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Published by Ai Rimando

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Published by: Ai Rimando on Feb 06, 2013
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07/09/2013

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I. INTRODUCTION
The millennium paved way for a fast paced life coupled with oodles of unhealthyhabits and lifestyles. Fast food chains sprouted from the streets like crazy and became thesource of staple food for a lot of the working class. Economies of vices like cigarettessmoking and drinking were at their peak and are at their highest. Parallel to the rampant shiftof trends accompanied the rise of modifiable lifestyle diseases like hypertension, diabetesmellitus and kidney failure.According to the Department of Health, from year 2001-2005, an average of 69,741out of 100,000 population suffer from diseases of the heart and in 2006 there was an increaseto 83, 081. On the other hand, Diabetes Mellitus covered a rate of 18.5 % on average in theyear 2001-2005 and after a year it increased to 23.3 %.Chronic kidney disease (CKD) is an important source of long-term morbidity andmortality. It has been estimated that CKD affects more than 20 million people in the UnitedStates. Given that most patients are asymptomatic until the disease has significantly progressed, they remain unaware of the condition. Renal failure is the ninth leading cause of death among Filipinos according to the survey conducted by the Philippine InformationAgency dated June 4, 2012.In addition, the Philippine Renal Disease Registry as disclosed by Estela Ilagan, Nurse Coordinator of the Department of Health (DOH) in Region XII said that 1 Filipinodevelops Chronic Renal Failure every hour or about 120 Filipinos per million populations per year. More than 5,000 Filipino patients are presently undergoing dialysis.CKD is a worldwide public health problem. It is recognized as a common conditionthat is associated with an increased risk of cardiovascular disease and chronic renal failure(CRF). In the United States, there is a rising incidence and prevalence of kidney failure, with poor outcomes and high cost. On the other hand, in the country, the National Kidney andTransplant Institute (NKTI) Executive Director, Dr. Aileen Reigo-Javier said based on thePhilippine Renal Disease Registry (PRDR), the top causes of kidney failure in the country is
1 |Page
 
diabetes (44.6%), followed by the high blood pressure (23%) and inflammation of thekidneys (19.3%).Chronic kidney disease, also known as chronic renal disease, is a progressive lossinrenal functionover a period of months or years. The symptoms of worsening kidneyfunction are unspecific, and might include feelinggenerally unwelland experiencingareduced appetite. Often, chronic kidney disease is diagnosed as a result of 
 
screeningof  people known to be at risk of kidney problems, such as those withhigh blood pressureor diabetesand those with a blood relative with chronic kidney disease.All individuals with a glomerular filtration rateof less than 60 mL/min/1.73 m
2
for 3months are classified as having chronic kidney disease, irrespective of the presence or absence of kidney damage. The rationale for including these individuals is that reduction inkidney function to this level or lower represents loss of half or more of the adult level of normal kidney function, which may be associated with a number of complications.CKD is classified into five stages. Stage I is the mildest, usually causing fewsymptoms like slightly diminished function; kidney damage with normal or relatively highGFR of ≥90 mL/min/1.73 m
2
. On the other hand, stage 5 is established kidney failure of GFR <15 mL/min/1.73 m
2
and permanent renal replacement therapy. (Kidney Disease OutcomeQuality Initiative, 2009) Stage V is also referred to as “established” CKD, also called End-Stage Renal Disease (ESRD), Chronic Kidney Failure and Chronic Renal Failure. The prevalence of kidney disease has been an increasing trend, especially the End-Stage RenalDisease as reported in the Philippine Renal Disease Registry.As aforementioned in the above paragraphs, Diabetes and Hypertension individuallyaggravates the risk of developing chronic kidney disease. But in the case of patient EVG, she possesses both the co-morbidity thereby increasing her risk two-folds. As critical care nurses,our interest rocketed and our desire to understand and explore this scenario jolted us tochoose the case of the patient.
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A. G
ENERAL
O
BJECTIVES
This case presentation aims to identify and determine the general and specifichealth problems and needs of the patient with an admitting diagnosis of ChronicKidney Disease secondary to Diabetic Nephropathy and Hypertensive Nephrosclerosis.. This presentation also intends to help patient promote health andmedical understanding of such condition through the application of the nursing skills.
B. S
PECIFIC
 
OBJECTIVES
To be able to identify causes and risk factors in developing end-stagerenal disease as well as the relationship of co-morbidities with its prevalence
To be able to understand the pathophysiology of Chronic KidneyDisease according to the patient’s pattern
To be able to provide sufficient and innermost information to patient aswell as their families regarding the course of management of Chronic KidneyDisease with regards to medical and surgical management that would further improve compliance
To be able to identify specific nursing interventions that will help the patient cope up with Chronic Kidney Disease and improve long term patientoutcomes.
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