NR 324 RUA Case Study Chronic Kidney Disease Adult
Health I Chamberlain College of Nursing
Managing Chronic Kidney Disease
Patient Natasha Williams is a 45-year-old African American female who came into the
emergency room on Tuesday, May 28, 2019, at 1800 with a chief complaint of swelling in both
feet and ankles. N.W. says that the swelling has been present for the past three days.
Health History
During the interview process it was discovered that Natasha Williams past medical
history includes obesity, hypertension, diabetes (diagnosed five years ago), and chronic kidney
disease (diagnosed within the last year). N.W.’s family health history includes her mother, who
has hypertension, and her father, a non-compliant diabetic who died last year. Mrs. Williams
states she has no known allergies. When asked how she felt about her overall health she stated,
“I feel more tired than usual these days.” N.W. denies any history of surgery or blood
transfusion.
Her current home medications include Glipizide 10 mg once daily by mouth to manage diabetes,
and Tylenol 650 mg by mouth every 4 hours as needed for pain. The patient states that she
currently works as a marketing technologist, which requires her to spend most of her days on the
computer and making phone calls. N.W. has a history of smoking a pack of cigarettes a day for
the past twenty-five years, and drinks alcohol three nights out of the week to relax from work
when she gets home. N.W. is married with two children, ages five and seven. She says her
husband does most of the cooking at home, but with her busy schedule she normally picks up
fast food.
Focused assessment findings: patient is alert with some confusion. Vital signs: Temp 97.7
NR 324 RUA Case Study Chronic Kidney Disease Adult
Health I Chamberlain College of Nursing
, NR 324 RUA Case Study Chronic Kidney Disease Adult
Health I Chamberlain College of Nursing
F, Pulse rate: 116 bpm, Respirations: 20, Blood pressure: 142/92. Lung sounds are clear in all
lobes, tachycardia noted with cardiac sounds, no murmur auscultated, no JVD noted, upper
extremity skin color appropriate to race, lower extremity skin color is ashen, no hair is present on
lower extremities (patient reports using Nair hair removal), 2+ moderate pitting edema on left
and right lower extremities, grade 1+ dorsalis pedis pulse, capillary refill > 2 seconds, legs cool
to touch. As per doctor orders, patient labs will be drawn, results are pending until the
morning.
Laboratory and Diagnostic Testing
Patient Natasha Williams laboratory tests results at 0630 on Wednesday, May 29, 2019.
Creatinine Clearance: 14 GFR: 17
(Normal: 60+ mL/min) (Normal: 90-120/min/1.73 m2)
BUN: 30 A1C: 8.5
(Normal: 7-20 mg/dL) (Normal: <5.7%)
Creatinine: 3 Hgb: 11
(Normal: 0.5-1.1 mg/dL) (Female Normal: 12-16 g/gL)
Sodium: 149 Hct: 35
(Normal: 135-145 mEq/L) (Female Normal: 36-46%)
Potassium: 7 Glucose: 136
(Normal: 3.5-5 mg/dL) Normal: Fasting: <100
Before meal: 70 - 130
After meal: (1-2 hrs) <180
A1c: Less than around 7.0%
Laboratory tests used to diagnose and monitor chronic renal failure include blood studies,
NR 324 RUA Case Study Chronic Kidney Disease Adult
Health I Chamberlain College of Nursing
Health I Chamberlain College of Nursing
Managing Chronic Kidney Disease
Patient Natasha Williams is a 45-year-old African American female who came into the
emergency room on Tuesday, May 28, 2019, at 1800 with a chief complaint of swelling in both
feet and ankles. N.W. says that the swelling has been present for the past three days.
Health History
During the interview process it was discovered that Natasha Williams past medical
history includes obesity, hypertension, diabetes (diagnosed five years ago), and chronic kidney
disease (diagnosed within the last year). N.W.’s family health history includes her mother, who
has hypertension, and her father, a non-compliant diabetic who died last year. Mrs. Williams
states she has no known allergies. When asked how she felt about her overall health she stated,
“I feel more tired than usual these days.” N.W. denies any history of surgery or blood
transfusion.
Her current home medications include Glipizide 10 mg once daily by mouth to manage diabetes,
and Tylenol 650 mg by mouth every 4 hours as needed for pain. The patient states that she
currently works as a marketing technologist, which requires her to spend most of her days on the
computer and making phone calls. N.W. has a history of smoking a pack of cigarettes a day for
the past twenty-five years, and drinks alcohol three nights out of the week to relax from work
when she gets home. N.W. is married with two children, ages five and seven. She says her
husband does most of the cooking at home, but with her busy schedule she normally picks up
fast food.
Focused assessment findings: patient is alert with some confusion. Vital signs: Temp 97.7
NR 324 RUA Case Study Chronic Kidney Disease Adult
Health I Chamberlain College of Nursing
, NR 324 RUA Case Study Chronic Kidney Disease Adult
Health I Chamberlain College of Nursing
F, Pulse rate: 116 bpm, Respirations: 20, Blood pressure: 142/92. Lung sounds are clear in all
lobes, tachycardia noted with cardiac sounds, no murmur auscultated, no JVD noted, upper
extremity skin color appropriate to race, lower extremity skin color is ashen, no hair is present on
lower extremities (patient reports using Nair hair removal), 2+ moderate pitting edema on left
and right lower extremities, grade 1+ dorsalis pedis pulse, capillary refill > 2 seconds, legs cool
to touch. As per doctor orders, patient labs will be drawn, results are pending until the
morning.
Laboratory and Diagnostic Testing
Patient Natasha Williams laboratory tests results at 0630 on Wednesday, May 29, 2019.
Creatinine Clearance: 14 GFR: 17
(Normal: 60+ mL/min) (Normal: 90-120/min/1.73 m2)
BUN: 30 A1C: 8.5
(Normal: 7-20 mg/dL) (Normal: <5.7%)
Creatinine: 3 Hgb: 11
(Normal: 0.5-1.1 mg/dL) (Female Normal: 12-16 g/gL)
Sodium: 149 Hct: 35
(Normal: 135-145 mEq/L) (Female Normal: 36-46%)
Potassium: 7 Glucose: 136
(Normal: 3.5-5 mg/dL) Normal: Fasting: <100
Before meal: 70 - 130
After meal: (1-2 hrs) <180
A1c: Less than around 7.0%
Laboratory tests used to diagnose and monitor chronic renal failure include blood studies,
NR 324 RUA Case Study Chronic Kidney Disease Adult
Health I Chamberlain College of Nursing
