Fluids and Electrolytes Clinical Case Study
History of Present Illness: Greg Walton is a 60-year-old man who visited his physician with complaints of hypertension and weakness. For several years, Greg has been monitoring his blood pressure at a local pharmacy; it had been about 125/80. Approximately one month prior to the doctor's visit his blood pressure rose to 135/102.
During the past month, Greg has noticed muscle weakness. Greg, an avid hiker for most of his life, noticed that his legs were weak when he tried to climb stairs. He also felt weak in his arms. His physician told him that he might be excreting too much potassium.
Look at the mechanism for aldosterone release. Note that both high serum potassium and high renin levels stimulate increased potassium secretion.
Answer the following questions to demonstrate your knowledge.
1. If Greg's kidneys increase the rate of potassium secretion, what should happen to aldosterone levels if normal negative feedback is occurring? How does this renal change in potassium secretion affect potassium levels in the blood?
· Blood pressure 138/98, otherwise unremarkable.
· Serum sodium of 148 mEq/L
· Serum potassium of 2.5 mEq/L
Looking at Greg's data, his physician suspected that Greg had a narrowing of the renal arteries [see the table for normal sodium and potassium levels]
2. If Greg suffered from an adrenal tumor that secreted excess aldosterone instead of an arterial problem, how would his renin levels be affected?
Greg's physician ordered a test called a digital subtraction angiogram, which revealed stenosis (narrowing) of Greg's right renal artery.
If Greg's right renal artery is stenotic (narrowed), how would blood flow to his right kidney be affected?
4. What impact would reduced blood flow have on renin secretion by his right kidney?
5. What mechanism is responsible for a change in renin?
6. What effect would the change in renin have on Greg's serum sodium and potassium?
7. Develop a Plan of care for Greg Walton. Include problem list, Nursing diagnosis, Patient Goals, and Nursing intervention with scientific rationale. Attach it to this form.