Case

IHUMAN Case Study Ken Fowler - Complete Solutions (Graded A+)

Week #7: Week #7 - Conditions of the Renal and Genitourinary

Systems

NRNP 6550: Advanced Care of Adults in Acute Settings II

i-Human: Ken Fowler V5

FILL OUT THIS TEMPLET AS YOU GO THROUGH THE I-HUMAN PATIENT MODULE SO

YOU KNOW WHAT YOU ARE DOING AS YOU GO.

YOU ARE ALL WELCOME!!!

Name: Ken Fowler

Age: 70 years

Sex: M

Ht: 5'10" (178.0 cm)

Wgt: 190 lb (86.0 kg) (BMI 27.3)

NOTES FROM i-HUMAN ASSESSMENT:

1) Observations: warm and sweaty

2) Chief complaint: Nausea and fatigue

QUESTIONS: (ask the patient up to 100 questions)

1) How can I help you today? "I went to see my doctor this morning because I have been

feeling bad for the past few days. I'm tired, with nausea & vomiting. Well, he

examined me and ordered some labs, and then told me that "kidneys are failing,"

something about a big change in my creatinine and that I needed to come to the

emergency department. He told me to bring the test results here with me. [Test results

today: creatinine 3.2 mg/dL; 1 month ago Test results 1.1 mg/dL; urine protein = 400

mg microalbuminuria] Do you understand what all that means? I sure don't!"

2) Do you have any other symptoms or concerns we should discuss? I also feel

exhausted, probably from all the vomiting and not eating.

3) When did your nausea start? It started three days ago, I woke up feeling nauseous

and started throwing up everything I ate.

4) What are the events surrounding this start of your nausea and vomiting? Nothing

really happened that I can think of.

5) Do you have difficulty breathing? Uh… no.

6) When do you fatigue start? Just the last few days.

7) Do you have a problem with fatigue/tiredness? Yup

8) Does your fatigue come and go? No.

9) Have you gained or lost weight or intentionally, despite normal appetite and

exercise? Uh… no.

10) Have you gained weight? No.

11) Has there been a change in your urination frequency? Actually, I have been peening

less recently.

12) What is the color of urine, has it changed recently? It's usually fine, but I have been

peeing less recently

13) Does anything make your fatigue/tiredness better or worse? No.

14) Do you have pain anywhere? If so where? I hurt my back last week, but that's fine

now.

15) Have you noticed swelling in any part of your body? No

16) Can you tell me about any current or past medical problems she had? I have high

blood pressure. I take medications for that. I was told last month my blood pressure

has caused some kidney damage. Something about my protein in my urine. Oh, about

a week ago I pulled my back lifting a heavy carton when I was cleaning out my

garage. It was pretty painful so I took something for the pain. My back is really pretty

good right now, but then this nausea vomiting began.

17) Any previous medical, surgical, or dental procedures? Yes. I had my tonsils out as a

kid and then my appendix out about 35 years ago now.

18) What treatments have you had for the pain in your back? Just Naproxen.

19) Are you taking any prescription medications? I take lisinopril, metoprolol, and

hydrochlorothiazide for BP. I have not taken anything for the last 24 hours because I

feel so sick, can’t keep the pills down.

20) Do you have any pain in your back? Not anymore

21) When you urinate, have you noticed any pain, burning, blood, difficulty starting or

stopping, dribbling, incontinence, urgency during day or night, or any changes in

frequency? Uh, no. In fact, I am barely peeing at all.

22) When are the events surrounding the start of your difficulty urinating? That’s not a

problem for me.

23) When you pee, is a stream or flow of urine weak or do you dribble? No

24) Do you have problems with nausea, vomiting, constipation, diarrhea, coffee

grounds in your vomit, dark tarry stool, bright red blood in your bowel movements,

early satiety or bloating? Yes, I have already told you about my nausea and vomiting.

But none of the other stuff. My poop is normal

25) How severe is your nausea and/or vomiting? I have not eaten much of anything in

the last three days, so I am not sure how to answer that question. Vomiting is and

miserable business so for me it is bad.

26) Does anything make your nausea and/or vomiting better or worse? It does get

worse when I eat, that's why I haven't eaten much.

27) What treatments have you had for nausea and/or vomiting? Nothing

28) Do you have any problems with fatigue, difficulty sleeping, or intentional weight

loss or gain, fevers, or night sweats? Yeah I feel exhausted, but I think it is because of

my nausea… just keeps me up at night. No fevers

29) Does your fatigue/tiredness improve after a good night's rest? No

30) What does your vomit look like? Clear or residual food particles, but I haven't eaten

for over 24 hours

31) When do you nausea and/or vomiting start? It started 3 days ago, I woke up feeling

nauseous and started throwing up everything I ate.

32) Do you have diabetes? Uh… no