Mr. J.R. is a 73-year-old man, who was admitted to the hospital with clinical manifestations of gastroenteritis and possible renal injury. The patient’s chief complaints are fever, nausea with vomiting and diarrhea for 48 hours, weakness, dizziness, and a bothersome metallic taste in the mouth. The patient is pale and sweaty. He had been well until two days ago, when he began to experience severe nausea several hours after eating two burritos for supper. The burritos had been ordered from a local fast-food restaurant. The nausea persisted and he vomited twice with some relief. As the evening progressed, he continued to feel “very bad” and took some Pepto-Bismol to help settle his stomach. Soon thereafter, he began to feel achy and warm. His temperature at the time was 100. 5°F. He has continued to experience nausea, vomiting, and a fever. He has not been able to tolerate any solid foods or liquids. Since yesterday, he has had 5–6 watery bowel movements. He has not noticed any blood in the stools. His wife brought him to the ER because he was becoming weak and dizzy when he tried to stand up. His wife denies any recent travel, use of antibiotics, laxatives, or excessive caffeine, or that her husband has an eating disorder.
Case Study Questions
The attending physician is thinking that Mr. J.R. has developed an Acute Kidney Injury (AKI). Analyzing the case presented name the possible types of Acute Kidney Injury. Link the clinical manifestations described to the different types of Acute Kidney injury.
Create a list of risk factors the patient might have and explain why.
Unfortunately, the damage on J.R. kidney became irreversible and he is now diagnosed with Chronic kidney disease. Please describe the complications that the patient might have on his Hematologic system (Coagulopathy and Anemia) and the pathophysiologic mechanisms involved.
Reproductive Function:
Ms. P.C. is a 19-year-old white female who reports a 2-day history of lower abdominal pain, nausea, emesis and a heavy, malodorous vaginal discharge. She states that she is single, heterosexual, and that she has been sexually active with only one partner for the past eight months. She has no previous history of genitourinary infections or sexually transmitted diseases. She denies IV drug use. Her LMP ended three days ago. Her last intercourse (vaginal) was eight days ago and she states that they did not use a condom. She admits to unprotected sex “every once in a while.” She noted an abnormal vaginal discharge yesterday and she describes it as “thick, greenish-yellow in color, and very smelly.” She denies both oral and rectal intercourse. She does not know if her partner has had a recent genitourinary tract infection, “because he has been away on business for five days.
Microscopic Examination of Vaginal Discharge
(-) yeast or hyphae
(-) flagellated microbes
(+) white blood cells
(+) gram-negative intracellular diplococci
Case Study Questions
According to the case presented, including the clinical manifestations and microscopic examination of the vaginal discharge, what is the most probably diagnosis for Ms. P.C.? Support your answer and explain why you get to that diagnosis.
Based on the vaginal discharged described and the microscopic examination of the sample could you suggest which would be the microorganism involved?
Name the criteria you would use to recommend hospitalization for this patient
Submission Instructions:
You Must complete both case studies when there are more than one.
Your initial post should be at least 500 words, formatted using the questions or a phrase that summarize the question as heading. This should be bold and centered and responses to each question under the heading. You must cite in current APA style with support from at least 2 academic sources within the last 5 years. Your initial post is worth 8 points.
**Possible Types of Acute Kidney Injury (AKI) for Mr. J.R.:**
Prerenal AKI: Prerenal AKI occurs due to decreased blood flow to the kidneys, leading to impaired perfusion and subsequent renal dysfunction. In Mr. J.R.’s case, the clinical manifestations of fever, nausea with vomiting, diarrhea, weakness, and dizziness could indicate dehydration and hypovolemia, resulting in decreased renal perfusion. The history of vomiting and diarrhea, coupled with decreased fluid intake, suggests volume depletion, contributing to prerenal AKI.
Intrinsic AKI: Intrinsic AKI involves direct damage to the renal parenchyma, leading to renal dysfunction. Mr. J.R.’s exposure to a possible toxin or infectious agent from the fast-food burritos could have caused direct renal injury, leading to intrinsic AKI. Additionally, the presence of fever, nausea, vomiting, and diarrhea may suggest an infectious etiology, such as gastroenteritis, which could lead to systemic inflammation and renal injury.
**Risk Factors for Mr. J.R.:**
Dehydration: History of vomiting, diarrhea, and decreased fluid intake.
Possible Toxin Exposure: Consumption of fast-food burritos that may have been contaminated or contained harmful substances.
Infectious Etiology: Symptoms of fever, nausea, vomiting, diarrhea, and possible gastroenteritis suggest an infectious cause, which can contribute to AKI.
Age: Advanced age (73 years old) may increase susceptibility to dehydration and renal injury.
Coexisting Medical Conditions: Presence of other medical conditions, such as hypertension or diabetes, could predispose Mr. J.R. to AKI.
**Complications of Chronic Kidney Disease (CKD) on Hematologic System:**
Coagulopathy: CKD is associated with platelet dysfunction, impaired platelet aggregation, and abnormal coagulation factors, leading to an increased risk of bleeding and thrombotic events. The pathophysiologic mechanisms involved include uremia-induced platelet dysfunction, decreased production of coagulation factors by the liver due to impaired renal clearance of toxins, and endothelial dysfunction.
Anemia: CKD commonly leads to anemia due to decreased production of erythropoietin by the kidneys, resulting in decreased red blood cell production. Additionally, CKD-related inflammation and shortened red blood cell lifespan contribute to anemia. The pathophysiologic mechanisms involve impaired erythropoiesis, increased red blood cell destruction, and reduced red blood cell survival.
**Diagnosis and Microorganism for Ms. P.C.:**
**Probable Diagnosis:** Ms. P.C. likely has pelvic inflammatory disease (PID), an infection of the upper reproductive organs, based on her clinical manifestations of lower abdominal pain, nausea, emesis, and a malodorous vaginal discharge. The presence of greenish-yellow discharge and microscopic examination revealing gram-negative intracellular diplococci strongly suggest Neisseria gonorrhoeae infection, which is a common cause of PID.
**Microorganism Involved:** Neisseria gonorrhoeae is the likely microorganism involved, as indicated by the presence of gram-negative intracellular diplococci on microscopic examination. This bacterium is a common sexually transmitted pathogen associated with PID and can cause severe complications if left untreated.
**Criteria for Hospitalization Recommendation:**
Severe Symptoms: Ms. P.C. is experiencing severe symptoms such as lower abdominal pain, nausea, emesis, and malodorous vaginal discharge, indicating a potentially serious infection requiring close monitoring and intravenous antibiotic therapy.
Complications: PID can lead to serious complications such as pelvic abscess, septicemia, and infertility. Hospitalization is warranted to initiate prompt treatment and prevent complications.
Need for Intravenous Therapy: Intravenous antibiotics may be necessary for severe cases of PID to achieve optimal therapeutic levels and ensure rapid resolution of infection. Hospitalization allows for close monitoring and administration of intravenous therapy.
Patient’s Safety and Comfort: Hospitalization ensures that Ms. P.C. receives comprehensive care, including pain management, intravenous fluids, and supportive measures, to alleviate symptoms and promote recovery in a controlled clinical setting.
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