Renal disease Case Study
Renal disease Case Study 2
Case Scenario
K.B. is a 32-year-old woman being admitted to the medical floor for fatigue and dehydration. While taking her history, you discover that she has diabetes mellitus (DM) and has been insulin dependent since the age of 8. She has undergone hemodialysis (HD) for the past 2 years because of end-stage renal disease (ESRD). Your initial assessment of K.B. reveals a pale, thin, slightly drowsy woman. Her skin is warm and dry to the touch with poor skin turgor, and her mucous membranes are dry. Her vital signs are 140/88, 116, 18, 99.9° F (37.7° C). She tells you she has been nauseated for 2 days so she has not been eating or drinking. She reports severe diarrhea. The following blood chemistry results are back.
Laboratory Test Results
| Lab | Value | Reference |
| Sodium (Na + ) | 145 mEq/L | 135 – 145 mEq/l |
| Potassium (K + ) | 6.0 mEq/l | 3.5 – 5.0 mEq/l |
| Chloride (Cl – ) | 93 mEq/L | 96 – 106 mEq/l |
| Bicarbonate (HCO 3 – ) | 27 mEq/L | 22 – 26 mEq/l |
| BUN | 48 mg/dl | 6 – 20 mg/dl |
| Creatinine | 5.0 mg/dl | 0.6 – 1.2 mg/dl |
| Glucose | 238 mg/dl | 70 – 99 mg/dl (fasting) |
- What aspects of your assessment support her admitting diagnosis of dehydration?
- Explain any laboratory results that might be of concern.
- Identify 2 possible causes for K.B.’s low-grade fever.
- What is an AV fistula? Why does K.B. have one?
- What steps do you take to assess K.B.’s AV fistula, and what physical findings are expected? Explain.
- As you continue the assessment, you notice that the UAP comes in to take K.B.’s BP. The UAP places the BP cuff on K.B.’s left arm. What, if anything, do you do?
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