Closer Attention 1
Running head: WE NEED TO ACT FAST
Excretion is Key
Marian N. Guerrero BSN, RN
The University of Texas at Arlington College of Nursing
In partial fulfillment of the requirements of
N5315 Advanced Pathophysiology
John D. Gonzalez DNP, RN, ACNP-BC, NP-BC
January 28, 2017
, 2
WE NEED TO ACT FAST
Excretion is Key
1. What four etiologies in this case are responsible for causing hyperkalemia? How do each
of the etiologies cause hyperkalemia?
Answer:
End stage renal disease(ESRD), anemia, HIV and lack of proper medication
management. Due to ESRD, Mr. X is not producing urine, potassium is not being
excreted from his body and this is causing hyperkalemia. The elevated BUN and
creatinine, hyperphosphatemia and anemia reflect renal failure. The renal tubules are
secreting potassium; however, the potassium is not leaving the body and dialysis is
urgently needed. Hypervolemia is evidenced by 2+ pitting edema to his bilateral lower
extremities, shortness of breath and anemia. The kidneys are not producing red blood
cells because they are failing, the lack of red blood cells but increase of fluid increases
the cardiac workload and decreases pulmonary function (McCance, Huether, Brashers, &
Rote, 2014).
Having a patient with HIV and ESRD can present a challenge for a provider when it
comes to medication management; however, it is necessary to understand drug
interactions and adverse effects. Mr. X is taking several different classifications of
medications including sulfamethoxazole- trimethoprim, which is typically used to treat
opportunist infections in those that have HIV. This medication has been shown to cause
hyperkalemia along with other electrolyte imbalances as well as Didanosine
(Salfu&Misra,2015). Mr. X is taking several medications that are contraindicated with
noted adverse effects in those with renal impairment, some of these medications have
safer renal doses; however, he is taking high dosages.
Running head: WE NEED TO ACT FAST
Excretion is Key
Marian N. Guerrero BSN, RN
The University of Texas at Arlington College of Nursing
In partial fulfillment of the requirements of
N5315 Advanced Pathophysiology
John D. Gonzalez DNP, RN, ACNP-BC, NP-BC
January 28, 2017
, 2
WE NEED TO ACT FAST
Excretion is Key
1. What four etiologies in this case are responsible for causing hyperkalemia? How do each
of the etiologies cause hyperkalemia?
Answer:
End stage renal disease(ESRD), anemia, HIV and lack of proper medication
management. Due to ESRD, Mr. X is not producing urine, potassium is not being
excreted from his body and this is causing hyperkalemia. The elevated BUN and
creatinine, hyperphosphatemia and anemia reflect renal failure. The renal tubules are
secreting potassium; however, the potassium is not leaving the body and dialysis is
urgently needed. Hypervolemia is evidenced by 2+ pitting edema to his bilateral lower
extremities, shortness of breath and anemia. The kidneys are not producing red blood
cells because they are failing, the lack of red blood cells but increase of fluid increases
the cardiac workload and decreases pulmonary function (McCance, Huether, Brashers, &
Rote, 2014).
Having a patient with HIV and ESRD can present a challenge for a provider when it
comes to medication management; however, it is necessary to understand drug
interactions and adverse effects. Mr. X is taking several different classifications of
medications including sulfamethoxazole- trimethoprim, which is typically used to treat
opportunist infections in those that have HIV. This medication has been shown to cause
hyperkalemia along with other electrolyte imbalances as well as Didanosine
(Salfu&Misra,2015). Mr. X is taking several medications that are contraindicated with
noted adverse effects in those with renal impairment, some of these medications have
safer renal doses; however, he is taking high dosages.
