LABORATORY AND DIAGNOSTIC TESTS KUB ULTRASOUND Date: June 25, 2013 Time: 8:15 a.m.

Roentgenological Findings Right kidney measures 9.9 cm x 4.3 cm ( !" #hi$e the $e%t kidney measures 4.8 x 4.5 cm ( !" &'th sh'#ing increased (arenchyma$ ech'genia$ity. )' dem'nstra&$e %'ca$ mass n'r $ithiasis seen. *e$+'ca$yces n't di$ated. ,'rtica$ thickness- R./1.1 cm, ./1.0 cm 0rinary &$adder is m'derate$y distended sh'#ing s$ight$y thickened #a$$s. )' dem'nstra&$e %'ca$ mass n'r $ithiasis seen.

Im !ession 1i%%use rena$ (arenchyma$ disease &i$atera$ ,ystitis

Anal"sis ,ystitis is in%$ammati'n '% y'ur &$adder due t' an in%ecti'n 'r irritati'n. 0sua$$y cystitis 'n$y a%%ects y'ur &$adder and is kn'#n as a $'#er urinary tract in%ecti'n (023". 3% the in%ecti'n g'es higher, t' y'ur ureters 'r kidneys, this can &e a m're seri'us i$$ness kn'#n as an u((er urinary tract in%ecti'n. 3t4s m're c'mm'n in #'men. 5 (ers'n #h' has kidney disease is (r'ne %'r cystitis &ecause sugar and (r'tein (resent in the urine enc'urages &acteria$ gr'#th #hen st'red in the &$adder. Reference: http://hcd2.bupa.co.uk/fact_sheets/html/cystitis.html C#EST $%RAY Date: June 24, 2013 Time: 8:00 a.m. Roentgenological Findings &A' L"ing (ie)* *isua$i6ed $ung %ie$ds are c$ear. 2here is an increase in the trans+erse diameter '% the heart. 5'rta is ca$ci%ied. 7ther chest structures n't remarka&$e.

Im !ession ,'ngesti+e changes in &'th $ungs. 8eart is magni%ied #ith increased cardiac trans+erse diameter 5ther'mat'us a'rta

Anal"sis

,'ngesti'n is due t' (u$m'nary edema. Retenti'n '% s'dium and #ater causes accumu$ati'n '% %$uid in the (u$m'nary tissues caused &y $'ng9standing e%%ects '% kidney damage. 5ther'sc$er'sis is a c'nditi'n in #hich an artery #a$$ thickens as the resu$t '% a &ui$d9u( '% %atty materia$s such as ch'$ester'$. 3t is a syndr'me a%%ecting arteria$ &$''d +esse$s, a chr'nic in%$ammat'ry res('nse in the #a$$s '% arteries, in $arge (art due t' the accumu$ati'n '% macr'(hage #hite &$''d ce$$s and (r'm'ted &y $'#9 density $i('(r'teins #ith'ut ade:uate rem'+a$ '% %ats and ch'$ester'$ %r'm the macr'(hages &y %uncti'na$ high density $i('(r'teins. Risk %act'rs inc$ude hy(ertensi'n, genetic susce(ti&i$ity, e$e+ated serum $e+e$s '% uric acid, chr'nic systemic in%$ammati'n, stress and e+en sh'rt s$ee( durati'n. Reference: http://en.wikipedia.org/wiki/Atherosclerosis URINALYSIS Date: Time: TEST ,'$'r 2rans(arency 0;<25<=13 8:2> am RESULT ?e$$'# @$ight$y tur&id 0;<28<=13 9:45 am RESULT ?e$$'# @$ight$y tur&id 0;<25<=13 0;<28<=13 8:2> am 9:45 am ANALYSIS )'rma$ 5&n'rma$. 2his is due t' increased c'ncentrati'n '% g$uc'se n't n'rma$$y a measura&$e :uantity in urine. Reference: A Look At Laboratory and Diagnostic ests with !ursing "mplications# p. $%& )'rma$ )'rma$ 5&n'rma$. 3n ,.1, the %irst sign '% deteri'rating kidney %uncti'n is the (resence '% sma$$ am'unts '% a$&umin in the urine, a c'nditi'n ca$$ed Dicr'a$&uminuria. 5s kidney %uncti'n dec$ines, the am'unt '% a$&umin in the urine increases, and Dicr'a$&uminuria &ec'mes %u$$9($edged (r'teinuria. Reference: http://www.steadyhealth.com Cr'teinuria is caused &y g$'meru$ar ca(i$$ary mem&rane damage #hich a$$'#s &$''d ce$$s and (r'teins t' esca(e %r'm &$''d int' the %i$trate. Reference: 'edical ( )urgical !ursing: *ritical hinking in *lient

NOR+AL (ALUES @tra# t' 1ark ?e$$'# ,$ear

(8 @(eci%ic Bra+ity 0rine Cr'tein

5.0 1.015 2race

5.0 1.010 2race

4.; A ;.5 1.010 A 1.025 )'ne

*are# +th edition# p. ,,$

0rine @ugar

(E"

(9"

(9"

!F,

2'' numer'us t' c'unt

10912 h(%

095 h(%

RF,

49; h(%

49; h(%

092 h(%

5&n'rma$. )'rma$ -lycosuria# g$u c'se in the urine, resu$ts %r'm the g$'meru$ar %i$trati'n '% m're g$uc'se than the rena$ tu&u$e can a&s'r&. 2he rena$ thresh'$d is 1809200 mg<d .. Reference: http://en.wikipe dia.org/wiki/-l ycosuria http://www.ncb i.nlm.nih.go. 5&n'rma$. 2his indicates an in%ecti'n. 3n additi'n, 3nterca(i$$ary g$'meru$'(athy in rena$ %ai$ure may in+'$+e in%$ammat'ry changes such as chem'taxis '% $euk'cytes and scarring. !hite &$''d ce$$s may exit int' the urine #hen rena$ %uncti'n dec$ines. Reference: 'edical/)urgical !ursing: *linical 'anagement for 0ositi.e 1utcomes# p. 2&3 5&n'rma$. 2y(ica$$y, micr'sc'(ic hematuria indicates damage t' the u((er urinary tract (kidneys". 2here are +ari'us diseases that can c'ntri&ute t' &$''d in urine $ike ,.1 #hich can a$s' in%$ame the ca(i$$aries in the kidneys res('nsi&$e %'r

%i$tering the &$''d. References: http://www.bu44le.com/articles /red/blood/cells/in/urine.html http://www.emedicinehealth.c om/blood_in_the_urine/article _em.htm 8ematuria may resu$t %r'm 'ne '% t#' mechanisms: ru(ture 'r (er%'rati'n '% +esse$s in the rena$ system 'r urinary tract, 'r im(aired g$'meru$ar %i$trati'n, #hich a$$'#s RF,s t' see( int' the urine. http://www.wrongdiagnosis.co m/k/kidney_disease/book/ diseases/%$a.htm )'rma$.

5m'r(h'us 0rates Facteria

D'derate D'derate

D'derate D'derate

)'rma$ in (8 $ess than ;.5 )'ne 5&n'rma$. 3n%ecti'n is (resent. 5$s', &acteria$ casts %'rmed in a (r'tein matrix in urine sediments can &e a diagn'stic cue and an im('rtant %inding in kidney damage. Reference: A Look At Laboratory and Diagnostic ests with !ursing "mplications# p. +5%

BLOOD C#E+ISTRY Fasting Blood S,ga! Date: June 24, 2013 Time: 9:0> a.m. TEST GF@ RESULT >.83 mm'$< NOR+AL (ALUES 3.9095.80 mm'$< ANALYSIS 3ncreased. 5ttri&uted t' a&n'rma$ rena$ g$uc'ne'genesis and increased car&'hydrate meta&'$ism ass'ciated #ith end9stage rena$ disease. Reference: A Look At Laboratory and Diagnostic ests with !ursing "mplications# p. +2+

B"%'!od,cts Date: June 24, 2013 Time: 9:0> a.m. TEST RESULT NOR+AL ANALYSIS

@erum ,reatinine

193 um'$<

(ALUES 44.29150.3 um'$<

F0)

9.2 mm'$<

2.99>.9 mm'$<

F$''d 0ric 5cid

>1; um'$<

149941; um'$<

3ncreased. 5n increase is indicati+e '% rena$ disease as serum creatinine increases in c'nHuncti'n #ith g$'meru$ar damage. 2his is due t' retenti'n '% meta&'$ic #aste (r'duct. References: A Look At Laboratory and Diagnostic ests with !ursing "mplications# p. %+6 'edical ( )urgical !ursing: *ritical hinking in *lient *are# +th edition# p. %626 3ncreased. 5n e$e+ated &$''d urea nitr'gen $e+e$ is an indicati'n '% rena$ dys%uncti'n and is due t' retenti'n '% meta&'$ic #aste (r'duct. Reference: A Look At Laboratory and Diagnostic ests with !ursing "mplications# p. ,6 3ncreased. 2he increased $e+e$ may &e seen in se+ere dia&etes me$$itus (#hich incurs $'ng term c'm($icati'ns '% ne(hr'(athy". 3t is due t' retenti'n '% meta&'$ic #aste (r'duct. Re%erence: A Look At Laboratory and Diagnostic ests with !ursing "mplications# pp.+2$/+23

Se!,m Elect!ol"tes Date: Time: TEST @'dium 0;<24<=13 8:24 am RESULT 10; mm'$< 0;<30<=13 3:5> (m RESULT 129 mm'$< 0;<24<=13 0;<30<=13 8:24 am 3:5> (m ANALYSIS 1ecreased. 8y(er+'$emic hy('natremia is characteri6ed &y an increase in &'th t'ta$ &'dy )a (and thus I,G +'$ume" and 2F! #ith a re$ati+e$y greater increase in 2F!. *ari'us edemat'us dis'rders, inc$uding heart %ai$ure and cirrh'sis, cause hy(er+'$emic hy('natremia. Rare$y, hy('natremia 'ccurs in ne(hr'tic syndr'me, a$th'ugh (seud'hy('natremia may &e due t' inter%erence #ith )a measurement &y e$e+ated $i(ids. 3n each '% these dis'rders, a decrease in e%%ecti+e circu$ating +'$ume resu$ts in the re$ease '% 518 and angi'tensin 33. Reference: http://www.unboundmedicine.com/m erckmanual/ub/.iew/'erck/'anual/ 0ro/&56,$%/%/hyponatremia 1ecreased. 3n the )'rma$ (resence '% rena$ %ai$ure, the (r'('rti'n '% ('tassium excreted thr'ugh

NOR+AL (ALUES 138914; mm'$<

C'tassium

2.9 mm'$<

3.10 mm'$<

3.594.9 mm'$<

the gut increases. Reference: http://emedicine. medscape.com/ar ticle/2+255,/ o.er.iew #E+ATOLOGY Com lete Blood Co,nt Date: Time: TEST !F, 0;<24<=13 8:20 am RESULT 28.41 k<u 0;<30<13 9:10 am RESULT 1;.;9 k<u

NOR+AL ANALYSIS (ALUES 4.;910.2 3ncreased. 5n e$e+ated $e+e$ '% k<u $euk'cytes in the &$''d den'tes in%ecti'n. euk'cyt'sis is attri&uted t' &eing the &'dy=s res('nse t' any %'rm '% tissue damage t' the site '% inHury, in (articu$ar the g$'meru$ar tissue in dia&etic ne(hr'(athy. Reference: A Look At Laboratory and Diagnostic ests with !ursing "mplications# p. +&& 3>980J 3ncreased. )eutr'(hi$s are the m'st numer'us circu$ating $euk'cytes in the &$''d and they res('nd ra(id$y t' in%$ammat'ry changes and tissue inHury (i.e. g$'meru$ar tissue in the kidney" &y mu$ti($ying in great num&ers. Reference: A Look At Laboratory and Diagnostic ests with !ursing "mplications# p. +&3 1ecreased. ym(h'(enia 'r a decrease in the num&er '% $ym(h'cytes in (eri(hera$ &$''d may mani%est in rena$ %ai$ure and 'ther acute kidney c'm($icati'ns (i.e. ne(hr'(athy". Reference: A 'anual of Laboratory and Diagnostic ests# p. $% )'rma$. 1ecreased. I'sin'(enia can 'ccur #ith stress%u$ c'nditi'ns and in the (resence '% acute &acteria$ in%ecti'n c'm('unded

1i%%erentia$ ,'unt !eutrophils

89.9J

8>J

Lymphocytes

>.9J

8.9J

10950J

'onocytes 7osinophils

3.1J 0.1J

3.>J 0.4J

39>J 193J

#ith $euk'cyt'sis. Reference: A 'anual of Laboratory and Diagnostic ests# p. $+

8asophils 8emat'crit

0.0J 21J

0.0J 2>J

0.091J 3>.>9 4>.9J

8em'g$'&in

;9 g<

;8 g<

1209140 g<

C$ate$et ,'unt

29> x 103<

343 x 103<

1429424 x 103<

)'rma$. 1ecreased. 8emat'crit is the +'$ume '% (acked RF,s in 100 m '% &$''d ex(ressed as (ercentage. 5n a$terati'n in erythr'('ietin $e+e$ in the kidney ('ccurring #ith rena$ damage" can a%%ect RF, (r'ducti'n. 2hus, a decrease in hemat'crit +a$ue may indicate a kidney (r'&$em. Reference: A Look At Laboratory and Diagnostic ests with !ursing "mplications# p. 2%, 1ecreased. 2he causati+e r'$e '% erythr'('ietin de%iciency in kidney disease inc$udes circu$ating $e+e$s '% erythr'('ietin are n't su%%icient t' maintain hem'g$'&in #ithin the n'rma$ range. Re%erence: htt(:<<###.kidney.'rg<(r'%essi'n a$s )'rma$