primary medical Dx stage II RF, secondary medical Dx dehydration, Chronic illnesses?

Daytonite, BSN, RN · Oct 22, 2009

Isn't your primary medical diagnosis what the patient was admitted for? If so, then it is the dehydration. The patient's signs and symptoms will be that of dehydration and that is what the doctor is admitting and treating him for.

RNstudentc/o2010 · Oct 22, 2009

Oh okay... well, would the secondary be renal failure? Lab tests later confirmed that the pt had renal failure, but can't renal failure be caused by dehydration?

Thank you for helping me!!!

Daytonite, BSN, RN · Oct 22, 2009

can't renal failure be caused by dehydration?

did you read the physician's progress notes? is this acute or chronic renal failure? there is a distinction. chronic renal failure is usually a long standing problem that happens over a long period of time. this patient has hypertension. what is the pathophysiology of the hypertension?

morte, LPN, LVN · Oct 22, 2009

Hi, I am working on my care plan and I have never had a patient with a secondary medical diagnosis. However, the patient I was just assigned to care for does, and the link between the primary and secondary medical diagnosis is a clean picture. I hope that I am doing this right!
He was admitted for dehydration, and the doctor later confirmed that he did in fact have stage 2 renal failure. He also had CAD, HTN, COPD, colon cancer, CHF, and glaucoma.
I was just wondering if I am doing this right: I think that the Primary med. Dx is stage 2 renal failure. I think that the secondary diagnosis is dehydration. I think that the chronic illnesses are the CAD, COPD, colon cancer, HTN, CHF, and glaucoma.
Am I doing this right? Thank you for taking the time to read my entry and try to help me. Have a great day!!!

i am thinking, this may be renal failure, secondary to, dehydration......

RNstudentc/o2010 · Oct 24, 2009

I did read the progress notes, and the progress notes indicated that the pt is in stage II chronic renal failure. He is dehydrated and also malnourished. I thought it was odd that he was being prescribed a diuretic for his HTN even though he was Dx'd with dehydration. Does this strike anyone else as odd? Even if he was taking this at home, should it have been discontinued until his hydration status was stabilized? It just doesn't seem to me that the dehydration could be reversed if the pt is taking a diuretic. Plus, his 24h I&O was 750 cc and 4400 cc via foley. I did not hear crackles, but I heard rhonchi bilaterally.

He is also being prescribed NS 10 mL Q24H. I know that this is an isotonic solution, so he is probably taking this for his dehydration. This probably also indicates that his e-lytes are proportionately balanced, right? This would also lead to an increase in BP secondary to increase in blood volume, though. He was not hypertensive while in the hospital, and his BP was 132/64, but he was AFib on the monitor. So, he is probably still taking the diuretic because the NS is compensating, but 10 mL q24h is not enough compensation, is it? Maybe he needs to increase his BP because this is a low value for him because his body has adjusted to the HTN and the HTN is his new WNL, right? His SaO2 high was 98% and the low was 95%.

I know that I probably have some errors up there. Can you help me figure out how I am looking at the situation wrong? Thank you for helping me.

So, do you think that maybe the dehydration caused the RF in this pt? would both of these still be the primary Dx with no secondary, and all of the chronic D/o's listed under chronic conditions? His HTN is a chronic condition and is not limited to this visit. I think that I forgot to include a few of the chronic conditions, also: CAD, angina, CHF ("Acute/chronic systolic"), chronic bronchitis, open angle glaucoma, cataracts, colon cancer, and GERD.

Thank you so much for all of your help! This care plan is a real kicker, but I have learned a lot from my interaction with this pt.

I also have another question I wanted to ask. I am going to post it in this message and I am also going to post it as a separate entry. This pt's oral mucosa was bright pink (very strange coloration). His tongue had longitudinal grooves in it (fissures) and his tongue was bubble-gum pink... almost like a hot pink. I know that findings associated with anemia and dehydration are often fissured, smooth tongue that is dark "beefy" red in coloration. Is there another condition in which the pt's mouth will appear bright pink with a fissured tongue? His tongue was not coated. The whole tongue was bubble-gum pink. The texture of his tongue reminded me of a piece of wood, and I could not see any taste buds. His lips and gingivae were the same way. I couldn't really evaluate his conjunctiva because he has open angle glaucoma and his conjunctiva and sclera were extremely dry and reddened.

Thank you so much for your help! Thank you for guiding me in this assessment.

RNstudentc/o2010 · Oct 24, 2009

is there a distinction between a secondary medical Dx and a Dx secondary to another Dx?

Daytonite, BSN, RN · Oct 24, 2009

before you go any further you need to read up on and learn about chronic renal failure in order to better understand what is going on with this patient. the dehydration and malnutrition are complications of the renal failure. i told you previously to investigate the pathophysiology of this patient's hypertension. it may not be related to the renal problem. look carefully at the diuretic that was prescribed and what it does pharmacologically. does it do more than just cause the patient to diurese fluid?

see

http://www.kidneyschool.org/splash/toc.shtml -- kidney school
http://www.renalinfo.com/us/ -- what is kidney failure?
http://www.ccmtutorials.com/renal/index.htm

is there a distinction between a secondary medical dx and a dx secondary to another dx?

no