A 65-year-old male patient presents with sudden onset of oliguria and signs of dehydration His blood pressure is 90/60 mmHg, heart rate is 110 bpm and he has poor skin turgor. Laboratory results show elevated blood urea nitrogen (BUN and creatinine levels. Which of the following is the most likely cause of his acute kidney injury (AKI)?
Hypovolemia leading to decreased renal perfusion
Acute tubular necrosis
Urinary tract obstruction
Chronic kidney disease
The Correct Answer is A
A. Hypovolemia leading to decreased renal perfusion. Hypovolemia from dehydration and low blood pressure reduces blood flow to the kidneys, resulting in pre-renal AKI, characterized by elevated BUN and creatinine.
B. Acute tubular necrosis. Acute tubular necrosis may cause AKI but is often due to prolonged hypoperfusion, nephrotoxic drugs, or ischemia, not the immediate presentation seen here.
C. Urinary tract obstruction. A urinary tract obstruction leads to post-renal AKI, often with symptoms like flank pain or difficulty urinating, not dehydration and low blood pressure.
D. Chronic kidney disease. Chronic kidney disease is a long-term condition and would not cause the acute symptoms or sudden onset of AKI as seen in this patient.
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Correct Answer is A
Explanation
A. Use written communication or visual aids to supplement verbal instructions. Written communication and visual aids are effective ways to enhance understanding and provide clear instructions to a patient with hearing loss.
B. Speak loudly and directly into the patient's ear. Speaking loudly can distort sounds and may make it harder for the patient to understand. Instead, clear and slow speech with normal volume is recommended.
C. Turn off all background noise and speak to the patient from behind. While reducing background noise is beneficial, speaking from behind is ineffective as the patient cannot see the nurse’s facial expressions or read lips.
D. Assume the patient can read lips and avoid using sign language or gestures. Assuming the patient can read lips is not appropriate; gestures or other visual aids should be used to enhance communication.
Correct Answer is A
Explanation
A. Drink plenty of fluids to stay hydrated. Staying hydrated is essential in managing viral pharyngitis to prevent dehydration, soothe the throat, and promote recovery.
B. Take antibiotics as prescribed until the course is complete. Antibiotics are not indicated for viral infections; they are only used for bacterial infections.
C. Avoid all forms of physical activity until fully recovered. While rest is recommended, light activities may be acceptable depending on the patient’s energy levels and symptoms. Total avoidance of all physical activity is unnecessary.
D. Use throat lozenges as needed but avoid resting to prevent throat swelling. Resting is beneficial to recovery. Throat lozenges may soothe irritation, but avoiding rest would be counterproductive.