51. A child is hоspitаlized аfter а mоtоr vehicle crash. The child is prescribed 6 units of Humulin Insulin at 0730. The nurse would correctly which equipment to administer the child's insulin?
Andre аwоke fоr the third time in twо hours. He knew thаt he probаbly wouldn’t be able to produce any urine, but he felt the urgency just the same. He got out of bed and walked to the bathroom— again! He had been diagnosed with benign prostatic hypertrophy, an enlarged prostate gland, when he was 51. He was now 57 and beginning to seriously consider having surgery. The enlarged gland (which surrounds the base of the urethra in males) had made it difficult to urinate; he felt like he needed to go all the time, yet he couldn’t produce a good stream. He had also begun having frequent urinary tract infections over the last year. His urine came out slowly, even though he felt he had a full bladder. The urine looked cloudy and smelled foul, and caused a burning sensation. “Not again,” he thought to himself. He would have to call the doctor to refill his antibiotic prescription. For now, he thought the best thing might be to take something to help with his headache and aching back. He reached for a bottle of ibuprofen. “Andre, you look terrible. When are you going to see the doctor?” Andre’s wife Maive was worried. Over the last two days, Andre had gotten worse. He had been up half the night vomiting, had terrible back pain just under his ribs, and had developed a fever. “I have an appointment today; you’ll need to drive me. I’m not up to it. I feel terrible.” At the clinic, the nurse found Andre’s blood pressure to be 180/110, and his fever was 102°F. The doctor wasted no time in ordering a urinalysis, Chem 7, and an ultrasound of his kidneys. “Andre, I think you may have a kidney infection, a very serious one at that. How long has this been going on?” asked the doctor. “For three or four days. I always have trouble peeing; but I noticed the smell in my urine a few days ago. I started having the back pain then, too. I didn’t start feeling nauseous until yesterday. That’s when the fever seemed to get worse. My hands and feet seem to be swollen, too; I can hardly feel anything in them.” The doctor nodded and asked, “Did you take anything? I see you had refills on your antibiotic prescription.” “No antibiotics; I ran out. I’ve been taking ibuprofen; it doesn’t seem to be working, though. When it didn’t help the back pain and headache, I just doubled up on the dose.” The doctor’s eyes widened. “Andre, it’s important to know how much ibuprofen you’ve been taking. High doses can damage the kidneys.” “I don’t know,” replied Andre, “I finished the bottle, I think.” Just then the nurse entered the exam room and handed the lab reports to the doctor. “Well, Andre, your blood urea, nitrogen, and creatinine levels are elevated well beyond normal; blood potassium and sodium are as well. There were also bacteria in the urine; I expected that. The urinalysis and blood results concern me. I’d like to admit you to the hospital. We need to get your electrolyte levels back to normal. We can address the infection with antibiotics. I think the combination of the infection and the excessive amounts of ibuprofen may have produced an acute tubular necrosis, causing your kidneys to stop working.” A) Which important ions does the kidney regulate that might be imbalanced if Andre’s kidneys are not functioning properly? What are the side effects of these imbalances? B) Andre is producing reduced amounts of urine, yet he is taking in a normal amount of fluids and electrolytes; how might this affect his blood volume? Could this be related to his blood pressure problems? How? Andre had been admitted to the hospital immediately. He was started on antibiotics for the infection and was put on dialysis. His blood levels of potassium had worried the doctor most, since elevated potassium could have a negative effect on the heart and respiration. The next day, as Andre lay sleeping in his room, a soft voice woke him. “How are you doing today, Andre? Feeling better?” The nurse examined the bag connected to Andre’s catheter. “You’re still not producing much urine, looks like only 300mL or so since yesterday at this time. It’s likely your kidneys need some time to recover from the infection and the ibuprofen toxicity. I’ve seen a lot of patients over 50 years old with enlarged prostates, but they usually don’t have kidney failure.” Andre began to feel better following dialysis; the excess electrolytes and metabolic wastes that had been challenging his body and causing much of his discomfort were eliminated. His fever subsided within 24 hours due to the antibiotic therapy. However, it was still several days before he was discharged. “Andre, you had a close call, but I think you are going to be okay. I’d like to schedule a follow-up visit next week and arrange a kidney function test. We will need to monitor your progress closely.” Andre sighed. “Thank you, Doctor. Would having the prostate surgery pre-vent this from happening again? I’ve been putting it off, but it may be time.” “Well, Andre, the infection most likely wouldn’t have caused renal failure on its own. The combination of obstruction, infection, and acute ibuprofen toxicity caused this problem. After we see how well your kidneys recover, we can discuss your options.” C) Why might Andre’s restricted flow of urine have caused damage to his kidneys? (Hint: Think of the anatomy of the kidney.) D) Acute tubular necrosis causes a decrease in glomerular filtration rate. Why wouldn’t Andre’s increased blood pressure have compensated for his reduced filtration? (Hint – Think about the autoregulatory response to increased BP) E) Which of his hormones were unable to adjust for Andre’s electrolyte imbalance? Which ones are normally involved in regulating the water content of his body and how do each of the adjust water balance?