Gregory Cahill

1.	For what type(s) of acute renal failure is she at risk? Why?
She is at risk of prerenal ARF due to hemorrhage, dehydration or cardiogenic shock.  Intrinsic factors for ARF include acute tubular necrosis which is often caused by trauma or prolonged renal ischemia.(Porth, 2011)

2.	Do any of her usual drugs increase her risk for ARF? Which one(s) and why?
Ibuprofen, like all NSAIDs, can damage the kidneys.  

3.	Is there any specific assessment data you could obtain without a prescription to evaluate her risk for acute renal failure?
The physician prescribes the following interventions:
•	IV placement with an 18-gauge cannula, NS at 200 mL/hr
•	Hematocrit and hemoglobin levels
•	Morphine sulfate 2 mg IV push
•	Foley catheter placement
•	Type and crossmatch for 4 units of packed red blood cells
•	X-rays of the left hip and leg and KUB
I would asses her intake and output and hydration status.  I would also assess urine color, cloudiness and odor.

4.	In what order (and why) should you perform these interventions
I would do these interventions in the following order.
•	IV placement with an 18-gauge cannula, NS at 200 mL/hr
•	Morphine sulfate 2 mg IV push 
•	Foley catheter placement 
•	Hematocrit and hemoglobin levels
•	 Type and crossmatch for 4 units of packed red blood cells
•	X-rays of the left hip and leg and KUB
“The priorities in treating acute renal failure are to optimize fluid balance, treat underlying causes, and initiate renal replacement therapy at the appropriate time.” (Jones, 2006)  With this in mind I would start the IV first so that I could help optimiz fluid balance.  I would then give the morphine to help with pain, I also need an IV in place to give a medication IV push.  The foley will help maintain fluid balance and help eliminate waste.  Then I would do the hemaocrit/hemophobin and packed red blood cells.  I would do the X-ray and KUB lost because I cannot do anything if the patient is to with imaging.

Jones, D. (2006). Early intervention in acute renal failure give intravenous fluids, not    
     loop diuretics. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/      
     PMC1553523/

Porth, C. (2011). Essentials of pathophysiology. (3rd ed.). Philadelphia, PA: Lippincott 
     Williams & Wilkins.