Acute Renal Injury and Chronic Kidney Disease

Case Study 6

Acute Renal Injury and Chronic Kidney Disease

Will is a 68-year-old male with a history of hypertension. Eight months ago, he started regular dialysis therapy for ESRD. Before that, his physician was closely monitoring his condition because he had polyuria and nocturia. Soon it became difficult to manage his hypertension. He also lost his appetite, became weak, easily fatigued, and had edema around his ankles. Will debated with his physician about starting dialysis, but she insisted, before the signs and symptoms of uremia increased, the treatment was absolutely necessary.

  1. What is the difference between azotemia and uremia?
  2. Two years ago, Will’s physician told him to decrease his protein intake. In spite of what the physician ordered, Will could not stop having chicken, beef, pork, or eggs at least once a day. Why did his physician warn him about his diet?
  3. Will’s feelings of weakness and fatigue are symptoms of anemia. Why is he anemic?
  4. Knowing what you do about Will’s history, why is left ventricular dysfunction a concern for his physician?

Case Study 7

Disorders of the Bladder and Lower Urinary Tract

Alvita is a frail 89-year-old woman residing in a nursing home. She is able to move slowly around the residence with the use of a walker, but appreciates when her daughter is there to hold her arm and walk alongside her. When one of the health care staff changes Alvita, her daughter helps. Alvita’s incontinence has progressed, particularly over the last six years since she has resided in the nursing home. Alvita can smile at her lack of bladder control, however, and says that her incontinence really began when she was a young woman, just after the birth of her second daughter.

  1. Alvita’s mobility is limited. How does this affect continence in the elderly?
  2. Shortly after the birth of her second daughter, Alvita experienced mild incontinence, particularly after laughing or coughing. What was she experiencing? What is the pathophysiology behind this type of incontinence?

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