Mini Case analysis. Due 10/04/15

Mini Case analysis. Due 10/04/15

Assessment 2 – Mini Case analysis 1500 words +/- 10%
Weighting 20%
This assessment enables you to link theory and practice by considering the patient’s medical history, analysing the findings and then evaluating the potential impact on their current clinical condition.
Mrs Martine is a 69 year old lady with Stage 4 Chronic Kidney Disease (CKD) secondary to Diabetic Nephropathy. Mrs Martine  is presenting to day surgery for routine  creation of vascular access prior to eventual commencement of haemodialysis.
Past medical history
Mrs Martine has a past medical history which includes, Diabetes type 1, peripheral vascular disease, Hypertension and Osteo arthritis. During a routine workup for living related transplantation a cardiac angiogram with contrast was performed, no significant findings were reported.
Current medications consist of:
•    Actrapid insulin (before meals)
•    Enalapril  20 mg daily
•    Attenolol 100mg daily
•    Panadol 2 tablets 4 hrly PRN
Prior to being diagnosed with CKD Mrs Martine had regularly used non-steroidal anti-inflammatories to ease the pain associated with the osteo-arthritis.
Clinical manifestations
Mrs Martine is alert and orientated and appears to have a good understanding of her condition and treatment options. Attendance at the nephrology outpatient department has been regular and Mrs Martine acknowledges that commencement of dialysis in the near future is inevitable.
Clinical manifestations
•    Temperature is 35.9
•    Heart rate 88
•    Blood pressure 150/85
•    SaO2 95%.
On admission Mrs Martine’s had fasted from 12 Midnight and the blood sugar level was 10mm/l
Case Analysis
Examine Mrs Martine’s medical history and analyse the implications/relationship between this and her current condition of CKD stage 4. Ensure you include in your discussion (not exclusively):
Predisposing factors to renal impairment
How each of these could impact on renal structure, perfusion, and glomerular filtration.

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