CHRONIC

KIDNEY
DISEASE

SUBMITTED BY:
MELISSA D. DAVID
SUBMITTED TO:
VANESSA ONG-UMALI

GENERAL OBJECTIVES:

The general objective of the case study is to gain the comprehensive

knowledge about the disease to gain the practical exercise about the Adult
Health Problem and also to gain Practical experience working with a patient
having chronic kidney disease and to give holistic patient care according to
their need.

SPECIFIC OBJECTIVES:

Describe Chronic Kidney Disease

Recognize its clinical signs and symptoms
Identify causative factors of heart failure
Identify diagnostic procedures used to determine the disease
Know the medical and surgical management

I.

INTRODUCTION
Chronic kidney disease is a progressive reduction of functioning renal
tissue such that the remaining kidney mass can no longer maintain the
bodys internal environment. CKD can develop insidiously over many
years, or it may result from an episode of a cure renal failure from which
the client has not recovered.
Chronic kidney disease affects many body systems. It can also lead to
many complications. This is the goal of health care providers, to prevent
any occurrence of complications. One of the complications of CKD is
hyperparathyroidism; this is due to the compensatory mechanism of the
parathyroid hormone once it detects any alteration in the calcium level of
the body.
It

is

important

for

clinicians

to

recognize

the

problem

of

hyperparathyroidism early in the course of chronic kidney disease so that

growth of the parathyroid glands can be prevented or halted, and
excessive secretion of hyperthyroidism can be controlled to help minimize
the adverse consequences on bone and mineral metabolism, which may
lead to bone pain and bone fractures, decreased growth in children,
muscle weakness, and elevations in the calcium phosphorus product,
which contributes to calcification of the heart valves and blood vessels
and contributes to the high cardiovascular mortality in patients with
advanced kidney disease.
Early detection of this complication of chronic kidney disease will
provide an opportunity to intervene to control the secretion of parathyroid
hormone and, thus, minimize the problem. Early detection will also allow
for the opportunity to prevent further growth of the parathyroid glands so
that the magnitude of the problem will be lessened as kidney function
deteriorates.

There

is

also

some

evidence

that

the

control

of

hyperparathyroidism may help to slow the progression of kidney disease.

Ultimately, it is hoped that with timely intervention to control this
complication of chronic kidney disease, improved patient outcomes on in
terms of morbidity and mortality will be achieved.
To ensure that the diagnosis of hyperparathyroidism is made early in
the course of chronic kidney disease, it is important to educate primary
care physicians, cardiologists, endocrinologists and other healthcare
providers who may see patients in the early stages of chronic kidney
disease, so that they may assess blood parathyroid hormone levels to
uncover this complication and either embark on the treatment of
hyperparathyroidism or consider referral to a nephrologists for further
advice

on

the

appropriate

management

strategies.

Referral

to

nephrologists would appear to be preferable at the present time as the

field is advancing with new therapies being evaluated and implemented in
practice.
As nurses, we could help our patients by having a deep
understanding of the disease, that we may learn the proper interventions
for the chronic kidney disease patients. In this way, we could render
quality care for them. We could as well lead them to the proper treatment
to lessen their sufferings brought by the kidney failure, in anyhow. By
having a wide understanding of the disease, we could impart teachings on
how we could prevent the occurrence of chronic kidney disease. As
nurses, it is our responsibility to render information and impart health
teachings to improve the condition of our patients to the best of our
abilities. One of the characteristics that we, nurses, should have is to be
informative and only through a keen study of disease such as this way for
us to gain all the information that we need to learn. May this case study
served its purpose through the help of our Lord, Jesus Christ.

II.

ANATOMY AND PHYSIOLOGY

The kidneys are bean-shaped organs. They are about 12 cm (45

in) long, 6 cm (23 in) wide and 3 cm (12 in) thick. A layer of fatty
tissue holds the kidneys in place against the muscle at the back of the
abdomen.
Gerotas fascia is a thin, fibrous tissue on the outside of the kidney.
Below Gerotas fascia is a layer of fat.
The renal capsule is a layer of fibrous tissue that surrounds s the
body of the kidney, inside the layer of fat.
The cortex is the tissue just under the renal capsule.
The medulla is the inner part of the kidney.
The renal pelvis is a hollow area in the centre of each kidney where
urine collects.
The renal artery brings blood to the kidney.
The renal vein takes blood back to the body after it has passed
through the kidney.
The renal hilum is the area where the renal artery, renal vein and
ureter enter the kidney.
The nephrons are the millions of small tubes inside each kidney. Each
nephron has 2 parts. Tubules are tiny tubes that collect the waste
materials and chemicals from the blood moving through the kidney.
The corpuscles contain a clump of tiny blood vessels called glomeruli
that filter the blood as it moves through the kidney. The waste products

are passed through the tubules to the collecting ducts, which drain into
the renal pelvis.

The main function of the kidneys is to filter water, impurities and

wastes from the blood. The blood from the body enters the kidneys
through the renal arteries. Once in the kidney, the blood passes
through the nephrons, where waste products and extra water are
removed. The clean blood is returned to the body through the renal
veins.
The waste products filtered from the blood are then concentrated into urine.
The urine is collected in the renal pelvis. The ureters move the urine to the
bladder, where it is stored. Urine is passed out of the bladder and the body
through the urethra.
The kidneys also act as endocrine glands. They make these hormones that
regulates specific body functions, such as metabolism, growth and
reproduction:
Erythropoietin (EPO) stimulates the bone marrow to make red blood
cells.
Calcitriol, a form of vitamin D, helps the colon absorb calcium. A
mineral that the body uses to build and maintain bones, teeth and
connective tissues (tissue that surrounds and supports various
organs in the body), and is essential in metabolism and the
functioning of nerves and muscles from the diet.
Renin helps control blood pressure.

III.

PATHOPHYSIOLOGY
Predisposing Factors
Genetics
Age >40

Precipitating
Environment(intrapartal)
Toxin/Virus
Obesity
Decrease Serum Potasium

Decrease insulin production/sensitivity

Increased Osmolarity due to Glucose

Polydipsia

Polyuria

Elevated Serum Glucose

PolyphagiaChronic elevation of Serum Glucose

Weight loss

Diabetic neuropathy

Impaired immune function

Small vessel diseaseDiabetic retinopathyAccelerated atherosclerosis

Hypertension
Symmetrical loss of sensation

Diabetic nephropathy
Coronary artery disease

Infection

Numbness and paresthesia

Wasting of intrinsic muscles

End-stage renal failure

Loss of vision
Increase LDL levels

Delayed wound healing

Autonomic neuropathy
Impotence

Dry, cracked skin

Diabetic foot ulceration

Charcot changes in joints

Neurogenic bladder
Gastroparesis

IV.

PATIENTS PROFILE
V.
VI.

VII.
VIII.
IX.
X.
XI.
XII.
XIII.
XIV.
XV.
XVI.
XVII.
XVIII.
XIX.

Patients Name:
Ward Rm:
Age:
Sex:
Civil Status:
Birth Place:
Nationality:
Religion:
Admission Date:
Physicians Diagnosis:
CC:

PATIENT MS
5D
33 y/o
Female
Married
Pasig City
Filipino
Catholic
08/16/2015
Chronic Kidney Disease
DOB

History of Present Illness:

Started two weeks PTC when patient had episodes of fever and

cough with associated SOB. Patient had no medication or consult done.

Patient was apparently well with occasional episode of SOB, easy
fatigueability and fever and loss of appetite. Two days PTC patient noted to
have DOB accompanied by palpitations and tremors. Seizure episode
cannot be confirmed at this point. Patient then sought consult to a station
hospital. At the station hospital it was noted that the patient presented
with unilateral leg swelling and a single posterior lesion oozing with pus at
the left inguinal area. For the DOB, patient was hooked to O2 via nasal
canula, antibiotic was planned to be started but was not given. Few hours
PTC, patient was noted to have apparent decrease in sensorium hence was
intubated. Post intubation, patient did not respond and decline of
sensorium persisted hence patient was refered to out service for further
management. At the ER, patient was GCS 3. Re-intubation was done. While
attempting to do so, patient had a 7 second seizure episode with noted
stiffness of extremities, bulging of eyes and increase secretion. Patient was
subsequently admitted.
XX.
XXI.
PHYSICAL EXAMINATION
XXII.
VITAL SIGNS:
BP 140/80 PR 133 bpm
O2 Sat 95%
XXIII.
SKIN:
Good skin turgor, warm to touch, no lesion,
no rashes

XXIV.
XXV.

HEENT:
CHEST/LUNGS:

Anicteric Sclera, PERRLA

Symmetric chest expansion with supraclavicular

retractions,
XXVII.

XXVI.
HEART:

rhythm, (-) murmurs

XXVIII.
ABDOMEN:
XXIX.
EXTREMITIES:
XXX.
NEUROGICAL:

clear breath sounds

Adynamic
precordium,

tachycardic,

regular

Flabby abdomen, NABS, soft, non-tender

Full and equal pulse, (+) edema
GCS 3

XXXI.

LABORATORY PROCEDURES

XXXII.
XXXVII.
XXXIII.

Diagnosti
c/
XXXIV.
Laborator
y XXXV.
Procedur
e

XXXIX.
XL.

1. CBC

XLI.

Hgb

CXXXI.

CLXXXIV.

CCXXXIII.

XCII.

CXXXII.

CLXXXV.

CCXXXIV.

XCIII.

CXXXIII.

CLXXXVI.

CCXXXV.

XCIV.

Usually done
CXXXIV.
to
a pt. with renal
disease to CXXXV.
determine CXXXVI.
if the
kidneys ability
to releaseCXXXVII.
erythorpoietin
CXXXVIII.
factor is already
affected
CXXXIX.

CLXXXVII.
72

CCXXXVI.
120170
g/L

XLIII.
XLIV.
XLV.
XLVI.

XLVIII.

XCV.
XCVI.

XLIX.

XCVII.

L.

XCVIII.

LI.

Hct XCIX.

LII.

C.

LIII.
LIV.
LV.
LVI.

Purpose (s)

Re
sult

XCI.

XLII.

XLVII.

Indication (s)
XXXVI.

Nor
mal
Valu
es
XXXVIII.
used
by
the
hosp
ital

CI.

103
107
CLXXXVIII.
118
CLXXXIX.
109
CXC.
CXCI.

CCXXXVII.

CXL.

CXCII.

CCXXXVIII.

CXLI.

CXCIII.

CCXXXIX.

CXLII.

CXCIV.

CCXL.

CXLIII.

CXCV.

CCXLI.

CXLIV.

.23
CXCVI.

CCXLII.

CXLV.

.31
CXCVII.

CCXLIII.
.
40-.
CCXLIV.
50

Used to
CXLVI.
measure RBC
number andCXLVII.
volume. It is an
integral partCXLVIII.
of
the evaluation

.33
.36
CXCVIII.
.32
CXCIX.

Analysis and
Interpretation

Results were all

below the
normal level,
thus indicating
renal
malfunction and
thereby causing
anemia

Result were all

below the
normal range
thus, showing
anemia and

LVII.
LVIII.
CII.

LIX.
LX.
LXI.
LXII.
LXIII.
LXIV.
LXV.

WBC

CIII.
CIV.

CVI.

CVIII.

LXVII.

CX.

LXX.

CXI.
CXII.
CXIII.

LXXI.
LXXII.
LXXIII.
LXXIV.
LXXV.
LXXVI.
LXXVII.
LXXVIII.

CXIV.
CXV.
Neutrop
hils CXVI.
CXVII.
CXVIII.
CXIX.
CXX.

LXXIX.
LXXX.

CCXLV.

CLI.

CCII.

CCXLVI.

CLII.

CCIII.

CCXLVII.

CLIII.

7.7
CCIV.
6
CCV.
6.0
1CCVI.

CCXLVIII.

CLIV.

CVII.

Leukoc
ytes CIX.

LXIX.

CCI.

CV.

LXVI.

LXVIII.

of anemic CXLIX.
patients
CL.

Lympho
cytes
CXXI.

CC.

renal disease

CCXLIX.
5- CCL.
10x1
CCLI.
09/L

CLV.
Determines any
inflammation
and infection CLVI.

9.4
0
CCVII.
8.5
CCVIII.
8

CLVII.

CCIX.
9.5

CLVIII.

CCX.

CCLII.

CLIX.

CCXI.
.81

CCLIII.

CLX.
Determines any
acute bacterialCLXI.
infection
CLXII.

CCXII.
.75

. CCLIV.
50-.
CCLV.
70

CCXIII.
.72

CLXIII.

CCXIV.
.74

CLXIV.

CCXV.

CLXV.

CCXVI.

CLXVI.

CCXVII.

CLXVII.

CCXVIII.
.1

CLXVIII.
Determines any
CLXIX.
chronic
bacterial CLXX.
infection or viral
infection CLXXI.

CCXIX.
.13

CLXXII.

.71

CCXX.
.20
.15
.13
CCXXI.

Results were all

above normal
level. This
shows presence
of inflammation
and infection

Results were all

above normal
level. This
shows presence
of bacterial
infection

CCLVI.
CCLVII.
CCLVIII.
CCLIX.
CCLX.
.
CCLXI.
10-.
40

Results were all

within normal
level. Showing
absence of
chronic infection

LXXXI.

CXXII.

CLXXIII.

CCXXII.
.05

CCLXII.

LXXXII.

CXXIII.

CLXXIV.

CCXXIII.
.08

CCLXIII.

LXXXIII.

CXXIV.

CLXXV.

CCXXIV.
.04

CCLXIV.

LXXXIV.

CXXV.

DeterminesCLXXVI.
any
acute bacterial
infection CLXXVII.

CCXXV.
.09

CCLXV.

LXXXV.
LXXXVI.
LXXXVII.
LXXXVIII.
LXXXIX.
XC.

CCXXVI.
.07

Monocy
CXXVI.
tes
CXXVII.

CLXXVIII.
CLXXIX.

.04
CCXXVII.

CXXVIII.

CLXXX.

.04
CCXXVIII.

CXXIX.

CLXXXI.

.05
CCXXIX.

CXXX.

CLXXXII.
To determine
any allergic
CLXXXIII.
reaction of the
body

.04
CCXXX.
.06
CCXXXI.
CCXXXII.

CCLXVI.
.
00-.
07
CCLXVII.

Some of the
results were all
above normal
Level indicating
presence of
bacteria.

CCLXVIII.
CCLXIX.
CCLXX.
CCLXXI.
.
00-.
07

Results were all

within the
normal level.
This shows no
allergic
reactions.

CCLXXII.
CCLXXIII.
CCLXXIV.

Diagn
ostic/
CCLXXV.
Labor
atory
CCLXXVI.
Proce
dure

CCLXXVIII.

Indication (s)
CCLXXVII.
Purpose
(s)

Result

CCLXXIX.

CCLXXXV.

CCLXXXVIII.

CCXCIV.

CCLXXX.

CCLXXXVI.
2.
Hepat
itis
Profil
e

This isCCLXXXIX.
usually
done before
proceedingCCXC.
in
hemodialysis.
This is to CCXCI.
determine if
the patient was
expose to the

HBSAG- non-reactive
CCXCV.

CCLXXXI.

ANTI-HCV- nonreactive
ANTI-HBC- nonreactive

Analysis
and
Interpretati
on

Result
revealed
that the
patient
has no
hepatitis
virus and
was not

CCLXXXII.

virus of if there
CCXCII.
is presence of
CCXCIII.
hepatitis virus

CCLXXXIII.
CCLXXXIV.

CCLXXXVII.

ANTI-HBS-reactive

exposed
to any of
it.

HAV-IGM- nonreactive

In the blood of
the patient.

CCXCVI.
CCXCVII.
CCXCIX.
CCXCVIII.

Diag
nosti
c/
Labor
atory
CCC.
Proc
edure

In
di
ca
tio
n
(s)

CCCII.
CCCI.

Result

Pu
rp
os
e
(s)

CCCIII.

CCCV.

CCCVII.

CCCXXVI.

CCCIV.

3.Uri
CCCVI.
nalys
is

CCCVIII.
To
di
CCCIX.
ag
no
CCCX.
se
an
CCCXI.
d
CCCXII.
m
on
CCCXIII.
ito
r
CCCXIV.
re
CCCXV.
na
l
CCCXVI.
or
uri
na
CCCXVII.
ry
CCCXVIII.
tra
ct

Color: straw, light yellow, lightCCCXXVII.

yellow
Appearance: slightly turbid
pH: 5
Specific Gravity:
1.020, 1.025, 1.020
Albumin:
3+
Sugar: negative
Pus Cells: 1-2/HPF, 0-2/HPF, 2-5
/HPF
Red cells: 1-3/HPF,
1-3/HPF,4-6/HPF

Analysi
s and
Interpre
tation

Laborat
ory
results
reveale
d that
there is
presenc
e of
albumin
in the
blood;
this
indicate
s that
the
glomeru
lar
cannot
filter
large

CCCXXVIII.
CCCXXIX.
CCCXXX.
CCCXXXI.

CCCXIX.
di
se
CCCXX.
as
e
CCCXXI.

Epithelial Cells:

CCCXXII.

Rare, (-), (-)

CCCXXIII.

Bacteria: (-), few, (-)

CCCXXIV.

Amorphous urates:

CCCXXV.

Moderate, moderate, few

Rare
Mucus thread:

molecul
es such
as that
of
albumin
. It also
reveale
d that
there is
bacteria
l
infectio
n as
evidenc
ed by
presenc
e of
bacteria
, pus
cells
and red
cells in
the
urine.

CCCXXXII.

CCCLV.

CCCLXVIII.

CCCXCI.

CDXIII.

CCCXXXIII.

4. CCCLVI.
Creatin
ine

This
CCCLXIX.
test
CCCLXX.
was
ordered
CCCLXXI.
in order
to
CCCLXXII.
evaluat
CCCLXXIII.
e renal
function
CCCLXXIV.
.
CCCLXXV.

1499
CCCXCII.

44.20CDXIV.
150.3
0
umol/
L

CCCXXXIV.
CCCXXXV.
CCCXXXVI.
CCCXXXVII.
CCCXXXVIII.

CCCLVII.

CCCXXXIX.

CCCLVIII.

CCCXL.

5. CCCLIX.
Na+

CCCXLI.

CCCLX.

CCCXLII.

CCCLXI.

CCCXLIII.
CCCXLIV.

6. K+

CCCXLV.
CCCXLVI.
CCCXLVII.
CCCXLVIII.

CCCXLIX.

7.
Calciu
m
CCCLXII.
CCCLXIII.

CCCL.
CCCLI.
CCCLII.
CCCLIII.
CCCLIV.

8.
Phosp
hate

CCCLXXVI.
CCCLXXVII.

1430
1649
731
CCCXCIII.
CCCXCIV.
CCCXCV.
CCCXCVI.
137
CCCXCVII.
CCCXCVIII.

CCCLXXVIII.
CCCLXXIX.
To
evaluat
CCCLXXX.
e fluid
CCCLXXXI.
and
electrol
CCCLXXXII.
yte
imbalan
CCCLXXXIII.
ce and
CCCLXXXIV.
identify
renal
CCCLXXXV.
dysfunc
tion
CCCLXXXVI.

135150
mmol/
L

4.78
CCCXCIX.
CD.
CDI.
CDII.
6.4

CDIII.

CCCLXXXVII.

CDIV.

To
CCCLXXXVIII.
evaluat
CCCLXXXIX.
e fluid
and
CCCXC.
electrol
yte
imbalan
ce and
identify
renal
dysfunc

CDV.
CDVI.
186

CDXV.

WNL

3.5CDXVI.
5.5
mmol/
CDXVII.
L
CDXVIII.
CDXIX.

8.510.5
mg/dl

CDVII.
CDVIII.
CDIX.

Results
were all
above
the
normal
level
indicating
renal
malfuncti
on. The
kidney
cannot
excrete
nitrogeno
us waste
product
of protein
leading to
its
accumula
tion in the
blood

CDXX.

Results
were all
above
the
normal
level
indicating
renal
malfuncti
on.

tion
CCCLXIV.
CCCLXV.

To
evaluat
e
muscle
contract
ion,
nerve
impulse
transmi
ssion,
and
blood
clotting

CDX.

CDXXI.

CDXI.

CDXXII.

CDXII.

30150
u/L

Results
were all
above
the
normal
level
indicating
renal
malfuncti
on.

CDXXIII.

CCCLXVI.
CCCLXVII.

CDXXIV.

Medical CDXXV.
Management

To
evaluat
e the
metabol
ism of
carbohy
drates,
bone
formatio
n and
acidbase
balance
.

General DescriptionCDXXVI.

Indication
(s)

CDXXVII.

Purpose (s)

CDXXVIII.

CDXLIII.

CDLIV.

CDXXIX.

1. D5 LRS
CDXLIV.
KVO

A crystallized solution thatCDLV.

is
available in a variety of
concentrated water and
calories are provided. It is
hypertonic solution
containing equal amounts
of
CDLVI.
Na and Cl
CDLVII.

To maintain
fluid
balance of
the pt.

CDLVIII.
A catheter tube is inserted
into vein in either your neck,
chest, leg or near the groin.
It has two chambers to allow
CDLIX.
two-way flow of blood
CDLX.

Temporary
access for
hemodialysi
s

CDLXI.
It is intravenous replacement
of loss or destroyed blood
compatible citrated human
blood it is also the
introduction of whole blood
or blood component

To
immediatel
y restore
blood
volume to
treat severe
anemia, to
be able to
maintain
oxygen
transport to
the different
parts of the
body

iL x
CDXXX.
CDXXXI.

2. D5 NaCl
iL x KVO

CDXXXII.

CDXLV.

CDXXXIII.

CDXLVI.
3.
CDXLVII.
Subclavian
catheterizat
ion

CDXXXIV.
CDXXXV.
CDXXXVI.

CDXLVIII.
CDXLIX.
4.Blood
Transfusion

CDXXXVII.
CDXXXVIII.
CDXXXIX.

CDL.

CDXL.

CDLI.

CDXLI.

CDLII.

CDXLII.

5.
CDLIII.
Hemodialysi
s

Medical treatment used to

promote excretion of wastes
materials from the blood of
CDLXII.
patient.
CDLXIII.

It is
indicated
for the
patient
because the

kidneys
cannot
function
very well to
excrete the
nitrogenous
waste
products,
thus leading
to its
accumulatio
n in the
blood.

CDLXIV.

CDLXV.
CDLXVI.
CDLXXII.
CDLXXIII.

CDLXXIV.
CDLXXV.
CDLXXVI.

CDLXXVII.
CDLXXVIII.

NURSING CARE PLAN

Assessm
CDLXVII.
ent
Subjective
CDLXXIX.
data:

Namamag
a ang
mukha at
kamay ko
as
verbalized
by the
patient.
Objective
data:
- patients
face and
hand was
swelling
-irritable
-appears
weak

CDLXVIII.
Nsg.
Diagno
sis
Excess
CDLXXX.
fluid
volume
related
to fluid
accumu
lation
betwee
n
dialysis
treatme
nts.

Plann
CDLXIX.
ing
CDLXXXI.
Patient
will
maint
ain
fluid
volum
e
status
CDLXXXII.
within
establi
shed
param
CDLXXXIII.
eters.
CDLXXXIV.

Intervention
CDLXX.
-weight, lung
CDXCI.
sounds and
extremities
were assessed
for presence of
edema.
CDXCII.
-input and
output was
monitored.

-To determine
CDXCIX.
the
fluid volume so
that treatment
parameters can
be identified.

CDXCIII.
-laboratory
data was
monitored

-nitrogenous
waste and
electrolytes
accumulate
between
treatments.
Anemia and blood
losses associated
with hemodialysis
are complications
associated with
kidney failure.

CDLXXXV.
CDLXXXVI.
CDLXXXVII.
CDLXXXVIII.

Rationale
CDLXXI.

-fluid
restrictions
between
treatment CDXCIV.
was
maintained.

-Intake is limited
and must be
monitored to
prevent fluid
volume overload.

-to prevent
excess intake,

Evaluation
Patient was
able to
maintain fluid
volume status
within
established
parameters.

CDLXXXIX.
CDXC.

-the need for

restricting CDXCV.
sodium intake
CDXCVI.
was teached.

which can lead to

hypervolemia

-sodium intake
stimulates thirst
which can lead to
excessive fluid
intake and
subsequent
hypervolemia

CDXCVII.
CDXCVIII.

D.

Assessm DI.
ent

Nsg.DII.
Diagno
sis

Plann
DIII.
ing

Intervention

DIV.

Rationale

DV.

Evaluation

DVI.
DVII.

DVIII.
DIX.
DX.
DXI.
DXII.
DXIII.
DXIV.
DXV.

Subjective
DXVI.
data:
Nahihirap
an akong
kumilos,
parang
ang bigat
ng likod at
dibdib ko.
as
verbalized
DXVII.
by the
patient
Objective
data:
-weakness
-dyspnea
-tiredness
-limited
ROM
- PR 104
bpm
- BP
180/90
DXVIII.

DXIX.

Activity
DXX.
intolera
nce r/t
imbala
nced
O2
supply
and
deman
d
AEB:
Patient
s
statem
ent,
Nahihi
rapan
akong
kumilos
,
parang
ang
bigat
ng likod
at
dibdib
ko.
weakne
ss,
tiredne
ss,
dyspne
a,
limited
ROM
and
ABN
BP/puls

After
DXXI.
8
hours
of
nursin
g care,
DXXII.
theDXXIII.
patien
t will
report
DXXIV.
measu
DXXV.
rable
increa
seDXXVI.
in
activit
DXXVII.
y
intoler
ance
with
vital
signs
within
DXXVIII.
norma
DXXIX.
l
range
DXXX.
DXXXI.

DXXXII.
DXXXIII.
DXXXIV.

Positioned DXXXV.
the
client to Highfowlers DXXXVI.
position. DXXXVII.
DXXXVIII.
Provide positive
and calm
atmosphere
DXXXIX.
Assist patientDXL.
in self-care
activities
DXLI.
DXLII.
Monitor
DXLIII.
response of
patient to an
activity andDXLIV.
recognize the
DXLV.
signs and DXLVI.
symptoms DXLVII.
Encourage
patient to have
DXLVIII.
adequate bed
DXLIX.
rest and sleep DL.
Instruct to
avoid strainingDLI.
during
DLII.
defecation DLIII.
DLIV.
Dependent
Administer
Oxygen
therapy as
indicated

To promote lung DLV.

expansion.
Helps minimize
frustrations,
rechanneling
energy
To promote
comfort
To indicate need
to alter activity
level

To promote
relaxation of the
body
Valsalva
maneuver may
disrupt blood flow

To provide
sufficient
oxygenation of
tissues

After 2 hours
of nursing
interventions,
airway
patency of
the patient
has been
maintained
and signs of
dyspnea has
been
lessened.

II.

I.

VII.

VIII.

IX.
X.

XI.

XII.
XIII.

XIV.

e
Name of
respons
Drug
e to
activity

XXI.
Amlodipi
XXII.
ne
besylate
norvasc XXIII.
XXIV.
XXV.

XXVI.
Metoprol
ol
tartate
neobloc
XXVII.
XXVIII.
Iberet-XXIX.
XXX.

folic acid
XV.
XVI.

DLVI.
DLVII.
DLVIII.
DLIX.
DLX.
DLXI.

XVII.

XXXI.
furosemi
XXXII.
de
XXXIII.
lasix

XVIII.

XIX.
XX.

calcium
carbonat
XXXIV.
e
XXXV.

XXXVI.

Rou
te
of
adm
in.
III.
Dos
age
and
freq
. Of
adm
in.
XXXVII.

XXXVIII.
PO 5
mg
OD

PO
50
XXXIX.
mg XL.
OD

PO 1
cap
BIDXLI.

XLII.

PO
40XLIII.
mgXLIV.
XLV.
OD
XLVI.
XLVII.
PO 1
XLVIII.
tab.
TID

IV.
Gener
al
action V.

XLIX.
Calciu L.
m
antago
nist,
antihyp
ertensi
ve
LI.

LII.

Beta
blocker
s,
antihyp
ertensi
ve drug
LIII.

LIV.

Iron
deficie
ncy

Indicati VI.
on (s)
Purpos
e(s)

LX.
To
LXI.
decreas
e
increase
blood
pressure
LXII.
LXIII.

Patient
did not
show any
side
effects

LXIV.
To
decreas
e
increase
blood
LXV.
pressure
LXVI.
For LXVII.
patient
having
anemia

Patient
did not
show any
side
effects

LV.
DiuretiLVI.
c
LVII.
LVIII.
Calciu
LIX.
m
supple
ment

Clients
response
to
medicati
on

For LXVIII.
LXIX.
oliguric
patient

To treat
hypocal
LXX.
cemiaLXXI.

Patients
stool was
dark
green in
color
Patient
did not
show any
side
effects
Patient
did not
show any
side
effects

DLXII.

DISCHARGE PLANNING

DLXIII.
DLXIV.

DLXVII.
DLXVIII.

Cate
gorie
s
Medi
catio
n
DLXIX.
DLXX.

DLXV.

DLXXI.

DLXXII.
DLXXIII.

DLXXIV.

DLXXXIV.

Exer
cise

Plan

DLXVI.

Rationale

DLXXV.
-Compliance to
Instruct patient to take prescribed
appropriate medication and
medications regularly and comply
treatment prevents further
with
the
treatment
regimen
complications and resistance
prescribed by the physician.
to antibiotics and promote
continuous recovery of
Teach patient regarding the names
optimal health.
of the drug, its dosage, time
of
DLXXVI.
-The patient has the
administration, its contraindication
right to know his drugs
and side effects.
therapeutic effects as well as
its adverse effects. He also
Inform patient and significant
has the right to gain
others not to take drugs not
awareness about why is it
prescribed by the physician.
given to him.
Instruct the patient to check for
the
DLXXVII.
-Drug interactions may
expiration date of the drug before
occur which may be fatal to
taking it.
patients current situation.
DLXXVIII.
-Checking for the
expiration date of the drug
Do not administer any other drug
before administering it
with same action without the
ensures it potency and safety.
physicians prescription.
It also prevents any
Educate the patient and the
unwanted reactions like
significant
others
about
the
hypersensitivity.
expected responses of drug toDLXXIX.
the
-Non-prescription drug
body, side effects, adverse effects
may have antagonistic or
that may possibly seen into the
synergistic effects if taken
patient.
with other drugs.
Instruct the significant othersDLXXX.
to
DLXXXI.
-To be geared up of
report any remarkable adverse
enough
information that may
reactions or any appearance of side
lead to immediate medical
effects noted.
responses.
DLXXXII.
DLXXXIII.
-For immediate
remedial action
response and to
prevent any
complicated reactions.
DXCV.
-Exercises promote
Explain to patient the significance
proper blood circulation
of regular exercise like walking and
and prevent arterial
stretching. If unable to mobilize
and venous stasis thus
alone, instruct the watcher to give

assistance all the time. Encourage

to use crutches or any device for
support.
Stretching
upper
extremities also promote healthy
living. Also instruct patient to
perform passive range of motion.

DLXXXV.

DLXXXVI.
DLXXXVII.
DLXXXVIII.
DLXXXIX.
DXC.
DXCI.

DXCVI.
Teach patient to wait for 1 to
2
hours
after
eating
before
DXCVII.
performing any physical activities.
DXCVIII.

Instruct the patient to practice

deep breathing exercise.

DXCII.
DXCIII.
DXCIV.

DXCIX.
DC.

DCI.

Treat
ment

Instruct patient to comply with DCIII.

his
medication treatment like the
continuous use of beta blocker
Metoprolol
for
control
of
DCIV.
hypertension
and
Insulin
for
DCV.
diabetes mellitus.
DCVI.
Instruct client to seek medical help
if any unusualties are felt such as
tingling sensation or paresthesia,
DCVII.
fatigue
and
body
malaise,
DCVIII.
dizziness, headaches, irritability,
DCIX.
tremors, diaphoresis, etc.
DCX.
As part of long-time treatment,
advise patient to wear medical
alert bracelet all the time and

lessens platelet
coagulation to aged
people. Older people
have weakened blood
vessel walls which can
cause any alteration in
blood flow.
Also exercise prevents
atrophy of the muscles.
-Older people has
slower digestion rate,
thus they need to
conserve more oxygen
which will be necessary
for digestion of food.
Activities must be
limited to decrease
oxygen demand by
organs and tissues
other than the digestive
system.
-Deep breathing
exercises promote
thoracic expansion
which allows air to
enter the respiratory
tract and provide
oxygen to the alveoli to
avoid atelectasis or
lung collapse due to
increase fluid pressure
in the pleural space.
-Maintenance meds
should not be forgotten
to achieve highest
therapeutic effect.
-These unusualties may
be indicative of
worsening condition.

-Medical alert bracelet

provides basic
information about the
client in case of

DCII.

DCXVI.

wherever he goes. It contains the

DCXI.
patients name, disease condition,
DCXII.
address and contact person.
DCXIII.
Advise to have a family member
DCXIV.
take your blood pressure to check if
youre maintaining a stable blood
pressure.

Since the client has his own

DCXV.
glucose monitor, tell client to
continue monitoring blood glucose
level, and immediately seek for
medical help if level is abnormally
high.
Hygi
Instruct patient to practice DCXXII.
foot
ene
care to prevent ulceration and
formation of gangrenous tissues to
DCXXIII.
the lower extremities.
DCXVII.
- Check and carefully washDCXXIV.
your
DCXXV.
feet every day.
DCXXVI.
DCXVIII.
-Do not wear shoes that are
too
DCXXVII.
small or socks that do not fit right
DCXXVIII.
inside your shoes.
DCXXIX.
DCXIX.
-Soak your feet in warm soapy
DCXXX.
water for 10 minutes before cutting
DCXXXI.
your nails. Trim your toenails
DCXXXII.
DCXXXIII.
straight across to prevent ingrown
toenails. You may also fileDCXXXIV.
down
DCXXXV.
your toenails. Do not cut your nails
DCXXXVI.
into the corners or close to the
skin.
DCXXXVII.
You should not dig under orDCXXXVIII.
around
the nail.
DCXXXIX.
Emphasize the importance DCXL.
of
DCXLI.
bathing everyday. Wash genitals
with mild soap.
DCXX.
Instruct client to maintain good oral
hygiene.
Instruct to wear clean clothes and
DCXLII.
underwear.
DCXLIII.
DCXXI.

DCXLIV.

accidents.

-Monitor of blood
pressure is significant
for evaluating the
medications
effectiveness.
-Glucose monitoring is
a big factor in the
management of
diabetes mellitus.
-Proper foot care
prevents injury to feet
and toes.

-Proper bathing
eliminates proliferation
of germs and bacteria
in the body. Mild soap
does not irritate the
skin and the genitals.
-Tooth brushing
prevents build up of
plaques and cavities.
-Dirty or improperly
washed underwear may
become a sanctuary for
microbial growth.
Microbes may enter the
genitals and might

DCXLV.

Out-
Patie
DCXLVI.
nt
DCXLVII.
Refe
DCXLVIII.
rral
DCXLIX.
DCL.
DCLI.
DCLII.
DCLIII.
DCLIV.
DCLV.
DCLVI.
DCLVII.
DCLVIII.
DCLIX.
DCLX.
DCLXI.
DCLXII.
DCLXIII.
DCLXIV.
DCLXV.
DCLXVI.
DCLXVII.
DCLXVIII.
DCLXIX.
DCLXX.
DCLXXI.
DCLXXII.
DCLXXIII.
DCLXXIV.
DCLXXV.

DCLXXVI.
DCLXXVII.

DCLXXVIII.
Encourage patient to undergo
physical therapy sessions.

DCLXXIX.

DCLXXX.

DCLXXXI.

DCLXXXII.
Advise to have check-ups after
discharge.
DCLXXXIII.
Advise to have regular laboratory
exams for creatinine, albumin,
DCLXXXIV.
sodium, potassium and calcium.
Encourage to undergo ABG Test
every month or once every 2
months.

DCLXXXV.
DCLXXXVI.
DCLXXXVII.

worsen the clients

UTI/Cystitis.
-A Physical Therapist is
a source of information
to understand agerelated changes and
offer assistance for
regaining lost abilities
or develop new ones.
Physical therapy can be
applied to the clients
condition: arthritis,
urinary and fecal
incontinence,
amputation, and
cardiac and pulmonary
disorders. It can :
a). increase, restore or
maintain range of
motion, physical
strength, flexibility,
coordination, balance
and endurance
b.) aids adaptations to
make the home
accessible and safe
teach positioning,
transfers, and walking
skills
c.) promote maximum
function and
independence within an
individual's capability
d.) increase overall
fitness through exercise
programs
e.) prevent further
decline in functional
abilities through
education, energy
conservation
techniques, joint
protection, and use of
assistive devices to
promote independence
f.) improve sensation,
joint proprioception
g.) reduce pain
-Serves as an

DCLXXXVIII.
DCLXXXIX.

Diet

DCXC.
DCXCI.
DCXCII.

DCXCIII.

Instruct client to avoid simple DCXCIV.

sugars. Take energy from complex
carbohydrates like unpolished rice,
bread and vegetables.

Encourage patient to eat fibrous

foods like fruits and vegetables. But
do not eat too much as it can irritate
DCXCV.
the GI tract and causes bleeding.
Other examples of sources of fiber
are: whole grains, cereals and
legumes.
Limit intake of purine rich foodsDCXCVI.
such
DCXCVII.
as liver, beef kidneys, brains and
DCXCVIII.
meat extracts. Encourage to eat
in
moderate amount: asparagus, DCXCIX.
cauliflower, spinach, mushrooms,
green peas, dried peas and beans.

DCC.

DCCI.

evaluation process to
note if condition has
progressed to better or
worse.
-To assess for renal
function.
-Simple sugars easily
break down and enter
the blood stream.
Complex carbohydrates
can sustain the bodys
energy requirement for
a longer time because
they are not broken
down easily.
-A diet rich in fiber
relieves constipation. It
adds bulk to the
excreta and facilities
expulsion.

-Accumulation of uric
acid in the joints causes
arthritis. Uric acid is the
by product of purine
break down in the liver.
Because of renal
malfunction, uric acid is
retained in the blood
stream and is shunted
to connective tissues.