Please complete each assignment in questions/answer format. Answers must be in complete sentence and paragraph style. Please cite any references used other than the text.
Case Scenario:
Kyle, age 72 years, is a lifelong 2 ppd smoker, who doesn’t go to the doctor routinely. He has recently suffered a heart attack, damaging his left ventricle. He appears to be suffering from left-side heart failure. Stroke volume, blood pressure, and cardiac output are all reduced. He is hypoxic and has audible wheezing. On assessment, he has clubbing of the fingers and a barrel-shaped chest. He is pursed-lip breathing, and is using accessory muscles to breath. He is having difficulty catching his breath while speaking. Inspection reveals peripheral edema. Vital signs include a heart rate of 82 beats per minute and respiratory rate of 12 breaths per minute. Oxygen saturation is 82%. Spirometry results show reduced vital lung capacity and reduced forced vital capacity. Kyle’s renal function is also impaired. Serum BUN and Cr levels are increasing and GFR is significantly reduced. Oliguria is present, as are edema of the face and extremities. Kyle seems to be becoming more and more confused and disoriented. Further blood laboratory values reveal hypocalcemia, hyperkalemia, and anemia.
1. Based on the information provided, list 5 possible diagnoses for this patient.
2. Why has Kyle developed a barrel-shaped appearance to his chest and clubbing of his nail beds.
3. Is Kyle’s oxygen saturation value normal?
4. What is the significance of the spirometry test results?
5. Which type of renal dysfunction is most likely occurring in Kyle’s case: prerenal, intrarenal, or postrenal?
6. What information leads you to your conclusion?
7. Why are Kyle’s serum BUN and Cr levels increasing?
8. Why may Kyle be experiencing oliguria?
9. Given Kyle’s current issues, why may he have developed peripheral edema?
