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Doctors Lounge - Nephrology Answers
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| cockerham
- Thu Feb 03, 2005 6:44 am |
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Hi, I wrote yesterday about a case study I was working on. I didn't give all the information so the doctor was unable to answer my question. here is the complete case study. Mr. RF, 96, was brought into the ED by his son due to extreme confusion that had progressed rapidly throught the day. His son indicated that he had never seen his father like this, generally he's healthy, oriented, and able to get around using his walker. In fact, yesterday Mr. F. watched TV and worked on crossword puzzles. But at breakfast today, he didn't know it was morning, and by lunchtime, he was unsure where he was and throught he was eating dinner. By midafternoon, he knew little more than his name. The ED physician diagnosed abnormal mental state and admitted him to the 23-hour observation unit where you work. As you review the ED form you note that at admission Mr. Ft's temperature was 104F (orally), P 86 (regular), R 18 (clear and unlabored), BP 90/40. Admitting lab values were: WBC 30,300 mm3, RBC-3.61 millioin/mme, Hgb 11.6 gm/kL, Hct 34.3%. At 1630 an IV (1000mL) of 0.9% NS was begun @ 75 mL/hr. He received 150 mg of Gentamycin IM and 1g of Ampicillin IV. As you assess Mr.F. you note that his skin is warm, dry, and lacks turgor. His temp is 99F (orally), P 80 (regular), R 18 (regular and even), BO 106/54. He has no abdominal or chest pain and no cough. He doesn't take any medications and has an uneventful medical history, except for surgery 4 mos ago to correct a factured right hip. Since then he's had an indwelling urinary catheter to relieve urinary retention. He has received 150mL of the IV NS and his uring output has been at least 30mL/h. Serum chemistry tests ordered in the ED resulted in the following: Na 137 mEq/L, K 3.8 mEq/L, chloride 106 mEq/L, co2 18 mmol/L, BUN 19 mg/dL, creatinine 1.0 mg/dL. Microscopic urinalysis revealed bacteria and a high number of WBC, urine culrue showed more than 100,000 oranisms/mL, chest X-ray was negative.
From this information, we are to determine if this patient has impaired renal functioning. With his BUN and Creatinine being WNL, is this possible? I know his age will factor in this decision also.
thanks
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| Theresa Jones, RN
- Mon Feb 07, 2005 9:18 am |
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 Hi cockerham,
I have not yet read your other post but from what you describe here, In my opinion I would consider urosepsis or septicemia.
Sincerely,
Rntdj
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