Manny Castillo and his partner, Andy White, have just moved to Kinzig from the bustling city of Chicago. They were hoping to move out of the busy city to reduce Mannys stress level because it has taken a toll on his health. Due to uncontrolled hypertension Manny has been diagnosed with renal insufficiency. Manny is being followed by Dr. Martin, a nephrologist in Kinzig who was recommended by his nephrologist in Chicago. His records were sent to Dr. Martins office and Manny has set up his first appointment with Dr. Martin. Manny went to Dr. Martins office and had blood work drawn. Dr. Martin conducted a comprehensive exam and reviewed his health history, medications and developed a plan of care for Manny. Manny left the office with a new medication regime to treat his renal insufficiency. The medications he will take are: 20mg furosemide once a day, 10mg enalapril once a day, and 1 Nephplex vitamin capsule once a day. · What are the indications for the furosemide, enalapril, & Nephplex vitamin? · What non-pharmacological treatments could help Manny? A few days later Manny received the test results and was educated that he needed to be sure to follow his medication regime and watch his diet. A couple weeks after the visit with Dr. Martin, Manny and Andy received a phone call from the adoption agency notifying them of a possible little girl who they could adopt. This was great news for Manny and Andy because they have been waiting for this phone call for years! They want nothing more than to be parents and now it could be possible. Even though this was going to add stress to Mannys life, they decide to go through with the paperwork as this was their ultimate dream. · What could the added stress do to Mannys health? · How can Manny decrease his stress level during this intense time? A few months later Manny started feeling bad and went back to the nephrologist. Dr. Martin ordered more lab tests and a urinalysis. Two days later Manny received a phone call from Dr. Martins office regarding his blood work and lab tests and was asked to immediately come to see Dr. Martin. In fear of bad news, Manny called Andy and he met Manny at the Dr.s office to provide support. Once they arrived to the office, Dr. Martin reviewed the blood work with Manny and Andy. Mannys BUN is 50mg/dL, creatinine is 5.6mg/dL, GFR is 14mL/min, K is 6.2 mEq/L, Phosphorus is 5.4mEq/L, Hemoglobin is 8.2mg/dL, Hematocrit is 27.3. His UA revealed protein and glucose in his urine. · What do you think is happening here? · What are normal BUN & Creatinine, GFR, K, Mg, Phosphorus, Hemoglobin and Hematocrit levels? · Why did he have protein and glucose in his urine? Dr. Martin instructs Andy to immediately take Manny to the hospital because he will need to be admitted for emergency dialysis. This news worried Manny and Andys ability to adopt their little girl. They worried they would not be approved due to Mannys declining health. An interesting point about the little girl they could possibly adopt is that she too has renal issues and requires special medical care. Manny was admitted to the hospital and a hemodialysis catheter was placed and dialysis was done. His lab values trended back to normal and he was able to go home but on a dialysis schedule of Monday, Wednesday & Friday. During his hospital stay he had an AV fistula created in his left lower arm by a very skilled vascular surgeon, Dr. Evans. Manny understand that he still needs to continue having his dialysis using his hemodialysis catheter until his AV fistula matures. He was also sent home with a different medication regime. His new regime is: 10mg enalapril PO BID 800mg Renvela PO TID with meals 50units/kg Epogen IV 3 times a week (during dialysis) 100mg Iron sucrose IV 3 times a week (during dialysis) 1 Nephplex vitamin PO BID · What are the therapeutic indications of each of these drugs? · What are the adverse reactions/side effects of each of these drugs that you would need to teach Manny? · What dietary restrictions are you going to educate Manny about? · What will you educate Manny about regarding his new AV fistula? Manny goes home and reports Monday to an outpatient dialysis clinic for his dialysis session. After 30 minutes on the dialysis machine, Manny complains of severe cramping and pain. · What can the nurse do for him to alleviate the cramping and pain? Good news, the adoption was approved and Manny and Andy have their little girl!
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