Parathyroid Hormone - Superficial Excoriations of his Skin from Scratching - Nursing Assignment Help

Assignment Task:

Case Studies

The patient is a 41 year-old male who has a longstanding history of hypertension and diabetes and presents with a complaint of pruritus, lethargy, lower extremity oedema, nausea and vomiting. He denies any other medical problems. 

On physical exam the patient is a well-developed, well-nourished male in moderate distress. Blood pressure 180/110, pulse 80, respirations 24 and he was afebrile. Body weight 76.5 kg. 

Cardiac exam had an S1, S2 and S4. The remainder of the exam was remarkable for 2+ lower extremity oedema and superficial excoriations of his skin from scratching.

Case Questions 

1. "Presents with a complaint of pruritus, lethargy, lower extremity oedema, nausea and emesis." what does the symptoms suggest to you? 

2. What does S4 signify? What cardiac findings will you expect to find in a hypertensive? 

3. What are the possibilities for his 2+ lower extremity oedema? 

4. What is the significance of the finding “superficial excoriations of his skin from scratching.”? 

5. Why was a renal ultrasound ordered? What information can you gather from renal ultrasound studies? 

6. How do the results of the renal ultrasound influence your thinking on the diagnosis? What is the normal size of the kidney? Is his kidney size normal? What does small or large kidney signify? 

7. What evidence in renal ultrasound, will suggest obstruction? 

8. Is the cause of this patient’s renal failure acute or chronic? How did you arrive at that conclusion? 

9. What is the calculated GFR? 

10. What would be the calculated GFR in this case, if the patient was female? 

11. What is the 24 hour urine protein excretion in this patient? 

12. Is this 24 hour urine collection adequate? How did you arrive at that conclusion? 

13. How is 24 hour urine to be collected and when is it appropriate to order this test? 

14. What is the measured GFR in this patient? 

15. Why is the parathyroid hormone elevated? 

16. What is the most likely cause of this patient’s anaemia? 

17. Should this patient be started on dialysis? What are the indications for dialysis? 

18. What is the most likely diagnosis for his renal disease? How did you arrive at that conclusion?

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