Case Study

A nurse is caring for an 80-year-old patient who was admitted to the hospital with a diagnosis of dehydration. The patient stated he had been vomiting for 2 days and had been unable to take food or fluids. He has been healthy and currently takes only a diuretic for his blood pressure. On physical examination, the nurse notes the patient’s skin is dry with decreased turgor, oral mucous membranes are dry, heart rate is 100, and blood pressure is 90/60. The patient’s urine is dark amber with a specific gravity of 1.028. His urine output was 30 cc/hour for the past 4 hours since admission.
When reviewing the patient’s laboratory results the nurse notes the BUN is 60 and a creatinine of 1.2.

1. What type of renal failure is most often seen with dehydration?
Acute Renal Failure.
2. What signs and symptoms noted by the nurse are characteristic of renal failure?
Dehydration, blood pressure of 90/60, heart rate of 100 bpm, dry skin with decreased turgor, dry oral mucous membranes are dry, BUN level of 60 and creatinine of 1.2, and dark amber urine with a specific gravity of 1.028.

3. If the blood pressure continued to drop in this patient and the patient developed acute tubular necrosis, what would happen to the kidney tubule?
The kidney tubule would be damaged or destroyed.

4. What are the three phases of acute tubular necrosis? Identify two important nursing interventions for each phase.
The three phases of acute tubular necrosis are: Initiating phase-injury to tubules occurs; Maintenance phase-GFR decreases, nitrogenous waste increases, urine output decreases; Recovery phase- GFR, urine output, blood levels of nitrogenous wastes return to normal.

Phase I
-check vital signs
-give more fluid if not indicated, and maintain skin integrity

Phase II
-check lab values BUN and creatinine level,
-Document intake and output

Phase III
-check and document that blood levels of nitrogenous wastes and urine output return to normal.
-teach patient strategies to prevent recurrence and to take medications properly if any.