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DIABETIC NEPHROPATHY
A Case Study
Submitted by:
History
Diabetic nephropathy (nephropatia diabetica), also known as Kimmelstiel-
Wilson syndrome and intercapillary glomerulonephritis, is a progressive kidney
disease caused by angiopathy of capillaries in the kidney glomeruli. It is
characterized by nephrotic syndrome and nodular glomerulosclerosis. It is due to
longstanding diabetes mellitus, and is a prime cause for dialysis in many Western
countries.
Discovered by British physician Clifford Wilson (1906-1997) and German-
born American physician Paul Kimmelstiel (1900-1970) and was published for
the first time in 1936.
Causes
The exact cause of diabetic nephropathy is unknown, but it is believed that
uncontrolled high blood sugar leads to the development of kidney damage. In
some cases, your genes or family history may also play a role. Not all persons
with diabetes develop this condition.
Each kidney is made of hundreds of thousands of filtering units called
nephrons. Each nephron has a cluster of tiny blood vessels called a glomerulus.
Together these structures help remove waste from the body. Too much blood
sugar can damage these structures, causing them to thicken and become
scarred. Slowly, over time, more and more blood vessels are destroyed. The
kidney structures begin to leak and protein (albumin) begins to pass into the
urine.
Persons with diabetes who have the following risk factors are more likely
to develop this condition:
African American, Hispanic, or American Indian origin
Family history of kidney disease or high blood pressure
Poor control of blood pressure
Poor control of blood sugars
Type 1 diabetes before age 20
Smoking
Diabetic nephropathy generally goes along with other diabetes
complications including high blood pressure, retinopathy, and blood vessel
changes.
Prevalence and Incidence Rate
Diabetes has become the primary cause of end-stage renal disease
(ESRD), and the incidence of type 2 diabetes mellitus continues to grow in the
United States and worldwide. Approximately 44% of new patients entering
dialysis in the United States are diabetics. Early diagnosis of diabetes and early
intervention are critical in preventing the normal progression to renal failure seen
in many type 1 and a significant percentage of type 2 diabetics.
In the United States, approximately 20.8 million people, or 7.0% of the
population, are estimated to have diabetes, with a growing incidence. Roughly
one third of this population, 6.2 million, is estimated to be undiagnosed with type
2 diabetes. The prevalence of diabetes is higher in certain racial and ethnic
groups, affecting approximately 13% of African Americans, 9.5% of Hispanics,
and 15% of Native Americans, primarily with type 2 diabetes. Approximately 20%
to 30% of all diabetics will develop evidence of nephropathy, although a higher
percentage of type 1 patients progress to ESRD.
Epidemiology
The syndrome can be seen in patients with chronic diabetes (15 years or
more after onset), so patients are usually of older age (between 50 and 70 years
old). The disease is progressive and may cause death two or three years after
the initial lesions, and is more frequent in men. Diabetic nephropathy is the most
common cause of chronic kidney failure and end-stage kidney disease in the
United States. People with both type 1 and type 2 diabetes are at risk. The risk is
higher if blood-glucose levels are poorly controlled. Further, once nephropathy
develops, the greatest rate of progression is seen in patients with poor control of
their blood pressure. Also people with high cholesterol level in their blood have
much more risk than others.
Complications
Possible complications include:
hypoglycemia (from decreased excretion of insulin)
rapidly progressing chronic kidney failure
end-stage kidney disease
hyperkalemia
severe hypertension
complications of hemodialysis
complications of kidney transplant
coexistence of other diabetes complications
peritonitis (if peritoneal dialysis used)
increased infections
Treatments and drugs
The goals of treatment are to keep the kidney disease from getting worse
and prevent complications. This involves keeping the blood pressure under
control (under 130/80). Controlling high blood pressure is the most effective way
of slowing kidney damage from diabetic nephropathy.
The doctor may prescribe the following medicines to lower the blood
pressure:
Angiotensin-converting enzyme (ACE) inhibitors
Angiotensin receptor blockers (ARBs)
These drugs help reduce the amount of protein in the urine. Many studies
have suggested that a combination of these two types of drugs may be best.
It is also very important to control lipid levels, maintain a healthy weight,
and engage in regular physical activity.
Closely monitor the blood sugar levels. Doing so may help slow down
kidney damage, especially in the very early stages of the disease. Change
diet to help control blood sugar.
The doctor may also prescribe medications to help control the blood
sugar. Dosage of medicine may need to be adjusted from time to time. As
kidney failure gets worse, our body removes less insulin, so smaller doses
may be needed to control glucose levels.
Urinary tract and other infections are common and can be treated with
appropriate antibiotics.
Dialysis may be necessary once end-stage renal disease develops. At this
stage, a kidney transplant must be considered. Another option for patients
with type 1 diabetes is a combined kidney-pancreas transplant.
PATIENT’S PROFILE
I. VITAL INFORMATION
NAME: Mrs. A.
ADDRESS: Guiuan, Eastern Samar
AGE: 69 years old
SEX: Female
HEIGHT: 5 Ft.
WEIGHT: 58 Kg
NATIONALITY: Filipino
RELIGION: Roman Catholic
BIRTHDAY: June 22, 1939
STATUS: Married
OCCUPATION: Housewife
ADMISSION DATE: March 02, 2009
ROOM NO: Female Medical Ward
BED NO: 5
ATTENDING PHYSICIAN: Dra. Myrna Diaz
CHIEF COMPLAINT: Easy fatigability, Chest and back pain
INFORMANT: Patient itself
Psychosocial History
Mrs. A is an elementary graduate from Guiuan National High
School, unfortunately, she haven’t finished her secondary level. Her
father died with no known cause at her age of 34, while her mother
succumbed to DM at her age of 42. She married at the age of 22, and
blessed with 6 children, 3 of whom are boys and 3 were girls. But 3 of
which are dead, 1 boy and 2 girls. Upon recall of Mrs. A, at 1 y.o his
son died because of measles, also her daughter at the same age died
because of the same disease. Her other daughter died due to leukemia
at the age of 24, but have married at the age of 20 and blessed with 2
children. Her 4th and only unmarried son remains in their house at the
proper of Guiuan, and the other 2 already have their own family.
Mrs. A has a small sari-sari store where she spends most of her
time. This store is there primary source of income. She’s fond of eating
sweet foods.
She is a smoker, she begin smoking in her younger years. She
can consume 3 sticks in a day just after eating her meals. She also
drinks tuba and beer occasionally. However she quitted smoking due
to diabetes mellitus.
Environmental History
Mrs. A and her husband lives in Brgy. Barbo, Guiuan Eastern
Samar. They prefer to stay there, where in fact they have their house
in the proper of Guiuan. A sari-sari store is in their front yard, this
keeps her busy every day.
Fruit trees are visible in their vicinity. Water supplies for
drinking, cooking, washing are taken from a communal faucet near the
river, 20 meters away from the comfort room.
Food preparation is usually done by her. They usually store their
food in the refrigerator. They have a pail flush type toilet located at the
back of their house. They throw their garbage in their compost pit
located at their backyard.
FAMILY HEALTH HISTORY
Mother Father
(+) DM Unknown Disease
Deceased Deceased
3rd Child
1st Child 2nd Child (F) 4th Child 5th Child
(F) (M) DM (M) (F)
Hpn
1st Child 2nd Child 3rd Child 4th Child 5th Child 6th Child
(F) (M) (F) (M) (M) (F)
Deceased Deceased Deceased
L Msl Msl
LEGEND:
DM - Diabetes Mellitus
Hpn - Hypertension
Ass - Asthma
Msl - Measles
L - Leukemia
M/F - Male/Female
Patterns of Functioning
General Survey: upon assessment, the patient was seen on bed conscious.
V/S: T = 37.7°C; P =98 bpm; RR =24 cpm; BP =180/90 mmHg.
Physical Assessment
Head
Size, shape & Rounded, smooth skull Normal in size,
symmetry contour rounded,
Presence of nodules & Smooth, uniform Absence of
masses consistency, nodule or
absence of nodules masses,
or masses smooth skull.
Hair
Scalp Evenly distributed hair Evenly
Thickness/thinness Thick hair distributed hair
Texture Silky, resilient hair Thick hair
Amount Variable Silky, resilient
hair
Variable
Eyes
Eyebrows Hair evenly distributed Symmetrically
aligned
Eyelids Skin intact soar Skin intact
Eyelashes Equally distributed Equally
distributed
Conjunctiva Transparent & shiny Transparent &
shiny
Nose
Integumentary
External Nose Symmetric & straight Symmetrical and
straight, no
Ears drainage.
Auricle color Color same as facial skin Color same as
facial skin
Size Firm Firm
Position Symmetric position Symmetrical
Skin
Color No scar Scar noted on Obtained during
both legs on her
childhood years
Peripheral Pulse
Palpations Full palpations Full palpations
Peripheral Perfusion
Cardiovascular
Skin Skin color pink Pale Due to anemia
Skin temperature not Skin temperature
excessively warm or normal
cold
Mouth
Lips Pink & moist Dry lips, slightly Due to dryness
pale of mucosal
lining bec . she
was dyspnic
Gums Smooth & shiny Slightly dark in Due to smoking
color
Teeth 32 adult teeth Incomplete
dentures
Tongue Central position & Central position
smooth
Gastrointestinal Abdomen
Skin Unblemished skin & Unblemished
uniform in color skin and
uniformed in
Palpation color
Light palpation No tenderness; relaxed Noted Due to kidney
abdomen with tenderness and impairment
smooth, consistent hypersentivity
tension on LLQ
Deep Palpation No tenderness Localized Due to kidney
tenderness on impairment
LLQ
Bladder
Palpation Not Palpable Distended and Due to urinary
palpable as retention
GUT
smooth, round,
tense mass
Percussion Dullness with full bladder Large dull areas
ANATOMY AND PHYSIOLOGY
Function
Role in disease
Pituitary The pituitary gland is a small oval endocrine gland that lies at the
base of the brain. It is sometimes called the master gland of the
body. This part of the brain consists of three lobes called
"anterior", "interior" and "posterior".
Hyper- Gigantism
Corticosteroid -mineral
s corticoids
-
glucocorticoid
s
-cortisol
(natural anti-
inflammatory)
-androgens,
e.g.
acdosterone.
Melanin Stimulating
Hormone (MSH)
Gonadotrophins - Secondary sexual
characteristics.
Thyroid Located in the anterior part of the neck in the midline. It consists
Gland of two lateral lobes lying on each side of the thyroid cartilage
(Adam's apple) and connected by a band of tissue called the
isthmus.
Hyper-Thyroidism = ‘over-active
thyroid’ = Thyrotoxicosis
Symptoms: increase in BMR;
increase in heart-rate; loss of
weight; hyper-activity; insomniac;
develops bulging eyes due to
accumulation of fluid behind the
eye; may develop Goitre; possible
link with Attention Deficit Disorder.
Hypo-Thyroidism
Symptoms; decrease in BMR;
weight gain; lethargy; skin becomes
dry and puffy; hair becomes thin
and brittle.
Causes: Derbyshire Neck
(originally due to insufficient iodine
in the soil in Derbyshire), Graves
Disease, and Cretinism (= metal
and sexual development imapaired,
if occurs in children).
Parathyroi Small glands of the endocrine system which are located behind
d Gland the thyroid. There are four parathyroid glands which are normally
about the size of a pea.
Thymus The thymus gland is located straddled across the trachea &
bronchi in the upper thorax (a bi-lobed organ in the root of the
neck, above and in front of the heart).
The thymus (a gland associated with the immune system), is
enclosed in a capsule and divided internally by cross-walls into
many lobules (full of T-lymphocytes).
Islets of Located within the pancreas. Contains groups of both Alpha- and
Langerhan Beta- cells.
Ovaries The ovaries are pair of female reproductive organs. They are
located in the pelvis, one on each side of the uterus.
Testes Two glands suspended within a sac of skin called scrotum. They
are composed of a large number of seminiferous tubules
Secondary sexual
characteristics. e.g. body hair,
muscle development, voice
change.
The pancreas houses two distinctly different tissues. The bulk of its mass
is exocrine tissue and associated ducts, which produce an alkaline fluid loaded
with digestive enzymes which is delivered to the small intestine to facilitate
digestion of foodstuffs. Scattered throughout the exocrine tissue are several
hundred thousand clusters of endocrine cells which produce the hormones
insulin and glucagon, plus a few other hormones.
Insulin and glucagon are critical participants in glucose homeostasis and
serve as acute regulators of blood glucose concentration. From a medical
perspective, insulin in particular is enormously important - a deficiency in insulin
or deficits in insulin responsiveness lead to the disease diabetes mellitus.
The pancreas is an elongated organ nestled next to the first part of the
small intestine. The endocrine pancreas refers to those cells within the pancreas
that synthesize and secrete hormones.
The endocrine portion of the pancreas takes the form of many small
clusters of cells called islets of Langerhans or, more simply, islets. Humans have
roughly one million islets. In standard histological sections of the pancreas, islets
are seen as relatively pale-staining groups of cells embedded in a sea of darker-
staining exocrine tissue.
Pancreatic islets house three major cell types, each of which produces a
different endocrine product:
• Alpha cells (A cells) secrete the hormone glucagon.
• Beta cells (B cells) produce insulin and are the most abundant of the islet
cells.
Interestingly, the different cell types within an islet are not randomly
distributed - beta cells occupy the central portion of the islet and are surrounded
by a "rind" of alpha and delta cells. Aside from the insulin, glucagon and
somatostatin, a number of other "minor" hormones have been identified as
products of pancreatic islets cells.
Islets are richly vascularized, allowing their secreted hormones ready
access to the circulation. Although islets comprise only 1-2% of the mass of the
pancreas, they receive about 10 to 15% of the pancreatic blood flow.
Additionally, they are innervated by parasympathetic and sympathetic neurons,
and nervous signals clearly modulate secretion of insulin and glucagon.
The urinary system consists of two kidneys, two ureters, the urinary
bladder, and the urethra. The formation of urine is the function of the kidneys,
and the rest of the system is responsible for eliminating the urine.
Body cells produce waste products such as urea, creatinine, and
ammonia, which must be removed from the blood before they accumulate to
toxic levels. As the kidneys form urine to excrete these waste products, they also
accomplish several other important functions:
Distal convoluted tubule - here the cells are cuboidal and thinner than those seen
in the proximal convoluted tubule. This shows that these cells play a role in
secreting substances into the filtrate rather than removing substances from it.
Here we also see two cell types:
1. intercalated cells (cuboidal with microvilli) - these function in acid/base
balance of the blood.
2. principal cells ( no microvilli) - these function in body Na+ and water
balance.
Collecting duct - Not a part of the Nephron. The distal convoluted tubules
connect to collecting ducts. Passes through the renal pyramids and ends at the
renal papillae where it empties into a minor calyx.
Blood supply - renal arteries feed into segmental arteries, which turn into
interlobar arteries (in renal columns) which feed into arcuate arteries (branched
out at the level between the cortex and medulla). Interlobular arteries branch off
of the arcuate arteries and run out into the cortex. From these branch the afferent
arterioles which bring blood to the glomeruli (blood filtrate enters the urinary
tubules). Blood leaving the glomerulus enters an efferent arteriole which takes
the blood to peritubular capillaries around the convoluted tubules OR vasa recta
surrounding the ascending and descending limbs of Henle. At this point the blood
enters veins that parallel the arteries. That is, interlobular veins to arcuate veins
to interlobar veins to renal veins to the IVC.
Urinary bladder - storage bag for urine. It is located behind the pubic symphysis
yet in front of the rectum in males and in front of the uterus in females.
Urethral wall -The inside of the wall is lined by mucous membrane surrounded by
a thick layer of smooth muscle. We also see urethral glands which secrete
mucous into the urethral canal. There is an external urethral sphincter which is
composed of voluntary skeletal muscle.
Increased basal hepatic glucose Stimulate brain Breakdown of fats Increased plasma osmolality of
production (Hypothalamus) to eat (Lypolysis) glucose
Atherosclerosis
Excessive Urination (Polyuria)
Hypertension
The cell will shrink/dehydrated
Weight loss
decreased blood perfusion
Impaired immune function of supply to vital organs Excessive thirst (Polydipsia)
Infection
Diabetic Retinopathy Diabetic Neuropathy Diabetic Nephropathy
Increased extracellular
matrix deposition &
messangial hypertrophy
Expansion of messangial
area
Edema
LABORATORY TESTS & RESULTS
A complete blood count (CBC), also known as full blood count (FBC) or
full blood exam (FBE) or blood panel, is a test requested by a doctor or other
medical professional that gives information about the cells in a patient's blood. A
lab technician (diploma holder) or technologist (bachelor holder) performs the
requested testing and provides the requesting Medical Professional with the
results of the CBC. A CBC is also known as a "hemogram".
Red cells
• Total red blood cells - The number of red cells is given as an absolute
number per litre.
• Hemoglobin - The amount of hemoglobin in the blood, expressed in grams
per decilitre. (Low hemoglobin is called anemia.)
• Hematocrit or packed cell volume (PCV) - This is the fraction of whole
blood volume that consists of red blood cells.
• Red blood cell indices
Mean corpuscular volume (MCV) - the average volume of
the red cells, measured in femtolitres. Anemia is classified
as microcytic or macrocytic based on whether this value is
above or below the expected normal range. Other conditions
that can affect MCV include thalassemia and reticulocytosis.
Mean corpuscular hemoglobin (MCH) - the average amount
of hemoglobin per red blood cell, in picograms.
Mean corpuscular hemoglobin concentration (MCHC) - the
average concentration of hemoglobin in the cells.
• Red blood cell distribution width (RDW) - a measure of the variation of the
RBC population
White ce lls
• Total white blood cells - All the white cell types are given as a percentage
and as an absolute number per litre.
A complete blood count with differential will also include:
• Neutrophil granulocytes - May indicate bacterial infection. May also be
raised in acute viral infections.Because of the segmented appearance of
the nucleus, neutrophils are sometimes referred to as "segs." The nucleus
of less mature neutrophils is not segmented, but has a band or rod-like
shape. Less mature neutrophils - those that have recently been released
from the bone marrow into the bloodstream - are known as "bands" or
"stabs". Stab is a German term for rod.
• Lymphocytes - Higher with some viral infections such as glandular fever
and. Also raised in lymphocytic leukaemia CLL. Can be decreased by HIV
infection. In adults, lymphocytes are the second most common WBC type
after neutrophils. In young children under age 8, lymphocytes are more
common than neutrophils.
• Monocytes - May be raised in bacterial infection, tuberculosis, malaria,
Rocky Mountain spotted fever, monocytic leukemia, chronic ulcerative
colitis and regional enteritis
• Eosinophil granulocytes - Increased in parasitic infections, asthma, or
allergic reaction.
• Basophil granulocytes - May be increased in bone marrow related
conditions such as leukemia of lymphoma.
Platelets
• Platelet numbers are given, as well as information about their size and the
range of sizes in the blood.
Clinical
Day Normal Values Result Remarks indications
Significance
Feb.
28, Leucocytes No. 7.1 x Normal To identify
2009 Cone 109/L normal blood
Adult: cells to
5-10 x109/L diagnosed
blood
disease
Hemoglobin
Mass Cone:
12.0-14.0 g/L 6.0 g/L Decreased Measures -anemia and heart
the amount disease
of
hemoglobin
in the blood
Hematocrit
0.37-0.47 0.18 Decreased Measure of -anemia
RBC found
in the blood,
stated as a
percentage
of the total
blood
volume
Clinical Chemistry
Clinical
Day Normal Values Result Remarks indications
Significance
March.2, Hgt
2009 80-120 mg/dL 200 Increased To (+) DM
mg/dL determine
the level of
blood sugar
in the blood
Blood Urea
Nitrogen
1.7-8.3 mmol/L 16.3 Increased The amount Diabetic
mmol/L of nitrogen nephropathy
in the blood
in the form
of urea
Serum
Creatinine
0.5-1.2 mg/dl 9.8 Increased Measures Diabetic
mg/dL the amount nephropathy
of creatinine
in the blood
Urinalysis
A urinalysis is a group of manual and/or automated qualitative and semi-
quantitative tests performed on a urine sample. A routine urinalysis usually
includes the following tests: color, transparency, specific gravity, pH, protein,
glucose, ketones, blood, bilirubin, nitrite, urobilinogen, and leukocyte esterase.
Some laboratories include a microscopic examination of urinary sediment with all
routine urinalysis tests. If not, it is customary to perform the microscopic exam, if
transparency, glucose, protein, blood, nitrite, or leukocyte esterase is abnormal.
Purpose
Routine urinalyses are performed for several reasons:
Transparency
Clear turbid Presence of Debris, bacteria
blood cells sediment
Gravity
1.005-1.030 1.015 Normal Indication of Increase acidity
urine with renal tubular
concentration acidosis tract
or amount of infection
solutes
present in
the urine.
pH
7.35-7.45 5.0 Decreased To determine Acidity, UTI
Ave: 6.0 the relative
acidity and
alkalinity of
urine and
assess the
clients acid-
based status.
Glucose 0 or
not present trace Present Important High blood
test of glucose level
diabetic and
other
disorder
Blood not
present (+) Present To determine UTI and Diabetic
the presence nephropathy
of blood in
the urine
Clinical
Day Normal Values Result Remarks indications
Significance
Mar. 3, Color
2009 Amber yellow yellow Normal
Transparency
Clear turbid Presence of Debris, bacteria
blood cells sediment
Gravity
1.005-1.030 1.020 Normal Indication of Increase acidity
urine with renal tubular
concentration acidosis tract
or amount of infection
solutes
present in
the urine.
pH
7.35-7.45 5.0 Decreased To determine Acidity, UTI
Ave: 6.0 the relative
acidity and
alkalinity of
urine and
assess the
clients acid-
based status.
Glucose 0 or
not present (+1) Present Important High blood
test of glucose level
diabetic and
other
disorder
Furosemide Loop diuretic Inhibits sodium and To prevent nocturia, Advise patient to take Contraindicated in
(Lasix) choride reabsorption give P.O. and IM drug with food to patients hypersensitive
at the proximal and preparations in the prevent GI upset, and to drug and in those
distal tubules and the morning. Give second to take drug in with anuria.
ascending loop of dose in early morning to prevent
henle. afternoon. need to urinate at
Monitor weight , BP, night.
and pulse rate Inform patient of
routinely with long- possible need for
term use and during potassium or
rapid dieresis. magnesium
Monitor fluid intake supplements.
and output and Instruct patient to
electrolyte, BUN and consult health care
carbon dioxide levels professional regarding
frequently. a diet high in
Watch for signs of potassium.
hypokalemia, such as
muscle weakness and
cramps.
Metoprolol Beta blockers A selective beta Always check Instruct patient to take Contraindicated in
(Lopresor) Antianginals, blocker that patient’s apical pulse drug as exactly as patients hypersensitive
antihypertensives selectively blocks rate before giving prescribed and with to drug or other beta
beta receptors; drug. meals. blockers.
decreases cardiac Monitor glucose level Tell patient to alert
output, peripheral closely because drug prescriber if shortness
resistance, and masks common S/Sx of breath occurs.
cardiac oxygen of hypoglycemia. Instruct patient not to
consumption; and Monitor BP frequently; stop drug suddenly
depresses rennin drug masks common but botify prescriber
secretion. S/Sx of shock. about unpleasant
Monitor I&O output adverse reactions.
ratios and daily
weight.
NURSING CARE PLAN
ASSESSMENT NSG. DIAGNOSES RATIONALE EXPECTED OUTCOME NSG. INTERVENTION RATIONALE EVALUATION
Subjective: Knowledge deficit -Absence or deficiency of After an hour of health Independent After an hour of health
- “ano dawla regarding condition, cognitive information related teaching on essential 1).Create an environment of 1).Rapport of respect need teaching on essential
kahinugad hen nga prognosis, treatment, self to specific topic. (Gulanick, elements regarding trust by listening to to be established before the elements regarding the
ak lawas” as care and discharge needs et. Al) condition, prognosis, concerns, being available patient will be willing to take disease, the patient
verbalized by the related to unfamiliarity -Information must be taught part in the learning process.
patient with information to pt. with DN in order to treatment, self care and (Doenges, et.al) verbalized understanding of
resources as manifested allay anxiety, prevent discharge needs, the patient 2).Discuss disease process, 2).Provide knowledge based condition / disease process,
Objective: by frequent asking of complications and it may will be able to verbalize prognosis, and precipitating on which the pt. can make prognosis & treatment;
V/S: questions regarding serve as an opportunity for understanding of condition / factors. informed choices. identified relationship of sign
- T : 37.7˚C Diabetes Nephropathy. learning self management disease process, prognosis (Doenges, et.al) / symptoms to the disease
- PR : 98 BPM skills. (Doenges, et.al) & treatment; identify 3).Discuss dietary plan 3).Adequate nutrition is process and correlate
- RR : 24 CPM limiting intake of sugar, fat, necessary to promote
relationship of sign / symptoms with causative
- BP : 180/90 mmHg salt, alcohol and eating healing/tissue regeneration
symptoms to the disease complex carbohydrates while adherence to factors; and initiated
Weight : 52 kg (pre-illness) process and correlate specially those high in fiber restrictions may prevent necessary lifestyle changes
58 kg (during symptoms with causative and ways to deal with meals complications and participates in treatment
hospitalization) factors; and initiate outside the home. 4).Changes may reflect regimen.
necessary lifestyle changes 4).Encourage patient to alterations in renal
Inaccurate follow through of and participate in treatment observe characteristics of function/need for dialysis.
instruction urine and amount/frequency (Doenges, et.al)
regimen.
Frequent asking about her of output. 5).Patient with ARF may
condition 5).Discuss activity restriction need to restrict activity
Verbalizing inaccurate and gradual resumption of and/or may feel weak for an
information desired activity. Encourage extended period during
use of energy-saving, lengthy recovery phase,
relaxation, and diversional requiring measures to
techniques. conserve energy and
reduce boredom /
depression. (Doenges, et.al)
6).Prevents excessive
6).Recommend scheduling fatigue and conserves
activities with adequate rest energy for healing, tissue
periods. regeneration. (Doenges)
NURSING CARE PLAN
ASSESSMENT NSG. DIAGNOSES RATIONALE EXPECTED OUTCOME NSG. INTERVENTION RATIONALE EVALUATION
Subjective: Fluid volume excess -Kidney failure decreases After 8 hours of fluid Independent The goal was met; patient
- “nahubag it ak siki” related to compromise kidney’s ability to excrete restrictions, administering 1).Record accurate intake 1).Accurate I/O is necessary has displayed/experience
as verbalized by regulatory mechanism salt in the urine. Thus, the medications(diuretics & and output (I/O). for determining renal normal fluid balance,
the patient (renal failure) as amount of salt in the body antihypertensive) as function and fluid appropriate urinary output
evidenced by venous increases, w/c causes the replacement needs and
Objective: distension, generalized body to retain water & indicated, the patient will reducing risk of fluid with specific gravity
V/S: edema, fatigue, weakness, decrease urine output. experience normal fluid overload. /laboratory studies near
- T : 37.7˚C body malaise, balance, display appropriate Dependent normal, stable weight and
- PR : 98 BPM restlessness and pitting urinary output with specific 2).Administer/restrict fluid as 2).Fluid management is absence of edema after 8
- RR : 24 CPM edema (25.4 mm). gravity /laboratory studies indicated. usually calculated to replace hours of fluid restrictions,
- BP : 180/90 mmHg near normal, stable weight output from all sources and administering medication
estimated insensible losses.
and absence of edema (diuretics &
Weight : 52 kg (pre-illness) 3).Administer medication as 3).Given early in oliguric
58 kg (during indicated (Diuretics). phase of renal failure in an antihypertensive) as
hospitalization) effort to convert nonoliguric indicated.
phase, flush the tubular
Venous distension lumen of debris and
Generalized edema promote urine volume.
Report of fatigue, weakness Antihypertensive Maybe given to treat
and body malaise hypertension by
Pitting Edema (25.4 mm) counteracting effects of
Restlessness renal blood flow and/or
circulating volume overload
Independent
4).Weigh daily at same time 4).Daily body weight is best
of day, on same scale, with monitor of fluid status.
same equipment and
clothing.
5).Assess skin, face, 5).Edema occurs in
dependent areas for edema. dependent tissues of the
body. (e.g. hands, feet,
lumbosacral area). Patient
can gain up to 10 lbs (4.5
kgs) of fluid before pitting
edema is detected.
6).Plan oral fluid 6).Helps minimizes
replacement with patient, boredom of limited choices
within multiple restrictions. and reduces sense of
deprivation and thirst.
.
ASSESSMENT NSG. DIAGNOSES RATIONALE EXPECTED OUTCOME NSG. INTERVENTION RATIONALE EVALUATION
Subjective: High risk for impaired skin -The risk of infection After following a 3 day Independent: Patient’s skin remains
- “maiha matambal integrity related to altered elevates the higher the series of health teachings 1).Anticipate and use 1).Decubitus ulcers are intact, as evidenced by no
an ak habol didi sensation secondary to Glucose level of a person on the preventive measures, preventive measures in pt’s difficult to heal, and redness over bony
han ak tuhod” as with diabetes. This is largely who are at risk for skin prevention is the best prominences and capillary
disease process as the pt. will maintain intact
verbalized by the because; High blood sugar breakdown, such as anyone treatment. (Doenges, et.al) refill less than 6 seconds
pt. evidenced by high causes the loss of sensation skin, identify risk factors and who is thin, obese, aging, or over areas of redness after
Objective: glucose levels of HGT: (neuropathy) and impedes demonstrate debilitated. following a 3 day series of
V/S: 200 mg/dl; and lesions circulation throughout the behaviors/techniques that health teachings on the
- T : 37.7˚C noted on both legs body (specially the feet). prevents skin breakdown. 2).Maintain strict skin 2).A daily bath Is usually not preventive measures.
- PR : 98 BPM Diminished sensation can hygiene, using mild, necessary in erderly
- RR : 24 CPM interfere with the body’s nondetergent soap (if any), patients because there is
- BP : 180/90 mmHg injury warning system, pain. drying gently and atropy of sebaceous and
Thus, Small cuts, abrasions thoroughly, and lubricating sweat glands, and bathing
Weight : 52 kg (pre-illness) and other skin alterations with lotion or emollient. may create dry-skin
58 kg (during may go unnoticed and problems. However, as
illness) become infected. (Wolfe, L.) epidermis thins with age,
. cleansing and use of
High Glucose level RBS by lubricants is needed to keep
hgt: skin soft/pliable and protect
03/02/09 : 200 mg/dl susceptible skin from
Lesions noted on both legs breakdown. (Doenges, et.al)
-Do not use alcohol-based -it may cause the skin to dry
lotions on your skin and crack, increasing the
chance of infection. (Wolfe,
L.)
ASSESSMENT NSG. DIAGNOSES RATIONALE EXPECTED OUTCOME NSG. INTERVENTION RATIONALE EVALUATION
Subjective: Fatigue related to -Fatigue is a feeling of After a day of providing Independent Patient verbalized having
- “maluya pirme it ak decreased metabolic tiredness, exhaustion, or alternate activities with 1).Discuss with pt. the need 1).Education may provide sufficient energy to
pagabat” as energy production as lack of energy. It feels mildly periods of rest and for activity. Plan schedule motivation to increase complete desired activities
verbalized by the evidenced by weakness, fatigued because of uninterrupted sleeps, the with pt. and identify activity level even though pt. after a day of providing
patient restlessness, pallor, overwork, poor sleep, worry, client will improve sufficient activities that lead to fatigue.
may feel too weak initially. alternate activities with
severe anemia & high boredom, or lack of energy to complete desired (Gulanick, et. Al) periods of rest and
Objective: glucose level RBS of hgt: exercise. Any illness, such light activities. 2).Assess patient’s ability to 2).Influences choice of uninterrupted sleeps.
V/S: 200 mg/dl. as a cold or the flu, may perform normal tasks/ interventions/ needed
- T : 37.7˚C cause fatigue, which usually noting reports of weakness, assistance. (Gulanick, et.
- PR : 98 BPM goes away as the illness fatigue, and difficulty Al)
- RR : 24 CPM clears up. A stressful accomplishing task
- BP : 180/90 mmHg emotional situation may also
cause fatigue. This type of 3).Alternate activity w/ 3).Prevents excessive
Weight : 52 kg (pre-illness) fatigue usually clears up periods of rest / fatigue. (Gulanick, et. Al)
58 kg (during when the stress is relieved. uninterrupted sleep.
illness) Many prescription and
nonprescription medicines 4).Monitor pulse, respiratory 4).Indicates physiologic
Severe Anemia can also cause fatigue. It rate and BP before/after levels tolerance. (Gulanick,
Weakness may be caused by a more activity. et. Al)
Pallor serious health problem,
Restlessness such as: Metabolic 5).Discuss ways of 5).Pt. will be able to
disorders, such as diabetes, conserving energy while accomplish more with a
High Glucose level RBS by in which sugar (glucose) bathing, transferring, and so decreased expenditure of
hgt: remains in the blood rather on. energy.
03/02/09 : 200 mg/dl than entering the body’s
cells to be used for energy. 6).Increase pt. participation 6).Increases confidence
Normal Value: (WebMD) in ADLs as tolerated. level/self-esteem as well as
HGT : 70 – 100 mg/dl tolerance level. (Gulanick,
et. Al)
NURSING CARE PLAN
ASSESSMENT NSG. DIAGNOSES RATIONALE EXPECTED OUTCOME NSG. INTERVENTION RATIONALE EVALUATION
Subjective: Decreased tissue Occlusion of peripheral After 4 hours of Independent After 4 hours of treatment
- “agsub ak umabat perfusion related to blood vessels will alter flow implementing measures to 1).Give antihypertensive 1).A wide range of the goal was met, the
nga matutumba ak” peripheral vaso-occlusion of blood to perfuse the reduce vascular resistance drugs, diuretics as medications is available for patient blood pressure was
as verbalized by of blood vessels different cells of the body. and improve tissue prescribed. treatment: vasodilators, decreased from 180/90
the patient secondary to disease (http://www.elsevier.com) perfusion: beta-blockers, and
Objective: process as evidenced by -giving antihypertensive angiotensinogen-converting mmHg to 130/80.
V/S: chest pain, restlessness, drugs enzyme (ACE) inhibitor.
- T : 37.7˚C pallor, fatigue, generalized -maintain fluid and dietary Dependent
- PR : 98 BPM edema, elevation in BUN sodium restrictions 2).Monitor blood pressure 2).To knows the base line of
- RR : 24 CPM (16.3 mmol/l, capillary -maintain physical and every 4 hours. BP.
- BP : 180/90 mmHg refill > 3 secs and BP of emotional rest
180/90 mmHg the patient blood pressure 3).Implement measures to 3).
Weight : 52 kg (pre-illness) will decrease from 180/90 reduce vascular resistance
58 kg (during mmHg to 130/80. and improve tissue
illness) perfusion:
Pallor -Maintain fluid and dietary -to reduce fluid retention,
Chest pain sodium restrictions which contributes to
Restlessness hypertension.
Fatigue -Discourage intake of -caffeine stimulates
Generalized edema noted coffee, tea, colas, and sympathetic nervous system
Pitting edema noted chocolate, which are high in
Elevation in BUN (16.3 caffeine -causes vasoconstriction
mmol/l -discourage smoking and contributes to
Capillary refill > 3 secs decreases tissue
oxygenation by reducing O2
High Glucose level RBS by availability
hgt: -sedatives can be used to
03/02/09 : 200 mg/dl -maintain physical and reduce stress and
emotional rest. associated vasoconstriction.
Normal Value: 4).Volume depletion
HGT : 70 – 100 mg/dl 4). Ensure adequate fluid enhances potency of
BUN: 1.7-8.3 mmol/l intake unless contraindicated hypertensive drugs and also
reduces perfusion to
kidneys.
NURSING CARE PLAN
ASSESSMENT NSG. DIAGNOSES RATIONALE EXPECTED OUTCOME NSG. INTERVENTION RATIONALE EVALUATION
Subjective: Activity intolerance -because of diminished Short term: Independent The patient revealed an
- “maluya pirme it ak related to imbalance oxygen-carrying capacity of After 8 hours of complete 1).Assess patients to 1).Influences choice of increase in activity
pagabat” as between oxygen supply the red blood cells, thus bed rest with elevated HOB perform normal task or interventions or needed tolerance, demonstrating a
verbalized by the and demand as evidenced resulted to insufficient and implementing energy activities of daily living. assistance. reduction in physiological
patient by weakness, physiological energy to saving technique, the 2).Elevate head of bed as 2).Enhances lung expansion signs of intolerance and
restlessness, fatigue, endure or complete required patient will report an tolerated. to maximize oxygenation for laboratory values within
Objective: pallor, severe anemia & or desired daily activities. increase in activity tolerance cellular uptake. normal range after 8 hours
V/S: high glucose level RBS of (http://knol.google.com/k/ including activities of daily 3).Identify or implement 3).Encourage patient to do of complete bed rest with
- T : 37.7˚C hgt: 200 mg/dl. charles-pollack/shortness- living, demonstrate a energy saving technique like as much as possible, while elevated HOB and
- PR : 98 BPM of-breath/zqxdlFRm decrease in physiological sitting while doing a task. conserving limited energy & implementing energy saving
- RR : 24 CPM /sj1LaA#) signs of intolerance and preventing fatigue. technique.
- BP : 180/90 mmHg display laboratory values 4).Recommend quite 4).Recommend quite
within acceptable range. atmosphere, bed rest if atmosphere, bed rest if
Weight : 52 kg (pre-illness) indicated. indicated.
58 kg (during Long term:
illness) After months of nursing 5).Note changes in 5).May indicates
interventions the patient is balance/gait disturbances neurological changes
Fatigue free from weakness and risk and muscle weakness. affecting patient safety or
Severe Anemia of complications has been risk of injury.
Weakness prevented. 6).Provide or recommend 6).Enhances rest to lower
Pallor assistance with activities or body’s oxygen requirements
Restlessness ambulation as necessary, and reduce strain on the
Exertional allowing patient to do as heart and lungs.
discomfort/dyspnea much as possible.
7).Plan activity progression 7).Although help maybe
High Glucose level RBS by with patient, including necessary, self esteem is
hgt: activities that the patient enhanced when patient
03/02/09 : 200 mg/dl views essential. does some things for self.
Promotes gradual return to
Normal Value: normal activity level and
HGT : 70 – 100 mg/dl improved muscle tone or
stamina without undue
fatigue.
Collaborative:
8).Monitor lab studies Hb, 8).Identifies deficiencies in
Hct, & RBC count. RBC components affecting
oxygen transport &
treatment needs or
response to therapy.
NURSING CARE PLAN
ASSESSMENT NSG. DIAGNOSES RATIONALE EXPECTED OUTCOME NSG. INTERVENTION RATIONALE EVALUATION
Objective: Altered fluid & The production of an Short term: Independent Goal partially met; patient
V/S: electrolytes balance abnormally small volume of After 8 hours of treatment: 1).Assess the cause of 1).To be able to apply the passed out urine at least
- T : 37.7˚C related to urinary urine is a result of kidney encouraging client to void decrease urinary output. proper therapeutic regimen. 300 cc
- PR : 98 BPM retention as evidenced by failure. every 2-4 hours and when
- RR : 24 CPM dyspnea, decrease of urge is noted, the patient 2).Encourage client to void 2).May minimizes urinary
- BP : 180/90 mmHg urine output 250 cc, Renal failure will be able to increase urine every 2-4 hours and when retention/over distention of
generalized edema, pitting output to at least 1500 cc. urge is noted. the bladder.
Weight : 52 kg (pre-illness) edema on lower
58 kg (during extremities, restlessness, Decrease blood flow to Long term: 3).Determine the initial fluids 3).Serves as baseline for
illness) dribbling of urine kidney At the end of hospitalization and electrolytes level progress.
the patient will be able to
Dyspnea have a normal urine output 4).Monitor I/O hourly. 4).To determine the
Decrease of urine output Decrease perfusion in and voiding pattern. progress of the disease.
250 cc Dependent
kidney
Generalized edema 5).Percuss/palpate 5).A distended bladder can
Pitting edema on lower suprapubic area be felt in the suprapubic
extremities Decrease urinary output area.
Restlessness 6).Observe sign and 6).To be able to prevent
Dribbling of urine symptoms of fluid and further complication and
electrolytes imbalance such administer proper
Urinary retention
High Glucose level RBS by as dyspnea and changes in therapeutic regimen.
hgt: ECG.
03/02/09 : 200 mg/dl
Normal Value:
HGT : 70 – 100 mg/dl
Urine Output(adult) : 1200-
1500 cc/day
NURSING CARE PLAN
ASSESSMENT NSG. DIAGNOSES RATIONALE EXPECTED OUTCOME NSG. INTERVENTION RATIONALE EVALUATION
Subjective: Anxiety related to change -Anxiety is a normal After maintaining a calm Independent The client appeared relaxed
- “san-o dawla ak in health status experience. Moderate or and tolerant manner while 1).Assess patient’s level of 1).Helps determine the kind and report anxiety to a
hin matatambal (progressive/debilitating high level of anxiety can interacting with pt., and anxiety. of interventions required. manageable level,
maiha nah in nga disease) as manifested by increase alertness and assisting in developing (Gulanick, et al) verbalized awareness of
ak sakit” as frequent asking of performance in particular 2).Acknowledge awareness 2).acknowledgement of
verbalized by the questions regarding her situation. However, people anxiety-reducing skills of patient’s anxiety. patient’s feelings validates feelings of anxiety and
patient condition, weakness, who experience continues (relaxation, deep breathing, the feelings and identified healthy ways to
confusion, distressed, or recurring fears or positive visualization, communicates acceptance deal with and express
Objective: increased blood pressure, episodes of intense fear can reassuring self-statements, of those feelings. (Gulanick, anxiety after maintaining a
V/S: fearful; restlessness, feel powerless to manage etc.) the client will appear et al) calm and tolerant manner
- T : 37.7˚C feelings of helplessness & their symptoms and their relaxed and report anxiety 3).Maintain a calm and 3).Staff’s anxiety may be while interacting with pt.,
- PR : 98 BPM discomfort, sleep lives become severely tolerant manner while easily perceived by patient.
to a manageable level, and assisting in developing
- RR : 24 CPM problems; and restricted. interacting with patient. The patient’s feeling of
forgetfulness (http://www.panicanxiety verbalize awareness of stability increases in calm anxiety-reducing skills
- BP : 180/90 mmHg
disorder.orgau/index.htm) feelings of anxiety and and nonthreatening (relaxation, deep breathing,
Weight : 52 kg (pre-illness) identify healthy ways to deal atmosphere.(Gulanick, et al) positive visualization,
58 kg (during with and express anxiety. 4).Reduce sensory stimuli 4).Anxiety may escalate reassuring self-statements,
hospitalization) by maintaining a quite with excessive conversation etc.)
environment. and noise. (Gulanick, et al)
Frequent asking about her 5).Assist in developing 5).Utilizing anxiety-reduction
condition anxiety-reducing skills strategies enhance patient’s
Weakness (relaxation, deep breathing, sense of personal mastery
Confusion positive visualization, and confidence. (Gulanick,
Distressed reassuring self-statements, et al)
Increased blood pressure etc.) 6).Staff availability
Fearful 6).Encourage patient to reinforces a feeling of
Restlessness notify staff when anxious security for patient.
Feelings of helplessness & feelings occur. (Gulanick, et al)
discomfort 7).To medications maybe
Forgetfulness Dependent used if patient’s anxiety
Sleep problems 7).Administer antianxiety continues to escalate and
medications as indicated the anxiety becomes
disabling. (Gulanick, et al)
NURSING CARE PLAN
ASSESSMENT NSG. DIAGNOSES RATIONALE EXPECTED OUTCOME NSG. INTERVENTION RATIONALE EVALUATION
Subjective: Impaired gas exchange -kidney failure causes a After 30 minutes of Independent The client demonstrated
- “kinakapos ak hit related to decreased O2- decreased production of elevating HOB to 45°, 1).Position with proper body 1).This promotes lung improved ventilation and
paghinga” as carrying capacity of blood erythropoeitin w/c produces providing bed rest and alignment for optimal expansion and improves air adequate oxygenation of
verbalized by the secondary to anemia as RBC. RBC are responsible supplemental oxygen the respiratory excursion (if exchange. (Doenges, et al.) tissues by ABG’s within
patient evidenced by dyspnea, on carrying O2 & nutrients to client will demonstrate tolerated, head of bed at > normal limits and absence
weakness, restlessness, vital organs of our body. improved ventilation and 45 degrees) of symptoms after 30
Objective: irritability, easy fatigue, Decrease RBC, causes adequate oxygenation of minutes of elevating HOB to
V/S: pallor, confusion, decreased of O2 carrying tissues by ABG’s within Dependent 45°, providing bed rest and
- T : 37.7˚C dizziness and RR of 24 capacity and may result to normal limits and absence 2).Provide supplemental 2).To provide adequate supplemental oxygen.
- PR : 98 BPM cpm impaired gas exchange. of symptoms. oxygen as indicated. oxygenation (Gulanick, et
- RR : 24 CPM (http://knol.google.com/k/ al)
- BP : 180/90 mmHg charles-pollack/shortness- 3).Assist with procedures as 3).To improve respiratory
of-breath/zqxdlFRm individually indicated(e.g function/oxygen-carrying
Weight : 52 kg (pre-illness) /sj1LaA#) transfusions) capacity (Doenges, et al.)
58 kg (during
hospitalization) Independent
4).Encourage frequent 4).Promotes optimal chest
Dyspnea position changes and teach expansion and to facilitate
Weakness the patient appropriate deep adequate air. (Gulanick, et
Restlessness breathing technique. al)
Easy fatigue 5).Routinely check the 5).Causing the abdomen to
Pallor patient’s position so he/she compress the diaphragm,
Dizziness does not slide down in bed. which would cause
Confusion respiratory embarrassment
Irritability (Gulanick, et al)
ASSESSMENT NSG. DIAGNOSES RATIONALE EXPECTED OUTCOME NSG. INTERVENTION RATIONALE EVALUATION
Subjective: Sleep pattern disturbance The client is unable to sleep After 8 hours of health Independent Goals partially met.
“pirmi ak piraw hin gab-i kay related to urinary she frequently urge to teaching regarding on 1). Create an environment 1).Rapport of respect need Patient’s sleeping pattern
diri ak nahingagaturog hin frequency as evidenced empty urinary bladder. proper management of of trust by listening to to be established before the increased from 4 hours to 6
maupay” as verbalized by by complaints of not Thus, her sleeping pattern is sleeping problems the concerns, being available patient will be willing to take hours a day after 8 hours of
the patient feeling rested, early disrupted (Klopp). part in the learning process.
morning awakening, patient will be able to (Doenges, et.al) health teaching regarding
Objective: restlessness, fatigue, increase the sleeping hours 2).Assess the inability to 2). Helps determine the kind on proper management of
V/S: irritability, weakness, from 4hours to at least 8 sleep. of interventions required. sleeping problems.
- T : 37.7˚C sleep problems and hours a day. (Gulanick, et.al)
- PR : 98 BPM distressed.
- RR : 24 CPM 3).Assist patient in 3).To promote relaxation.
- BP : 180/90 mmHg observing any previous (Gulanick, et.al)
bedtime ritual.
Weight : 52 kg (pre-illness)
58 kg (during 4).Advise daytime physical 4).To promote uinary
hospitalization) activities as indicated. elimination. Thus, reducing
bladder distention to
Complaints of not feeling promote sleep during night
rested time. (Gulanick, et.al)
Early morning awakening
Restlessness 5).Limit fluid intake before 5).To prevent urinary
Fatigue bedtime. bladder retention causing
Irritability dribbling of urine. (Gulanick,
Weakness et.al)
Sleep problems
Distressed 6).Discuss activity restriction 6).Patient with ARF may
and gradual resumption of need to restrict activity
desired activity. Encourage and/or may feel weak for an
use of energy-saving, extended period during
relaxation, and diversional lengthy recovery phase,
techniques. requiring measures to
conserve energy. (Doenges,
et.al)
7).Discourage pattern of 7).Napping can disrupt
daytime naps unless normal sleep pattern.
deemed necessary or part (Gulanick, et.al)
of usual pattern.
Our patient has a bad prognosis, she did not respond to medication and
treatment. Our patient died because of many complications that had occurred
and failed to response such given medication.
HEALTH TEACHING
1). Keep blood glucose levels as close to normal as possible. The American
Diabetes Association recommends that you keep your blood sugar levels at:
90 mg/dL to 130 mg/dL before meals
110 mg/dL to 150 mg/dL at bedtime.
Less than 180 mg/dL 1 to 2 hours after meals.
Three keys to success in monitoring your blood sugar anywhere are:
Keeping your meter and supplies with you at all times so that you always
have them when you need them.
Making it a habit to check your blood sugar level by building it into your
routine.
Checking your blood sugar meter's accuracy when you visit your doctor by
comparing your results with your doctor's results.
3). Maintain blood pressure at less than 130/80 mm Hg with medicine, diet,
and exercise. Learn to check blood pressure at home.
How to take your blood pressure at home
You should not eat, use tobacco products, use medicines known to raise
blood pressure (such as certain nasal decongestant sprays), or exercise
(for at least 30 minutes) before taking your blood pressure.
Avoid taking your blood pressure if you are nervous or upset. Rest at least
15 minutes before taking a reading.
When you first obtain a blood pressure device, check its accuracy by
comparing readings from it with readings obtained by a doctor or nurse
taken in the doctor's office. Ask your doctor or nurse to observe your
technique to make sure that you are using the device correctly and that it
works right. It is a good idea to have your device checked every year.
The size and position of the blood pressure cuff can greatly affect the
accuracy of blood pressure readings. If the cuff is too small or too large,
the blood pressure results will be inaccurate. As a general rule, the
inflatable part of the cuff needs to be at least as long as the widest
measurement around your upper arm.
Take your blood pressure while you are seated in a comfortable, relaxed
position. Try not to move or talk while you are measuring your blood
pressure. Be aware that the blood pressure readings may be 10 to 20 mm
Hg different between your right arm and your left arm. For this reason, you
may want to use the same arm for every reading.
Record your blood pressure reading.
4). Maintain a healthy weight. This can help prevent other diseases, such as
high blood pressure and heart disease.
5). Follow the nutrition guidelines for hypertension (including the Dietary
Approaches to Stop Hypertension, or DASH, diet).
Key points:
Eating fewer processed foods, such as snack items, luncheon meats, and
canned soups, will reduce the amount of sodium in your diet and help you
lower your blood pressure.
A diet high in calcium, potassium, and magnesium may lower your blood
pressure.
A diet high in sodium may cause high blood pressure.
To increase the potassium in your diet, fruits and vegetables are excellent
sources of this nutrient. Dairy products are high in calcium and
magnesium. DASH recommends that you eat 8 to 10 servings of fruits and
vegetables and 3 servings of low-fat dairy products each day.
Eating a diet low in both saturated fat and total fat will also help lower your
blood pressure. Only 30% of your total calories should be from fat, with
only 7% to 10% of your fat calories from saturated fat. Saturated fat is
found in meats, cheeses, butter, poultry, snack foods, and other
processed foods.
In general, vegetarian diets reduce blood pressure. The DASH diet could
easily be a vegetarian diet if legumes were substituted for meat.
Vegetarian diets tend to be higher in potassium, magnesium, and calcium,
as is the DASH diet. Vegetarian diets also are higher in fiber and
unsaturated fat than other diets.
8). Treat other conditions that may block the normal flow of urine out of the
kidneys, such as kidney stones, an enlarged prostate, or bladder problems.
9). Avoid the use of medicines that may be harmful to our kidneys,
especially nonsteroidal anti-inflammatory drugs (NSAIDs). Be sure that your
health professional knows about all prescription, nonprescription, and herbal
medicines you are taking.
11). Avoid situations where you risk losing large amounts of blood, such as
unnecessary surgeries. Do not donate blood or plasma.