As a renal failure patient, Jim's urine output began to diminish, albeit it stayed consistent most of the time. Because of his body's tremendous fluid retention, he began to experience swelling in his feet and ankles. Jim would experience drowsiness, exhaustion, confusion, nausea, and shortness of breath at some time. He would also have acute chest aches on occasion.
Jim's medical history as a renal failure patient is derived from other medical condition reports.At some point in his life, Jim suffered from high blood pressure and was also diagnosed as diabetic in his early fifties which eventually caused him to have a heart failure. Changes in his blood pressure indicated hypertensive levels which might have resulted from an abnormal buildup of fluid in his body and could be the possible reason for his acute renal failure. He has also added some weight in the past couple of months resulting from fluid retention which resulted from the heart attack he suffered. Finally, Jim's age could also be a key factor which caused his renal failure due to loss of nephrons hence a decline in renal function.
Drug administration to Jim requires careful consideration. As an elderly patient with a renal disorder, it should be assumed that a certain degree of renal impairment exists in him (Home, 2014). Even if his case is considered as a mild one, chances of kidney failure are high in his case, and a thorough renal function checkup needs to be done before any drug which needs dose modification is prescribed (Sun et al., 2009). This checkup is necessary to avoid problems with medication such as ineffectiveness of some drugs, numerous side effect, and failure to excrete the drug and its metabolites.
Depending on the severity of Jim's case, for the purpose of dose prescription, His renal impairment is categorized under three grades. Patients with mild renal impairment - Glomerular filtration rate (GFR) 20-50 ml/minute - require the administration of serum creatinine of approximately 150-300 µmol/L. Patients who are suffering from moderate renal impairment - GFR 10-20 ml/minute - should be given a dosage of 300-700 µmol/L. Finally, severely renal impaired patients with a GFR below 10 ml/minute should be administered with serum creatinine above 700 µmol/L. Patients indicating a GFR which is above 50 ml/minute usually do not require the administering of any dosage change (Sun et al., 2009). A drug like Nephrotoxic ought not to be used in patients with any renal disease as the consequences of its nephrotoxicity could be dangerous in cases of renal reserve depletion. However, when a patient starts dialysis, the situation may change because some drugs get excreted by dialysis which can lead to drugs losing their therapeutic effect (Home, 2014). A follow-up ought to be carried out on Jim, and if his case is considered to be acute with indications of dialysis therapy, he should be taken to a hospital where dialysis is performed on him (Sun et al., 2009).
References
Home. (2014, November 24). History and physical examination information. What to expect. Retrieved February 9, 2017, from http://patient.info/doctor/history-and-physical- examination.
Sun, Q., Shen, Y., Sun, N., Zhang, G. J., Chen, Z., Fan, J. F., Puschner, B. (2009). Diagnosis, treatment and follow-up of 25 patients with melamine-induced kidney stones complicated by acute obstructive renal failure in Beijing children's hospital., 169(4),.Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2820665/
