you think? We are not here to do your assignments for you but to guide you once you show your own work/thoughts.

So again what do you think the answers are?

[NICU Guy, BSN, RN]

for answers of the case study. thank you.

Tell us what you think the answers are and will help guide you. You can not learn if we do it for you.

What in the assessment and labs would indicate dehydration?

Google AV Fistula or look in your book to find what it is for and what you would feel and hear when palpated and auscultated.

[slivairegie]

thank you guys, this is what have done so far, not sure if it is correct..

K.B. is a 32 y.o. woman who is being admitted to the medical floor for complaints of fatigue and dehydration. While taking your nursing history you discover that she has diabetes and has been insulin dependent since the age of eight. She has been in chronic renal failure (CRF) and undergoing hemodialysis for the past 3 years. Your initial assessment of K.B. reveals a pale, thin, lethargic woman in no acute distress. Her admitting chemistries are Na 145 mEq/L, K 5.5 mEq/L, Cl 93 mEq/L, HCO3 27 mEq/L BUN 40 mg/dl, creatinine 3.0 mg/dl, glucose 238 mg/dl. Her skin is warm and dry to touch with poor skin turgor, and her mucous membranes are very dry. Her VS are 140/88, 116. 18. 99.9F. She tells you she has been nauseated for 2 days so she has not been eating or drinking. She denies vomiting. The rest of K.B.’s physical assessment is within normal limits. She tells you she has an AV fistula in her left arm

1.What aspects or your assessment support her admitting diagnosis of dehydration?

1. Severediarrhea aggravates Mrs. KB’s condition. In addition to that vomiting and decreased food fluid intake may leavepatient to hypovolemic shock.

2. Poorskin turgor ,dry mucus membrane are clear signs of dehydration. Left untreatedcan lead to life threatening events.

3. Increasedblood pressure and pulse are short term compensatory mechanism to perfuse thevital tissues

All the above factshelps the treating team to come to a conclusion of admitting Mrs. KB.

.

2.Identify 2 possibilities for K.B.’s low-grade fever.

Dehydration causesdecreased urine output. Hence lead to stagnant urine collection in the bladdermake the patient prone to urinary tract infection further causes fever

Increased blood sugarprovide a better medium for the pathogen to grow ,which is another reasonbehind low grade fever

I'm still working on questions 3 & 4, what do you guys think on those answers,, thank you

[BuckyBadgerRN, ASN, RN]

Again, try to figure it out on your own. You could have found your answer on Google just as quickly as it took you to type it out here. Not sure why your instructor is assigning case studies with things like fistulas if you've never even heard of one. Find what a fistula is and you'll have your answer to #3 and 4! Good luck!

[Brett SPN]

Breakdown what you know...

SHE IS....

32 years old (young)

Type 1 diabetic

Female

ESRD- (little to no kidney function)

Dialysis x3 days x3 years (presumably 3x days)

Poor turgor

Dry membranes

PALE

Thin

Lethargic or obtunded

BS 238

Generally speaking, her lab values aren't that bad for a dialysis patient

Had no intake for x2 days

Skin is warm and dry

Temp 99.9

BP 140/88

P 116

RR 18

Base your diagnosis on what you know, not what you presume. I did not see anything about diarrhea or urinary retention but they are not unfounded assumptions. If I were you I would look harder at the implications and biological compensations of ESRD, hypovolemia, and acid/base balance.

[slivairegie]

thank you guys...

[schnookimz]

It seems that you're disregarding she's a dialysis patient. She may not be making urine! And there's a good chance that she is on a fluid restriction.

She should be weighed and this weight should be compared to her dry weight. If you aren't sure what that is, try googling "dialysis dry weight"