A patient with a history of COPD Is being monitored for potential complications. Which of the following findings should the nurse report immediately as it may indicate the development of a complication?
Mild wheezing
Fatigue and general malaise
Increased sputum production
Sudden onset chest pain and dyspnea
The Correct Answer is D
A. Mild wheezing: Mild wheezing can be a common symptom in COPD and does not immediately indicate a severe complication unless it worsens suddenly.
B. Fatigue and general malaise: Fatigue and malaise are often chronic in COPD and do not necessarily indicate an acute complication.
C. Increased sputum production: While increased sputum could suggest an infection, it is not the most urgent sign of a severe complication.
D. Sudden onset chest pain and dyspnea: Sudden chest pain and dyspnea are concerning for a pneumothorax or pulmonary embolism, both of which are potential complications in COPD and require immediate attention.
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Correct Answer is A
Explanation
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.
Correct Answer is B
Explanation
A. The client states that they consume a high calcium diet and have had high calcium in their blood. A high calcium diet or hypercalcemia is more associated with kidney stones, not typically with pyelonephritis.
B. The client reports that they had two urinary tract infections (UTI) in the past months. Recurrent UTIs are a risk factor for pyelonephritis, as untreated or recurrent infections can ascend from the bladder to the kidneys, leading to this condition.
C. The client states that they remember their mother saying their grandma had this same genetic disease. Pyelonephritis is not typically a genetic disease but rather an infection of the kidneys, often secondary to urinary tract infections.
D. The client reports that they took a lot of ibuprofen for arthritis for many years. Long-term NSAID use can impact kidney function but does not directly cause pyelonephritis.