CLIENT OVERVIEW
Erica
is a university student in her junior year. This is a summary of her health
problems. The data included is factual, but not thorough. Use it as an introductory
overview, and rely on the Client's Records for specific information.
Erica
is a 20-year-old university student, 5'6" weighing 130 lbs. During the spring
term of her junior year, she noticed a rash across the bridge of her nose.
She had also been suffering from severe headaches.
An examination by a doctor at the University Health Service revealed hypertension (BP=180/110) to which she was given medication. Urinalysis also showed azotemia; a referral to a nephrologist was made for further evaluation.
The
nephrologist took her blood pressure and ordered urinalysis, blood work, and
a renal biopsy. Her blood pressure improved on medication (140/80). Urinalysis
showed proteins (25 mg/dl) and blood work showed elevated BUN, creatinine,
and phosphorus, and low hematocrit levels. The biopsy revealed a diagnosis
of systemic lupus erythematosus (SLE). The nephrologist recommended that she
continues the medication for hypertension and prescribed corticosteroids for
SLE.
She was scheduled to see a registered dietitian who prescribed
a diet containing 2100 calories, 50-60 gm protein, 800 mg phosphorus and 3
gm sodium. No fluid restriction was necessary at this time. At a 2-week follow-up,
Erica progresses well.
At
home, during the summer, Erica does so well that she does not renew her medication,
does not follow her diet and does not keep her appointment with a local nephrologist
to whom she was referred. .
In
August, prior to the fall term of her senior year, her severe headaches return
and she reports general malaise. The nephrologist finds that she weighs
140 lbs, with a +3 edema of the extremities, a BP of 180/110, and a temperature
of 100o F. She also exhibits dypsnea, non-productive cough, pleural
effusion, headaches, general malaise and reports poor dietary intake. Her
blood work reveals elevated BUN, creatinine, potassium and phosphate levels.
The nephrologist starts her again on medication for hypertension
and corticosteroids for the SLE. In addition, he gives her calcium carbonate
and a vitamin supplement, Nephro-vite. The dietitian restricts her diet to
50 gm protein, 800 mg phosphorus, 2 gm sodium (87 mEq) and 1600 mg K (40 mEq).
Four
weeks after a catheter was placed, she began continuous ambulatory peritoneal
dialysis (CAPD). She tolerates CAPD quite well during the school year. By
the following spring she was changed to hemodialysis due to severe peritonitis.
The dietitian changes her diet to 25-35 kcal/kg/day, 4 gm of sodium, and 1000 mg phosphorus. Protein and K were not restricted
Erica
did not like dialysis. Her parents offered to donate one of their kidneys
to her. Both were tested and her father was selected as the most compatible
donor. Both daughter and father underwent surgery. The transplant was successful.
Following transplant, Erica was prescribed a no added salt,
low cholesterol diet.
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