First of all, Monica iswas diagnosed aswith acute kidney injury on the 2nd day. The main reason is her creatinine is changed from 4.8 to 39.2 mg/dl that normal(normal range is 0.8-2.0 mg/dlmg/dl) and her blood urea nitrogen is risingrose dramatically asfrom 42 to 160 (normal range is 7-22 mg/dl) comparecompared to a week ago when she havehad a result in the emergency department and this current result of rapid rising blood urea nitrogen and creatinine level shows diagnosis of acute renal failure (Uchino, 2012). Although increasing life expectancy due to advanced health service and technology, an elderly patientpatients such as 91 years old,91-year-old Monica still have a lot of triggers offor acute renal failure including heart failure, senility of kidneys, high prevalence of comorbidities and using medication and contrasts (Yokota et al., 2018).
On the 2nd day, Monica has a medical history of coronary artery disease and her current symptoms are increasing abdominal swelling, lower extremity edema and frequent shortness of breath that this. These symptoms show the signare signs of congestive heart failure (Scrutinio, 2011). She has gained 10kg weight sincein one month ago because her kidney acknowledges reduced intravascular volume and cardiac output and appliesseeks to gain these things by preserving water and sodium. and herHer total body fluids are increasing and it affectsincreasingly affecting the space of extravascular settles primarily that, causing retention of water and as. As a result, her body weight is increasedincreased (Thongprayoon), YEAR). Gaining or losing weight is also a specific control index of congestive heart failure (Han, 2011). Monica havehas heart failure and herthe blood pump by heart arepumping of her heart is not really working correct way and alsocorrectly. Also her heart becomes full of blood and this builds pressure ofon the main vein which is connected to the kidneys that causescausing decreased oxygen supply and possibility to make apossible blockage to the kidneys.