Module 8 Discussion

The Patient with Chronic Renal Failure

Mr. Rojas is a 49-year-old patient with End Stage Renal Disease. He has a history of hypertension and uncontrolled type 1 diabetes (since he was 12 years old). His last Hemoglobin A1c was 12.8%. He is currently receiving hemodialysis three times per week for three hours. He is in the hospital because he went into DKA a few days ago when he had a stomach virus. He is asking you about renal transplantation.

What are the criteria to be placed in the transplant list?

What options for transplantation does Mr. Rojas have?

What recommendations can you give Mr. Rojas on treatment compliance?

What other renal replacement therapies could Mr. Rojas be educated about?

What are their advantages and disadvantages?

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The Patient with Chronic Renal Failure

Introduction

The patient with chronic renal failure (CRF) comes to the emergency department because of renal colic.

The patient with chronic renal failure (CRF) comes to the emergency department because of renal colic.

The patient with chronic renal failure (CRF) comes to the emergency department because of renal colic. The patient has had constipation for 2 months, but it has worsened in the last week. He also complains that he has back pain, which was aggravated by eating dinner on Wednesday night.

The patient’s history includes no previous surgeries or trauma that could have caused his pain; he does not use any medications regularly and does not smoke or drink alcohol; he has no allergies but does take an over-the-counter medication for diarrhea once a day at bedtime every night since October 2018; his blood pressure is normal and so are his heart rate and respiratory rate; there are no other symptoms such as chest heaviness or shortness of breath despite sitting upright all day long while working at home doing manual labor jobs like painting walls etc..

Suspect that the symptoms are due to kidney stones.

• The most common cause of renal colic is a kidney stone.

• Kidney stones are small, hard deposits that form in the kidneys, usually when they become too big to pass through the urinary tract. They can also form inside other organs such as the bladder or ureter (the tube that carries urine from your kidneys to your bladder).

If you have kidney stones:

Make sure the patient doesn’t have signs and symptoms of complications, such as hyperkalemia and urosepsis, that could lead to cardiopulmonary arrest.

You should also make sure that the patient doesn’t have any signs or symptoms of complications, such as hyperkalemia and urosepsis (sepsis), which could lead to cardiopulmonary arrest. If a patient becomes ill with these conditions, they’ll need to be admitted to the hospital.

Begin intravenous hydration with normal saline to prevent dehydration and promote adequate urinary output and stone passage.

There are a few things that you can do to make the patient more comfortable in your care. The first is to start intravenous hydration with normal saline to prevent dehydration and promote adequate urinary output and stone passage.

If the patient is still not passing stones, increase the rate of infusion until they do so. If hyperkalemia is present, use a solution containing 5% glucose and 0.45% sodium chloride (e.g., Hartmann’s Solution)

Give an opioid analgesic, such as morphine or meperidine.

Opioids are the most effective painkillers. They work by mimicking the body’s own painkilling chemicals, so they are highly addictive and should not be used long term.

Obtain urine for urinalysis and culture.

Urinalysis is the most important part of your doctor’s evaluation because it’s used to determine the type, location, and amount of stones in your kidneys. The urinalysis may include:

• Dipstick test A simple way to check for blood in urine. It can be done by dipstick or microscopy.

• Microscopic examination Under high magnification (400x), any crystals or bacteria can be seen with this method. This can help guide treatment if you want to be treated sooner than later based on what’s going on with your kidneys

Place a low-set urinal or bedpan within reach so the patient can void without having to get out of bed.

• Place a low-set urinal or bedpan within reach so the patient can void without having to get out of bed.

• Place the bedpan on the side of your bed and make sure it’s within reach. If you have a roommate, ask them to hold it for you when you need to empty yourself at night.

When the patient has passed the stone, send it for analysis to guide prevention of another episode.

Once the stone has been passed, you may be able to prevent another episode by taking steps to reduce your risk of developing a stone. The following suggestions are based on the experiences of health care professionals.

• Don’t drink alcohol while taking medications that increase your risk of kidney stones.

• Don’t smoke or use tobacco products if you have chronic renal failure (CFR).

• Drink plenty of fluids so that urine output is increased along with urine dilution (enhanced urinary tract flow). This will help keep calcium and oxalate out of the bloodstream while allowing it to pass through the kidneys unchanged into urine where they can be excreted safely without forming stones or causing damage to cells lining those tubes in this organ system called nephrons (see below).

The treatment for kidney stones is based on their size and type.

The treatment for kidney stones is based on their size and type.

The patient should be monitored for signs of complications, such as hyperkalemia and urosepsis. He or she may also need to be given intravenous hydration with normal saline to prevent dehydration.

Conclusion

This is a typical presentation of CRF. The patient may have had renal colic, but the pain and nausea were probably not his first concern. Often, patients presenting with chronic renal failure (CRF) for the first time don’t realize that they need to seek medical attention, even though their symptoms can be serious. In many cases, you can prevent the development of further complications by immediately treating patients who have kidney stones in their system. This could mean giving them opioid analgesics like morphine or meperidine when they arrive at your hospital emergency department (ED). If they pass the stone while waiting here, send it off for analysis so you know what type of stone they most likely had and how best to prevent another episode from happening again!

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