i.

Kidney Function Test

Date and Time Ordered: November 1, 2021 at 7:40 a.m.

Description: Renal function tests (RFT) are a group of tests that may be performed together to
evaluate kidney (renal) function. The tests measure levels of various substances, including
several minerals, electrolytes, proteins, and glucose (sugar), in the blood to determine the
current health of the kidneys.

Purpose: This test was done to the patient to determine the function of the kidney. It identifies
and monitors the progression of renal disease which serves as a basis in selecting appropriate
patient management that prevents further deterioration of renal function.

Result:
Examination/Procedure Date Found Value Normal Value Significance
Adult: 6 to 24
Blood Urea Nitrogen November 1,
9.0 mmol/L mg/dL (2.1 to INCREASED
(BUN) 2021 8.5 mmol/L)
18 years to <41
November 1, years: Male:
Creatinine 1.50 mg/dL INCREASED
2021 0.74–1.35
mg/dL
Examination/Procedure Date Found Value Normal Value Significance
Blood Urea Nitrogen November 3, 8.0 mmol/L Adult: 6 to 24 NORMAL
(BUN) 2021 mg/dL (2.1 to
8.5 mmol/L)
Creatinine November 3, 1.30 mg/dL 18 years to <41 NORMAL
2021 years: Male:
0.74–1.35
mg/dL

Analysis:
Based on the results above, there is an increased levels of BUN and creatinine in acute pancreatitis.
The release of histamine causes fluid shifting from intravascular to interstitial space. This may also
cause fluid shifting in the retroperitoneal area causing decrease in intravascular volume, hence
leading to decreased perfusion of different organs, particularly in the kidneys. The hypoperfusion
causes the kidneys to lose nephrons that are required to maintain GFR, eventually resulting in acute
renal failure. When GFR declines, toxic metabolites such as BUN and creatinine accumulate. This is
in support with the statement made by Hack & Zeerleder (2001) as cited by Aggarwal, Manrai, &
Kochhar (2014) that pancreatic insult due to any etiology leads to release of pro-inflammatory
mediators, such as zymogens, cytokines and vasoactive factors. These mediators cause endothelial
cell activation leading to arteriolar vasoconstriction, increased permeability and circulatory stasis,
thereby inducing ischemia. This increased permeability, related to capillary leakage, causes
intravascular fluid loss and hypotension, and shock may ensue. In pre-renal acute kidney injury, In
 Pre-renal AKI, renal hypoperfusion leads to a decreased GFR (without damage to the renal
parenchyma), as an adaptive response to various extra-renal insults (Blantz, 1998 as cited by Makris
& Spanou, 2016) hence increase in BUN & creatinine.

Serum Electrolyte

Date and Time Ordered: November 1, 2021 at 7:40 a.m.

Description:
An electrolyte panel, also known as a serum electrolyte test, is a blood test that measures levels
of the body's main electrolytes such as sodium, chloride, potassium and bicarbonate.

Purpose:
An electrolyte test can help determine whether there's an electrolyte imbalance in the body. It
can also be used to monitor the effectiveness of treatment for an imbalance that affects the
functioning of an organ.

Result
Day 1
BASIC METABOLIC PANEL
RESULT NORMAL VALUE INTERPREATATION
Sodium (Na) 130 mEq/L 135 to 145 milliequivalents per liter (mEq/L) DECREASED
Potassium 5.8 mmol/L 3.6 to 5.2 millimoles per liter (mmol/L) DECREASED
(K)
DAY 1 (November 1, 2021)
BASIC METABOLIC PANEL
RESULT NORMAL VALUE INTERPREATATION
Sodium (Na) 138 mEq/L 135 to 145 milliequivalents per liter (mEq/L) NORMAL
Potassium 4.0 mmol/L 3.6 to 5.2 millimoles per liter (mmol/L) NORMAL
(K)

DAY 3 (November 3, 2021)

BASIC METABOLIC PANEL
RESULT NORMAL VALUE INTERPREATATION
Sodium (Na) 140 mEq/L 135 to 145 milliequivalents per liter (mEq/L) NORMAL
Potassium 4.5 mmol/L 3.6 to 5.2 millimoles per liter (mmol/L) NORMAL
(K)

 Analysis:
Based on the results above, serum sodium and potassium levels are decreased.
According to the Institute for Quality and Efficiency in Health Care Acute pancreatitis causes the
body to lose a lot of fluids quickly, which leads to a loss of important minerals too. Nausea and
vomiting also make it difficult to get enough fluids. The decrease of sodium levels or
hyponatremia is caused by the shift of fluid going into the interstitial space. This is supported by
the statement of Shah (2020) that sodium can be lost through renal or nonrenal routes.
Nonrenal routes include GI losses, excessive sweating, third spacing of fluids (eg, ascites,
peritonitis, pancreatitis, burns), and cerebral salt-wasting syndrome. Furthermore, Deranged
Physiology (nd) claimed that third space distribution of fluid is the key factor in the mechanism
of hyponatremia in which because of the low serum protein, oncotic pressure is reduced and
fluid migrates out of the intravascular compartment, reducing the effective circulating volume;
the shift of fluid due to third spacing affects serum sodium in such a manner that sodium also is
shifted to the interstitial space together with water. On the other hand, one of the causes of
hypokalemia is due to vomiting. Intestinal fluids contains large amount of potassium and severe
fluid loss from vomiting or diarrhea can cause depletion of potassium levels. This is supported
by Lederer (2021) that gastric fluid itself contains little potassium, approximately 10 mEq/L.
However, vomiting produces volume depletion and metabolic alkalosis, which are accompanied
by increased renal potassium excretion.

NURSING RESPONSIBILITIES FOR BASIC METABOLIC PANEL

Nursing Responsibilities Rationale
1. Check the doctor’s order To  determine  the  exact  procedure  to 
be  done

2. Confirm the patient’s identity using two identifiers. To  ensure  the  right  patient  to  under

go  this  procedure.
3. Explain the purpose of the procedure to the patient. To  gain  cooperation  and  decrease  a
nxiety.
4. Fill up the laboratory request form, completely. Then  To  notify  the  medical  technologist  a
forward it to the laboratory. nd  process  the  test  as  soon  as  possi
ble
5.  Instruct the patient and significant others the need t To  ensure  that  the  laboratory  tests  r
o fast for 8hrs before the test  esults  are  accurate.
6. Instruct the patient he may experience slight discomfort fr To  lessen  the  anxiety  felt  by  the  pati
om the tourniquet and needle puncture. ent.
7. Instruct the patient to cooperate fully and to follow directi To  have  a  smooth  flow  while  doing 
ons. Direct the patient to breathe normally and to avoid unne the  procedure.
cessary movement.
8. Upon the arrival of the result, refer it immediately to the p
For  the  physician  to  determine  the  a
hysician. ppropriate  management  to  be  given 
to  the  patient.
9. Document the interventions done For  legal  purposes  and  to  ensure  th
at  the  procedure  was  done.
Intervention to Normalize the Result
1. Administer D5L3 run for 8 hours. This  is  to  correct  electrolyte  and  flui
d  imbalances.
2. Encourage patient to drink water after undergone NPO. This  is  to  promote  exretion  of  metab
ollic  waste  product  easily.