Keola Akana is a 70-year-old male with a history of heart failure

Keola Akana is a 70-year-old male with a history of heart failure. He was admitted to the
medical-surgical unit on Monday for medication adjustment, monitoring, and cardiac
Keola Akana is a 70-year-old male with a history of heart failure. He was admitted to the
medical-surgical unit on Monday for medication adjustment, monitoring, and cardiac rehabilitation. On Thursday at 1400, Mr. Akana experiences confusion, decreased urinary output,
and elevated blood urea nitrogen, creatinine, and potassium values. The client is sitting in bed
with head of bed at 45 degrees and 3 pillows behind his back and head. He is complaining of
difficulty breathing and is intermittently confused. Urine output has been below 30 mL per hour
for the past 16 hours, and labs have just returned indicating elevated blood urea nitrogen (BUN),
creatinine, and potassium. 3+ pitting edema is present in his legs, and lung sounds are coarse. His
wife Zoe is in the room. She is supportive and patient.
Past Medical History
• Hypertension
• High cholesterol
• Congestive heart failure
Physical examination findings
Vital signs: BP 154/92 mmHg, Pulse 98/min irregular, RR 30/min and laboured, SaO2 91% on
3L O2 via nasal cannula, Temp 36.9 0C3Scenario adopted from Elsevier-modified & edited by Nazool Alli
Respiratory
• developed shortness of breath at rest
• use of accessory muscles.
• Chest with bibasilar coarse crackles on auscultation
Cardiac
• heart sounds irregular
Neurological
• Confused
• Keola asks, “Where am I? Who are you?”
Abdomen
• no abdominal distention
• bowel sounds present
Neck
• distended neck veins
• JVD with jugular venous pressure >4cm
• no bruits noted on auscultation
Extremities
• 2+ bilateral pre-tibial pitting edema and also in feet and ankles
• Palpable pedal pulses
Integumentary
• Pale, cool and clammy
• Slightly diaphoretic4Scenario adopted from Elsevier-modified & edited by Nazool Alli
Laboratory Results
Tests Results Normal value
Red blood cell count 4.9 million/mm3 4.4 – 5.7 X 1012/L
White blood cell count 11.0 × 109 /L 4.0-10.0 × 109 /L
Troponin <0.01 μg/L < 0.01 μg/L
B-type natriuretic peptide
(BNP).
>400 pg/ml
HF very likely
<100 pg/ml
sodium 132 mmol/L 135-145 mmol/L
potassium 6.0 mmol/L 3.5-5.0 mmol/L
Blood urea nitrogen (BUN) 10.0 mmol/L 2.5 – 8.0 mmol/L
Serum Creatinine 700 μmol/L 70 – 120 μmol/L
eGFR <60
mL/min/1.73m2
> 90 mL/min/1.73m2
**HF= Heart Failure
Arterial blood Gas (ABG)
Results Normal value
pH 7.32 7.35- 7.45
PaCO2 31 35- 45 mmHg
HCO3- 12 21- 28
PaO2 70 80- 100 mmHg
Urinalysis
• fixed specific gravity of 1.010
• cell casts present.
Diagnosis
Mr. Akana was diagnosed with acute kidney injury (AKI) based on his clinical presentation. The
following were ordered by the physician to manage Mr. Akana acute kidney injury:
• Furosemide 40 mg IV x 1 now
• Sodium polystyrene sulfonate 15 grams oral elixir x 1 now
• 12-lead ECG STAT

what quesition is

What is the significance of the abnormal laboratory results? Explain each in detail.
Include in your discussion, which laboratory finding(s) would be your priority to address
and why.