NUR 133 MED SURG END STAGE RENAL
DISEASE CASE STUDY
Scenario K.B. is a 32-year-old woman being admitted to the medical floor for complaints of 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.
1. What aspects of your assessment support her admitting diagnosis of dehydration?
- Patient’s poor skin tugor, mucous membranes are dry. The patient’s inability to eat or drink for
the past two days with severe diarrhea would conclude the patient’s output is higher than the
patient’s intake. The patient also appears drowsy.
2. 2. Explain any laboratory results that might be of concern
- Patient’s BUN and Creatinine are elevated. Patients Glucose level is elevated. Patient’s Potassium
level is elevated. Patient’s Chloride level is low.
3. 3. Identify two possible causes for K.B.'s low-grade fever.
- It could possibly be a bacterial or viral infection.
- Reaction to medication
- It can be the body is beginning to prepare to defense against potential threats
Case Study Progress The rest of K.B.'s physical assessment is within normal limits. You note
that she has an arteriovenous (AV) fistula in her left arm
4 . What is an AV fistula? Why does K.B. have one?
- It is a device that a surgeon will put in a patient who is receiving dialysis. The surgeon connects
an artery to a vein. It provides the highest blood flow for dialysis patients. It will last long and
the device is less likely to become infected or clotted. It makes a blood vessel wider to allow the
flow of blood to circulate while on dialysis.
- They use Heparin to keep it from clotting.
- Check PPt lab vaules
- K.B has end stage renal failure and is currently on dialysis for the past two years.
5.What steps do you take to assess K.B.'s AV fistula, and what physical findings are expected? Explain
- Check for Bruit with a Stethoscope, this will determine if it’s patent in the patient's arm.
DISEASE CASE STUDY
Scenario K.B. is a 32-year-old woman being admitted to the medical floor for complaints of 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.
1. What aspects of your assessment support her admitting diagnosis of dehydration?
- Patient’s poor skin tugor, mucous membranes are dry. The patient’s inability to eat or drink for
the past two days with severe diarrhea would conclude the patient’s output is higher than the
patient’s intake. The patient also appears drowsy.
2. 2. Explain any laboratory results that might be of concern
- Patient’s BUN and Creatinine are elevated. Patients Glucose level is elevated. Patient’s Potassium
level is elevated. Patient’s Chloride level is low.
3. 3. Identify two possible causes for K.B.'s low-grade fever.
- It could possibly be a bacterial or viral infection.
- Reaction to medication
- It can be the body is beginning to prepare to defense against potential threats
Case Study Progress The rest of K.B.'s physical assessment is within normal limits. You note
that she has an arteriovenous (AV) fistula in her left arm
4 . What is an AV fistula? Why does K.B. have one?
- It is a device that a surgeon will put in a patient who is receiving dialysis. The surgeon connects
an artery to a vein. It provides the highest blood flow for dialysis patients. It will last long and
the device is less likely to become infected or clotted. It makes a blood vessel wider to allow the
flow of blood to circulate while on dialysis.
- They use Heparin to keep it from clotting.
- Check PPt lab vaules
- K.B has end stage renal failure and is currently on dialysis for the past two years.
5.What steps do you take to assess K.B.'s AV fistula, and what physical findings are expected? Explain
- Check for Bruit with a Stethoscope, this will determine if it’s patent in the patient's arm.
