Skip to Main Content

++

INTRODUCTION

++

CASE LEARNING OBJECTIVES

  • Identify specific consequences associated with end-stage renal disease (ESRD)

  • Design an appropriate therapeutic approach for specific consequences associated with ESRD

  • Recommend an appropriate monitoring plan to assess the effectiveness of pharmacotherapy for ESRD and specific consequences

  • Educate patients with CKD about the disease state, the specific consequences, lifestyle modifications, and pharmacologic therapies used for treatment of CKD

++

PATIENT PRESENTATION

++

Chief Complaint

++

"I missed my last dialysis session"

++

History of Present illness

++

Harold Palmer is a 67-year-old Caucasian male who presents to the ED with SOB and nausea. He is relatively compliant with his dialysis appointments but missed his last session because he did not have a ride to the dialysis center. His normal hemodialysis schedule is on Mondays, Wednesdays, and Fridays.

++

Past Medical History

++

HTN: diagnosed 35 years ago

++

DM type 2: diagnosed 35 years ago

++

Dyslipidemia: diagnosed 35 years ago

++

CAD, h/o NSTEMI: 7 years ago

++

ESRD: began hemodialysis 9 months ago via left AV fistula

++

Family History

++

Father: deceased, MI at age 88 years

++

Mother: living in a nursing home, HTN, CKD stage 3, and Alzheimer's disease, age 90

++

Social History

++

The patient lives at home with his wife of 45 years. He is a retired plumber. He denies any tobacco use, drinks alcohol only on occasion, and denies any history of illicit drug use.

++

Medications

++

Lisinopril 40 mg PO daily

++

Candesartan 8 mg PO daily

++

Carvedilol 25 mg PO twice daily

++

Insulin glargine 10 units SC at bedtime

++

Insulin lispro per sliding scale SC before meals

++

Atorvastatin 20 mg PO at bedtime

++

Calcium acetate 1334 mg PO three times daily with meals

++

Multivitamin 1 tablet PO daily

++

Calcium carbonate/cholecalciferol 500 mg/400 IU 1 tablet PO twice daily

++

Ferrous sulfate 325 mg PO three times daily

++

Allergies

++

No known drug or food allergies

++

Physical Examination

++
General
++

The patient is a 67-year-old male in no acute distress. He is of normal stature with good hygiene and good affect.

++
Vital Signs
++

BP 132/78 mm Hg, P 93 bpm, RR 12, T 37°C, pain 0

++

Weight: 290.4 lb (132 kg)

++

Height: 73 in. (185 cm)

++
Skin
++

Dry-appearing skin. No noted scars, bruises, rashes or tattoos.

++
HEENT
...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.