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Regain fluid balance, as evidenced by weight loss, decreasing edema, and normal vital signs. Experience decreased dyspnea. Maintain intact skin and mucous ...
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Dorothy Rainwater is a 45-year-old Native American woman hos- pitalized with acute renal failure that developed as a result of acute glomerulonephritis. She is expected to recover, but she has very little urine output. Ms. Rainwater is a single mother of two teenage sons.Until her illness, she was active in caring for her fam- ily, her career as a high school principal, and community activities.
Mike Penning, Ms. Rainwater’s nurse, notes that she is in the olig- uric phase of acute renal failure, and that her urine output for the previous 24 hours is 250 mL; this low output has been constant for the past 8 days. She gained 1 lb (0.45 kg) in the past 24 hours. Laboratory test results from that morning are: sodium, 155 mEq/L (normal 135 to 145 mEq/L); potassium, 5.3 mEq/L (normal 3.5 to 5.0 mEq/L); calcium, 7.6 mg/dL (normal 8.0 to 10.5 mg/dL), and urine specific gravity 1.008 (normal 1.010 to 1.030).Ms.Rainwater’s serum creatinine and blood urea nitrogen (BUN) are high; how- ever, her ABGs are within normal limits. In his assessment of Ms. Rainwater , Mike notes the following:
At the end of the shift, Mike evaluates the effectiveness of the plan of care and continues all diagnoses and interventions. Ms. Rainwater gained no weight, and her urinary output during his shift is 170 mL. Her urine specific gravity remains 1.008. Her vital signs are unchanged, but her crackles and wheezes have de- creased slightly. Her skin and mucous membranes are intact. Ms. Rainwater tolerated the bedside chair without dyspnea or fatigue.