Renal Case Study
Janet is a 32 year old female with end-stage renal disease (ESRD) R/T chronic
glomerulonephritis. She has been maintained on conservative therapy for the past year.
Today she presents at her scheduled 10:00 doctor's appointment c/o fatigue, lethargy, a
persistent headache and nausea. She explains that she has gained 4 pounds in the last week
accompanied by an even more pronounced decrease in urine output (total urine output of
100 ml daily).
Significant assessment and diagnostic information includes:
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Vital signs: BP 150/95, HR 95, Resp 26, Temp 98.0, & O2 sat. 94%;
3+ edema in her lower extremities and sacrum;
periorbital edema;
lungs CTA;
skin warm, dry, and tight with a yellowish discoloration.
ABGs: pH 7.34, PaCO2 30, HCO3 18, PaO2 90.
An ECG reveals normal sinus rhythm.
The physician orders her to be admitted to your hospital where she will receive her first
hemodialysis treatment at 14:00 by way of an AV fistula created two months ago in
preparation for this day.
Questions to ponder/answer…(answer questions on this page prior to looking at
questions on page 2)
A CBC and a full chemistry panel are pending. Based on your knowledge of ESRD, which of the
CBC and chemistry values do you expect to be increased, decreased, or WNL? What lab value
is the primary serum indicator of renal disease?
Why was a UA not ordered?
You believe that Janet is showing signs of fluid volume excess. What symptomology is
validating that thought process? Explain why.
What is the pathophysiology of her edema?
What type of acid-base imbalance does she have? Is compensation occurring? What
assessment and ABG information presented in this case study are of greatest importance in
determining this? What other electrolyte that is retained in renal failure is contributing to the
imbalance?
The physician wants Janet admitted to the cardiac unit for telemetry monitoring.
Why is cardiac monitoring important in this 32 year old patient without history of cardiac
disease whose EKG is normal?
As Janet's nurse on 2G (the cardiac unit) at PPMC, what additional signs and symptoms
related to hyperkalemia are you going to monitor her for in the next few hours before she
goes to dialysis? Is her hyperkalemia actual or relative?
Janet's hyperkalemia will likely be temporarily resolved by her hemodialysis treatment. If she
was not going for dialysis, what medications would be appropriate for lowering her
potassium?
Upon to return to the unit, Janet was given erythropoietin via the venous line. At 18:45, she is
brought back up to 2G. Her assessment now shows:
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Vital signs: BP 140/90, HR 90, Resp 20, Temp 98.6, & O2 sat. 96%;
Edema has significantly decreased;
Lungs continue CTA
Following dialysis, as her nurse, you want to assess how Janet tolerated her dialysis run.
What information do you want to interpret from the dialysis flow sheet?
She will be monitored on telemetry through the night and discharged tomorrow if she
remains stable, with an order for hemodialysis 3 times a week.
What teaching might you want to do this evening with Janet regarding diet and fluid intake?
Developed by Carol Thorn, RN, MS
May be used for nursing education purposes.