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Case study Course: pathophysiology – (BMS252M) Class: 4p1/4p2/4p3/4p4 Student’s name in the Group (ID): 3. Patient Case (Full Medical History) & Background Information 68years old male, BMI (28.7), a longstanding history of hypertension and diabetes Regular Medications and frequency: Antihypertension (atacand 8mg/day) and antidiabetic (Glucophage 850mg twice /day)drugs The present complain: He has had more headaches recently, his legs and feet are swollen, and he has noticed that more frequent voiding, both during the day and at night, is necessary. He constantly feels tired and does not feel hungry plus nausea vomiting and pruritus. Current Physical Exam Findings General manifestations ; his legs and feet are swollen P=90/min BP-180/110 Respiratory rate 24 SaO2=35% He has gained 12 pounds in the last 2 months Skin: superficial excoriations of his skin from scratching Laboratory Parameters Blood Laboratory data; Na-133(136-146mmol/L) K=6.2(3.5-5.3MMOL/L) CL=100(98-108MMOL/L) Total CO2:15(23-27mmol/L)-low serum bicarbonate BUN=170(7-22MG/DI CREATININE=16(0.7-1.5MG/DI)high serum levels PHOSPHORUS=10.5(2.6-6.4MG/DI) ALKALINE PHOSPHATASE=306(30-11OUT/L) Parathyroid hormone; 895(10-65pg/ml Hemoglobin: 8.6(14-17gm/ml-low Hematocrit: 27.4(40-54%)-low Urinalysis: pH 6.0 / specific gravity=very low(1.010) PROTEIN=1+ /Waxy casts +ve GLUCOSE –VE /ACETONE=VE BILE-VE OCCULT BLOOD=VE 24-hour urine : Volume=850ml / Protein=600mg/dl/Creatinine=180mg/1 II-Renal ultrasound : Right kidney 9×6.0cm/Left kidney: 9.2×5.8cm Both kidneys illustrate hyper echogenicity and no hydronephrosis. The diagnosis is renal insufficiency, or chronic renal failure. Leader: distribute task and collect information, and give order 1. What is the most likely cause for this patient renal disease? How did you arrive at that conclusion? 2. Why the patient has high blood pressure and what are the possible complications he can developed? 3. Student comment on laboratory data. 4. Student comment on elevation of parathyroid hormone. 5. Student comment on patient’s anemia. 6. Student comment on lower extremity edema and the weight gain. 7. Student comment on metabolic acidosis. 8. State three factors contributing to fatigue 9. Explain why patient is voiding frequently and has a very dilute urine?. 10. List the signs indicating that this patient has progressed into uremia, or end-stage renal failure. 11. Should this patient be started on dialysis? If yes, mention why? Rubric Objectives: By the end of this activity, students will be able to: 1- Identify the main medical Issues/problems within the case and the steps toward diagnosis of renal failure 2- Discuss how the patient developed renal failure (etiology of renal failure) 3- Recognize manifestations of stages of renal failure and gather assessment data. 4- Discuss the complications and Leam management (will the patient be hospitalized; taking medication, the patient need hemodialysis, or the patient need a kidney transplant). 5. Utilize research databases, evidence, and resources to apply in case. 6- Collaborate and cooperate dynamically with the group.
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