A 68-year-old retired school administrator has been feeling…
A 68-year-old retired school administrator has been feeling ill for approximately five days. It started as a scratchy throat and a dry cough, initially attributed to seasonal allergies. However, by day three, the cough became productive with thick, rust-colored sputum, and a persistent low-grade fever. The patient has a significant medical history of Hypertension (HTN), Type 2 Diabetes Mellitus, osteoarthritis, and Stage 3 Chronic Kidney Disease (CKD) with a baseline creatinine of 1.4 mg/dL. To manage chronic pain from osteoarthritis, he has taken “extra strength” Ibuprofen (an NSAID) several times a day over the last month. The morning of admission, the wife noticed he was increasingly lethargic and struggled to finish sentences. The patient complained of nausea,” and the wife noted he had not used the bathroom since the previous evening. Concerned by the sudden confusion and cool, clammy skin, she drove him to the Emergency Department. Upon arrival, ER staff found him slumped over in the passenger seat, appearing dusky and breathing rapidly.Patient weight: 188 lbs. Based on the patient’s history of CKD and recent NSAID use, the nurse will suspect the patient’s acute kidney injury is caused by: