R. Jones; 72 yr old; African American Male
von Brittany Hill
1. Weight Gain (10 lbs in 2 mo)
2. Swelling in hands and feet
3. oliguria "only small amounts"
4. "Dazed" and fatigued
5. Physical Assessment: "2 nonpitting, bilateral pedal edema. Pallor. Poor skin turgor."
6. Prerenal Dysfunction due to uncontrolled HTN; kidneys are unable to properly filtrate and excrete toxins/waste
7. Renal insufficiency secondary to uncontrolled hypertension; blood flow is compromised due to injured arteries, leading to inadequately filtered blood.
8. Furosemide 40 mg po qd
9. Tums (Calcium Carbonate)
10. bonds to dietary phosphate to form an insoluble calcium phosphate complex which is excreted in feces resulting in decreased serum phosphorus concentrations thereby leading to increased calcium levels; also can be used as replacement of calcium in deficiency states
11. 1. Do not take 1-2 of other medication taken, and avoid taken enteric-coated tablets an hour after taking calcium carbonate as it will prematurely dissolve the tablets 2. May cause constipation, use constipation methods or laxatives if necessary
12. Low Sodium/Low Protein diet
13. Low Sodium: low sodium diet will help prevent the reabsorption of water thereby causing swelling/edema (water follows sodium, so limiting sodium means limiting water reabsorption), will also help keep blood pressure within the normal range. Low Protein: proteins are broken down into amino acids which are then broken down into nitrogen compounds. This elevates BUN. low protein diet will help lower BUN levels.
14. Furosemide
15. Decreases edema
16. 1.Take as directed, if missed dose take as soon as remembered, but do not double dose 2. If weight gain of 3lbs in one day, contact healthcare provider
17. Be cautious of new dietary changes triggering alterations in mood, exacerbating Hx of depression
18. Risk Factor: Hx of Depression
19. Risk Factor: Hx of borderline HTN; untreated
20. Creatinine>1.5 BUN>20 K >5.3 Ph>4.5 Ca<8.5
21. High BP: 188/92 HR: 94 O2 Sat: 94%
22. "decreased appetite"
23. Uncontrolled hypertension leads to decreased CO and decreased perfusion, which forces the heart to work harder.
24. Risk Factor: African American; older adult
25. Increased risk for developing renal disorder
26. Hx of depression could make patients have mood changes as he is dealing with Prerenal Dysfunction and starting new treatment plans.
27. Lisinopril 10 mg po qd
28. Furosemide 40 mg po qd
29. Inhibits angiotensin converting enzyme thereby preventing the formation of angiotensin II and causing vasodilation which will lower his blood pressure; also decreases aldosterone secretion which lowers blood volume
30. Loop Diuretic helps rid sodium and water retention which will relieve blood pressure
31. 1. Take same time each day, do not miss dose, do not double dose. Do not discontinue, taper off slowly. 2. Avoid salt substitutes containing potassium, or foods with high levels of sodium or potassium. 3. Be cautious of orthostatic hypotension
32. 1.Take as directed, if missed dose take as soon as remembered, but do not double dose 2. If weight gain of 3 lbs in one day, contact healthcare provider 3. Be cautious of orthostatic hypotension
33. Inhibits reabsorption of sodium and chloride from the loop of Henle and distal renal tubule; prevents reabsorption of water; increases renal excretion of water, sodium, chloride, magnesium, potassium, and calcium; helps return electrolyte levels back to normal ranges
34. 1.Take as directed, if missed dose take as soon as remembered, but do not double dose 2. If weight gain of 3 lbs in one day, contact healthcare provider
