RENAL DISORDERS
TASK:Create a conceptual map using the case scenarios as guide. Conceptual map should include pathophysiology, medical diagnosis, signs and symptoms, and risk factors, if any. Nursing diagnosis, nursing interventions, medical management (medication and procedures), expected outcomes.
A 61- year old male, long standing type 2 diabetic and hypertensive, with end stage renal disease secondary to diabetic nephopathy on maintenance thrice weekly hemodialysis since the last 20- months started developing acute onset of chills, rigors, acute anxiety, vomiting and unexplained abdominal pain about ½- 1 hour into the dialysis session. These episodes which had not occurred earlier, had started from the previous one month and caused acute distress to the patient, necessitating request for early termination of dialysis. The patient denied any complaints home except for severe itching, which has started at approximately at the same time. No new medications had been initiated in the preceding months and no history of documented allergies could be got from the patient. He denied any specific food allergies as well. Metochlopramide and diphenhydramine administered on dialysis failed to have any impact. These events were seen with unfailing regularity at every session of dialysis and stopped only after discontinuing the dialysis. The dialyser used was a 1.3 m2 polysulphone dialyser. The tubing and the dialyser were changed, but this did not bring about any change.
Laboratory results are:
Hemoglobin- 9 g/dl
WBC- 10,800/ mm3
Differential count Eosinophils- 24%
Absolute eosinophils – 2600/mm3- normal- 40- 440
Urea reduction rate on dialysis- 62%
Liver function test, calcium and phosphorus were normal
Physical examination revealed xerotic, exfoliating skin all over the body, more on the extensor aspect of the arms and back. The oral cavity did not show any mucosal lessons. Examination of the cardiovascular, respiratory and gastrointestinal system was normal. He was given a course of prednisone at 0.5 mg/kg for two weeks followed by a gradual taper over four weeks. The Absolute Eosinophil Count (AFC) reduced to 260/mm3 with treatment and adverse reactions subsided on dialysis. No definite cause for hyper eosinophilia was detected in this patient. No recurrence has been seen at one month follow up so far and the AEC remains greater than 200 cells/mm3
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