Author Question: A patient is admitted to the critical care unit in congestive heart failure secondary to renal ... (Read 83 times)

lbcchick · **on:** Jun 25, 2018

A patient is admitted to the critical care unit in congestive heart failure secondary to renal insufficiency

The patient reports that over the past few weeks, his urine output has decreased, and he has developed peripheral edema and ascites. A diagnosis of renal failure is made. The nurse would expect to see elevated values in the following laboratory results: (Select all that apply).

a. BUN.
b. creatinine.
c. glucose.
d. hemoglobin and hematocrit.
e. protein.

Question 2

A patient has been experiencing drowsiness, confusion, and slight focal deficits for 3 days. The CT report findings are negative. The patient is being prepared for a lumbar puncture. The nurse anticipates that the CSF would appear

a. cloudy.
b. bloody.
c. xanthochromic.
d. clear.

kishoreddi · **Reply #1 on:** Jun 25, 2018

Answer to Question 1

A, B, D
With kidney dysfunction, the blood urea nitrogen (BUN) is elevated because of a decrease in the glomerular filtration rate and resulting decrease in urea excretion. Elevations in the BUN can be correlated with the clinical manifestations of uremia; as the BUN rises, symptoms of uremia become more pronounced. Creatinine levels are fairly constant and are affected by fewer factors than BUN. As a result, the serum creatinine level is a more sensitive and specific indicator of kidney function than BUN. Creatinine excess occurs most often in persons with kidney failure resulting from impaired excretion. Decreased hematocrit value can indicate fluid volume excess because of the dilutional effect of the extra fluid load. Decreases also can result from anemias, blood loss, liver damage, or hemolytic reactions. In individuals with acute kidney failure, anemia may occur early in the disease.

Answer to Question 2

B
If the initial computed tomography findings are negative, a lumbar puncture is performed to obtain cerebrospinal fluid (CSF) for analysis. CSF after subarachnoid hemorrhage (SAH) appears bloody and has a red blood cell count greater than 1000 cells/mm3 . If the lumbar puncture is performed more than 5 days after the SAH, the CSF fluid is xanthochromic (dark amber) because the blood products have broken down. Cloudy CSF usually indicates some type of infectious process such as bacterial meningitis, not SAH.