NUR251 Nursing Tasks - Assignment Solution

Task 1 

Of the three priority nursing assessments I would conduct for the patient David Smith, the first would be monitoring the vitals – the heart rate and the blood pressure. Patients with a history of chronic kidney disease (CKD) are more susceptible to cardiovascular risks (Bryant & Knights, 2014). As per the past history, Mr. Smith already had anxiety, reflective of hypertension. His kidneys also have a reduced ability to excrete urine due to acute kidney injury (AKI). This can often aggravate possibilities of hypertension and tachycardia. Any form of persistent tachycardia, or increased heart rates, can lead to heart failure and consequently, death (Gopinathannair & Olshansky, 2015). A clinical progress notes document will be necessary to record the findings.

Secondly, I would monitor Mr. Smith’s mentation and keep track of any alterations in his level of consciousness. Changes in the level of consciousness is indicative of fluid shifts and electrolyte imbalance in the body (Upadhyay, Bhalerao & Pratinidhi, 2017). Since Mr. Smith has significantly low GFR and urine output less than 400 mL or oliguria, he is in the maintenance phase of AKI, which is characterised by a tendency of fluid retention and electrolyte imbalances such as hyperkalaemia and hyponatraemia (Levett-Jones, et. al., 2016). These can eventually lead to oedema that increases the risks of heart failure and pulmonary oedema. Mr. Smith is already overweight, so his weight should be constantly monitored because rapid weight gain is a good indicator of fluid status in an oliguric individual (Levett-Jones, et. al., 2016). A Glasgow Coma Scale (GCS) can be used to assess the level of consciousness (Durant & Sporer, 2011) and findings recorded in a GCS template.

Lastly, I would monitor the patient’s hearing and check if he is complaining of tinnitus.  Mr. Smith has received a medication order of immediate intravenous frusemide, which is a high-ceiling (loop) diuretic. A high-dose of 80mg has been prescribed. Loop diuretics in high doses are known to increase the risk of ototoxicity (Tiziani, 2013). Monitoring for ototoxicity is necessary because the impacts can be reversed if detection is made early and the medicine is discontinued (Levett-Jones, et. al., 2016). Audiometric tests need to be conducted to rule out ototoxicity. Ototoxic monitoring to be charted in a graph and recorded.