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SBAR71G.W.docxSBAR 71 G.W
Scenario G.W., a 34-year-old African American man, presents with increasing right knee swelling. He states that the swelling has gotten worse over the past two weeks and on presentation is now having difficulty ambulating. He reports taking over-the-counter ibuprofen 200 mg tablets at least 4 to 8 tablets per day for nearly 1 year for persistent back and knee pain. He has not seen his primary care physician (PCP) in nearly 2 years. G.W. also complains of weakness, fatigue, decreased urine output, and joint pain and stiffness. He also tells you that when he does urinate, it looks “rusty.” His vital signs are as follows: BP 210/100, P 86, R 24, T 98.7º F (37.1º C)
CASE STUDY PROGRESSG.W. tells you that a few years ago he was diagnosed with high blood pressure, but he did not like the medication’s side effects, so he stopped taking it. He said that he was told that he had “kidney problems” but never kept the appointments to check his kidneys. After further assessment, the nurse finds that the abdomen appears firm, round, and distended with edema. He has +2 edema on his ankles and shins bilaterally. He reports decreased urine output; on admission urine is dark and rust-colored. G.W. is alert and oriented to person, place, time and situation. He is lethargic but easily arousable and coherent. His blood work shows a BUN of 35 mg/dL (12.5 mmol/L), serum creatinine of 4.7 mg/dL (415 mcmol/L), albumin 1.2 g/dL (12 g/L), Hgb 7.1 g/dL (71 g/L) and Hct 23.5%. The results of his urinalysis are listed here: Chart View Urinalysis
Appearance Clear
Color: Rust
Odor: Aromatic
pH 6.2
Protein Positive
Glucose Negative
White blood cells 5
WBC casts Many
Red blood cells 10
RBC casts Many
CASE STUDY PROGRESS The nephrologist is consulted and the results of a renal biopsy confirm the diagnosis of chronic glomerulonephritis. G.W. received a furosemide (Lasix) drip, and had a total urine output of 450 mL in the next 24 hours. G.W.’s BP has improved but remains elevated at 198/102. The nephrologist ordered lisinopril 5 mg PO once daily, IV methylprednisolone (Solu-Medrol) and cyclophosphamide 2 mg/kg PO daily
CASE STUDY PROGRESS Orders for G.W. include fluid restriction and a “renal diet.” The dietitian visits G.W. to discuss the changes to his diet
CASE STUDY OUTCOME After 3 days, G.W.’s creatinine and BUN remained elevated with continued hypertension, edema, and decreased urine output. He was started on hemodialysis for management of renal function and the Solu-Medrol was changed to PO prednisone. He remained in the hospital for 3 weeks before being transferred to a rehabilitation facility.
SBAR 71
G.W
Scenario
G.W., a 34
-
year
-
old African American ma
n, presents with increasing right knee
swelling. He states that the swelling has gotten worse over the past two weeks and on
presentation is now having difficulty ambulating. He reports taking over
-
the
-
counter ibuprofen
200 mg tablets at least 4 to 8 table
ts per day for nearly 1 year for persistent back and knee pain.
He has not seen his primary care physician (PCP) in nearly 2 years. G.W. also complains of
weakness, fatigue, decreased urine output, and joint pain and stiffness. He also tells you that
when
he does urinate, it looks “rusty.” His vital signs are as follows: BP 210/100, P 86, R 24, T
98.7º F (37.1º C)
CASE STUDY PROGRESSG.W. tells you that a few years ago he was diagnosed with high
blood pressure, but he did not like the medication’s side effects,
so he stopped taking it. He said
that he was told that he had “kidney problems” but never kept the appointments to check his
kidneys. After further assessment, the nurse finds that the abdomen appears firm, round, and
distended with edema. He has +2 edema
on his ankles and shins bilaterally. He reports decreased
urine output; on admission urine is dark and rust
-
colored. G.W. is alert and oriented to person,
place, time and situation. He is lethargic but easily arousable and coherent. His blood work
shows a
BUN of 35 mg/dL (12.5 mmol/L), serum creatinine of 4.7 mg/dL (415 mcmol/L),
albumin 1.2 g/dL (12 g/L), Hgb 7.1 g/dL (71 g/L) and Hct 23.5%. The results of his urinalysis
are listed here:
Chart View
Urinalysis
Appearance
Clear
Color:
Rust
Odor:
Aromatic
pH
6.
2
Protein
Positive
Glucose
Negative
White blood cells
5
SBAR 71 G.W
Scenario G.W., a 34-year-old African American man, presents with increasing right knee
swelling. He states that the swelling has gotten worse over the past two weeks and on
presentation is now having difficulty ambulating. He reports taking over-the-counter ibuprofen
200 mg tablets at least 4 to 8 tablets per day for nearly 1 year for persistent back and knee pain.
He has not seen his primary care physician (PCP) in nearly 2 years. G.W. also complains of
weakness, fatigue, decreased urine output, and joint pain and stiffness. He also tells you that
when he does urinate, it looks “rusty.” His vital signs are as follows: BP 210/100, P 86, R 24, T
98.7º F (37.1º C)
CASE STUDY PROGRESSG.W. tells you that a few years ago he was diagnosed with high
blood pressure, but he did not like the medication’s side effects, so he stopped taking it. He said
that he was told that he had “kidney problems” but never kept the appointments to check his
kidneys. After further assessment, the nurse finds that the abdomen appears firm, round, and
distended with edema. He has +2 edema on his ankles and shins bilaterally. He reports decreased
urine output; on admission urine is dark and rust-colored. G.W. is alert and oriented to person,
place, time and situation. He is lethargic but easily arousable and coherent. His blood work
shows a BUN of 35 mg/dL (12.5 mmol/L), serum creatinine of 4.7 mg/dL (415 mcmol/L),
albumin 1.2 g/dL (12 g/L), Hgb 7.1 g/dL (71 g/L) and Hct 23.5%. The results of his urinalysis
are listed here: Chart View Urinalysis
Appearance Clear
Color: Rust
Odor: Aromatic
pH 6.2
Protein Positive
Glucose Negative
White blood cells 5
