Case Study | 1

Case Study

Student: Charle Ryan Paguel

Student No: 822-851-358
Date Submitted: March 16, 2015
Nurs. 252: Complex Issues and Patient Safety
Humber College North

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Chronic Kidney Failure

A 32 year old male was brought to acute care centre accompanied by his sister due to
complaints of generalized weakness and feeling unwell. This client is alert and oriented to
person, place, and time. However, he has generalized edema throughout, and generalized
weakness with one person assist to ambulate. The client present vital signs are; temperature 36 C,
pulse rate 120, respiration 22, blood pressure 130/68, and oxygen saturation of 93% on room air.
His blood worked indicates a sodium level of 132 mmol/L below the normal range of (135-145)
mmol/L, a potassium level of 3.2mmol/L also below the normal range of (3.5-5.0)mmol/L, and a
magnesium level of 0.68 mmol/L within normal range of (.65-1.05)mmol/L. The client medical
past history includes; diagnosed with clinical depression in 2007, he is currently on several antidepressive medications, and the client is also diagnosed with chronic kidney failure requiring
dialysis to maintain normal kidney functionality. Considering the current physical condition of
the client I decided to focus my highest priority on chronic kidney failure.
Psychosocial and Pathophysiological Priority
As the nurse assigned to care for this client, I came up with two important priorities.
Firstly, psychosocial factor that is centered on the client living alone, with the client current
health condition he could be at risk of social isolation, general anxieties, and because of poor
maintenance of his chronic kidney disease in the past, I came up with a nursing diagnosis of
ineffective health maintenance related to his chronic kidney disease.
Secondly, chronic kidney failure as pathophysiological factor that needs to be address
first because of the client abnormal vital signs, this include increase heart rate, decreased
diastolic pressure, and declined oxygen saturation, and a laboratory results indicated by below

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normal ranges of sodium, and potassium level. The client is experiencing a decrease functional
ability related to anemia, a decrease of oxygen carrying capacity of the red blood cells that is
common to client undergoing dialysis, as evidenced by generalized weakness. The client is also
experiencing altered nutrition less than body requirements because of dietary restriction to
maintain healthy lifestyle for clients with chronic kidney failure. Lastly, the client is
experiencing excess fluid volume related to inability of the kidneys to excrete excess fluid,
evidence by generalized edema.
According to the research study by Paul Arora, Priya Vasa, Darren Brenner, Karl Iglar,
Phil McFarlane , Howard Morrison , Alaa Badawi, Between 2007 and 2009, 12.5% of Canadian
adults (2.9 million people) were living with chronic kidney disease, an important risk factor for
end-stage renal disease and all-cause mortality. The research study suggests that if chronic
kidney disease is not treated immediately it will lead to kidney failure, additionally when the
kidneys fail; it affects whole body system which is important in maintaining a good physical
health. The cardiovascular system worked together with the kidneys to maintain proper fluid
volume levels, and electrolytes balances within the body. Because of this reason I choose to
focus on excess fluid volume related to inability of the kidneys to excrete excess fluid.
Clinical Manifestations
The client present physical condition shows alteration of some important electrolytes that
can greatly affect the fluid volume within the clients body. Sodium is the major extracellular
cation, and potassium is the major intracellular cation, both electrolytes are necessary for the
conduction of nerve impulses and for muscle contraction (Marieb, 2009). The client presented
with generalized edema due to excess fluid in the body, generalized weakness that are associated

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with low potassium and sodium level, tachycardia, declined oxygen saturation, and low diastolic
pressure meaning a decrease of blood flow to the ventricles of the heart during periods of rest
because of poor renal perfusion that can result in an increase of creatinine levels. In addition, the
clients laboratory results show that the sodium level of 132mmol/L is below the normal range of
135-145 mmol/L, Sodium may be normal or low in renal failure. Because of impaired sodium
excretion, sodium is retained along with water. If large quantities of body water are retained,
dilutional hyponatremia occurs. Sodium retention can contribute to edema, hypertension, and
congestive heart failure, (Lewis, Dirksen, Heitkemper, Bucher, Camera, Barry, Goldsworthy
and Goodridge, 2014, p.1342).
Nursing Interventions
Nursing diagnosis of excess fluid volume related to inability of the kidney to excrete
excess fluid, evidence by the client present physical condition with generalized edema,
tachycardia, abnormal blood pressure, declined oxygen saturation, and history of chronic kidney
failure. As a nurse assigned to this client, I will start my intervention by monitoring blood
pressure, monitoring periorbital, sacral, and peripheral edema, and monitoring for shortness of
breath which are indicators of fluid volume excess (Lewis et al, 2014). As fluid accumulates
inside the body this causes the heart to work harder to compensate for the increase volume;
however, with decrease capability of the kidney to excrete excess fluid, it will results in fluid
accumulation in the interstitial tissue (edema), and into the lungs (pulmonary edema).
Maintain fluid restriction if ordered, Fluid intake for patients with chronic kidney disease
depends on the daily urine output and overall fluid balance. For patients receiving hemodialysis,
fluids are generally restricted as urine output begins to decline. Patients not yet on dialysis, fluids

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are generally not restricted and diuretics and a low-sodium diet help to manage fluid retention
(Lewis et al, 2014, p.1347).
To accurately determine the fluid volume inside the client body, monitoring weight,
intake and output is very important to evaluate treatment on volume status. An ideal body weight
(IBW) is the result of body mass index (BMI) calculated from a client weight over height square,
this will provides an estimate of what a person should weigh. If rapid weight gain is detected it
usually reflects a fluid shift, (Potter &Perry, 2014).
Provide the client with appropriate diet instruction to help control edema and
hypertension (Lewis et al, 2014). Nutritional intake for people with chronic kidney disease is
very important because some food can contribute to an increase in electrolytes like sodium, and
potassium. For example, some foods that are rich in sodium are process foods, and potassium
rich foods are green leafy vegetables. Therefore, the client needs to be referred to a dietician for
safe nutritional food intake options. Protein is moderately restricted because blood urea nitrogen
is an end product of protein metabolism (Lewis et al, 2014, p.1346).
Educate the client about the signs and symptoms of hypervolemia, and its treatment to
help monitor and control fluid overload and related hypertension (Lewis et al, 2014). With the
client increase knowledge of his disease process, he can prevent future complications. The client
needs to learn how to monitor his weight daily, following diet restriction, and to comply with all
treatment regimens.
Conclusion
I therefore conclude that to prevent chronic kidney failure progress to end stage renal
disease, as a nurse caring for a client with chronic kidney failure we need to emphasize the

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importance of lifestyle changes that include diet and fluid restriction, maintaining a healthy body
weight, and following all treatment regimens especially while on dialysis. It is also very
beneficial to educate the client about their chronic kidney failure to increase their awareness of
how to prevent future complications. However, when all treatments fail I recommend kidney
transplant as the last alternative for the client with chronic kidney failure to be able to live a
longer and normal life.

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References
Arora, P., M.Sc, Vasa, Priya,M.Sc, M.D., Brenner, D., PhD., Iglar, K., M.D., McFarlane,
Phil,M.D., PhD., Morrison, H., PhD., & Badawi, A., PhD. (2013). Prevalence estimates of
chronic kidney disease in canada: Results of a nationally representative survey. Canadian
Medical Association.Journal, 185(9), E417-23. Retrieved from
http://search.proquest.com/docview/1413334971?accountid=11530
Marieb, E. (2009). Essentials of human anatomy & physiology (9th ed.). San Francisco:
Pearson/Benjamin Cummings.
Lewis, S. M., Heitkemper, M. M., Dirksen, S. R., OBrien, P.G., & Bucher, L. (2014). Medicalsurgical nursing in Canada: Assessment and management of clinical problems (3rd ed.).
Toronto: Elsevier.
Potter, P.,Perry, A.G., Ross-Kerr, J., Wood, M., Astle, B., & Duggleby, W. (2014).
Canadian fundamentals of nursing (5th ed). Toronto: Mosby.