AP MODULE 4 DISCUSSION 4

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Urinary Function: Mr. J.R. is a 73-year-old man, who was admitted to the hospital with clinical manifestations of gastroenteritis and possible renal injury. The patient’s chief complaints are fever, nausea with vomiting and diarrhea for 48 hours, weakness, dizziness, and a bothersome metallic taste in the mouth. The patient is pale and sweaty. He had been well until two days ago, when he began to experience severe nausea several hours after eating two burritos for supper. The burritos had been ordered from a local fast-food restaurant. The nausea persisted and he vomited twice with some relief. As the evening progressed, he continued to feel “very bad” and took some Pepto-Bismol to help settle his stomach. Soon thereafter, he began to feel achy and warm. His temperature at the time was 100. 5°F. He has continued to experience nausea, vomiting, and a fever. He has not been able to tolerate any solid foods or liquids. Since yesterday, he has had 5–6 watery bowel movements. He has not noticed any blood in the stools. His wife brought him to the ER because he was becoming weak and dizzy when he tried to stand up. His wife denies any recent travel, use of antibiotics, laxatives, or excessive caffeine, or that her husband has an eating disorder. Case Study Questions 1. The attending physician is thinking that Mr. J.R. has developed an Acute Kidney Injury (AKI). Analyzing the case presented name the possible types of Acute Kidney Injury. Link the clinical manifestations described to the different types of Acute Kidney injury. 2. Create a list of risk factors the patient might have and explain why. 3. Unfortunately, the damage on J.R. kidney became irreversible and he is now diagnosed with Chronic kidney disease. Please describe the complications that the patient might have on his Hematologic system (Coagulopathy and Anemia) and the pathophysiologic mechanisms involved. Reproductive Function: Ms. P.C. is a 19-year-old white female who reports a 2-day history of lower abdominal pain, nausea, emesis and a heavy, malodorous vaginal discharge. She states that she is single, heterosexual, and that she has been sexually active with only one partner for the past eight months. She has no previous history of genitourinary infections or sexually transmitted diseases. She denies IV drug use. Her LMP ended three days ago. Her last intercourse (vaginal) was eight days ago and she states that they did not use a condom. She admits to unprotected sex “every once in a while.” She noted an abnormal vaginal discharge yesterday and she describes it as “thick, greenish-yellow in color, and very smelly.” She denies both oral and rectal intercourse. She does not know if her partner has had a recent genitourinary tract infection, “because he has been away on business for five days. Microscopic Examination of Vaginal Discharge (-) yeast or hyphae (-) flagellated microbes (+) white blood cells (+) gram-negative intracellular diplococci Case Study Questions 1. According to the case presented, including the clinical manifestations and microscopic examination of the vaginal discharge, what is the most probably diagnosis for Ms. P.C.? Support your answer and explain why you get to that diagnosis. 2. Based on the vaginal discharged described and the microscopic examination of the sample could you suggest which would be the microorganism involved? 3. Name the criteria you would use to recommend hospitalization for this patient Submission Instructions: • • • • • • You must complete both case studies. Your initial post should be at least 500 words per case study, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points. You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.) All replies must be constructive and use literature where possible. Initial post and 2 replies must be 150 words each. No AI and Turn it in must be less than 20% plagiarism Please include Turn it in and AI report
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Case Study

Urinary Function: Case Study on Mr. J.R.
The paper describes the case of a 73-year-old man, Mr. J.R., who had a fever, vomiting,
diarrhea, and a metallic taste in his mouth that pointed towards Acute Kidney Injury (AKI) on a
clinical basis. AKI is defined as a sudden loss of renal function, and it is divided into three
categories: prerenal, intrarenal, and postrenal. In the case of Mr. J.R., prerenal AKI is the best
likely hypothesis for such a reason. Prerenal AKI, therefore, results from problems in the
circulation, leading to decreased blood flow without actual damage to the kidney structure. Such
could have precipitated dehydration and hypovolemia, continued by uncontrolled vomiting and
diarrhea over 48 hours to at least affect blood flow to kidneys and cause renal dysfunction
(Kellum et al., 2021). His symptoms—dizziness, weakness, and pale, sweaty appearance—are
consistent with volume depletion. The statement of metallic taste may be related to uremia if
there is an accumulation of nitrogenous by-products due to reduced clearance by the kidney. If
Prenal AKI is further left untreated, it will go through chronic AKI, particularly ATN, as a result
of ischemic damage to renal tubular cells.
The following are risk factors for AKI in Mr. J.R:
1. Elderly and Infantry: As age increases, renal function diminishes, and elderly people are
more vulnerable to AKI.
2. Dehydration: Resulting from persistent vomiting and diarrhea.
3. Food poisoning from dirty food: Probably the first cause of diarrhea with loss of fluids.
4. Over-the-Counter Medications: Also, it is essential to state that using pepto-bismol,
which is made from bismuth subsalicylate, can worsen renal perfusion where there is

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volume depletion.

5. No Oral Intake: Due to the patient’s increased hypovolemia and hypotension, he cannot
take any fluids orally.
Further, it mentioned that during the development of his case, Mr. J.R.’s renal damage
had become irreversible, suggesting the change from AKI to CKD. Therefore, CKD is termed as
a state of impaired kidney function for at least three months together with or without kidney
damage. In this stage, complications are found these days to involve several systems in the body,
but most predominantly the hematologic system, which gives rise to anemia and coagulopathy.
Anemia in CKD mainly results from the deficiency of erythropoietin, which is synthesized in the
kidneys and is required to encourage the formation of red blood cells in the bone marrow. With
the decrease of the functional renal mass, the pain of EPO production manifests itself in
normocytic and normochromic anemia. Furthermore, CKD patients have reported low dietary
iron intake, chronic inflammation, which affects iron metabolism (functional iron deficiency),
and iron loss through recurrent blood sampling (Stauffer & Fan, 2014).
Disordered hemostasis in CKD is more from platelet dysfunction resulting from uremia,
not from anemia. Such molecular changes make blood platelets less able to adhere and aggregate
due to toxins in patients with uremia. In some cases, using a PFA-100 assay, actual clotting
factors may be usual, yet bleeding time is significantly increased. This is especially important
during surgery or catheterization for dialysis, which must be adjusted with desmopressin or
dialysis pre-procedure. In conclusion, Mr. J.R. did have pre-renal acute kidney injury resulting
from hypovolemia from gastroenteritis, and the condition led to a case of irreversible kidney
disease and chronic kidney disease. His main hematologic complications include anemia, which

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is brought about by reduced erythropoietin production, as well as coagulopathy resulting from
platelet dysfunction in uremia. These effects demonstrate the outcomes for CKD as a chronic
illness and the effort that is required from several settings.

Reproductive Function: Case Study on Ms. P.C.
The patient is a sexually active 19-year-old female student who has been experiencing
lower abdominal, nausea, vomiting, and foul-smelling, thick, greenish-yellow vaginal discharge
for two days. Safety-guardedly, the patient confesses to recent unprotected sexual intercourse
and denies any history of STDs. While the microscopic examination of her vaginal discharge for
yeast and flagellated protozoa are harmful, there are white blood cells and gram-negative
intracellular diplococci that point towards Neisseria gonorrhoeae as the pathogens. These
developments lead to the conclusion that the patient has been diagnosed with Pelvic
Inflammatory Disease (PID). PID is, therefore, a polymicrobial disease of female upper
reproductive tracts comprising the uterus, fallopian tubes, and ovaries, with the standard genital
pathogens being N. Gonorrhoeae and Chlamydia Trachomatis (Workowski ...