AKI Pre- renal
Primary Biliary Cholangitis
Pulmonary hypertension
Primary Malignant Neoplasm of the Upper lube in Left Lung
Right Congestive Heart Failure
Hypertension
Other Pertient Medical History
AFIB: atria beat out of sync with ventricles. Possibly associated with transplant surgery from increased adrenergic stimulation
GERD
Anxiety
build up of pressure on the esophagus that promotes reflux of gastric contents
could have been promoted by pts ascites when suffering with liver cirrhosis
autoimmune destruction of bile ducts in the liver leading to the patient’s cirrhosis.
The destruction of the bile ducts does not allow the secretion of bile which increases bilirubin in the blood, resulting in jaundice.
Jaundice is the yellowing of skin & sclera
buildup of bile eventually lead to the patient’s cirrhosis which resulted in ascites
swelling of the abdomen
increased portal vein pressure causing lack of blood flow to liver
hepatic encephalopathy
The increase in portal vein pressure could be associated with the patients hx of esophageal varices
This is when large veins surround the esophagus related to lack of blood flow to organs such as the liver
the build up of toxins from decreased liver function with causes confusion, disorientation, and coma.
This resulted in her orthotropic transplant 7/8/2021 which cured her cirrhosis
Medications r/t transplant
Tacromilus
Prednisone
decreased blood flow to kidneys
There is nothing wrong with the kidney itself, there is just not enough blood flow to maintain normal kidney function
If not fixed it could eventually cause problems to the kidney itself
In assessment pt presented with unresponsive to diuretics, urine excretion is decreased, edema is noted and creatine is elevated.
all signs of decreased kidney function
This can be r/t the patient right sided heart failure which is causing decreased blood flow to kidneys
Pt also suffers from hypertension which can damage blood vessels in the kidneys resulting in decrease kidney function
Medications for AKI
Pt has lung cancer which is most likely associated with her history of smoking
She smoked consecutively for many years but quit 20 years ago.
Her mother also has a history of cancer, although not lung having cancer in the family still increases a person’s risk.
The patient is experiencing coughing, chest pain, shortness of breath, and cachexia which is related to the cancer.
Due to the cancer in the patients’ lungs, she is building up pressure that is resulting in pulmonary hypertension
when the pressure in the arteries of the lungs increase.
This makes it harder for the right side of the heart to pump blood due to the resistance of the lungs.
It ultimately causes less oxygen in the blood and can contribute to right sided heart failure if the heart cannot pump against the resistance which is seen in this patient.
The patient’s history of cirrhosis can also play a part in pulmonary HTN.
The buildup of portal vein pressure can result in pressure in the lungs as well.
Although patients’ cirrhosis is cured from transplant, she endured the effects for many years
The pulmonary hypertension is worsening patients symptoms of shortness of breath from lack of oxygen and worsening her AKI from lack of perfusion in the blood.
Meds for Pulmonary HTN
The pulmonary hypertension is causing the patients right congestive heart failure.
the heart cannot push against the higher pressure/resistance in the lungs
the blood is being pushed back from the right ventricle, then right atrium, and eventually backward flow into the body.
This back up of blood into body is causing the patients peripheral edema.
The lack of blood flow out of the heart is also contributing to the patients pre-renal AKI since there is lack of perfusion.
increase in blood pressure which increases the workload of the heart, ultimately worsening pts congestive heart failure
Hypertensions causes peripheral resistance which constricts the blood vessels causing the heart to work harder to push the blood out to the body
The resistance and constriction also causing decrease blood flow to organs like the kidneys.
This cycle with the kidneys can ultimately worsen the patient’s hypertension and acute kidney injury.
When the kidneys decrease blood flow, they retain water and sodium
try to increase the blood pressure to regain perfusion
The patient’s father has hypertension which could have promoted the disease in the patient.
The patient also has a history of smoking which can increase risk for blood pressure.
Hypertension is a silent killer meaning there is usually not many symptoms correlated with it.
the effects are mainly seen by the influence on other organs and vasculature
Hypertension Meds
Meds to help with symptoms of Lung cancer
Meds to help R CHF
Orders to assess fluid retention r/t Right CHF & AKI
Strict I/O's
Free Standing wts
Free water limit of 1500
Orders to asses fluid retention r/t AKI & R side CHF
Strict I/O's
Free Standing wts
Free water limit 1500 mL
Order r/t Lung cancer & symptoms (SOB, weakness, cough, pain)
Fall precautions r/t overall weakness & SOB
Telemetry: continuous pulse ox assess for additional oxygen needs
WORK CITED
Needs to be treated
Increase pt risk of CVA d/t afib and hypertension
Treated with Amiodarone 200 mg oral daily
antiarrhythmic drug
Incentive spirometer for breathing exercises for more productive cough
Guaifenesin 600 mg BID Q12 oral
Allows for more productive cought
Mometasone Formoterol 2 puffs (12 mcg) Q12 Oral inhalation
Metolazone 5 mg oral Daily
Decrease of BP, reduces edema in heart failure & kidney failure, most effective diuretic in kidney failure
Medications to treat patients anxiety
Mirtazapine 15 mg oral nightly
Buspirone 5 mg TID oral
Local bronchodilator, prevents bronchoconstriction. Inhibits release of histamines, leukotrienes (hypersensitivity) from mast cells in the lung.
allows for easier breathing
Albuterol nebulizer 2.5 mg Q4 Oral inhaltion
Decreases air way resistance, facilitates mucus drainage & increases vital capacity
Serotonin receptor agonists; increases the action of serotonin receptors in brain
Tetracyclic antidepressant, enhances noradrenergic & serotonergic activity
Meds to help GERD
Famotidine 20 mg daily oral
H2 blockers that decreases amt of hydrochloric acid made in the stomach’s parietal cells
Melatonin 6 mg nightly oral
Improving sleep patterns by regulating sleep-wake cycles
Metoprolol Tartrate 12.5 mg BID oral
Decreases blood pressure and heart rate by inhibiting sympathetic NS
Midodrine 5 mg BID oral
decrease BP with renal & liver disease
Helps decrease orthostatic hypotension d/t kidneys not able to compensate
Immunosuppressive to prevent & treat organ rejection
Prevents rejection of kidney, heart, or liver transplant
Acetaminophen 975 mg PRN Q6 oral
Treats pain, inflammation
Ondansetron 4 mg PRN Q4 IV
Decrease nausea esp after surgery or chemo
Hydroxyzine HCl 10 mg PRN Q6 oral
Decreases symptoms of anxiety attacks
related to the meds for lung cancer
The diuretics used for HTN
Centers for Disease Control and Prevention. (2021, October 18). What are the symptoms of lung cancer? Lung Cancer. Retrieved November 5, 2021, from https://www.cdc.gov/cancer/lung/basic_info/symptoms.htm.
Healthwise Staff. (2017, May 3). Prerenal Acute Kidney Injury. Retrieved November 5, 2021, from https://wa.kaiserpermanente.org/kbase/topic.jhtml?docId=aa115544.
Planck-Gesellschaft, M. (2017, November 22). Lung Cancer triggers pulmonary hypertension. ScienceDaily. Retrieved November 5, 2021, from https://www.sciencedaily.com/releases/2017/11/171122103614.htm.
Hoffman, J. J., & Sullivan, N. J. (2020). Davis advantage for medical-surgical nursing: Making connections to practice (2nd ed.). F.A. Davis.