NUR 502 Module 4 Discussion: Urinary Function

NUR 502 Module 4 Discussion: Urinary Function

Urinary Function

The attending physician is thinking that Mr. J.R. has developed an Acute Kidney Injury (AKI). Analyzing the case presented name the possible types of Acute Kidney Injury. Link the clinical manifestations described to the different types of Acute Kidney injury.

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  1. JR has a pre-renal type of acute kidney injury. Pre-renal kidney injury occurs due to a decrease in renal perfusion. It is often attributed to volume depletion. Mr. JR has experienced significant fluid loss due to diarrhea. Clinical manifestations such as feeling weak and dizzy also signify fluid volume depletion (Goyal et al., 2023). Therefore, he likely has a pre-renal kidney injury.

Create a list of risk factors the patient might have and explain why.

  1. The risk factors for acute kidney injury evident in the case study include hypovolemia due to gastrointestinal fluid loss, hypotension due to fluid volume depletion, and shock due to the infection (Goyal et al., 2023).

Unfortunately, the damage on J.R. kidney became irreversible and he is now diagnosed with Chronic kidney disease. Please describe the complications that the patient might have on his Hematologic system (Coagulopathy and Anemia) and the pathophysiologic mechanisms involved.

 

  1. Patients with chronic kidney disease have coagulopathy problems. Chronic kidney disease causes platelet dysfunction, which increases bleeding rates and thrombosis. Chronic kidney disease also deranges vWF and platelet interactions. This impairs the normal physiologic fibrinolysis processes and increases nitric oxide. As a result, patients are prone to massive bleeding, which causes anemia. The effects also cause delays in clot formation, which increases bleeding and, hence, anemia. Chronic kidney disease also impairs erythropoietin formation (Lutz & Jurk, 2020; Shaikh et al., 2023). Erythropoietin is important for red blood cell production, which contributes to the development of anemia.

References

Goyal, A., Daneshpajouhnejad, P., Hashmi, M. F., & Bashir, K. (2023). Acute Kidney Injury. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK441896/

Lutz, P. D. med J., & Jurk, P. D. rer nat K. (2020). Platelets in Advanced Chronic Kidney Disease: Two Sides of the Coin. Seminars in Thrombosis and Hemostasis, 46(3), 342–356. https://doi.org/10.1055/s-0040-1708841

Shaikh, H., Hashmi, M. F., & Aeddula, N. R. (2023). Anemia of Chronic Renal Disease. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK539871/

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Reproductive Function

According to the case presented, including the clinical manifestations and microscopic examination of the vaginal discharge, what is the most probably diagnosis for Ms. P.C.? Support your answer and explain why you get to that diagnosis.

  1. Gonorrhea is the most probable diagnosis for Ms. PC. Neisseria gonorrhoeae is a gram-negative, intracellular diplococcus bacterium that causes gonorrhea. The laboratory investigation is positive for the gram-negative intracellular diplococci. Ms. PC also has symptoms that patients with gonorrhea experience. They include yellow vaginal discharge, dysuria, and lower abdominal pain or tenderness (Lewis, 2020). Ms. PC also recently engaged in unprotected sex with her partner who has been away on business for five days. Therefore, gonorrhea is the most probable diagnosis.

Based on the vaginal discharged described and the microscopic examination of the sample could you suggest which would be the microorganism involved?

  1. The microorganism that is involved in Ms. PC’s infection is Neisseria gonorrhoeae. Neisseria gonorrhoeae is a gram-negative bacterium that causes gonorrhea.

Name the criteria you would use to recommend hospitalization for this patient

  1. PC might require hospitalization for further treatment should have additional symptoms or comorbidities that might affect treatment outcomes. Firstly, she might have to be hospitalized if she is immunocompromised. The hospitalization would be necessary to prevent the development of other opportunistic infections. Ms. PC might also have to be hospitalized if the initial outpatient treatment failed. The hospitalization would be necessary to ensure close monitoring and adjustment of treatment options based on her response to treatment. Ms. PC might also be hospitalized if she demonstrates severe symptoms. This includes fever, severe abdominal pain, nausea, and vomiting. The hospitalization would be essential to promote her stabilization and management of other co-existing conditions. A hospitalization would also be necessary if Ms. PC. Is found to have tubo-ovarian abscess (Gaydos & Melendez, 2020; Młynarczyk-Bonikowska et al., 2020). Gonorrhea might lead to the formation of pus in the fallopian tubes and ovaries. Affected patients experience symptoms such as fever, lower abdominal pain, and abnormal vaginal discharge. Hospitalization would be important to facilitate further specialized management.

References

Gaydos, C. A., & Melendez, J. H. (2020). Point-by-Point Progress: Gonorrhea Point of Care Tests. Expert Review of Molecular Diagnostics, 20(8), 803–813. https://doi.org/10.1080/14737159.2020.1778467

Lewis, D. A. (2020). 54—Gonorrhea. In E. T. Ryan, D. R. Hill, T. Solomon, N. E. Aronson, & T. P. Endy (Eds.), Hunter’s Tropical Medicine and Emerging Infectious Diseases (Tenth Edition) (pp. 524–527). Elsevier. https://doi.org/10.1016/B978-0-323-55512-8.00054-5

Młynarczyk-Bonikowska, B., Majewska, A., Malejczyk, M., Młynarczyk, G., & Majewski, S. (2020). Multiresistant Neisseria gonorrhoeae: A new threat in second decade of the XXI century. Medical Microbiology and Immunology, 209(2), 95–108. https://doi.org/10.1007/s00430-019-00651-4

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Urinary Function:
Mr. J.R. is a 73-year-old man, who was admitted to the hospital with clinical manifestations of gastroenteritis and possible renal injury. The patient’s chief complaints are fever, nausea with vomiting and diarrhea for 48 hours, weakness, dizziness, and a bothersome metallic taste in the mouth. The patient is pale and sweaty. He had been well until two days ago, when he began to experience severe nausea several hours after eating two burritos for supper. The burritos had been ordered from a local fast-food restaurant. The nausea persisted and he vomited twice with some relief. As the evening progressed, he continued to feel “very bad” and took some Pepto-Bismol to help settle his stomach. Soon thereafter, he began to feel achy and warm. His temperature at the time was 100. 5°F. He has continued to experience nausea, vomiting, and a fever. He has not been able to tolerate any solid foods or liquids. Since yesterday, he has had 5–6 watery bowel movements. He has not noticed any blood in the stools. His wife brought him to the ER because he was becoming weak and dizzy when he tried to stand up. His wife denies any recent travel, use of antibiotics, laxatives, or excessive caffeine, or that her husband has an eating disorder.

Case Study Questions

  1. The attending physician is thinking that Mr. J.R. has developed an Acute Kidney Injury (AKI). Analyzing the case presented name the possible types of Acute Kidney Injury. Link the clinical manifestations described to the different types of Acute Kidney injury.
  2. Create a list of risk factors the patient might have and explain why.
  3. Unfortunately, the damage on J.R. kidney became irreversible and he is now diagnosed with Chronic kidney disease. Please describe the complications that the patient might have on his Hematologic system (Coagulopathy and Anemia) and the pathophysiologic mechanisms involved.

Reproductive Function:
Ms. P.C. is a 19-year-old white female who reports a 2-day history of lower abdominal pain, nausea, emesis and a heavy, malodorous vaginal discharge. She states that she is single, heterosexual, and that she has been sexually active with only one partner for the past eight months. She has no previous history of genitourinary infections or sexually transmitted diseases. She denies IV drug use. Her LMP ended three days ago. Her last intercourse (vaginal) was eight days ago and she states that they did not use a condom. She admits to unprotected sex “every once in a while.” She noted an abnormal vaginal discharge yesterday and she describes it as “thick, greenish-yellow in color, and very smelly.” She denies both oral and rectal intercourse. She does not know if her partner has had a recent genitourinary tract infection, “because he has been away on business for five days.
Microscopic Examination of Vaginal Discharge
(-) yeast or hyphae
(-) flagellated microbes
(+) white blood cells
(+) gram-negative intracellular diplococci

Case Study Questions

  1. According to the case presented, including the clinical manifestations and microscopic examination of the vaginal discharge, what is the most probably diagnosis for Ms. P.C.? Support your answer and explain why you get to that diagnosis.
  2. Based on the vaginal discharged described and the microscopic examination of the sample could you suggest which would be the microorganism involved?
  3. Name the criteria you would use to recommend hospitalization for this patient

 

Submission Instructions:

 

  • You must complete both case studies
  • Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.
  • You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.)
  • All replies must be constructive and use literature. MUST be done on a SEPARATE day from the initial post.
  • Please post your initial post by 11:59 PM ET Thursday, and comment on the posts of two classmates by 11:59 PM ET Sunday.
  • You can expect feedback from the instructor within 48 to 72 hours from the Sunday due date.

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Grading Rubric


Your assignment will be graded according to the grading rubric.

Discussion Rubric
Criteria Ratings Points
Identification of Main Issues, Problems, and Concepts Distinguished – 5 points
Identifies and demonstrates a sophisticated understanding of the issues, problems, and concepts.
Excellent – 4 points
Identifies and demonstrates an accomplished understanding of most issues, problems, and concepts.
Fair – 1-3 points
Identifies and demonstrates an acceptable understanding of most issues, problems, and concepts.
Poor – 0 points
Identifies and demonstrates an unacceptable understanding of most issues, problems, and concepts. Or nothing was posted.
5 points
Use of Citations, Writing Mechanics, and APA Formatting Guidelines Distinguished – 3 points
Effectively uses the literature and other resources to inform their work. Exceptional use of citations and extended referencing. High level of APA precision and free of grammar and spelling errors.
Excellent – 2 points
Effectively uses the literature and other resources to inform their work. Moderate use of citations and extended referencing. Moderate level of APA precision and free of grammar and spelling errors.
Fair – 1 point
Ineffectively uses the literature and other resources to inform their work. Moderate use of citations and extended referencing. APA style and writing mechanics need more precision and attention to detail.
Poor – 0 points
Ineffectively uses the literature and other resources to inform their work. Unacceptable use of citations and extended referencing. APA style and writing mechanics need serious attention. Or nothing was posted.
3 points
Response to Posts of Peers Distinguished – 2 points
Student constructively responded to two other posts and either extended, expanded, or provided a rebuttal to each.
Fair – 1 point
Student constructively responded to one other post and either extended, expanded, or provided a rebuttal.
Poor – 0 points
Student provided no response to a peer’s post.

 

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