NR 603 Week 3 Collaboration Cafe_Kidney Disease Exacerbation and Acute Decompensated Heart Failure

J.L. is a 66-year-old male presenting with shortness of breath, worsening lower extremity edema, and fatigue over the past two weeks. He has a history of CKD stage 2, type 2 DM, hypertension, and CHF. His physical exam reveals diminished pedal pulses with +3 bilateral pitting edema that extends up to his mid-shins. There is delayed capillary refill in his lower extremities, along with mild JVD. An increased work of breathing with bibasilar crackles and dullness in the bilateral lower lung fields is noted. O2 sats are only 92% on room air, along with a BP of 162/94, HR 98, RR 22, and a weight of 210lbs, which is a 5-7lb weight gain in one week. Since the patient has a significant past medical history, it is important to thoroughly and accurately diagnose the patient to avoid treatment errors. In the case of J.L., it would be important to obtain blood work, including a CBC, CMP, BNP, and troponin levels, to assess for any organ dysfunction such as kidney function, electrolyte balance, potential for anemia, and cardiac function. An EKG can show if there is additional heart strain and potential for myocardial infarction. A chest X-ray is important to assess for cardiomegaly and pleural effusions. c. Compare and contrast the management of each assigned diagnosis, including similarities and differences in pharmacologic and non-pharmacologic treatment, client education, referral, and follow-up care. Consider how the client’s unique past medical history and social history impact care decisions. Kidney Disease Exacerbation- chronic kidney disease is defined as the presence of kidney damage or eGFR less than 60 mL/min persisting for more than three months (Vaidya & Aeddula, 2024). The most common causes of CKD include types 1 and 2 diabetes, hypertension, primary glomerulonephritis, chronic tubulointerstitial nephritis, hereditary or cystic diseases, secondary glomerulonephritis or vasculitis, plasma cell dyscrasias or neoplasm, and sickle cell nephropathy (Vaidya & Aeddula, 2024). Medical management of kidney disease includes adjusting drug dosages as needed based on the patient’s eGFR levels, and preparing the patient for renal replacement therapy, whether that be hemodialysis or peritoneal dialysis (Vaidya & Aeddula, 2024). Non-pharmacologic treatment includes identifying and treating potentially reversible causes of kidney disease, such as an infection, drugs, hypotension, and hypovolemia (Vaidya &Aeddula, 2024). Blood pressure and glucose management are essential in the management of kidney disease and help to prevent further progression (Viadya & Aeddula, 2024). It is essential to educate the client on their disease process, signs, and symptoms to watch for, which could indicate an increase in their kidney dysfunction. Including swelling of their lower extremities, weight gain, fatigue, and increasing shortness of breath. Patients should be aware of their daily blood pressure and weight, and record them. Dietary education to avoid foods that are high in potassium, the importance of taking their medications, such as diuretics, phosphorus binders, and not missing a dose (Viadys & Aeddula, 2024). Patients with increasing kidney function and other signs and symptoms of kidney dysfunction need to be referred to a nephrologist to