Case Study -
A nurse is caring for an 80-year-old patient, who lives alone and has a home attendant for 2 hours each day, was admitted to the hospital with a diagnosis of dehydration. The patient stated he had been vomiting for 2 days and had been unable to keep down any food or fluids. He has been healthy and currently takes only a diuretic for his blood pressure. On admission, it is noted that the patient does not have a healthcare proxy or any advance directives in place. On physical examination, the nurse notes that the patient's skin is bruised, dry with decreased turgor, oral mucous membranes are dry, heart rate is 100, and blood pressure is 90/60. The patient' urine is dark amber with a specific gravity of 1.028. His urine output was 30cc/hr for the past 4 hours since admission.

1. What type of renal failure is most often seen with dehydration? What signs and symptoms noted by the nurse are characteristic of renal failure?

2. If the blood pressure continued to drop in this patient and the patient developed acute tubular necrosis, what would happen to the kidney tubule?

3. What are the three phases of acute tubular necrosis? Identify two important nursing interventions for each phase.

4. Please identify all issues related to the nursing care of this elderly gentleman and identify which other services can ameliorate his safety and healthcare once discharged.