ACUTE RENAL FAILURE AND CHRONIC RENAL FAILURE

I. ROC Part I Name: Julie Marrow Age: 24 Gender: Female History: -2 days post partum -underwent Cesarean section -had Lupus Erythematosus for 3 years Complaints: - 34 weeks pregnant - Pregnancy induced Hypertension (HTN) Upon admission: -diagnosed with HELLP syndrome H -- hemolysis (the breakdown of red blood cells) EL -- elevated liver enzymes LP -- low platelet count Upon delivery: -hypovolymic -suffered hypovolymic shock - massive bleeding several hrs after delivery : -remained hemodynamically unstable inspite of blood, blood products and fluid replacement -dopamine @ 3-10 mcg/kg/min -levophed @ 4 mcg/min For the past 2 days: - BP ranges from 60/48 to 98/58 For the last 12 hours: - urine output in minimal (0-30 cc/hour * <250 ml/day) *oliguria Current Data: Complete Blood Count shows: WBC (White blood cells) 18,000 [normal 5,000-10,800/microliters] RBC (Red Blood ceels) 2.8 [normal 4.8 million/microliters *females] Hgb (Hemoglobin) 7.0 [normal 12-16 g/100ml of blood *females] Hct (Hematocrit) 24% [normal 38-46% *females normal 40-45% *males] AGB s (Arterial Blood Gasses) pH- 7.20 [normal 7.35-7.45] PaO2 (partial pressure of Oxygen) 78 [normal 70-100] PaCO2 (partial pressure of Carbon Dioxide) 30 [normal 35-45] HCO3 (bicarbonate) 16 [normal 19 -25]

SaO2 (Oxygen saturation) 90% [normal 90-95 %] BUN 145 [normal 7-20 mg/dl] Creatinine- 9.4 [normal 0.5-1.4] K-6.4 U/L Ca-8.0 U/L Alk P- 154 U/L SGOT (serum glutamic-oxaloacetic transaminase; or AST aspartate transaminase) 34 mcg/L [normal
<39 IU/L] SGPT (serum glutamic-pyruvic transaminase; or ALTalanine transaminase) 54 U/L (normal <35 IU/L) VS (Vital Signs) HR (Heart Rate) 124 beats/min (normal 75 beats/min) RR (Respiratory Rate) 32 /min (normal 12/min) BP (Blood Pressure) 102/62 mmHg (normal <120/80) Temp (temperature) - 99.4 degrees Farenheit ( 98.6-101 F) CVP (Central Venous Pressure) 14 (normal 5 to 10 cm H2O) Resp (Respiration) BS (Breath Sounds) audible for scattered crackles and ronchi throughout all lung fields CXR (Chest X-Ray) positive for pulmonary infiltrates and possible pulmonary edema. CV (Cardiovascular) Heart sounds S1 and S2 audible but distant Neuro

II. Definition Of Terms y TLC - total lung capacity the amount of gas contained in the lung at the end of a maximal inhalation.

D5LR - LactatedRinger sSolutionwith 5%Dextrose, Electrolytes in1000 ml; Sodium-130mmol Potassium-4 mmol Calcium-1.4mmol Chloride- 109mmol Lactate-28 mmol, Hypertonic Solutions are those that have an effective osmolarity greater than the body fluids.T his pulls the fluid into the vascular by osmosis resulting in an increase vascular volume. It raises intravascular osmotic pressure and provides fluid, electrolytes and calories for energy breath sounds- sounds heard on auscultation over the respiratory tract; bronchial and ventricular ones are heard normally at certain places, whereas a cavernous one indicates a lung cavity.