I. INTRODUCTION Chronic or irreversible, renal failure is a progressive reduction of functioning renal tissue such that the remaining kidney mass can no longer maintain the body’s internal environment. CRF can develop insidiously over many years, or it may result from an episode of a cure renal failure from which the client has not recovered. The incidence of CRF varies widely by state and country. In the United States, the incidence is 268 new cases per million populations. Chronic renal failure affects many body systems. It can also lead to many complications. This is the goal of health care providers, to prevent any occurrence of complications. One of the complications of CRF is hyperparathyroidism; this is due to the compensatory mechanism of the parathyroid hormone once it detects any alteration in the calcium level of the body. It is important for clinicians to recognize the problem of hyperparathyroidism early in the course of chronic kidney disease so that growth of the parathyroid glands can be prevented or halted, and excessive secretion of hyperthyroidism can be controlled to help minimize the adverse consequences on bone and mineral metabolism, which may lead to bone pain and bone fractures, decreased growth in children, muscle weakness, and elevations in the calcium 1
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I. INTRODUCTION
Chronic or irreversible, renal failure is a progressive reduction of
functioning renal tissue such that the remaining kidney mass can no longer
maintain the body’s internal environment. CRF can develop insidiously over
many years, or it may result from an episode of a cure renal failure from which
the client has not recovered. The incidence of CRF varies widely by state and
country. In the United States, the incidence is 268 new cases per million
populations.
Chronic renal failure affects many body systems. It can also lead to many
complications. This is the goal of health care providers, to prevent any
occurrence of complications. One of the complications of CRF is
hyperparathyroidism; this is due to the compensatory mechanism of the
parathyroid hormone once it detects any alteration in the calcium level of the
body.
It is important for clinicians to recognize the problem of
hyperparathyroidism early in the course of chronic kidney disease so that growth
of the parathyroid glands can be prevented or halted, and excessive secretion of
hyperthyroidism can be controlled to help minimize the adverse consequences
on bone and mineral metabolism, which may lead to bone pain and bone
fractures, decreased growth in children, muscle weakness, and elevations in the
calcium phosphorus product, which contributes to calcification of the heart
valves and blood vessels and contributes to the high cardiovascular mortality in
patients with advanced kidney disease.
Early detection of this complication of chronic kidney disease will provide
an opportunity to intervene to control the secretion of parathyroid hormone and,
thus, minimize the problem. Early detection will also allow for the opportunity to
prevent further growth of the parathyroid glands so that the magnitude of the
problem will be lessened as kidney function deteriorates. There is also some
evidence that the control of hyperparathyroidism may help to slow the
progression of kidney disease. Ultimately, it is hoped that with timely intervention
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to control this complication of chronic kidney disease, improved patient outcomes
on in terms of morbidity and mortality will be achieved.
To ensure that the diagnosis of hyperparathyroidism is made early in the
course of chronic kidney disease, it is important to educate primary care
physicians, cardiologists, endocrinologists and other healthcare providers who
may see patients in the early stages of chronic kidney disease, so that they may
assess blood parathyroid hormone levels to uncover this complication and either
embark on the treatment of hyperparathyroidism or consider referral to a
nephrologist for further advice on the appropriate management strategies.
Referral to a nephrologist would appear to be preferable at the present time as
the field is advancing with new therapies being evaluated and implemented in
practice.
At the American Society of Nephrology Renal Week 2004 meeting, results
are being presented on the administration of oral paricalcitol, now in capsular
form, so that its use can be evaluated in patients with earlier stages of kidney
disease (stage III and IV), who are not yet on dialysis. The phase 3 studies of
orally administered paricalcitol showed that this strategy is effective in reducing
the degree of hyperparathyroidism, and that the administration of this vitamin D
analog is not associated with hypercalcemia, hyperphosphatemia, or
hypercalcuria. Thus, the treatment was effective and well tolerated and appeared
to be free of side effects. These studies are important because they provide a
new therapy for the complication of hyperparathyroidism in the course chronic
kidney disease, and, thus, if the diagnosis of this complication can be made
earlier in the course of chronic kidney disease, treatments such as oral
paricalcitol may be effective in managing this complication.
As nurses, we could help our patients by having a deep understanding of
the disease, that we may learn the proper interventions for the chronic kidney
disease patients. In this way, we could render quality care for them. We could as
well lead them to the proper treatment to lessen their sufferings brought by the
kidney failure, in anyhow. By having a wide understanding of the disease, we
could impart teachings on how we could prevent the occurrence of chronic
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kidney disease. As nurses, it is our responsibility to render information and impart
health teachings to improve the condition of our patients to the best of our
abilities. One of the characteristics that we, nurses, should have is to be
informative and only through a keen study of disease such as this way for us to
gain all the information that we need to learn. May this case study served its
purpose through the help of our Lord, Jesus Christ.
II. NURSING ASSESSMENT
A. Personal Data and History (Demographic Data)
Mr. Scrooge is a 53-year-old male, married living at 21 St. Cecilia, Paula
Complex, Laguna. He was born on September 16, 1952 in Laguna. He is married
for 29 years now and has six children. He was not able to finished his desired
career during his college years because their family business was suddenly went
bankrupt. According to Mr. Scrooge, education is important that’s why he decided
to look for more affordable career. While studying he decided to work to be able
to support his education. With his perseverance and determination, he was able
to finished aircraft maintenance. But with all of this stress and difficulties
happening in his life, he learned how to smoke. According to him, smoking helps
him to be relaxed. He consumed 8 sticks/day. He was also an occasional drinker.
He worked as aircraft maintenance in Clark Air Base in Pampanga for more than
20 years.
Mr. Scrooge said that he is fond of eating meat and poultry products. After
work, he only stays at home because he feels very tired after work. At present,
he still works as aircraft maintenance in Clark Air Base in Pampanga.
Mr. Scrooge was admitted in Angeles University Foundation Medical
Center last February 3, 2005. He was admitted due to body weakness and
severe anemia. He was discharged on February 10, 2005.
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B. Family Health-Illness History
Mother Side Father Side
C. History of Past Illness
Mr. Scrooge was known for being hypertensive for 5 years now. He was
diagnosed of hypertension and kidney failure last 2001. He was hospitalized in
St. Luke’s Hospital because of the said health problem. According to him, his
chief complain that time was only hypertension. He was discharged from the
hospital after six days of confinement. After his discharge, Mr. Scrooge
consistently having his blood chemistry and creatinine check-up every month in
AUFMC. If the results are all normal, his check-up becomes every month. These
all became routine on him.
On May 2004, he was hospitalized for the second time in AUFMC. After
two days of confinement in the hospital, he decided to transfer in St. Luke’s
Hospital. Mr. Bean experienced difficulty of breathing and fatigability that time.
He was diagnosed of Pulmonary Congestion.
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Lola (+) DM Lolo (+) HPNLolaLolo
Moma
Pop
Mr. Scrooge(+) HPN(+)Kidney Failure
D. History of Present Illness
Four days prior to admission, Mr. Scrooge experienced easy fatigability.
No other accompanying signs and symptoms. His condition was persisted until
one day prior to admission, he already experiencing body weakness, body
malaise, pallor and fatigability that’s why he consulted AUFMC. He was advised
to have laboratory examination (Hgb and Hct), which revealed anemia and he
was advised to be admitted. His initial vital signs were as follows: T-36.8, RR- 22,
PR- 64, BP- 170/100.
E. Physical Examination
February 3, 2005
Upon Admission:
VS:
T - 36.8
RR - 22
PR - 64
BP - 170/100
Integumentary
A. Skin- pallor, brown in complexion, with good skin turgor
B. Nails- pallor nailbed, clean with weak capillary refill (approximately within 4
seconds)
Head-no mass palpated
A. Scalp- hair evenly distributed without any presence of lice and lesions
B. Eyes- with pale palpebral conjunctiva, no discharges noted, pupils are equally
round and reactive to light and accommodation
C. Ears- symmetrical with cerumen, no discharges noted
D. Nose- without flaring of nostrils, no discharges noted
E. Mouth- with dry and pale lips
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F. Neck- no mass palpated, without lesions, no enlargement of lymph nodes and
pain
G. Chest and Lungs- with bibasal rales
Abdomen- soft, flat, tender
GIT: loss of appetite
Renal and Urologic changes: fatigability, oliguria
Cardiovascular changes: hypertension
Hematopoietic changes: anemia
Skeletal changes: hypocalcemia and hyperphosphatemia
February 7, 2005
Vital Signs:
T - 36
RR - 22
PR - 81
BP - 170/100
Integumentary
A. Skin- pallor, brown in complexion, with good skin turgor
B. Nails- pallor nailbed, clean with weak capillary refill (approximately within 4
seconds)
Head-no mass palpated
A. Scalp- hair evenly distributed without any presence of lice and lesions
B. Eyes- with pale palpebral conjunctiva, no discharges noted, pupils are equally
round and reactive to light and accommodation
C. Ears- symmetrical with cerumen, no discharges noted
D. Nose- without flaring of nostrils, no discharges noted
E. Mouth- with dry and pale lips
F. Neck- no mass palpated, without lesions, no enlargement of lymph nodes and
pain
G. Chest and Lungs- with bibasal rales
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Abdomen- soft, flat, tender
Cardiovascular changes: hypertension
Renal and urologic changes: oliguria
Hematopoietic changes: anemia
February 8, 2005
Vital Signs:
T - 36.2
RR - 16
PR - 80
BP - 170/100
Integumentary
A. Skin- pallor, brown in complexion, with good skin turgor
B. Nails- pallor nailbed, clean with weak capillary refill (approximately within 4
seconds)
Head-no mass palpated
A. Scalp- hair evenly distributed without any presence of lice and lesions
B. Eyes- with pale palpebral conjunctiva, no discharges noted, pupils are equally
round and reactive to light and accommodation
C. Ears- symmetrical with cerumen, no discharges noted
D. Nose- without flaring of nostrils, no discharges noted
E. Mouth- (-) pallor, dry lips
F. Neck- no mass palpated, without lesions, no enlargement of lymph nodes and
pain
G. Chest and Lungs- with bibasal rales
Abdomen- soft, flat, tender
Renal and Urologic changes: oliguria
Cardiovascular changes: hypertension
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February 9, 2005
Vital Signs:
T - 36.4
RR - 20
PR - 71
BP - 160/100
Integumentary
A. Skin- pallor, brown in complexion, with good skin turgor
B. Nails- pallor nailbed, clean with weak capillary refill (approximately within 4
seconds)
Head-no mass palpated
A. Scalp- hair evenly distributed without any presence of lice and lesions
B. Eyes- with pale palpebral conjunctiva, no discharges noted, pupils are equally
round and reactive to light and accommodation
C. Ears- symmetrical with cerumen, no discharges noted
D. Nose- without flaring of nostrils, no discharges noted
E. Mouth- with (-) pallor, dry lips
F. Neck- no mass palpated, without lesions, no enlargement of lymph nodes and
pain
G. Chest and Lungs- with bibasal rales
Abdomen- soft, flat, tender
Renal and Urologic changes: oliguria
Cardiovascular changes: hypertension
Hematopoietic changes: anemia
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February 10, 2005
Vital Signs:
T - 37
RR - 17
PR - 85
BP - 180/90
Integumentary
C. Skin- pallor, brown in complexion, with good skin turgor
D. Nails- pallor nailbed, clean with weak capillary refill (approximately within 4
seconds)
Head-no mass palpated
H. Scalp- hair evenly distributed without any presence of lice and lesions
I. Eyes- with pale palpebral conjunctiva, no discharges noted, pupils are equally
round and reactive to light and accommodation
J. Ears- symmetrical with cerumen, no discharges noted
K. Nose- without flaring of nostrils, no discharges noted
L. Mouth- (-) pallor
M. Neck- no mass palpated, without lesions, no enlargement of lymph nodes and
pain
N. Chest and Lungs- with bibasal rales
Abdomen- soft, flat, tender
Renal and Urologic changes: oliguria
Cardiovascular changes: hypertension
Hematopoietic changes: anemia
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F. Diagnostic and Laboratory Procedures
Diagnostic/ Laboratory Procedure
Date Ordered
Date Result in
Indication (s)Purpose (s) Result
Normal Values used by the
hospital
Analysis and Interpretation
1. CBC
Hgb
Hct
WBCLeukocytes
Neutrophils
Ordered2/3,4,6,8,9/05
Result:2/3,4,6,8,9/05
Ordered2/3,4,6,8,9/05
Result:2/3,4,6,8,9/05
Ordered2/3,4,6,8,9/05
Result:2/3,4,6,8,9/05
Ordered2/3,4,6,8,9/05Result:2/3,4,6,8,9/05
Ordered2/3,4,6,8,9/05
Usually done to a pt. with renal disease to determine if the kidney’s ability to release erythorpoietin factor is already affected
Used to measure RBC number and volume. It is an integral part of the evaluation of anemic patients
Determines any inflammation and infection
Determines any acute bacterial infection
Determines any chronic bacterial infection or viral
72103107118109
.23
.31
.33
.36
.32
7.766.019.408.589.5
.81
.75
.71
.72
.74
.1
.13
.20
120-170 g/L
.40-.50
5-10x109/L
.50-.70
.10-.40
Results were all below the normal level, thus indicating renal malfunction and thereby causing anemia
Result were all below the normal range thus, showing anemia and renal disease
Results were all above normal level. This shows presence of inflammation and infection
Results were all above normal level. This shows presence of bacterial infection
Results were all within normal level. Showing absence of
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Lymphocytes
Monocytes
Eosinophils
Result:2/3,4,6,8,9/05
Ordered2/3,4,6,8,9/05
Result:2/3,4,6,8,9/05
Ordered2/3,4,6,8,9/05
Result:2/3,4,6,8,9/05
infection
Determines any acute bacterial infection
To determine any allergic reaction of the body
.15
.13
.05
.08
.04
.09
.07
.04
.04
.05
.04
.06
.00-.07
.00-.07
chronic infection
Some of the results were all above normalLevel indicating presence of bacteria.
Results were all within the normal level. This shows no allergic reactions.
Nursing Responsibilities:
1. Explain the procedure to the patient
2. Tell the patient that no fasting is required
3. Apply pressure or a pressure dressing to the venipuncture site
4. Assess the venipuncture site for bleeding
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Diagnostic/ Laboratory Procedure
Date Ordered
Date Result in
Indication (s)Purpose (s) Result Analysis and
Interpretation
2. Hepatitis Profile
Ordered:2/3/05
Performed:2/5/05
This is usually done before proceeding in hemodialysis. This is to determine if the patient was expose to the virus of if there is presence of hepatitis virusIn the blood of the patient.
Result revealed that the patient has no hepatitis virus and was not exposed to any of it.
Nursing Responsibilities:
1. Explain the procedure to the patient
2. Tell the patient that no fasting is required
3. Apply pressure or a pressure dressing to the venipuncture site
4. Handle the specimen as if it were capable of transmitting hepatitis
5. Immediately discard the needle in the appropriate receptacle
6. Send the specimen to the laboratory promptly
Diagnostic/ Laboratory Procedure
Date Ordered
Date Result in
Indication (s)Purpose (s) Result
Normal Values used
by the hospital
Analysis and Interpretation
3.Urinalysis Ordered:2/3,6,7/05
Result:2/3,6,7/05
To diagnose and monitor renal or urinary tract disease
Color: straw, light yellow, light yellow
Appearance: slightly turbid
pH: 5
Specific Gravity:1.020, 1.025, 1.020
Albumin:
Laboratory results revealed that there is presence of albumin in the blood; this indicates that the glomerular cannot filter large molecules such as that of
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3+
Sugar: negative
Pus Cells: 1-2/HPF, 0-2/HPF, 2-5 /HPF
Red cells: 1-3/HPF, 1-3/HPF,4-6/HPF
Epithelial Cells:Rare
Mucus thread:Rare, (-), (-)
Bacteria: (-), few, (-)
Amorphous urates:Moderate, moderate, few
albumin. It also revealed that there is bacterial infection as evidenced by presence of bacteria, pus cells and red cells in the urine.
Nursing Responsibilities:
1. Explain the procedure to the patient
2. Tell the patient that no fasting is required
3. Instruct the patient to catch the midstream urine for better result
4. Send the specimen to the laboratory promptly
Diagnostic/ Laboratory Procedure
Date OrderedDate Result in
Indication (s)Purpose (s) Result
Normal Values used
by the hospital
Analysis and Interpretation
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4. Creatinine
5. Na+
6. K+
7. Calcium
8. Phosphate
Ordered:2/3,4,6,8/05
Result in:2/3,4,7,9/05
Ordered:2/3/05
Result in:2/3/05
Ordered:2/3,6/05
Result in:2/3,7/05
Ordered: 2/3/05
Result in:2/3/05
Ordered: 2/3/05
Result in:2/3/05
This test was ordered in order to evaluate renal function.
To evaluate fluid and electrolyte imbalance and identify renal dysfunction
To evaluate fluid and electrolyte imbalance and identify renal dysfunction
To evaluate muscle contraction, nerve impulse transmission, and blood clotting
To evaluate the metabolism of carbohydrates, bone formation and acid-base balance.
149914301649731
137
4.78
6.4
186
44.20-150.30 umol/L
135-150 mmol/L
3.5-5.5 mmol/L
8.5-10.5 mg/dl
30-150 u/L
Results were all above the normal level indicating renal malfunction. The kidney cannot excrete nitrogenous waste product of protein leading to its accumulation in the blood
Normal result which means there is still fluid and electrolyte balance
Normal result which means there is still fluid and electrolyte balance
Results were all above the normal level indicating renal malfunction.
Results were all above the normal level indicating renal malfunction.
Nursing Responsibilities:
1. Explain the procedure to the patient
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2.Tell the patient that no fasting is required
3. Apply pressure or a pressure dressing to the venipuncture site
4. Assess the venipuncture site for bleeding
III. ANATOMY AND PHYSIOLOGY
Function of the Urinary System
The major functions of the urinary systems are performed by the kidneys
and the kidneys plays the following essentials roles in controlling the composition
and volume of body fluids:
1. Excretion. The kidneys are the major excretory organs of the body. They
remove waste products, many of which are toxic, from the blood. Most waste
products are metabolic by- products of cells and substances absorbed from
the intestine. The skin, liver, lungs, and intestines eliminate some of these
waste products, but they cannot compensate if the kidneys fail to function.
2. Blood volume control. The kidneys play an essential role in controlling
blood volume by regulating the volume of water removed from the blood to
produce urine.
3. Ion concentration regulation. The kidneys help regulate the concentration
of the major ions in the body fluids.
4. pH regulation. The kidneys help regulate the pH of the body fluids. Buffers in
the blood and the respiratory system also play important roles in the
regulation of pH
5. Red blood cell concentration. The kidneys participate in the regulation of
red blood cell production and therefore, in controlling the concentration of red
blood cells in the blood.
6. Vitamin D synthesis. The kidneys. Along with the skin and the liver,
participate in the synthesis of vitamin D.
15
Kidneys
The kidneys balance the urinary excretion of substances against the
accumulation within the body through ingestion or production. Consequently,
they are major controller of fluid and electrolyte homeostasis. The kidneys also
have several non-excretory metabolic and endocrine functions, including blood
A crystallized solution that is available in a variety of concentrated water and calories are provided. It is hypertonic solution containing equal amounts of Na and Cl
A catheter tube is inserted into vein in either your neck, chest, leg or near the groin. It has two chambers to allow two-way flow of blood
It is intravenous replacement of loss or destroyed blood compatible citrated human blood it is also the introduction of whole blood or blood Component
To maintain fluid balance of the pt.
To maintain fluid balance of the pt.
Temporary access for hemodialysis
To immediately restore blood volume to treat severe anemia, to be able to maintain oxygen transport to the different parts
Patient felt discomfort
Patient experienced bleeding and felt discomfort on incision site
During the blood transfusion, patient was chilling for a short period of time. There was no further adverse reaction noted upon the transfusion
Patient fluid status was maintained
Patient fluid status was maintained
Patient did not show any further bleeding
Patient did manifest some reaction such as chilling but there was not further reaction after the treatment
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5.Hemodialysis
Ordered:2/7,8,9/05
Performed:2/7,8,10/05
Medical treatment used to promote excretion of wastes materials from the blood of patient.
of the body
It is indicated for the patient because the kidneys cannot function very well to excrete the nitrogenous waste products, thus leading to its accumulation in the blood.
Patient was slightly nervous about the treatment.
There was no adverse reaction noted during and after the procedure
Nursing Responsibilities
1. Blood transfusion
Before
a. Assess client for history of previous BT and any adverse reactions
b. Ensure that the client has an 18 to 19 gauge IV catheter in place
c. Use 0.9% sodium chloride IVF
d. Verify the ABO group, Rh type, client and blood numbers and expiration
date.
e. Take baseline vital signs before initiating BT
f. Identify the patient prior to transfusion
g. Explain the purpose of the transfusion
During
a. Start transfusion slowly
b. Maintain prescribed transfusion rate
c. Monitor patient closely. Check vital signs every 15 mins. Until 2 hours post
transfusion
After
a. Monitor for adverse reactions
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b. Documentation
2. Hemodialysis
Before
a. Explain the purpose of the transfusion
b. Have client void
c. Chart client’s weight
d. Withhold antihypertensive, sedatives, vasodilators, to prevent hypotension
(unless ordered otherwise)
During
a. Obtain and record vital signs before and every 30 mins. during the
procedure
b. Ensure bedrest with frequent position changes for comfort
c. Proper heparinization must be done to prevent coagulation during the
therapy
d. Inform client that headache and nausea may occur
e. Monitor closely for bleeding since blood has been heparinized for
procedure
After
a. Weight the patient after the therapy and record
b. Monitor vital signs especially hypotension.
c. Assess for complications (hypovolemic shock, dialysis
disequilibrium syndrome)
Name of Drug
Date orderedDate Taken
Date changed or D/C
Route of admin. Dosage
and freq. Of admin.
General action Indication (s)Purpose(s)
Client’s response to medication
Amlodipine besylate
norvasc
Ordered:2/3/05
Taken:2/3-10/05
PO 5 mg OD Calcium antagonist, antihypertensive
To decrease increase blood pressure
Patient did not show any side effects
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Metoprolol tartate
neobloc
Iberet- folic acid
furosemide
lasix
calcium carbonate
Ordered:2/3/05
Taken:2/3-10/05
Ordered:2/3/05
Taken:2/3-10/05
changed:2/3/05
Ordered:2/3/05
Taken:2/3-10/05
Ordered:2/3/05
Taken:2/3-10/05
D/C:2/3/05
PO 50 mg OD
PO 1 cap BID
PO 40 mg OD
PO 1 tab. TID
Beta blockers, antihypertensive drug
Iron deficiency
Diuretic
Calcium supplement
To decrease increase blood pressure
For patient having anemia
For oliguric patient
To treat hypocalcemia
Patient did not show any side effects
Patient’s stool was dark green in color
Patient did not show any side effects
Patient did not show any side effects
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Nursing Responsibilities
Prior:
1. Check and determine the prescribed the drug.2. Inform the patient about the prescribed the drug.3. Explain the procedure, purpose, indication and side effects of the drug.
During:1. Check vital signs to obtain baseline data.2. Monitor BP3. Prepare the drug and the materials4. Observe for initial assessment.5. Observe for any initial response to the treatment.
After:1. Observe for any intolerance and side effects on the prescribed drug.
Type of dietDate orderedDate started
Date changed
General description
Indication (s)Purpose (s)
Client’s response to the diet
DAT
Low salt, low protein
Ordered:2/3/05Started:2/3/05Changed:2/3/05
Ordered:2/3/05Started:2/3-10/05
Any foods and fluids that are being tolerated by the patient
Foods that has low salt and protein value
To provide nutrients needed by the body
To decrease further production of purine which can contribute in increasing level of creatinine in the blood
Patient followed the diet
Patient strictly complied with the prescribed diet
Nursing Responsibilities
Prior:1. Check and determine the prescribed diet
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2. Inform the SO about the prescribed diet3. Explain the procedure and purpose of the prescribed diet4. Cite foods that are restricted.
During:1. Check vital signs to obtain baseline data2. Observe for initial response.
After:1. Inform SO if it would be changed2. Observe and monitor for changes
Type of activityDate orderedDate started
Date changed
General description
Indication (s)Purpose (s)
Client’s response to the activity
Bed rest Ordered:2/3/05Started:2/3-10/05
An activity wherein the patient is not allowed to do any activity. Patient stays at bed.
To decrease consumption of oxygen and to be able to conserve energy
Patient strictly complied with the prescribed activity
Nursing Responsibilities
1. Explain the procedure to patient.
2. Explain importance of activity.
3. Assist patient in doing the activity.
B. Surgical Management
Arteriovenous Fistula
An AV fistula requires advance planning because a fistula takes a while
after surgery to develop (in rare cases, as long as 24 months). But a properly
formed fistula is less likely than other kinds of vascular accesses to form clots or
become infected. Also, fistulas tend to last many years, longer than any other
kind of vascular access.
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A surgeon creates an AV fistula by connecting an artery directly to a vein,
usually in the forearm. Connecting the artery to the vein causes more blood flow
into the vein. As a result, the vein grows larger and stronger, making repeated
insertions for hemodialysis treatment easier. For the surgery, you will be given a
local anesthetic. In most cases, the procedure can be performed on an outpatient
basis.
These fistulas require up to 6 weeks to mature before they can be used,
which makes this approach inappropriate for immediate hemodialysis. Peritoneal
dialysis or large venous access catheters may be used while the fistula is
maturing. External arteriovenous shunts are rarely used.
C. Nursing management
Actual SOAPIE
February 3, 2005
S> “madali akong mapagod”
O> received patient on semi-fowler’s position, with an ongoing IVF of D5 NM 1 L
X120 cc/hr @ 900 cc level, infusing well on the right hand
> Afebrile, with pink conjunctiva and lips, easy fatigability, appears weak
29
>VS taken and recorded as follows: T-36, PR-64, RR-18, BP-150/90