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called established chronic kidney disease and is synonymous with the now outdated terms end-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