I. INTRODUCTION

A. Brief Description

Chronic kidney disease (CKD), also known as chronic renal disease, is a progressive

loss of renal function over a period of months or years. The symptoms of worsening kidney

function are unspecific, and might include feeling generally unwell and experiencing a reduced

appetite. Often, chronic kidney disease is diagnosed as a result of screening of people known to

be at risk of kidney problems, such as those with high blood pressure or diabetes and those with

a blood relative with chronic kidney disease. Chronic kidney disease may also be identified

when it leads to one of its recognized complications, such as cardiovascular disease, anemia or

pericarditis.

Chronic kidney disease is identified by a blood test for creatinine. Higher levels of

creatinine indicate a falling glomerular filtration rate and as a result a decreased capability of the

kidneys to excrete waste products. Creatinine levels may be normal in the early stages of CKD,

and the condition is discovered if urinalysis (testing of a urine sample) shows that the kidney is

allowing the loss of protein or red blood cells into the urine. To fully investigate the underlying

cause of kidney damage, various forms of medical imaging, blood tests and often renal biopsy

(removing a small sample of kidney tissue) are employed to find out if there is a reversible

cause for the kidney malfunction. Recent professional guidelines classify the severity of chronic

kidney disease in five stages, with stage 1 being the mildest and usually causing few symptoms

and stage 5 being a severe illness with poor life expectancy if untreated. Stage 5 CKD is also

called established chronic kidney disease and is synonymous with the now outdated terms end-

stage renal disease (ESRD), chronic kidney failure (CKF) or chronic renal failure (CRF).

There is no specific treatment unequivocally shown to slow the worsening of chronic

kidney disease. If there is an underlying cause to CKD, such as vasculitis, this may be treated

directly with treatments aimed to slow the damage. In more advanced stages, treatments may

be required for anemia and bone disease. Severe CKD requires one of the forms of renal

replacement therapy; this may be a form of dialysis, but ideally constitutes a kidney transplant.

B. Statistics

a. International

An Estimated 26 Million Adults in the United States have Chronic Kidney Disease (CKD).

Among the key findings in the CDC Chronic Kidney Disease (CKD) Surveillance Report:

In 1999–2006, among (National Health and Nutrition Examination Survey) NHANES

survey participants, <5% of those with kidney disease stages 1 or 2 (mild disease)

reported being aware of having CKD; of those with CKD stage 3 (moderate disease),

awareness was only about 7.5%; for stage 4 (severe disease), awareness was still only

less than half (about 40%).

Among those with CKD stage 3 or 4, younger (15%) and male (13%) participants and

those who were non-Hispanic black (21%) had the greatest levels of awareness relative

to their counterparts.

Awareness rates for CKD stage 3 or 4 were higher in those with comorbid diagnoses of

diabetes and hypertension, but still quite low (20% and 12%, respectively).

Persons with CKD in the community are unlikely to be aware of their disease and seek

appropriate treatment.

II. OBJECTIVES

A. General Objectives

At the end of the clinical exposure, we should be able to attain and enhance our

knowledge, skills and attitude to provide nursing care to our patient with chronic kidney failure.

B. Specific Objectives

During the exposure, we should be able to:

Cognitive:

Discover how the patient acquired the disease through the nursing health history,

physical examinations, and some other some other factors that may contribute in relation

to chronic kidney failure and be able to assess, organize and validate those data

efficiently.

Understand chronic kidney disease, its causes and pathophysiology.

Design a plan of care for patient with chronic kidney disease (CKD).

To be able to formulate those data into nursing diagnoses that may aid in the patient’s

current health condition.

To be able to set priorities and goal outcomes in collaboration with the patient.

To be able to document patient responses to care and verbal reports, if any.

Skills:

Conduct physical assessment and organize data efficiently.

Perform nursing procedures effectively and correctly to attain his optimum level of

wellness.

Attitude:

To be able to establish rapport with the patient and folks.

To be able to develop respect and trust.

III. ANATOMY AND PHYSIOLOGY OF THE DISEASE

Your Urinary System and How It Works

The organs, tubes, muscles, and nerves that work together to create, store, and carry

urine are the urinary system. The urinary system includes two kidneys, two ureters, the bladder,

two sphincter muscles, and the urethra.

How does the urinary system work?

The urinary tract is a pathway that includes the:

kidneys: two bean-shaped organs that filter waste from the blood and produce urine.

ureters: two thin tubes that take pee from the kidney to the bladder.

bladder: a sac that holds pee until it's time to go to the bathroom.

urethra: the tube that carries urine from the bladder out of the body when you pee.

The kidneys are key players in the urinary tract. They do two important jobs — filter

waste from the blood and produce pee to get rid of it. If they didn't do this, toxins (bad stuff)

would quickly build up in your body and make you sick. That's why you hear about people

getting kidney transplants sometimes. You need at least one working kidney to be healthy.

You might wonder how your body ends up with waste it needs to get rid of. Body processes

such as digestion and metabolism (when the body turns food into energy) produce wastes, or

byproducts. The body takes what it needs, but the waste has to go somewhere. Thanks to the

kidneys and pee, it has a way to get out.

Physiology

Urine is produced by individual renal nephron units which are fundamentally similar from

fish to mammals, however, the basic structural and functional pattern of these nephrons varies

among representatives of the vertebrate classes in accordance with changing environmental

demands. Kidneys serve the general function of maintaining the chemical and physical

constancy of blood and other body fluids. The most striking modifications are associated

particularly with the relative amounts of water made available to the animal. Alterations in

degrees of glomerular development, in the structural complexity of renal tubules, and in the

architectural disposition of the various nephrons in relation to one another within the kidneys

may all represent adaptations made either to conserve or eliminate water.

Regulation of volume

Except for the primitive marine cyclostome Myxine, all modern vertebrates, whether

marine, fresh-water, or terrestrial, have concentrations of salt in their blood only one-third or

one-half that of seawater. The early development of the glomerulus can be viewed as a device

responding to the need for regulating the volume of body fluids. Hence, in a hypotonic fresh-

water environment the osmotic influx of water through gills and other permeable body surfaces

would be kept in balance by a simple autoregulatory system whereby a rising volume of blood

results in increased hydrostatic pressure which in turn elevates the rate of glomerular filtration.

Similar devices are found in fresh-water invertebrates where water may be pumped out either

as the result of work done by the heart, contractile vacuoles, or cilia found in such specialized

“kidneys” as flame bulbs, solenocytes, or nephridia that extract excess water from the body

cavity rather than from the circulatory system. Hence, these structures which maintain constant

water content for the invertebrate animal by balancing osmotic influx with hydrostatic output

have the same basic parameters as those in vertebrates that regulate the formation of lymph

across the endothelial walls of capillaries.

Electrolyte balance

A system that regulates volume by producing an ultrafiltrate of blood plasma must

conserve inorganic ions and other essential plasma constituents. The salt-conserving operation

appears to be a primary function of the renal tubules which encapsulate the glomerulus. As the

filtrate passes along their length toward the exterior, inorganic electrolytes are extracted from

them through highly specific active cellular resorptive processes which restore plasma

constituents to the circulatory system.

Movement of water

Concentration gradients of water are attained across cells of renal tubules by water

following the active movement of salt or other solute. Where water is free to follow the active

resorption of sodium and covering anions, as in the proximal tubule, an osmotic condition

prevails. Where water is not free to follow salt as in the distal segment in the absence of

antidiuretic hormone, a hypotonic tubular fluid results.

Nitrogenous end products

Of the major categories of organic foodstuffs, end products of carbohydrate and lipid

metabolism are easily eliminated mainly in the form of carbon dioxide and water. Proteins,

however, are more difficult to eliminate because the primary derivative of their metabolism,

ammonia, is a relatively toxic compound. For animals living in an aquatic environment ammonia

can be eliminated rapidly by simple diffusion through the gills. However, when ammonia is not

free to diffuse into an effectively limitless aquatic environment, its toxicity presents a problem,

particularly to embryos of terrestrial forms that develop wholly within tightly encapsulated

eggshells or cases. For these forms the detoxication of ammonia is an indispensable

requirement for survival. During evolution of the vertebrates two energy-dependent biosynthetic

pathways arose which incorporated potentially toxic ammonia into urea and uric acid molecules,

respectively. Both of these compounds are relatively harmless, even in high concentrations, but

the former needs a relatively large amount of water to ensure its elimination, and uric acid

requires a specific energy-demanding tubular secretory process to ensure its efficient excretion.

Urine concentration

The unique functional feature of the mammalian kidney is its ability to concentrate urine.

Human urine can have four times the osmotic concentration of plasma, and some desert rats

that survive on a diet of seeds without drinking any water have urine/plasma concentration

ratios as high as 17. More aquatic forms such as the beaver have correspondingly poor

concentrating ability.

The concentration operation depends on the existence of a decreasing gradient of solute

concentration that extends from the tips of the papillae in the inner medulla of the kidney

outward toward the cortex. The high concentration of medullary solute is achieved by a double

hairpin countercurrent multiplier system which is powered by the active removal of salt from

urine while it traverses the ascending limb of Henle's loop (Fig. 2). The salt is redelivered to the

tip of the medulla after it has diffused back into the descending limb of Henle's loop. In this way

a hypertonic condition is established in fluid surrounding the terminations of the collecting ducts.

Urine is concentrated by an entirely passive process as water leaves the lumen of collecting

ducts to come into equilibrium with the hypertonic fluid surrounding its terminations.

IV. VITAL INFORMATION

Name (initials): R.E.B

Age: 52 years old

Sex: Male

Address: Estonilo Subdivision, Roxas City

Civil Status: Married

Religion: Roman Catholic

Occupation: Government Employee

Date and Time admitted: September 8, 2009 at 10:45 pm

Ward: Saint Joseph Ward (SJW)

Chief Complaint: Difficulty of Breathing

Admitting Diagnosis: Acute LV dysfunction, CKD; Pneumonia – high risk

Final Diagnosis: Chronic Kidney Disease

Attending Physician/s: Dr. R. Blancaver, Dr. Obligacion

V. CLINICAL ASSESSMENT

A. Nursing History

Mr. R.E.B is a chronic smoker and an excessive alcohol drinker. He plays card games

for his past time activity at around 5 o’clock at the afternoon while playing cards, he experienced

sudden chest pain, and he did not mind the pain but continue playing cards. At around 8:30 pm

after dinner while smoking, he said to his wife that the pain is much more painful that it was just

recently then after an hour, Mr. R.E.B experience difficulty of breathing, and was brought in to

the hospital.

Current medications: diazepam (Valium) for anxiety disorders, tremor muscle and

muscle spasm; Erythromycin for respiratory tract infections and pneumonia; clonidine

(Catapres) for hypertension; doxofylline (Ansimar) for bronchial asthma and pulmonary

diseases; isosorbide-5-mononitrate (Angistad) for heart pain, severe weakness of the heart

muscle and high blood pressure; acetylcysteine (Fluimucil) for respiratory infections and acute

and chronic bronchitis and bronchial asthma; clopidogrel (Plavix) for preventing myocardial

infarction and acute coronary syndrome; nitroglycerin (Transderm – Nitro) for angina pectoris;

clindamycin (Clindamycin Hydrochloride) for respiratory tract infections; meloxicam (Mobic) for

flank pain.

B. Past Health Problem / Status

Past Illnesses: Mr. R.E.B is a 52 year old male suffering from hypertension, diabetes

mellitus type – 2 and base on his laboratory results, its shows that he has pneumonia on both

sides and pulmonary congestion. He also experienced chickenpox and measles during his

childhood.

Allergies: He has no known allergies to food or drugs.

Previous Hospitalization: Previous hospitalization was May 2003 due to difficulty of

breathing with a diagnosis of Pneumonia and had undergone appendectomy.

C. Family History of Illness

Both of his parents have hypertension, diabetes mellitus type -2 and a history of

bronchial asthma, eventually, he may acquire these diseases. Some of his siblings have it too,

and also to his children especially bronchial asthma.

Legend: Deceased male

Deceased female

Indicates patient

Living male

Living female

HPNDM-type II

HPN

HPN, BA, CKDCCCCCCCC

HPNBA

BA

FAMILY GENOGRAMFAMILY GENOGRAM

VI. BRIEF SOCIAL, CULTURAL AND RELIGIOUS BACKGROUND

A. Educational Background

Mr. R.E.B is a college graduate.

B. Occupational Background

He is working as a Government Employee.

C. Religious Background

He is a Roman Catholic and attends mass on Sundays and prays thee rosary at

night together with his family.

D. Economic Status

They belong to a middle class type of family and most of his children are schooling.

VII. CLINICAL INSPECTION

A. Vital Signs

Upon Admission During Care

Temperature 37.8C 36.5C

Pulse Rate 127 bpm 95 bpm

Respiration 36 bpm 25 bpm

Blood

Pressure

260/120 mmHg 140/90 mmHg

Cardiac Rate 130 bpm 98 bpm

B. Height, Weight, BMI – no data

C. Physical Assessment

General

Mr. R.E.B is conscious and restless. He appears to

be grumpy and irritable but conversive while sitting

or lying in bed.

Skin, Hair, Nails

Dry skin, uniform in color, (+) hematoma in right

arm and warm to touch. Hair is black with visible

white hair, no lice and dandruff and dry scalp.

Experiencing alopecia. Fingernails are trimmed, (+)

cyanotic nailbeds, toenails are not trimmed and

unclean.

Head, Face, Lymphatics

(+) Headache. No head injuries, round in shape

and oily face.

HEENT

Color of the eyes is dark brown, anicteric sclera

with pale conjunctiva. He has blurred vision and

wears glasses most of the time. His right & left ear

canal are not clean, (-) discharges, brown in color,

symmetrical in shape. Hearing is good with no pain

and infections. Have frequent colds. No discharges

or secretions and nosebleeds. Lips are dry. No

bleeding of gums or dentures noted. No inflamed

pharynx and able to swallow food without difficulty.

Neck and Upper extremities

No lumps or swollen glands. No reports of neck

pain and stiffness. Arms able to move freely.

Presence of palpitation in his wrist.

Chest, Breast and Axilla

Abnormal respiration upon admission with RR of

36 bpm and 25 bpm during care. Presence of chest

pain, (+) history of bronchial asthma, (+) rales, (+)

wheezing.

Respiratory System (Chest and Lungs)

Thorax is symmetric. (+) history of bronchial

asthma, RR is above normal. (+) dyspnea, (+)

wheezing. (+) Cough with presence of whitish

phlegm.CXR results: (+) pneumonia, (+) pulmonary

congestion.

Cardiovascular System

(+) history of hypertension with blood pressure of

260/120 upon admission and during care with the

BP of 140/90 mmHg. (+) dyspnea, (+) tachycardia,

(+) chest pain with discomfort. Cardiac rate is

above normal with AR of 130 bpm and respiration

of 36 bpm.

Gastrointestinal System (+) loss of appetite

Genito – Urinary System (+) oliguria

Musculoskeletal System (+) flank pain, (+) weakness, (+) limitation of

motion or activity, (+) bipedal pitting edema at the

lower extremities.

D. General Appraisal

Speech: He speaks clearly, attentive and conversive.

Language: The patient knows how to speak English, Tagalog, Bisaya.

Hearing: The patient’s hearing is good.

Mental Status: The patient is alert and attentive when asked but sometimes he is

grumpy, depending on his mood.

Emotional status: He is worried about his condition and thinks that he brings problem

to his family due to his situation.

VIII. LABORATORY AND DIAGNOSTIC DATA

A. Hematology

Hematology or haematology is the branch of biology (physiology), pathology, clinical

laboratory, internal medicine, and pediatrics that is concerned with the study of blood, the blood

of forming organs, and blood diseases. Hematology includes the study of etiology, diagnosis,

treatment, prognosis, and prevention of blood diseases.

Test Result Normal

Values

Significance

Date: 09/13/09

WBC count 20.0x10^9/L 4.5-11.0 Infection

RBC count 4.78x10^12/L 4.2-5.4 The result is Within Normal

Range.

Hemoglobin 100g/L 120-160 Anemia from Blood

loss, kidney disorder.

Hematocrit 0.27vol.fr 0.37-0.47 Acute massive blood

loss, severe anemias

Mean Corpuscular

Volume (MCV)

86.0cu.u 80-96 The result is Within Normal

Range.

Mean Corpuscular

Hemoglobin

(MCH)

28.5uug 27-31 The result is Within Normal

Range.

Mean Corpuscular

Hemoglobin the

Concentration

(MCHC)

33.0g/dL 32-36 The result is Within Normal

Range.

RDW 12.8% 11-16 The result is Within Normal

Range.

Neutrophils 65.0% 50-70 The result is Within Normal

Range.

Eosinophils 4.0% 0-3 Allergic reactions

Basophils 0.0% 0-1 The result is Within Normal

Range.

Lymphocytes 11.0% 20-45 It signifies severe

debilitating illnesses.

Monocytes 0.0% 0-8 The result is Within Normal

Limits.

Platelet 118 150-350 Uremia, infection.

B. Blood Chemistry

The serum chemistry profile is one of the most important initial tests that are commonly

performed on sick or aging patient. A blood sample is collected from the patient. The blood is then

separated into a cell layer and serum layer by spinning the sample at high speeds in a machine

called centrifuge. The serum layer is drawn off and a variety of compounds are then measured.

These measurements aid the veterinarian in assessing the function of various organs and body

systems.

Test Result Normal Values Significance

Date: 09/13/09

Glucose 6.78 mmol/L 4.10 – 5.90 Hyperglycemia

Sodium 125.3 mmol/L 137.0 – 145.0 Renal

insufficiency,

uremia

Magnesium 1.10 mmol/L .70 – 1.00 Renal disorder,

dehydration

Creatinine 298.3 mmol/L 71.0 – 133.0 Impaired renal

function, shock

Cholesterol 8.34 mmol/L 0.00 – 5.20 Elevation

indicates increase

risk in CAD

Direct HDLC .45 mmol/L 1.00 – 1.60 Indicates risks in

CAD

LDL 6.41 1.71 – 4.60 Elevation

indicates risk in

CAD

VLDL 1.49 0.00 – 1.03 Elevation

indicates increase

risk in CAD

Potassium 5.49 3.5 – 5.10 Acute renal failure

C. ABG Analysis

It is also called arterial blood gas (ABG) analysis, is a test which measures the amounts

of oxygen and carbon dioxide in the blood, as well as the acidity (pH) of the blood. It indicates

how well the lungs and kidneys are interacting to maintain normal blood pH (acid-base balance).

It evaluates how effectively the lungs are delivering oxygen to the blood and how efficiently they

are eliminating carbon dioxide from it.

Test Result Normal Values Significance

Date: 09/13/09

pH 7.462 7.35 – 7.45 The result is Within Normal

Limits.

paCO2 32.5 mmHg 33 – 45 mmHg The result is Within Normal

Limits.

paO2 96.0 mmHg 80 – 100 mmHg The result is Within Normal

Limits.

HCO3 22.9 mmol/L 22 – 26 mmol/L The result is Within Normal

Limits.

PCO2 53.6 mmol/L 35 - 45mmol/L Respiratory distress

ABE 0.4 mmol/L -2 - +2

SBE -0.4 mmol/L

SBC 24.7 mmol/L

O2 saturation 97.6% 97 – 100% The result is Within Normal

Limits.

FIO2 4 Lpm

D. Radiology

It provides a radiographic image of the organs or tissues, to detect abnormality such as

tumor, perforation, abscess, infection, foreign body or fracture.

Test X – ray Findings Impression

Date: 09/13/09

Chest PA

(mobile)

Follow – up study done 09/13/09 without an

endotracheal tube compared 09/09/09 shows

confluent opacities in the (R) upper lobe and

both bases.

There is an increase in the level of the (R)

and (L) level effusion.

The cardiac shadow is enlarged. The lower

borders are obliterated.

The rest of the findings are unchanged.

Bilateral pleural

effusion, increase in

amount

Pulmonary

Congestion

Cardiomegaly, LV

form

Pneumonia, both

bases and (R) upper

lobe with

consolidation.

E. Urinalysis

A urinalysis is a test performed on a patient's urine sample to diagnose conditions and

diseases such as urinary tract infection, kidney infection, kidney stones, inflammation of the

kidneys, or screen for progression of conditions such as diabetes and high blood pressure.

Test Result Normal

Range

Significance Justification

Date: 09/14/09

Color Straw Straw, Amber,

Transparent

WNL The color of the patient’s

urine doesn’t indicate any

deviations or

abnormalities.

Transparency Turbid Clear Abnormal

results. It

indicates

infection like

pyuria or

bacteuria

The patients’ urine may

have the presence of pus

or bacteria. This occurs

maybe due to infection.

pH 7.38 7.35 – 7.45 WNL

Specific

Gravity

1.025 1.010- 1.030 WNL

Glucose Negative Negative WNL

(Microscopic)

Pus 40 –

80/hpf

RBC 240 –

310/hpf

(Crystals)

Bacteria many Infection

F. Sputum test

Sputum test is a test of secretions from the lungs and bronchi (tubes that carry air to the

lung) to look for bacteria that cause infection.

Examination/s desired Result

Date: 09/14/09

Sputum Gram Stain

Seen on smear were occasional gram (+) cocci in singles

and in pairs, few gram (-) cocci, occasional gram (-) bacilli

5-14 pus cells/OIF, moderate squamous epithelial cells

and few yeast cells.

G. Serology and Immunology

It is the science that deals with the properties and reactions of serums, especially blood

serum. It analsizes the contents and properties of blood serum.

Serum Specimen Result/s

Date: 09/09/09

Troponin – 1 (-) Negative

H. Bacteriology

The science and study of bacteria, and hence a specialized branch of microbiology. It

deals with the nature and properties of the bacteria as living entities, their morphology and

developmental history, ecology, physiology and biochemistry, genetics, and classification.

Test Result/s

Date: 09/07/09

Nature of specimen: Sputum Organism identified: Very light growth of

Candida but not albicans.

IX. PATHOPHYSIOLOGY

When discussing the pathophysiology of CKD, renal structural and physiological

characteristics, as well as the principles of renal tissue injury and repair should be taken into

consideration.

Firstly, the rate of renal blood flow of approximately 400 ml/100g of tissue per minute is

much greater than that observed in other well perfused vascular beds such as heart, liver and

brain. As a consequence, renal tissue might be exposed to a significant quantity of any

potentially harmful circulating agents or substances. Secondly, glomerular filtration is dependent

on rather high intra- and transglomerular pressure (even under physiologic conditions),

rendering the glomerular capillaries vulnerable to hemodynamic injury, in contrast to other

capillary beds. In line with this, Brenner and coworkers identified glomerular hypertension and

hyperfiltration as major contributors to the progression of chronic renal disease. Thirdly,

glomerular filtration membrane has negatively charged molecules which serve as a barrier

retarding anionic macromolecules. With disruption in this electrostatic barrier, as is the case in

many forms of glomerular injury, plasma protein gains access to the glomerular filtrate. Fourthly,

the sequential organization of nephron microvasculature (glomerular convolute and the

peritubular capillary network) and the downstream position of the tubuli with respect to

glomeruli, not only maintains the glomerulo-tubular balance but also facilitates the spreading of

glomerular injury to tubulointerstitial compartment in disease, exposing tubular epithelial cells to

abnormal ultrafiltrate. As peritubular vasculature underlies glomerular circulation, some

mediators of glomerular inflammatory reaction may overflow into the peritubular circulation

contributing to the interstitial inflammatory reaction frequently recorded in glomerular disease.

Moreover, any decrease in preglomerular or glomerular perfusion leads to decrease in

peritubular blood flow, which, depending on the degree of hypoxia, entails tubulointerstitial injury

and tissue remodeling. Thus, the concept of the nephron as a functional unit applies not only to

renal physiology, but also to the pathophysiology of renal diseases. In the fifth place, the

glomerulus itself should also be regarded as a functional unit with each of its individual

constituents, i.e. endothothelial, mesangial, visceral and parietal epithelial cells - podocytes, and

their extracellular matrix representing an integral part of the normal function. Damage to one will

in part affect the other through different mechanisms,direct cell-cell connections (e.g., gap

junctions), soluble mediators such as chemokines, cytokines, growth factors, and changes in

matrix and basement membrane composition.

The main causes of renal injury are based on immunologic reactions (initiated by

immune complexes or immune cells), tissue hypoxia and ischaemia, exogenic agents like drugs,

endogenous substances like glucose or paraproteins and others, and genetic defects.

Irrespective of the underlying cause glomerulosclerosis and tubulointerstitial fibrosis are

common to CKD.

                                                            

An overview of the pathophysiology of CKD should give special consideration to mechanisms of

glomerular, tubular and vascular injury.

X. MEDICAL MANAGEMENT

A. Drug Study

Name of the

Drug with

Dosage

Generic Name Action Mechanism of

Action

Indications Side Effects Contraindications Nursing Responsibilities

Valium

2.5 g IV x 2

doses

OD

Diazepam - Anxiolytic

-Antiepileptic

-

Benzodiazep

ine

-Skeletal

muscle

relaxant

(centrally

acting)

Depresses the

CNS, and

suppresses the

spread of seizure

activity.

-Anxiety

disorders,

-Acute alcohol

withdrawal,

-Tremor

Muscle ,

relaxant:

Adjunct for

relief of reflex

skeletal

muscle spasm

due to local

pathology

(inflammation

of muscles or

joints) or

secondary to

-Drowsiness

-Dizziness

-GI upset

-Difficulty

concentrating

-Fatigue

-Nervousness

Contraindicated in

patients

hypersensitive to

drug or soy protein;

in patients

experiencing shock,

coma, or acute

alcohol intoxication

(parenteral form).

Diastat rectal gel is

contraindicated in

patients with acute

angle-closure

glaucoma

Monitor periodic hepatic,

renal, and hemtopoeitic

function studies in

patients receiving

repeated or prolonged

therapy.

Monitor elderly patients

for dizziness, ataxia,

mental status changes.

Patients are at an

increased risk for falls.

Warn patient to avoid

activities and good

coordination until effects

of drug are known.

trauma

before

endoscopic

procedures,

Preoperative

sedation

Tell patient to avoid

activities that requires

alertness and good

coordination until effects

of drug are known.

Tell patient to avoid

alcohol while taking drug.

Notify patients that

smoking may decrease

drug’s effectiveness.

Warn patient not to

abruptly stop drug

because withdrawal

symptoms may occur.

Eryc

300 mg TID

Erythromycin -Macrolide

-Anti-

infective

Bacteriostatic or

bactericidal in

susceptible

bacteria.

Binds to cell

membrane,

causing change in

protein function,

leading to cell

death.

Mild to

moderately

severe

respiratory

tract infection

Acute

infections

caused by

sensitive

strains of

Streptococcus

pneumonia.

-Stomach

cramping

-Discomfort

-Uncontrollable

emotions such

as crying,

laughing,

abnormal

thinking

Contraindicated in

those hypersensitive

to drug or other

macrolides.

Erythromycin estolate

is contraindicated in

patients with hepatic

disease.

Use erythromycin

salts cautiously in

patients with

impaired hepatic

function.

Don’t use drus to

treat neurosyphilis.

When giving suspension

note the concentration.

Monitor patients for

superinfection. Drug may

cause overgrowth of non

susceptible bacteria or

fungi.

Ototoxicity may occur,

especially in patients with

renal or hepatic

insufficiency and in those

receiving with high

dosage of drug.

Coated tablets or

encapsulated pellets

cause less GI upset, so

they may be better

tolerated by patients who

have trouble tolerating

drug.

Catapres

75 mg 1 tab

TID

Clonidine Anti-

hypertensive

Central

analgesics

Sympatholyti

c (centrally

acting)

Stimulates CNS

alpha2-adrenergic

receptors.

Inhibits

sympathetic

cardioaccelerator

and

vasoconstrictor

centers, and

decreases

sympathetic

outflow from the

CNS.

Treatment for

hypertension

-Drowsiness

-Dizziness

-

Lightheadednes

s

-Headache

-Weakness

-Dry mouth

Clonidine should not

be used in patients

with known

hypersensitivity to the

active ingredient or

other components of

the product, and in

patients with severe

bradyarrhythmia

resulting from either

sick sinus syndrome

or AV block of 2nd or

3rd degree.

Monitor blood pressure

carefully.

Report urinary retention,

changes in vision,

blanching of fingers and

rash.

Erceflora

Vial

BID

Bacillus clausii -Antidiarrheal

of microbial

origin

Contributes to the

recovery of the

intestinal microbial

flora altered during

the course of

microbial disorders

of diverse origin. It

produces various

vitamins,

particularly group

B vitamins thus

contributing to

correction of

vitamin disorders

caused by

antibiotics &

chemotherapeutic

agents. Promotes

normalization of

intestinal flora.

Acute diarrhea

Chronic or

persistent

diarrhea

No side effect

has been

reported.

Ascertained

hypersensitivity

towards the

components of the

product.

1.) Shake drug well before

administration.

2.) Monitor patient for any

unusual effects from drug. -

Monitoring allows detection of

possible side effects of the

drug since there has been no

known side effect of the drug.

3.) Administer drug within 30

minutes after opening

container.

-To avoid contamination of the

drug.

4.) Dilute drug with sweetened

milk, orange juice or tea.

-To allow easy administration

of the drug.

5.) Administer drug orally.

- Proper administration allows

better effects of the drug and

prevent

Ansimar

400 mg 1 tab

BID

Doxofylline Bronchodilat

or

Relaxes bronchial

smooth muscle by

the action of beta2

receptor with a

little effect on the

heart rate.

Treatment of

bronchial

asthma and

pulmonary

disease with

spastic

bronchial

component

-Nausea,

-vomiting,

-pain in the area,

-headache,

-irritability,

-insomnia

-tachycardia,

Contraindicated in

individuals who have

shown

hypersensitivity to its

components.

Contraindicated in

patients with acute

myocardial infarction

and hypotension.

Monitor heart rate

Check CNS stimulation

Notify physician if

palpitation, chest pain

and tachycardia occur.

Check for any allergy

that may occur in the

patient.

It may take with and

without food.

Angistad

40 mg/tab OD at

8 pm

BID

Isosorbide-5-

mononitrate

Anti-anginal

Nitrate

Vasodilator

Relaxes vascular

smooth muscle

with a resultant

decrease in

venous return and

decrease in

arterial BP, which

reduces left

ventricular

workload and

decreases

myocardial oxygen

consumption.

Long-term

treatment of

circulatory

disorders

affecting the

coronary

arteries

(ischemic heart

disease).

Prevention of

attacks of

angina (heart

pain).

High blood

pressure in the

lung circulation

(pulmonary

hypertension).

Treatment of

severe

weakness of

heart muscle

(chronic

-Dizziness

-Headache

-nausea

Hypersensitivity to

nitrate compounds.

Acute myocardial

infarction with low

filling pressures.

Impaired function of

the left ventricle (left

heart failure) with low

filling pressures.

Shock

Very low blood

pressure

Diseases of the heart

muscle with

narrowing of the

cavity of the heart

(hypertrophic

obstructive

cardiomyopathy)

Constrictive

pericarditis

Pericardial

tamponade

-Do not take any new

prescription or OTC

medications or herbal products

during therapy unless

approved by prescriber.

-Do not discontinue abruptly;

this could cause severe

reaction

-Avoid excess alcohol intake;

combination may cause severe

hypotension

cardiac

failure), in

combination

with cardiac

glycosides

and/or

diuretics.

Aortic stenosis

Mitral stenosis

Marked anemias

Head trauma

Cerebral hemorrhage

Closed-angle

glaucoma

Hyperthyroidism

Fluimucil

600 mg

TID

Acetylcysteine Mucolytic Splits links in the

mucoproteins

contained in

respiratory mucus

secretions,

decreases the

viscosity of the

mucus.

Antidote to

acetaminophen

hepatoxity: Protect

liver cells by

maintaining cell

function and

detoxifying

acetaminophen

metabolites.

Treatment of

respiratory

infections

characterized

by thick and

viscious

hypersecretion

s

Acute

bronchitis

Chronic

bronchitis and

its

exacerbation

Asthmatic

bronchitis

Increase

productive

cough

Nausea and

vomiting

GI upset

Brochospasm

Angioedema

Rashes

pruritus

Fever

Blurred vision

Known

hypersensitivity to

acetylcysteine. As

acetylcysteine

granules and tablets

contain aspartame, it

is contraindicated in

patients suffering

from phenylketunuria.

Dissolve the tablet or

the content of sachet in

a glass containing

quantity of water then

by mixing it with a

spoon, if necessary.

It is preferred not to

mixed other drugs with

acetylcysteine

(fluimucil) solution.

Report difficulty in

breathing or 6nausea

You may experience

increase productive

cough, nausea, and GI

upset.

Plavix

75 mg

OD

Clopidogrel Anti-

thrombotic

Adenosine

diphosphate

(ADP)

receptor

antagonist

Antiplatelet

Inhibits platelet

aggregation by

blocking ADP

receptors on

platelets,

preventing

clumping of

platelets.

Indicated for

the prevention

of:

Myocardial

infarction

Acute coronary

syndrome

-Diarrhea

-Abdominal pain

-Dyspepsia

-Headache

-Dizziness

-Vertigo

-Rash

Hypersensitivity to

the active substance

or to any of the

excipients of the

medicinal product.

Severe liver

impairment

Active pathological

bleeding such as

peptic ulcer or

intracranial

hemorrhage.

Provide frequent small

meals if GI upset

occurs.

Provide comfort

measures and arrange

for analgesics if

headache occurs.

Take daily as

prescribed. May be

taken with meals.

Monitor if GI bleeding

occurs.

Monitor carefully if

bleeding occurs if you

administered it with

warfarin.

Drug interactions:

Increased risk of GI

bleeding with NSAIDS.

Increased risk of

bleeding with warfarin.

Transderm-Nitro

(transdermal) 5

mg to anterior

chest wall, rub

for systolic

bloopd pressure

<90 mmHg

OD

Nitroglycerin Anti-anginal

Nitrate

Relaxes vascular

smooth muscle

with a resultant

decrease in

venous return and

decrease in

arterial BP, which

reduces left

ventricular

workload and

decreases

myocardial oxygen

consumption.

Angina

pectoris

Congestive

heart failure

Prevention of

phlebitis and

extravasations

Headache,

reddening of the

skin, itching or

burning

sensation, facial

flushing,

faintness or

light-

headedness,

dizziness,

postural

hypotension,

nausea, vomiting

Contraindicated with

allergy to nitrates,

severe anemia, early

MI, head trauma,

cerebral hemorrhage,

and hypertrophic

cardiomyopathy.

Drug interactions: Increased

risk of hypertension and

decreased antianginal effect

with ergot alkaloids. Decreased

pharmacological effects of

heparin. Risk for severe

hypotension and adverse CV

events with sildenafil, tadalafil,

vardenafil (avoid this

combination).

Clindamycin

Hydrochloride

300 mg

TID

Clindamycin Antibacterial The lincomycins

inhibit protein

synthesis in

susceptible

bacteria by binding

to the 50 S

subunits of

bacterial

ribosomes and

preventing peptide

bond formation.

They are usually

considered

bacteriostatic, but

may be

bactericidal in high

concentrations or

when used against

highly susceptible

organisms.

Infections

caused by

sensitive

staphylococci,

streptococci,

pneumococci,

bacteroides,

Fusobacterium

, and

clostridium

perfringes and

other sensitive

aerobic and

anaerobic

organisms.

-Abdominal pain

-esophagitis

-nausea

-vomiting

-diarrhea

-Vesiculobullous

rashes

-urticaria

-Jaundice

Skin rashes,

erythema multiforme,

Pruritus,

vaginitis,

Drug interactions:

Erythromycin: may block the

access to its site of action.

Avoid using together.

Kaolin: Decreased absorption

of oral clindamycin

Neuromuscular blockers:

Increased neuromuscular

blockade possible. Monitor

patient closely.

Drug doesn’t penetrate blood-

brain-barrier.

Don’t give opoid antidiarrheals

to treat drug-induced diarrhea;

they may prolong and worsen

diarrhea.

Mobic

7.5 mg

PRN for pain

Meloxicam Non steroidal

anti-

inflammatory

agents

Inhibits

cyclooxygenase

(COX), the

enzyme

responsible for

converting

arachidonic acid

into prostaglandin

H2—the first step

in the synthesis of

prostaglandins,

which are

mediators of

inflammation.

Relief from

signs and

symptoms of

flank pain,

osteoarthritis.

-stomach pain

-constipation

-diarrhea

gas

-heartburn

-nausea

-vomiting

-dizziness

Gastrointestinal

toxicity and bleeding,

tinnitus, headache,

rash, very dark or

black stool (sign of

intestinal bleeding).

Drug interactions: ACE

inhibitors: decrease

antihypertensive effect.

Monitor blood pressure.

Aspirin: may cause adverse

effect avoid using together.

Furosemide, thiazide diuretics:

NSAIDS can reduce sodium

excretion caused by diuretics,

leading to sodium retention.

Monitor patient for edema and

increase blood pressure.

Biogesic

500 mg

PRN for fever

Paracetamol Antipyretic Inhibition of

cyclooxygenase

(COX), an enzyme

responsible for the

production of

prostaglandins,

which are

important

mediators of

inflammation, pain

and fever.

Used for

patients who

have fever at

least 38.0°C.

GI upset

Skin rashes,

blood disorders

and a swollen

pancreas have

occasionally

happened in

people taking

the drug on a

regular basis for

a long time.

Rash, swelling of the

face, and sometimes

difficulty breathing.

Take this medication

after meals.

Observe for any

allergies that may

occur.

Drug Interactions:

Diuretics: it may force

the kidneys to excrete

urine more frequently,

and in greater amounts.

Lasix

40 mg

BID

FurosemideLoop

Diuretics

Acts on the Na+-

K+-2Cl- symporter

(cotransporter) in

the thick

ascending limb of

the loop of Henle

to inhibit sodium

and chloride

reabsorption.

To eliminate

water and salt

from the body.

Used to treat

excessive

accumulation

of fluid and/or

swelling

(edema) of the

body caused

by heart

failure,

cirrhosis,

chronic kidney

failure, and the

nephrotic

syndrome

Low blood

pressure,

dehydration and

electrolyte

depletion (for

example,

sodium,

potassium

Hypernatremia,

Hypokalemia,

Hypomagnesemia,

Dehydration,

Hyperuricemia, Gout,

Dizziness, Postural

hypotension,

Syncope

Instruct your patient

that he will never get

dehydrated.

Store this medication at

room temperature away

from heat, light, and

moisture.

Drug interactions:

Sucralfate,

Cholestyramine

Colestipol decreases

the action of ferosemide

B. Other Treatments

Hemodialysis

Hemodialysis (also haemodialysis) is a method for removing waste products such

as potassium and urea, as well as free water from the blood when the kidneys are inrenal

failure. Hemodialysis is one of three renal replacement therapies (the other two beingrenal

transplant; peritoneal dialysis).

Hemodialysis can be an outpatient or inpatient therapy. It involves diffusion of solutes

across a semipermeable membrane. Hemodialysis utilizes counter current flow, where the

dialysate is flowing in the opposite direction to blood flow in the extracorporeal circuit. 

Side effects:

Low Blood Pressure Fatigue Chest Pain Nausea Headache Leg Cramps

The severity of these symptoms is usually proportionate to the amount and speed of fluid removal. These side effects can be avoided and/or their severity lessened by limiting fluid intake between treatments or increasing the dose of dialysis

Complications of Hemodialysis

Sepsis Endocarditic (an infection affecting the heart valves) Osteomyelitis (infection affecting the bones) Bleeding

Complications during Hemodialysis

Hypotension Cramps Febrile Reaction Arrythmia Hemolysis Hypoxia

In hemodialysis, three primary methods are used to gain access to the blood: an intravenous catheter, an arteriovenous (AV) fistula and a synthetic graft. The type of access is influenced by factors such as the expected time course of a patient's renal failure and the condition of his or her vasculature. Patients may have multiple accesses, usually because an AV fistula or graft is maturing and a catheter is still being used.

PREPARING FOR HEMODIALYSIS 

Preparations for hemodialysis should be made at least several months before it will be

needed. In particular, you will need to have a procedure to create an "access" (described below)

several weeks to months before hemodialysis begins.

Vascular access — An access creates a way for blood to be removed from the body,

circulate through the dialysis machine, and then return to the body at a rate that is higher than

can be achieved through a normal vein. There are three major types of access: primary AV

fistula, synthetic AV bridge graft, and central venous catheter. Other names for an access

include a fistula or shunt.

The access should be created before hemodialysis begins because it needs time to heal

before it can be used. Discussions about the access should begin even earlier, since you will

need to avoid injuring blood vessels that will eventually be used for access. Having an

intravenous line (IV) or frequent blood draws in the arm that will be used for access can damage

the veins, which could prevent them from being used for a hemodialysis access. The access is

usually created in the non-dominant arm; for a right-handed person this would be their left arm.

Primary AV fistula — A primary AV fistula is the preferred type of vascular access. It

requires a surgical procedure that creates a direct connection between an artery and a vein.

This is often done in the lower arm, but can be done in the upper arm as well. Sometimes a vein

that would not normally be useful for creating an AV fistula can be moved so that it is more

accessible; this is often done in the upper arm.

Regardless of its location or how it is created, the access is located under the skin.

During dialysis, two needles are inserted into the access. Blood flows out of the body through

one needle, circulates through the dialysis machine, and flows back into the access through the

other needle.

A primary AV fistula is usually created two to four months before it will be used for

dialysis. During this time, the area can heal and fully develop or "mature".

Synthetic bridge graft — Sometimes, a patient's arm veins are not suitable for creating a fistula.

In these cases, a surgeon can use a flexible rubber tube to create a path between an artery and

vein. This is called a synthetic bridge graft. The graft sits under the skin and is used in much the

same way as the fistula except that the needles used for hemodialysis are placed into the graft

material rather than the patient's own vein.

Grafts heal more quickly than fistulas and can often be used about two weeks after they

are created. However, complications such as narrowing of the blood vessels and infection are

more common with grafts than with AV fistulas.

Central venous catheter — A central venous catheter uses a thin flexible tube that is

placed into a large vein (usually in the neck). It may be recommended if dialysis must be started

immediately and the patient does not have a functioning AV fistula or graft. This type of access

is usually used only on a temporary basis. In some cases, however, there can be problems

maintaining an AV fistula or graft, and the central venous route is used for long-term access.

Catheters have the highest risk of infection and the poorest function compared to other

access types; they should be used only if a primary fistula or synthetic bridge graft cannot be

maintained.

Dietary changes — some patients, especially those who receive dialysis in a center, will

need to make changes in their diet before and during hemodialysis treatment. These changes

ensure that you do not become overloaded with fluid and that you consume the right balance of

protein, calories, vitamins, and minerals.

A diet that is low in sodium, potassium, and phosphorus may be recommended, and the

amount of fluids (in drinks and foods) may be limited. A dietitian can help you to choose foods

that are compatible with hemodialysis treatment.

Members of the Health Team (CKD)

Mr. R.E.B

Nephrologists

A physician who has been trained in the diagnosis and

management of kidney disease, by regulating blood pressure,

regulating electrolytes, balancing fluids in the body, and

administering dialysis. Nephrologists treat many different

kidney disorders including acid-base disorders, electrolyte

disorders, nephrolithiasis (kidney stones), hypertension (high

blood pressure), acute kidney disease and end-stage renal

disease.

Peritoneal Dialysis Nurse

PD filters the patient’s blood

inside the body, requiring fewer

equipment restrictions.  This

allows our patients to dialyze at

home or at work.

Hemodialysis Nurse

The principle of hemodialysis is the same as other

methods of dialysis; it involves diffusion of solutes

across a semipermeable membrane. Hemodialysis

utilizes counter current flow, where the dialysate is

flowing in the opposite direction to blood flow in the

extracorporeal circuit. Counter-current flow

maintains the concentration gradient across the

membrane at a maximum and increases the

efficiency of the dialysis.

Pharmacist

The pharmacist may delegate

prescription-filling and

administrative tasks and

supervise their completion.

Patient Support System

Dedicated central point of

contact who assists providers

and patients

Social worker

It is a profession for those with a

strong desire to help improve

people’s lives. Social workers assist

people by helping them cope with

issues in their everyday lives, deal

with their relationships, and solve

personal and family problems.

Transplant Nephrologist

The majority of kidneys that are

transplanted come from deceased

organ donors. Organ donors are

adults who have become critically ill

and will not live as a result of their

illness. Parents or spouses can also

agree to donate a relative's organs

Nutritionist

A person whose professional

activity is devoted to

researching and advising on

matters of nutrition

XI. NURSING MANAGEMENT

A. Concept Map of Nursing Problems

`

B. Nursing Care Plan

CC: Difficulty of BreathingMedical

Diagnosis:Chronic Kidney

Disease

8. Activity Intolerance r/t generalized body weakness

Objective/s:(+) Body weakness, Ambulatory with assistance Irritability, (+) Weakness, (+) Shortness of breath, (+) Fatigue

9. Risk for impaired skin integrity r/t altered fluid status

Objective/s:(+) Pitting edema, (+) PD catheter, (+) IV cut down, (+) Hematoma at right arm; warm to touch.

9. Risk for impaired skin integrity r/t altered fluid status

Objective/s:(+) Pitting edema, (+) PD catheter, (+) IV cut down, (+) Hematoma at right arm; warm to touch.

Impaired gas exchange r/ t presence of secretions on both lung base

Objective/s:(+) Restlessness, (+) DOB, (+) Crackles, (+) Pallor, (+) Irritability, (+) Decreased hemoglobin – 133 g/L (N.V. 120 – 160), RR- 36 bpm, (+) History of bronchial asthma, X-ray Results: Pleural effusion, Pneumonia, both bases.

Impaired gas exchange r/ t presence of secretions on both lung base

Objective/s:(+) Restlessness, (+) DOB, (+) Crackles, (+) Pallor, (+) Irritability, (+) Decreased hemoglobin – 133 g/L (N.V. 120 – 160), RR- 36 bpm, (+) History of bronchial asthma, X-ray Results: Pleural effusion, Pneumonia, both bases.

4. Altered thermoregulation related to invasion of pathogens

Objective/s:Temp. 37.9 C, Skin warm to touch, Weak in appearance, WBC result - 20.0x10^9/L (N.V - 4.5-11.0), Neutrophils - 65.0% (N.V - 50-70), Lymphocytes 11.0% (N.V - 20-45)X-ray revealed:Bilateral pleural effusion, increase in amount, Pulmonary Congestion, Cardiomegaly, LV form, Pneumonia, both bases and (R) upper lobe with consolidation.

4. Altered thermoregulation related to invasion of pathogens

Objective/s:Temp. 37.9 C, Skin warm to touch, Weak in appearance, WBC result - 20.0x10^9/L (N.V - 4.5-11.0), Neutrophils - 65.0% (N.V - 50-70), Lymphocytes 11.0% (N.V - 20-45)X-ray revealed:Bilateral pleural effusion, increase in amount, Pulmonary Congestion, Cardiomegaly, LV form, Pneumonia, both bases and (R) upper lobe with consolidation.

10. Low self-esteemr/t loss of kidney function

Objective/s:(+) indecisive nonassertive behavior, (+) Weakness, Lack of eye contact, Refusal to participate in hospital procedures, increasingly dependent on her wife

7. Impaired Urinary Elimination r/t altered renal function

Objective/s:(+) HD 3x a week, (+)Oliguria, Urine output of 10cc/hr, Bloated abdomen upon palpation, Pale in appearance, Weak looking, Creatinine = 298.3 mmol/L

7. Impaired Urinary Elimination r/t altered renal function

Objective/s:(+) HD 3x a week, (+)Oliguria, Urine output of 10cc/hr, Bloated abdomen upon palpation, Pale in appearance, Weak looking, Creatinine = 298.3 mmol/L

2. Ineffective airway clearance related to presence of secretions in the

tracheobronchial tree.

Objective/s:(+) Crackles, (+) Whitish productive cough, (+) Chest pain, (+) DOB, (+) Tachycardia, (+) Cyanotic Nails, (+) Weakness, (+) Confusion, RR= 36 bpm, Hgb= 100 g/L, Hct= 0.27 Vol.frX-ray Results: Bilateral pleural effusion, pulmonary congestion pneumonia in both bases

2. Ineffective airway clearance related to presence of secretions in the

tracheobronchial tree.

Objective/s:(+) Crackles, (+) Whitish productive cough, (+) Chest pain, (+) DOB, (+) Tachycardia, (+) Cyanotic Nails, (+) Weakness, (+) Confusion, RR= 36 bpm, Hgb= 100 g/L, Hct= 0.27 Vol.frX-ray Results: Bilateral pleural effusion, pulmonary congestion pneumonia in both bases

5. Infection r/t invasion of bacterial microorganism in the lungs

Objective/s:Based on the Laboratory results:Eosinophils = 4.0% (0-3%), WBC = 20.0X10^9/L (4.5 – 11.0 X 10 ^ 9/L), Sputum: Occasional gram (+) cocci in singles & in pairs, few gram (-) bacilli 5-14 pus cells / OIF, moderate squamous epithelial cells & few yeast cells.(+) whitish productive cough, (+) temperature – 38C

5. Infection r/t invasion of bacterial microorganism in the lungs

Objective/s:Based on the Laboratory results:Eosinophils = 4.0% (0-3%), WBC = 20.0X10^9/L (4.5 – 11.0 X 10 ^ 9/L), Sputum: Occasional gram (+) cocci in singles & in pairs, few gram (-) bacilli 5-14 pus cells / OIF, moderate squamous epithelial cells & few yeast cells.(+) whitish productive cough, (+) temperature – 38C

6. Fluid volume excess related to impaired renal function

Objective/s: (+) Bipedal pitting edema, (+) Increase BP - 230/160 mmHg, (+) Tachycardia- 130 bpm, (+) Crackles(+) Tachypnea – RR – 36, Hgb 100g/L (N.V - 120-160), Hct 0.27vol.fr (N.V - 0.37-0.47), X-ray Results: Bilateral pleural effusion, Pulmonary congestion , Pneumonia in both bases

6. Fluid volume excess related to impaired renal function

Objective/s: (+) Bipedal pitting edema, (+) Increase BP - 230/160 mmHg, (+) Tachycardia- 130 bpm, (+) Crackles(+) Tachypnea – RR – 36, Hgb 100g/L (N.V - 120-160), Hct 0.27vol.fr (N.V - 0.37-0.47), X-ray Results: Bilateral pleural effusion, Pulmonary congestion , Pneumonia in both bases

3. Acute Pain r/t decrease renal function

Objective/s:(+) Flank pain, Pain scale of 6 out 0f 10, (+) Loss of appetite, (+) Guarding at the flank area, (+) Inadequate rest, (+) Irritability, (+) Facial grimace

3. Acute Pain r/t decrease renal function

Objective/s:(+) Flank pain, Pain scale of 6 out 0f 10, (+) Loss of appetite, (+) Guarding at the flank area, (+) Inadequate rest, (+) Irritability, (+) Facial grimace

ASSESSMENT NURSING

DIAGNOSIS

PLANNING NURSING

INTERVENTION/S

RATIONALE NURSING

THEORIST/S

EVALUATION

Subjective:

“Gina hapo ako”

as verbalized.

Objective/s:

(+) Restlessness

(+) DOB

(+) Crackles

(+) Pallor

(+) Irritability

(+) Decreased

hemoglobin – 133 g/L

(N.V. 120 – 160 g/L)

RR- 36 bpm

(+) History of

bronchial asthma

X-ray Results:

Pleural Effusion

Pneumonia, both

bases.

Impaired gas

exchange r/ t

presence of

secretions on

both lung base

After 4 hours of

nursing intervention,

Mr. REB will

verbalize decrease

in difficulty of

breathing AEB

decrease RR

Independent:

1. Position

Mr. REB in semi

fowler’s position and

change position every

2 hours

2. Encourage

deep breathing

exercise

3. Provide back

tapping to Mr. REB

1. Lowers

diaphragm

promoting chest

expansion and

decrease pressure

on the abdomen

2. To promote lung

expansion

3. This will allow

mobilization and

expectorations of

secretions.

Lydia Hall’s theory

of Care - Nurturance

Faye Abdellah’s

theory of 21 Nursing

Problems (Patient

approach to Nursing)

Virginia

Henderson’s theory

of 14 Basic Needs

(Doing the for the

patient what they

cannot do for

themselves)

Goal partially met.

After 4hours of

nursing intervention.

Mr. REB was able to

re-establish normal

breathing pattern but

some of the

secretions are still

present.

4. Suction as

indicated

Dependent:

1. Administer

Fluimucil 600mg as

indicated

2. Administer O2

therapy 21/msn

4. Clears airway

from secretions

1. To loosen

secretions for

efficient

expectorations

2. To relieve o2

deficit

Faye Abdellah’s

theory of 21 Nursing

Problems (Doing the

for the patient what

they cannot do for

themselves)

Dorothy Johnson’s

theory of Human

Behavioral System

(Medicine focus:

Cure)

Florence

Nightingale’s theory

of Environment

(Alleviate

unnecessary source

of pain and

suffering)

3. Administer

Erythromycin 300 mg

TID

4. Nebulization

1L/m with combivent

3. To inhibit the

growth of bacteria

(bacteriostatic)

4. To loosen and

liquefy secretions.

Dorothy Johnson’s

theory of Human

Behavioral System

(Medicine focus:

Cure)

Lydia Hall’s theory

of Components of

Nursing / Caring

(Core and Cure -

shared with other

health care

providers)

ASSESSMENT NURSING PLANNING INTERVENTION/S RATIONALE NURSING EVALUATION

DIAGNOSIS THEORIST/S

Subjective:

“Nabudlayan ako mag

ginhawa” as verbalized.

Objective/s:

(+) Crackles

(+) Whitish

productive cough

(+) Chest Pain

(+) DOB

(+)Tachycardia

(+) Cyanotic

Nails

(+) Weakness

(+) Confusion

RR= 36 bpm

Hgb= 100 g/l

Hct= 0.27 Vol.fr

CXR- bilateral

pleural effusion,

pulmonary

congestion

Ineffective

airway

clearance r/t

presence of

secretions in the

tracheobronchial

tree.

After 8 hours of

nursing

intervention, Mr.

REB will be able to

expectorate

secretions and

have normal

respiratory rate.

Independent:

1. Assist the Mr. REB

in performing

coughing and

breathing maneuvers.

2. Instruct the Mr.

REB in the

following:

Optimal

positioning (semi

fowlers)

Use of pillow or

hand splints when

coughing.

Use of

abdominal muscle

for more forceful

cough

1. This improves

the productivity of

cough

2. Controlled

coughing

techniques help

mobilize

secretions from

smaller airways to

larger airways

because coughing

is done at varying

times.

Faye Abdellah’s theory

of 21 Nursing Problems

(Problem Solving to

move the patients

towards health.)

Faye Abdellah’s theory

of 21 Nursing Problems

(Doing the for the

patient what they cannot

do for themselves.)

Goal partially

met.

After 8 hours of

nursing

interventions,

Mr. REB

secretions are

mobilized and

cough out but

the airway is

not totally free

from excessive

secretions AEB

abnormal lung

sounds or

crackles.

pneumonia in both

bases

Temperance of

ambulation and

frequent position

change.

3. Provide back

Tapping to patient.

Dependent:

1. Administer 02

therapy as ordered

4L/m

2. Administer flumucil

600mg ½ glass OD x

5 daily

3. To loosen

secretions

1. For effective

oxygenation

2. To loosen and

liquefy secretions

Virginia Henderson’s

theory of 14

Components of Nursing

Care (Process or

movements from

dependence to

independence.)

Florence Nightingale’s

theory of Environment

(Alleviate unnecessary

source of pain and

suffering)

Dorothy Johnson’s

theory of Human

Behavioral System

(Medicine focus: Cure)

3. Nebulization of

salbutamol 1neb x

3doses/15min

3. To promote

softening of

secretions for

better

expectoration of

secretions

Lydia Hall’s theory of

Components of Nursing

Caring (Core and Cure -

shared with other health

care providers.)

ASSESSMENT NURSING PLANNING INTERVENTION/S RATIONALE NURSING EVALUATION

DIAGNOSIS THEORIST/S

Subjective:

“ Ga sakit akon likod

sa may hawak” as

verbalized.

Objective/s:

(+) Flank pain

pain scale of 6

out 0f 10

(+) loss of

appetite

(+) guarding at

the flank area

(+) inadequate

rest

(+) irritability

(+) facial

grimace

Acute Pain r/t

decrease renal

function

After 2 hours of

nursing intervention,

Mr. REB will

verbalize decrease

of pain as evidence

by decrease pain

level.

Independent:

1. Perform a

comprehensive

assessment of pain

to include location,

characteristics,

onset, duration,

frequency, quantity,

Intensity, or severity

and precipitating

factors of pain.

2. Reduce or

eliminated the

factors that

precipitate or

increases Mr. REB’s

pain experience (e.g.

fear, fatigue,

monotony, and lack

of knowledge.)

1. Pain is as subjective

experience and must

be described by the

client in order to plan

effective treatment.

2. Personal factors can

influence pain and pain

tolerance. Factors that

may be precipitating or

augmenting pain

should be eliminated in

order for the pain

management to be

effective

Florence

Nightingale’s

theory of

Environment

(Alleviate

unnecessary source

of pain and

suffering)

Florence

Nightingale’s

theory of

Environment

(Alleviate

unnecessary source

of pain and

suffering)

Goal met.

After 2 hours of

nursing

intervention the

Mr. REB,

verbalized

decreased of pain

as evidence by

decreased in pain

levels from 0 out of

10

3. Teach the use of

nonpharmacologic

techniques (e.g.

relaxation, guided

imagery, music

therapy, distraction,

and massage.)

4. Evaluate the

effectiveness of the

pain control

measures used

through ongoing

assessment of Mr.

REB’s pain

experience

3. The use of

noninvasive pain relief

measure can increase

the release of

endorphins and

enhance the

therapeutic effect of

pain relief medication.

4. Research show that

most common reason

for unrelieved pain is

failure to routinely

assess pain and relief

pain. Many clients

tolerate pain if not

specifically talked

about.

Faye Abdellah’s

theory of 21 Nursing

Problems (Doing the

for the patient what

they cannot do for

themselves.)

Florence

Nightingale’s

theory of

Environment

(Alleviate

unnecessary source

of pain and

suffering)

Dependent:

1. Administer

Mobic 7.5 mg as

ordered

2. Administer O2,

2 Lpm therapy

as ordered

1. To relieve pain

2. For effective

oxygenation

Dorothy Johnson’s

theory of Human

Behavioral System

(Medicine focus:

Cure)

Florence

Nightingale’s

theory of

Environment

(Alleviate

unnecessary source

of pain and

suffering)

ASSESSMENT NURSING PLANNING NURSING RATIONALE NURSING EVALUATION

DIAGNOSIS INTERVENTION THEORY AND

THEORIST

Subjective:

“Ginalagnat siya ”

As verbalized by the

folks.

Objective/S:

Temp. 37.9 C

Skin warm to

touch

Weak in

appearance

WBC result

20.0x10^9/L

(N.V - 4.5-11.0)

Neutrophils H

65.0% (N.V - 50-

70)

Lymphocytes L

11.0% (N.V - 20-

45)

Altered

thermoregulation

related to invasion

of pathogens

After 2 hours of

nursing

intervention, the

patient’s

temperature will

decrease from

37.9 C to 37.0 C

within the shift.

Independent:

1. Provide tepid

sponge bath

2. Provide a cool

and calm

environment

1. May help reduce

fever and provide

comfort

2. Room

temperature/

number of

blankets should

be altered to

maintain near

normal body

temperature.

Betty Neuman

(Help the client’s

system attain,

maintain and

regain system

stability.)

Betty Neuman

(On the whole

person and

reaction to stress.)

Goal met.

Temperature is

decreased from

37.9C to 37C

X-ray revealed:

Bilateral pleural

effusion, increase in

amount

Pulmonary Congestion

Cardiomegaly, LV form

Pneumonia, both bases

and (R) upper lobe with

consolidation.

(September 13, 2009 )

3. Monitor

patient’s

temperature

every hour

Dependent:

1. Administer

Paracetamol

300 mg PRN

as ordered

3. Temperature

elevation may

occur because of

various factors

such as presence

of infection

1. To help reduce

fever by acting

directly on the

heat regulating

system

Betty Neuman

(Help the client’s

system attain,

maintain and

regain system

stability.)

Dorothy

Johnson’s theory

of Human

Behavioral

System (Medicine

focus: Cure)

ASSESSMENT NURSING PLANNING INTERVENTION/S RATIONALE NURSING EVALUATION

DIAGNOSIS THEORIST/S

Objective/s:

Based on the

Laboratory results:

o Eosinophils

4.0% (0-3%)

o WBC

20.0X10^9/L (4.5 –

11.0 X 10 ^ 9/L)

(+) Temperature.

– 38C

Sputum:

Occasional gram (+)

cocci in singles & in

pairs, few gram (-)

bacilli 5-14 pus cells /

OIF, moderate

squamous epithelial

cells & few yeast cells.

(+) whitish

productive cough

Infection r/t

invasion of bacterial

microorganism in

the lungs

After 8 hours of

nursing intervention,

Mr. REB is free of

infection as

evidenced by

negative culture,

resolution of

symptoms, and

temperature within

normal limits.

Independent:

1. Note for

physical evidence

of infection

2. Implement

appropriate

measures to protect

the patient from

potential infection

sources.

3. Obtain a recent

history for signs

and symptoms of

infection or

exposure to

infected individual.

1. Infections

must be treated to

stop the immune

response and

glomerular

inflammation.

2. Hand washing

by all people in

contact with the

patient is the primary

method to reduce the

risk of infection.

3. Symptoms of

Acute

glomerulonephritis

appear 10 to 14 days

after initial

streptococcal illness.

Ernestine

Weidenback

(Nurse meets

through

identification of

needs)

Dorothea Orem’s

theory of Nursing

Concepts

(Identifies what

Nursing Care is

needed)

Dorothea Orem’s

theory of Nursing

Concepts

(Identifies what

Nursing Care is

needed.)

Goal Partially Met.

After 8 hours of

nursing intervention

Mr. REB is free of

pain as evidence by

the decrease of

body temperature to

36.8 C

Dependent:

1. Review results

of specimen cultures

2. Administer

Erythromycin

300mg for positive

culture findings.

1. Identification of

specific

microorganism will

guide selection of

appropriate

antimicrobial drugs.

2. Viral infection

does not respond to

antibiotic therapy. To

decrease the risk of

development of

bacterial strains

resistant to

antibiotics, drug

therapy should be

based on specific

culture and sensitivity

results.

Dorothea Orem’s

theory of Nursing

Concept (Self care

– ability of the

person to take care

of himself)

Dorothy

Johnson’s theory

of Human

Behavioral System

(Medicine focus:

Cure)

ASSESSMENT NURSING PLANNING INTERVENTION/S RATIONALE NURSING EVALUATION

DIAGNOSIS THEORIST/S

Objective/s:

(+) Bipedal

pitting edema

(+) Increase

BP - 230/160

mmHg

(+) Tachycardia

- 130 bpm

(+) Crackles

(+) Tachypnea

– RR – 36

Hgb

100g/L (N.V -

120-160)

Hct

0.27vol.fr (N.V

- 0.37-0.47)

CXR- bilateral

pleural effusion,

pulmonary

congestion

pneumonia in both

Fluid volume

excess related to

impaired renal

function

After 8 hours of

nursing intervention,

Mr. REB’s

extremities will be

free of edema

Independent:

1. Note respiratory

Pattern and work of

breathing.

2. Auscultate for

Crackles.

3. Note the amount

of peripheral

edema by

palpating area

over the tibia,

ankles, sacrum

and back; and by

assessing

appearance on

1. Kussmaul’s

respiration and

dyspnea may be

evident.

2. Crackles signify

presence of fluid in

the small airways.

3. Dependent areas

often exhibit signs

of edema.

Ernestine

Weidenback (Nurse

meets through

identification of

needs)

Ernestine

Weidenback (Nurse

meets through

identification of

needs)

Ernestine

Weidenback (Nurse

meets through

identification of

needs)

Goal partially met.

After 8 hours of

nursing intervention

Mr. REB’s

extremities was not

totally free from

edema.

bases the face.

4. Note Mr. REB’s

compliance with

dietary and fluid

restriction at home.

5. Have Mr. REB

sit up if he

complains of

shortness of breath.

6. Elevate the

Mr. REB’s feet when

sitting down.

7. Independent:

1. Administer

Catapres

75 mg 1 tab as prescribed.

4.Excess and of

sodium intake can

lead to fluid

volume excess in

ESRD patient.

5. This maintains

optimal

positioning for air

exchange.

6.This prevents

fluid accumulation

in the lower

extremities

1. To lower

down

blood pressure

Ernestine

Weidenback (Nurse

meets through

identification of

needs.)

Lydia Hall’s theory

of Care - Nurturance

Lydia Hall’s theory

of Care - Nurturance

Dorothy Johnson’s

theory of Human

Behavioral System

(Medicine focus:

Cure)

2. Administer Lasix

40mg as prescribed

3. Restrict fluid

Intake as required

by the doctor to

patient’s condition.

2. For the

elimination of

excess fluids

3.Patients on

dialysis need to

importance of

maintaining fluid

balance between

dialysis.

Dorothy Johnson’s

theory of Human

Behavioral System

(Medicine focus:

Cure)

Callista Roy’s

theory of Adaptive

Mode (Physiological)

ASSESSMENT NURSING PLANNING INTERVENTION/S RATIONALE NURSING EVALUATION

DIAGNOSIS THEORIST/S

Subjective:

“Gamay lang siya

mangihi” as

verbalized by the

folks

Objective/s:

(+) HD 3x a

week

(+)Oliguria

Urine output of

10cc/hr

Bloated

abdomen upon

palpation

Pale in

appearance

Weak looking

Creatinine:

298.3 mmol/L

Impaired Urinary

Elimination r/t

altered renal

function

After 4 hours of

nursing

intervention, Mr.

REB will able to

demonstrate an

adequate urine

output about 30

cc.

Independent:

1. Provide an

environment that

encourages toileting

2. Encouraged

increase fluids and

maintain accurate

intake

1. Insufficient

toileting and

environmental factors

may contribute to

functional incontinence

or exacerbate other

forms of urinary leakage

2. Maintains

hydration and good

urine flow

Florence

Nightingale’s theory

of Environment

(Organizing and

manipulating the

environment

physical, social, and

psychological in

order to put the

person in the best

possible conditions

for nature to act)

Ernestine

Weidenback (Nurse

meets through

identification of

needs)

Goal not met.

Patient was not able

to demonstrate an

adequate urine

output about 30 cc.

3. Ensure Mr. REB’s

Compliance on

hemodialysis

procedure.

4. Monitor laboratory

results that are specific

to renal dysfunction

such as: Creatinine and

specific gravity.

Dependent:

1. Administer PNSS

1L at 40 cc/hour

as indicated

3. These will alleviate

the anxiety and fear of

the patient when doing

the procedure.

4. Specific gravity

measures the activity

for the kidneys to

concentrate urine

(1.006 – 1.030) and

creatinine measures

kidney damage (>0.5 –

1 mg/dl) which

indicates renal failure

1. Assist in

maintaining

hydration and

good urine flow

Dorothy Johnson’s

theory of Human

Behavioral System

(Medicine focus:

Cure)

Faye Abdellah’s

theory of 21 Nursing

Problems (Problem

Solving to move the

patients towards

health.)

Dorothy Johnson’s

theory of Human

Behavioral System

(Medicine focus:

Cure)

Collaborative

1. Monitor

electrolytes level

particularly creatinine

1. Creatinine

measures kidney

damage (>0.5 – 1

mg/dl) which

indicates renal

failure.

Lydia Hall’s theory

of Components of

Nursing Caring (Core

and Cure -shared

with other health

care providers.)

ASSESSMENT NURSING

DIAGNOSIS

PLANNING INTERVENTION/S RATIONALE NURSING

THEORIST/S

EVALUATION

Subjective:

“Nabudlayan ko

magtindog kung

wala may ga bulig

sakun” as

verbalized

Objective/s:

(+) Body

weakness

Ambulatory

with assistance

Irritability

(+)weakness

(+)shortness

of breath

(+)fatigue

Activity

Intolerance r/t

generalized body

weakness

After 6 hours of

nursing

interventions, Mr.

REB will improve

mobility and

positively respond

to medical

intervention

without any

hesitation and

refusal.

Independent:

1. Determine

Mr. REB’s perception

of causes of fatigue or

activity intolerance

2. Encourage

adequate rest periods

especially before

meals and ambulation

3. Encourage active

range of motion

exercises daily.

1. This maybe

temporary or

permanent,

physical

assessment guides

treatment

2. Rest between

activities provides

conservation and

recovery

3. Exercises

maintain muscle

strength.

Ernestine Weidenback

(Nurse meets through

identification of needs)

Faye Abdellah’s theory

of 21 Nursing Problems

(Patient approach to

Nursing)

Faye Abdellah’s theory

of 21 Nursing Problems

(Patient approach to

Nursing)

Goal Partially met.

After 6 hours of

nursing intervention

the patient was able

to positively respond

to medical

intervention without

any hesitation and

refusal but there is

still sign of shortness

of breath, weakness,

and fatigue

ASSESSMENT DIAGNOSIS PLANNING NURSING

INTERVENTION

RATIONALE NURSING

THEORY AND

EVALUATION

THEORIST

Objective/s:

(+) Pitting

edema

(+) PD

catheter

(+) IV cut

down

(+) Hematoma

At right arm,

warm to touch.

Risk for impaired

skin integrity r/t

altered fluid status

After 8 hours of

nursing intervention,

MR. REB’s optimal

skin integrity is

maintained as

evidenced by

absence of

breakdown.

Independent:

1. Note skin

Integrity for pitting

of extremities on

manipulation, and

demarcation of

clothing and shoes

on the patient’s

body.

2. Note for the

presence of

peripheral

neuropathy.

3. Instruct Mr. REB

1. Chronic fluid excess

can result in skin

breakdown.

2. This result in

changes in sensation

such as paresthesias

(burning), weakness, and

twitching.

3. Restrictive clothing

Ernestine

Weidenback

(Nurse meets

through

identification of

needs)

Ernestine

Weidenback

(Nurse meets

through

identification of

needs)

HildergardePeplau

Goal met.

There is no

presence of skin

breakdown.

to wear loose-fitting

clothing when

edema is present.

4. Teach factors

important to skin

integrity: nutrition,

mobility, hygiene,

early recognition of

skin breakdown.

5. Instruct the

patient regarding

dangers when

heating or cooling

devices are used.

6. Stress the

can increase risk of skin

breakdown.

4. Each factor plays a

role in preventing skin

breakdown or

contributes to successful

skin healing if

breakdown has

occurred.

5. The peripheral

neuropathy can impair

sensation, especially in

the lower extremities.

6. Scratching can

(Orientation,

Identification)

Betty Neuman

(Help the client’s

system attain,

maintain and regain

system stability.)

HildergardePeplau

(Orientation,

Identification)

Betty Neuman (On

importance of not

scratching skin and

of keeping finger

nails short.

7. Suggest use of

tepid water for

bathing

cause lesions and open

sores.

7. Increase warmth

can increase the itch.

the whole person

and reaction to

stress.)

Ernestine

Weidenback

(Nurse meets

through

identification of

needs)

ASSESSMENT NURSING

DIAGNOSIS

PLANNING INTERVENTION/S RATIONALE NURSING

THEORIST/S

EVALUATION

Objective/s:

(+)indecisive

nonassertive

behavior

(+)

Weakness

Lack of eye

contact

Refusal to

participate in

hospital

procedures

Increasingly

dependent on

her wife

Low self-esteem

r/t loss of kidney

function

After 8 hours of

nursing

intervention, Mr.

REB will

manifests more

positive self-

esteem and

positively respond

to medical and

nursing

interventions

without any

refusal.

Independent:

1. Note for signs of

Low self-esteem: self-

negating verbalization,

depression, expressed

anger, withdrawal,

expressions of

shame/guilt, or

evaluation of self as

unable to deal with

events.

2. Assist Mr. REB in

Identifying the major

areas of concern r/t

altered self-esteem.

3. Assist Mr. REB in

1.The long term

dialysis patient is faced

with long-term changes

in lifestyle, occupation,

and financial status

2. The nurse patient

relationship can provide

a strong basis for

implementing other

strategies to assist the

patient and family with

adaptation.

3. As Mr. REB’s

Imogene King’s

theory of Nurse –

Patient interactions

(Integrating personal

system; interpersonal

system; social

system)

Hildegard Peplau’s

theory of

Interpersonal /

Interactive

(therapeutic

interaction between

Nurse and Patient)

Hildegard Peplau’s

Goal met.

After 8 hours of

nursing intervention

Mr. REB was able to

participate in all the

nursing procedure

without any refusal

as evidence by

presence of smile on

his face and

conversant attitude

towards the health

care provider.

Incorporating changes

in health status into

activities of daily living,

social life, interpersonal

relationships, and

occupational activities.

4. Allow Mr. REB’s

time to voice concerns

and express anger

related to having a

chronic condition.

Collaborative:

1. Use case managers

and social workers as

necessary.

condition worsen with

CKD, it is more difficult

to engage in even

routing activities.

4. Denial and anger

are anticipated

responses to the

diagnosis of a chronic

illness.

1. They can provide

psychological support

and assist in financial

arrangement.

theory of

Interpersonal /

Interactive

(Orientation,

Identification)

Jean Watson’s

theory of

Interpersonal nature

of caring (Help

persons / patients

achieve a degree of

harmony within

themselves.)

Lydia Hall’s theory

of Components of

Nursing Caring (Core

and Cure -shared

with other health

care providers.)

2. Refer to psychiatric

consultant as

necessary

3. Encourage use of

support groups.

2. Most dialysis

patient experiences

some degree of

emotional imbalance.

With professional

psychiatric

consultation, most

patients can gradually

accept changed self-

esteem

3. Groups that come

together for mutual

goals can be most

helpful.

Dorothy Johnson’s

theory of Human

Behavioral System

(Nursing focus: The

behavior of the

person threatened

with illness or is ill.)

Lydia Hall’s theory

of Components of

Nursing Caring (Core

and Cure -shared

with other health

care providers.)

XII. DISCHARGE PLANNING

M – edications

Medications prescribed by the physician should be taken properly, to help the patient lessen

unusual condition.

The following are take home medications prescribed by the physician:

Angistad 40mg/tab OD

Coralan 5mg/tab I tablet OD

Catapres 75mg/tab TID

Clopidogrel 75mg/tab OD

Carcinor 1 tablet OD

Exforge 5/160 mg OD

E – xercise and Activity

Encourage Mr. R.E.B to have an active range of motion exercises thrice daily to maintain his

muscle strength.

T – reatment

Continue monitoring blood pressure, hemodialysis thrice a week and comply with the

medications given prescribed by the attending physician to prevent further complications that

may occur and to have a faster recovery.

H – ome Teaching/s

1. Instruct the client/folks on how to monitor fluid status, as well as, the signs and

symptoms in order to determine existing problems and to prevent further complications.

2. Teach/ educate the client and folks on infection prevention.

3. Explain the need for meticulous skin and oral care.

4. Instruct the client on how to delay weights and how to interpret the relationship of weight

loss/gain to need for sodium and water.

5. Instruct the client and folks about the medication metabolism.

6. Teach the client and folks about the dietary regimens such as low salt, low fat and high

fiber.

7. Importance of follow-up and physician appointment.

O – ut patient follow up

After discharge, Mr. R.E.B will have a regular follow-up check up with the physician to check

and monitor the patient’s medical condition and have a dialysis thrice a week to remove waste

products from the body and to prevent future complications.

D – iet

Maintain a low salt, low fat, and high fiber diet as prescribed by the attending physician. Advice

the patient not to eat foods that is high in cholesterol such as the fatty portion of the pork that

may increase the level of his blood pressure but to eat more green and leafy vegetables.

S – pirituality and Sexuality

In order to improve his spiritual aspects, he may attend holy masses or listen to gospel readings

and pray the holy rosary or he may seek for divine providence to the Lord. Assist the patient that

may include spiritual resources to help him deal with it.

ACKNOWLEDGEMENT

We, the group 1 of BSN – 3A would like to express our genuine gratitude to the

following persons who have helped and supported us in making this case study very successful.

Without them, the success of this study would be impossible.

Above everybody else, to our good Lord, our energy source, our Almighty king and

Father, for the strength, knowledge, guidance and the values that He provided us while doing

this case study. Without Him, everything that we’ve done is not possible.

To Sr. Editha A. Bagayaua DC, RN, MAN, Dean of the College of Nursing, for her full

support and willingness to help the students for without her this activity will not be

accomplished.

To Mrs. Katherine Conlu – Bengan, RN, our Level III Clinical Coordinator/Instructor for

her support, teachings and knowledge she shared to us. She has been a good educator,

facilitator, and cool clinical instructor. Pathophysiology would not be the same without her.

To Ms. Maureen Patricio, RN, our skillful clinical instructor for taking part in educating

us in the different nursing techniques and procedures we learn in the ward and for the

knowledge you’ve shared to the group. We learned a lot!

To Mrs. Pearl Joy Degoma, RN, our ever patient and understanding clinical instructor

for she has taught us some alternative techniques that would be helpful in the ward and some

significant and important facts/contributions that she impart to us in what she knows.

To Mrs. Rubilyn Sumaylo, RN, our humorous and witty clinical instructor for you had

made us laugh during the exposure, without you, life in the ward would be boring. Thank you for

the knowledge you’ve shared to the group although it’s only for a while.

And to all our teachers and mentors, who influenced, inspired, and shared their

knowledge and expertise to us to this activity. Thank you very much.

To St. Anthony Hospital staff nurses at the St. Joseph ward and to the other wards

as well, thank you for helping, guiding and teaching us during our exposure on your area.

To our patient with the initials of R.E.B and family, thank you for your warm acceptance,

trust and for allowing us to get some information’s and a one-on-one interview in just a speck of

time for the success of our case study.

To our beloved parents, for their never-ending moral support all throughout the study.

We love you so much!

To the Family of Mr. Jose Ian Kit Macato, for their warm accommodation in letting us,

use their house in making our case study from the beginning until now. Thank you so much!

To the BSN 3A students, for the support and the never-ending bond we’ve shared from

1st year until up to now.

To the Group 1 of BSN 3A, for the tireless effort, knowledge, wisdom, patience,

support, cooperation and teamwork for the success of this case study.

And lastly, to those whom we failed to mention who in one way or another helped us in

this undertaking, Thank You Very Much.

The Group 1 of BSN 3A

LIMITATIONS OF THE STUDY

This study is limited due to lack of time spent with the patient because we are only

scheduled for duty twice a week, within eight hours. Sometimes, duty hours are spent with other

school activities. This is why the attention, time and communication that are supposed to be

spent by the student nurse gathering data and working with interventions to the patient are

affected.

This study is limited to one person/patient only so that we can give enough attention and

proper nursing interventions to the problems being manifested, and for us to give our optimum

level of quality care for the patient.

TABLE OF CONTENTS

PAGE

I. Introduction

Brief Description of the Disease------------------------------------------

Statistics (International)----------------------------------------------------

II. Objectives

General and Specific Objectives----------------------------------------------

III. Anatomy and Physiology of Chronic Kidney Disease-------------------

IV. Vital Information------------------------------------------------------------------

V. Clinical Assessment

Nursing History----------------------------------------------------------------

Past Health Problem/Status-----------------------------------------------

Family History of Illness----------------------------------------------------

Family Genogram------------------------------------------------------------

VI. Brief Social, Cultural and Religious Background

Educational Background----------------------------------------------------

Occupational Background--------------------------------------------------

Religious Practices-----------------------------------------------------------

Economic Status--------------------------------------------------------------

VII. Clinical Inspection

Vital Signs----------------------------------------------------------------------

Physical Assessment--------------------------------------------------------

General Appraisal------------------------------------------------------------

VIII. Laboratory and Diagnostic Data----------------------------------------------

IX. Pathophysiology------------------------------------------------------------------

X. Medical Management

Drug Tabulation--------------------------------------------------------------

Hemodialysis-----------------------------------------------------------------

Members of the Health Team (CKD)-----------------------------------

XI. Nursing Management

Concept Map of Nursing Problems-------------------------------------

Nursing Care Plan--------------------------------------------------------- -

XII. Discharge Planning-------------------------------------------------------------

XIII. Journey---------------------------------------------------------------------------

XIV. Bibliography/References-----------------------------------------------------