Running Head- [Assignment]

Assignment- [“Patient Safety and Quality Improvement”]

[Name of Writer]

[Name of Institution]
“Patient Safety and Quality Improvement”

“Table of Contents”
“Introduction”............................................................................................................................3

“Acute Kidney Injury Brief Summary”.....................................................................................3

“Patient’s Case Scenario”..........................................................................................................4

“Medical Examination Assessment”..........................................................................................5

“Health Intervention for Chronic Kidney Injury”......................................................................6

“Evaluation of the Chronic Kidney Injury Intervention”...........................................................7

“Conclusion”..............................................................................................................................8

References................................................................................................................................10

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“Patient Safety and Quality Improvement”

“Introduction”

A chronic condition known as Acute Kidney Injury (AKI), sometimes known as

Acute Renal Failure, can quickly cause damage to the kidneys within a matter of hours or

days. AKI is also referred to in some contexts as Acute Renal Failure (ARF). Acute renal

failure results in an accumulation of nitrogenous waste products, as well as dehydration and

issues with acid-base balance. Patients admitted to the intensive care unit suffering from

acute kidney injury makeup between 4.9% and 7.2% of the total population (Meneghini.,

2020). Because the symptoms and indicators of acute kidney injury can vary greatly

depending on the root cause of the ailment, the prevalence of the condition can only be

determined by the conduct of a professional medical examination. Allergies, hypotension,

burns, and direct damage to the kidneys from vasculitis, sepsis, interstitial nephritis, multiple

myeloma, scleroderma, and thrombotic microangiopathy are all significant causes of acute

kidney injury (AKI).

“Acute Kidney Injury Brief Summary”

“Acute Kidney Injury” mortality has not been significantly reduced despite extensive

efforts to improve treatment and preventative measures. It is clear from the fact that AKI is

the leading cause of death for ICU patients, with a mortality rate of 80%. Sepsis,

cardiovascular illness, hypotension, heart attack, urinary tract obstruction, long-term pain

medication use, chronic kidney disease, neoplasia, diabetes mellitus, and systemic arterial

hypertension are all risk factors for acute kidney injury. The single most important aspect is

age. In response to this, the health industry has increased the life expectancy rate of the

elderly through improvements in population health services for the aged. Acute kidney injury

(AKI) is defined as a rise in serum creatinine (SCr) higher than 0.3mg/dl within 48 hours or

an increase up to 1.5times the SCr baseline within one week. AKI is a frequent chronic illness

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“Patient Safety and Quality Improvement”

(Ammirati., 2020). Patient Ms. Evans (pseudonym) is the major focus of this assignment to

maintain anonymity in accordance with the “Health Insurance Portability and Accountability

Act” (HIPAA), which mandates such safeguards.

“Patient’s Case Scenario”

Ms. Evans went to the emergency hospital in her town after experiencing symptoms

similar to illness for a period of three days. Her daughter, who had been acting as her primary

caregiver for the preceding six years, travelled with her mother. Because of her diabetes, Ms

Evans required assistance with the typical activities of daily living and required continual

attention. The workers at the regional healthcare institution stated that Ms Evans' symptoms

included a lack of appetite, difficulty breathing, decreased mobility, overall body weakness

and exhaustion, leg oedema, and pallor in the eyes. The patient's legs were extremely

swollen, and as a result, they were unable to walk without assistance (Legrand and

Rossignol., 2020). In addition to that, prior to the woman's trip to the health centre in the

neighbourhood, she had noticed blood in her pee many times. According to the information

contained in Ms Evans' medical files, she has been afflicted with “Type 2 Diabetes Mellitus”

for the past five years. In addition to this, she had been admitted to the hospital for a period of

seventeen days due to a worsening of her diabetic condition three months before to this visit.

As a nurse working at the healthcare institution that Ms Evans had been to, it was my

responsibility to convey to her the significance of maintaining the confidentiality of her

medical records. In addition to expressing sympathy for the patient, I reassured her that she

would receive superior medical care during her time spent recuperating from her illness. In

addition, I was entrusted with carrying out all diagnostic tests and sending them to the

laboratory for examination in order to determine the patient's current level of health. This was

done in order to assess the patient's condition (Meneghini., 2020). These examinations are

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“Patient Safety and Quality Improvement”

allowed to take place since the patient and whoever cares for the patient at home have both

given their consent.

“Medical Examination Assessment”

The first round of blood tests revealed that Ms Evans had “Acute Kidney Injury”

(AKI), with the possibility of chronic kidney disease emerging in the future (CKD). Because

the patient's serum creatinine level was 1100 mmol/L, his urea level was 94.0 mmol/L, and

his estimated “Glomerular Filtration Rate” (GFR) was 3.5 ml/min, acute kidney injury

developed in the patient. Ms Evans's acute kidney injury (AKI) had made it difficult for her

to hold her urine for the previous three days, which resulted in significant fluid retention in

her legs and lungs. Because of these factors, she struggled to breathe and had swollen legs in

addition to the condition. In addition, given the advanced stage of her diabetes, the proper

blood tests were carried out in order to evaluate the levels of sugar in her body. When the

kidneys get injured, there is either a reduction in the amount of urine that is expelled or an

increase in the serum creatinine level. Nevertheless, there is not yet a well-articulated

standard for doing so that is economical and does not involve invasive procedures. Due to the

fact that a double test revealed 128 milligrams of blood sugar per decilitre of blood, it was

determined that Ms Evans' blood sugar levels were excessive.

In light of these findings, it was decided that the patient needed to be moved to the

“Intensive Care Unit” (ICU) in order to get intensive monitoring and treatment in an effort to

lessen the likelihood that she would pass away (Kellum, et al., 2021). A group of medical

professionals, including a nephrologist, two nurses, and a urologist, provided treatment for

Ms Evans while she was in the hospital. The nephrologist was the one who was in charge of

making the diagnosis of chronic kidney disease in the patient and outlining the treatment

strategy. In addition to that, he made certain that the patient did not have any fluid retention

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“Patient Safety and Quality Improvement”

or that they did not have any levels of blood pressure in persons who have hypertension. The

job of the urologist, on the other hand, was to ensure that the patient's chronic kidney illness

did not have any effect on the patient's urinary system by recommending the right

medication. As nurses, it was our job to ensure that patients received the appropriate dosages

of their medications so that their glycerol levels could be brought back to normal. In addition,

the nurses attended to the patient's other medical requirements in a timely manner.

“Health Intervention for Chronic Kidney Injury”

Tests revealed that the legs were full of fluid. Ms Evans needed to go to the ICU since

she qualified for CCVH. Hemofiltration can prevent "Chronic Kidney Disease" by reducing

the chance of renal system failure (CKD). Intensive Insulin Therapy was needed to control

her hyperglycaemia. Ms Evans arrived at the ICU with a self-ventilating mask-in-situ, but

this had to be changed with nasal oxygen therapy to keep her "fluid-filled lungs" open and

stimulate gaseous exchange. Ms Evans needed broad-spectrum antibiotics since she was

hypertensive due to fluid build-up. Ms Evans, anuric, needed a catheter. CVVH was placed in

her right femoral vein. Ms Evans' daughter says a nasogastric tube was placed into her

mother's nose because she wasn't hungry. Ms Evans' "Glasgow Coma Scale" (GCS) score

was 10 due to ocular response to discomfort, inappropriate words as vocal response, and

motor responses indicating pain (E2 V2 M5). Ms Evans was bewildered, uneasy, and

fatigued. Metformin encephalopathy arises when treating type 2 diabetes. High-creatinine

patients shouldn't take metformin (Legrand and Rossignol., 2020). Metformin-treated

diabetics may have kidney problems. Ms Evans had been on Metformin for 3.5 years, so

physicians did an MRI and saw a "lentiform fork sign" on T2-weighted images. ASL showed

hyper perfusion of the basal ganglia and mixed vasogenic and cytotoxic oedema in both

lentiform nuclei. MRS identified lactate in lentiform nuclei. These instances had similar

radiological findings as metformin-induced encephalopathy with lentiform fork symptoms.

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“Patient Safety and Quality Improvement”

Ms Evans' hyperglycaemia was treated with rigorous insulin therapy when she was

brought to the ICU, and she discontinued using metformin. Her body fluids were drained to

cleanse the area, reduce creatinine build-up, and improve gas exchange. As suggested by

local health laws for vascaths, central venous catheters, and other invasive tubes, the urologist

cleansed the catheter insertion site in the femoral vein with chlorhexidine. Birmingham's

"Queen Elizabeth hospital" compared these dressings to similar ones without "chlorhexidine

gluconate" pads (CGH). A poll of 80 medical professionals indicated only 2% were willing to

apply the dressing in emergencies. Ms Evans' femoral line required more dressing changes

than non-CHG lines. The CHG dressing was more expensive than the previous treatment, but

it reduced the infection risk long-term. Ms Evans was given Aquarius-based CVVH. Citrate

is the trust's preferred RRT (RRT). Citrate anticoagulation as a primary hemofiltration

treatment is rising in the West. Ms Evans' high serum lactate level precludes using citrate.

Citrate poisoning from incorrect metabolism is the key concern. Total serum ionised calcium

above 2.5mmol/L increases citrate poisoning risk. Ms Evans was given heparin sodium to

offset citrate's blood-clotting effects (Ammirati., 2020).

Trust's protocol on heparin for CCVH requires clotting samples every 6-8 hours. 40

cc of 0.9% sodium chloride and 20,000 units of heparin are used to inject "Citrate Heparin."

Routinely check Ms Evans' invasive line sites, catheter, and nasogastric tube for bleeding.

Daily whole blood count tests look for a platelet count of 50 x 109/L. Ms Evans' blood

pressure wasn't too low, so she could tolerate fluid drainage.

“Evaluation of the Chronic Kidney Injury Intervention”

Ms. Evans's lung and foot fluid retention decreased dramatically over the next few

days. Now she needed less help getting around. Patients' ability to mobilise during a period of

illness has been shown to have a significant impact on their rate of recovery. Ms. Evans' urea

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“Patient Safety and Quality Improvement”

level reflected the improvement in her cognitive abilities; she was awake and alert, and her

level of bewilderment had diminished. After two weeks, the lactate peak was no longer

visible on an MRI. Consequently, it was concluded that metformin was responsible for the

lentiform sign observed in the lentiform nuclei. In addition, Ms. Evans's Chronic Kidney

Disease was brought on by her usage of metformin as an anti-diabetic. As far as we know,

metformin does not harm the kidneys in any way. Since Ms. Evans had type 2 diabetes, her

body was unable to produce enough insulin (Meneghini., 2020). The kidneys were unable to

process the excess glucose in the blood because of this. The ineffectiveness of the metformin

that had been given to her for four years to control her condition meant that her blood sugar

absorption was also inefficient. Lactic acidosis developed as a result of metformin

accumulation.

Constant usage of an ineffective drug (metformin) led to kidney damage, and that

damage eventually manifested as “Chronic Kidney Disease.” Ms Evans' health has improved

thanks to the healthcare unit's initiatives. Ms Evans and her daughter, who helped her at

home, were also required to follow a special diet for diabetics. In addition to stopping the

metformin, Ms. Evans was given sulfonylurea. She was warned not to use metformin under

any circumstances. Besides avoiding hard activities, the patient was told to maintain an active

lifestyle by exercising regularly in order to manage her (Kellum, et al., 2021). The patient

expressed her appreciation for the excellent treatment she received in the intensive care unit.

“Conclusion”

Damage to the kidneys leads to chronic kidney disease (CKD), a debilitating

condition. A patient admitted to the hospital with need rapid medical attention since death is a

real possibility. Some of the most fundamental forms of care include nasogastric feeding,

gastric lavage, and ventilation to improve gaseous exchange. Since the disease could have

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“Patient Safety and Quality Improvement”

several origins, it warrants careful investigation to pinpoint its true aetiology. Long-term

metformin use for type 2 diabetes treatment led to a build-up of lactic acidosis, which in turn

led to renal disease for Ms Evans. The patient quickly improved after receiving appropriate

medical attention and following the doctors' recommendations on her diet and way of life.

Protecting patient’s privacy should be a top priority for each nursing assistant. Health care

administration also requires the adoption of local standards. Care for intensive care unit

(ICU) patients should be guided by evidence-based methods. It's good for the patient, sure,

but it also helps the nurse out by giving her more practice and education.

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“Patient Safety and Quality Improvement”

References

Ammirati, A.L., 2020. Chronic kidney disease. Revista da Associação Médica Brasileira, 66,

pp.s03-s09.

Kalantar-Zadeh, K., Jafar, T.H., Nitsch, D., Neuen, B.L. and Perkovic, V., 2021. Chronic

kidney disease. The lancet, 398(10302), pp.786-802.

Kellum, J.A., Romagnani, P., Ashuntantang, G., Ronco, C., Zarbock, A. and Anders, H.J.,

2021. Acute kidney injury. Nature reviews Disease primers, 7(1), pp.1-17.

Legrand, M. and Rossignol, P., 2020. Cardiovascular consequences of acute kidney

injury. New England Journal of Medicine, 382(23), pp.2238-2247.

Meneghini, L. ed., 2020. Medical Management of Type 2 Diabetes. American Diabetes

Association.

Terada, Y., Wada, T. and Doi, K. eds., 2020. Acute kidney injury and regenerative medicine.

Springer Nature.

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