Presenting to urgent care is 58-year-old male landscaper named Mike. It is stated that
he has not been regularly seen by a health care provider in over 20 years. His history states
that he has been a smoker for 40 years (1-2 packs daily), is overweight, and has uncontrolled
hypertension. Though the client states that he has been taking acetaminophen frequently this
week for headaches; he does not currently take any other medications on the regular. His
family history is stated to include HTN, CAD, stroke, COPD, and diabetes. Client presented with
complaints of increasing chest pain, fatigue, generalized edema, and muscle cramps. When
assessed his vital signs were a BP of 220/105, EKG readings of tachycardia, peaked T waves, and
ST depression. Blood work resulted in abnormal readings of a cholesterol of 270, elevated
glucose of 202, elevated potassium (K) of 6.0, elevated BUN of 74, elevated creatinine of 14.0,
low calcium level of 7.2, elevated phosphorus of 9.5, and elevated GFR of 15.
Based on the assessment of Mike and his history, it is apparent that he may be
experiencing the start of renal failure. My immediate concern for Mike would be to address his
high blood pressure, which I believe he is experiencing a hypertensive emergency- which is
common occurrence for individuals with chronic kidney disease (CKD) ("220/105 Blood Pressure
- Good or Bad? - MyMedicalScore", 2020). This would be why my first concern to address with
him would be to get his blood pressure (BP) controlled in efforts to stop any further progression
of organ damage, i.e. his kidneys. According to the assessment data, Mike is currently in stage 4
(Severe CKD) with a GFR of 15. There are five stages of kidney disease; stage 1 is a normal or
high GFR (>90 mL/min), stage 2 mild CKD (GFR=60-89 mL/min), stage 3 moderate (GFR=30-59
mL/min), stage 4 severe (GFR 15-29 mL/min) and stage 5 end stage CKD (GFR <15 mL/min)
("Understanding Kidney Disease – NephCure Kidney International ®", 2020).
Another main concern for Mike is his dangerously high potassium level of 6.0. This
would not be to out of the ordinary, since having CKD increases his risk for high blood
potassium levels. This would also support why his labs were elevated since the kidneys filter
waste and excess fluid from blood- so when they fail, all this will build up resulting in the
elevated levels. This client should also have further cardiac testing done, such as cardiac
enzymes to rule out any ischemia that he may be experiencing. Since he has complaints of chest
pain, an abnormal EKG reading in particular the ST depression, and this elevated potassium –
these are all indicators of cardiac issues and should be addressed immediately. Pharmacological
interventions should be implemented; drugs such as calcium to help reduce the risk of
ventricular fibrillation which can be caused by hyperkalemia and diuretics to help cause loss of
potassium through the kidneys ("Which drugs are used in the treatment of hyperkalemia (high
serum potassium level)?", 2020). Mike also has hypocalcemia, which would explain his
complaints of fatigue and muscle cramps. Had this client not come in and this deficiency
progressed; he could’ve experienced a long-term deficiency which would have led to many
problems, most importantly alterations in the brain.
Overall, Mike will need dialysis for his CKD. Dialysis is usually needed when waste
products in the body become so high that the client becomes sick and their bodies can’t
maintain proper balance- this is the case for Mike ("Dialysis – NephCure Kidney International ®",
2020). All of his symptoms that he has been experiencing show that he is heading towards end
stage renal failure. This usually will result in being on dialysis for the rest of his life or until he is
able to receive a transplant. Being that he is in stage 4, education about dialysis and the lifestyle
changes that he will have to make to improve his quality of life should be given. Mike will have
to address his smoking habit and try to take part in some kind of smoking cessation program. I
would set this client up with a referral to social services with the hope that he will get guidance
and assistance in keeping up with the new medical regimen that he will have to take part in
once he starts dialysis. This being a life-saving necessity and Mikes past history of not keeping
up with his health; social services could help him work on changing these habits and become
more aware of the importance of taking care of himself.
References
220/105 Blood Pressure - Good or Bad? - MyMedicalScore. (2020). Retrieved 1 December 2020,
from https://mymedicalscore.com/blood-pressure/220-105/
Dialysis – NephCure Kidney International ®. (2020). Retrieved 2 December 2020, from
https://nephcure.org/livingwithkidneydisease/kidney-failure/dialysis/
Understanding Kidney Disease – NephCure Kidney International ®. (2020). Retrieved 3 December
2020, from https://nephcure.org/livingwithkidneydisease/what-is-kidney-disease-2/
Which drugs are used in the treatment of hyperkalemia (high serum potassium level)? (2020).
Retrieved 3 December 2020, from https://www.medscape.com/answers/766479122726/which-drugs-are-used-in-the-treatment-of-hyperkalemia-high-serum-potassiumlevel