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Renal Medicine

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by

Bryan Boey

on 25 October 2013

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Transcript of Renal Medicine

Department: Renal Medicine
Name: Mdm. R.

IC Number:SxxxxxxxG
Age: 56
Gender: Female
Race: Eurasian

Iron Sucrose
Admission for low Hb(5.0)
Left upper limb tremors
Hazy bilateral vision
Takes recormon 1/7 instead of prescribed 2/7
Past Hx
1. ESRF 2º Glomerular Nephritis
2. HYPT
3. High Cholesterol
4. DM (poor control)
5. R. Hip AVN
6. UTI (Klebsiella) (03/11)
7. Passed CBD stone (06/11)
8. Salmonella GE (06/12)
9. R. femur fracture from fall (11/12)
Feb 2011
Jun 2011
Nov 2012
Jun 2012
Apr 2006
Mar 2003
Boderline cellular rejection with global scelerosis
Renal Biopsy
Bile Stone
Central Bile Duct Stone passed out
Gastroenteritis
Salmonella GE
Fracture
Caused by fall
Right Distal Femur Fracture
Underwent LISS plating
Cadeveric Renal Transplant
Delayed Graft Function
Acute Tubular Necrosis
Admission for high Creatinine
Renal biopsy uneventful
High B.P.
Physical Examination
Alert
Afebrile
V/S: bp 130/80
SpO2: 99% (Room Air)
HR: 68

H:S1S2, soft ESM over Aortic Region
L: Clear
A: Soft non-tender, graft non-tender
DRE: no masses, no PR bleed/malaena, Anal tone intact


Neurological Examination
Left UL coarse tremors
Fine tremors over R UL
PEARL
CN intact
Power intact
No sensory loss
Issues
1. NCNC Anaemia with Stool OB+
2. Multi-focal CVA
3. Failing Graft
Diagnostics
Blood -FBC, PBF, GXM, Stool OB x3, Hepatoglobin
Graft function -LDH, LFT, CK
Heart -ECG, CXR
Urine -UFEME
Referrals
Management Plan
Mx plan
Drugs
CC
Diagnostic Results
Renal Failure
NCNC Anaemia
Kidney
EPO Production
Bone Marrow
RBC Production
Erythropoeisis
Iron
Folic Acid
Renal Anaemia
SEA-14.9%
World-24.8%
Risk Factors
Female
Age 65 or older
Family history of kidney disease
African-American, Native-American or Asian-American race
Diabetes
Hypertension
High cholesterol
Heart disease
Smoking
Obesity
2 pint RBC
Renal diet
4/24 V/S + SpO2
H/C TDS +10
Prepare Mdm. R. for PD
EPO
Anti-Hypertensives
Cholesterol Meds
Immunosuppressant
Iron & Folic Acid
Diuretic
Analgesic
Sodium Bicarb
Insulin

Nursing Diagnosis
Risk for falls
Rest in Bed
Remove obstacles around Mdm. R's bed
Easily accessible handrails
Medication non-compliance
Nutritional education for failed graft
Low Salt
Low Fat
Low Phosphate
Low Potassium
Low Protein
Fluid Restriction
Ineffective Coping
Counselling and preparaton for PD/ESRF
Show Mdm. R. examples of other patients who undergo similar therapy
Sharing session/Support group with patients undergoing PD
Risk for Infection
Encourage food and nutrition
Encourage rest
Assess for pressure ulcers
Encourage hygiene practices
Educate on the importance of medication consumption
Manage side effects
Neurology
Orthopaedic
General Surgery
Ophthalmology
Cardiovascular Medicine
+ve Stool Occult Blood
"I would rather die than undergo dialysis"
-Mdm. R.
References
American Diabetes Association. Standards of medical care in diabetes--2012. Diabetes Care. 2011 Jan;35 Suppl 1:S11-63.

Dean, B. B., Dylan, M., Jr, A. G., Knight, K., Ofman, J. J., & Levine, B. S. (2005). Erythropoiesis-stimulating protein therapy and the decline of renal function: a retrospective analysis of patients with chronic kidney disease. Current Medical Research and Opinion , 21 (7), 981-987.

World Health Organisation. (2008). Worldwide prevalence of anaemia 1993-2005. WHO Global Database on Anaemia. Geneva: World Health Organisation.
(Dean et al, 2005)
(WHO, 2008)
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