Name: Mrs. MM Nursing Diagnosis: Anxiety related to chronic illness w/ changes in roles/ body image.

Medical Diagnosis: ESRD secondary to DM Nephropathy Short-term Goal: At the end of my shift, patient will verbalize acceptance of self in situation.

Age: 77 years old

Long-term Goal: At the end of hospitalization, patient will demonstrate adaptation to changes or events that have occurred.

Cues: Body malaise Blurred in vision Restlessness

Problem

Scientific Rationale

ANXIETY Anxiety is a normal experience. Moderate or high level of anxiety can increase alertness and performance in particular situations. However, people who experience continues or recurring fears or episodes of intense fear can feel powerless to manage their symptoms and their lives can become severely restricted.

Nursing Interventions Assessed level of fear of client. Explained procedures/ care as delivered. Repeated explanations frequently as needed.

Rationale

Evaluation Goal met. Patient verbalized acceptance of self in situation.

http:/www.panicanxietydisorder.o rg au /index.htm

Helps determine the kind of interventio ns required. Fear of unknown is lessened by information & may enhance acceptanc e of permanen ce of ESRD and necessity for dialysis. Creates feeling of openness & cooperatio n& provides information that will assist in problem identificatio n/ solving.

Provided opportunities for client to ask questions & verbalization of concern.

Name: Mrs. MM Medical Diagnosis: ESRD secondary to DM Nephropathy

Age: 77 years old

Nursing Diagnosis: Altered Fluids & electrolytes r/t Urinary retention as evidence increase K & decrease Na. Short term Goal: At the end of my shift, patient will be able to increase urine output at least 1500cc in 24 hrs. Long term Goal: At the end of hospitalization, the patient will be able to have a normal urine output & voiding pattern.

Cues S- No subjective Objective: Decreased of urine output 380cc Dribbling of urine Potassium7.47 increased (3.5- 5.0 mg/dl)

Problem Oliguria

Scientific Rationale The production of an abnormally small volume of urine. This may be a result of copious sweating, kidney disease, loss of blood

Nursing Intervention Assess the cause of decrease urinary output

Rationale To be able to apply the proper therapeutic regimen.

Evaluation Goal partially met-patient passed out urine at least 300 cc.

Encourage client to void every 2-4 hrs & when urge is noted Determine the initial fluids and electrolytes level

Reference: Nursing Care Plans Page 89

May minimize urinary retention/overdisten tion of the bladder Serve as baseline for progress.

Monitor intake & output hourly Percuss/palpate suprapubic area.

Sodium- 134 decreased (135-145 mg/dl)

To determine the progress of the disease A distended bladder can be felt in the suprapubic area.

Observe Signs and symptoms of fluids & electrolytes imbalance such as dyspnea changes in ECG and restlessness.

To be able to prevent further complication and administer proper therapeutic agents as prescribed.

Ensure clients compliance on

Name: Mrs. MM Medical Diagnosis: ESRD secondary to DM Nephropathy Nursing Diagnosis: Sleep pattern disturbance r/t urinary frequency

Age: 77 yrs. old

Short-term Goal: at the end of my shift, the clients will increase the sleeping hours from 5 hrs. to 8 hrs. Long-term Goal: At the end of the patients hospitalization, patient achieves optimal amount of sleep as evidenced by rested appearance, verbalization of having a good sleep and improvement in sleep pattern.

Cues

Problem

Scientific Rationale The client is Unable to sleep because she frequent urge to empty urinary bladder. Thus her sleeping pattern is disrupted.

Nursing Interventions

Rationale

Evaluation

Subjective: Hindi ako makatulog ng husto as verbalized by the patient. Objective: restlessness Dark circles under eyes irritable

Lack of sleep

Assess the cause of inability to sleep. Assist patient in observing any previous b Bedtime ritual.

To determine the proper To promote relaxation.

Goal partially met. Patients sleeping pattern increased from 57 hrs.

Ref:

Advised

daytime

To

Nursing Care Plans Page 61 By: klopp

physical activities as indicated.

promote urinary elimination thus reducing bladder distention to promote sleep during night time.

Limit fluids before bedtime.

To prevent urinary bladder retention causing dribbling of urine.

Patients Name: Mrs. M.M.

Age: 77 years old

Medical Diagnosis:ESRD secondary to DM Nephropathy Nursing Diagnosis:Decreased tissue perfusion related to peripheral vasoconstriction as manifested by high blood pressure. Short Term Goal:At the end of my shift, patient will decrease blood pressure from 160/90 to 130/90 Long - Term Goal: At the end of the patients hospitalization, will maintain adequate tissue perfusion as evidenced by BP declining toward normal range for client. CUES Subjective: No subjective PROBLEM Decreased Tissue Perfusion SCIENTIFIC RATIONALE Constriction of the peripheral blood vessels will alter the flow of blood to perfuse the different cells of the body. Reference: www.elsevier.co m NURSING INTERVENTION . Measure and recorded blood pressure as indicated RATIONALE Provides objective data for monitoring. Presence of pallor: cool, moist skin; and delays capillary refill time may be due to peripheral vasoconstricti on. May indicate heart or EVALUATION Goal not met. Patients blood pressure remained 160/90.

Objective: Oliguria Hyperten sive Restless ness Cold and clammy skin

Observed skin color, moisture, temperature, and capillary refill time.

Noted dependent/general edema

renal failure

Provided calm, restful surroundings, minimize environmental activity/noise. Limit the number of visitors and length of stay. Maintain activity restrictions; such as bed rest/chair rest; schedule periods of uninterrupted rest; assisted client with self-care activities as needed.

Helps reduce sympatheti c stimulation ; promotes relaxation. Reduces physical stress and tension that affect blood pressure and the course of hypertensi on. Decreases discomfort and may reduce sympatheti c stimulation

Provided comfort

measure such back massage, elevation of head. Administered antihypertensive medications as prescribed

Encouraged compliance with dietary and fluid restriction therapy.

Antihypert ensive medication s play a key role in treatment of hypertensi on associated with chronic renal failure. Adherence to diet and fluid restrictions and dialysis schedule prevents excess fluid and sodium

accumulati on.

Patient's Name:Mrs. MM

Age: 77 years. Old

Medical Diagnosis:

ESRD secondary to DM nephropathy

Nursing Diagnosis: Risk for systemic infection related to hemodialysis procedure as manifested by fatigue, weakness and low Hb., Hct.level Short term goal: At the end of the shift, patient will experience no signs/symptoms of infection.

Long term goal: At the end of hospitalization, patient will maintain/demonstrate improvement in laboratory values Cues Problem Systemic Infection Objective: BP 160/90 mmHg Restlessn ess Oliguria Hct.level 0.25 Na level 134 Hb. 0.83gm/l Scientific Rationale Frequent IV cannnula will introduce microorganism in the blood circulation that would trigger systemic infection. Nursing Intervention Promoted good hand washing by client and staff. Use aseptic technique when manipulating IV/invasive lines. Encouraged deep breathing, coughing, frequent position changes. Rationale Evaluation

Reduces risk Goal met- Patient had experienced no of crosscontamination signs of infection. Reduces bacterial colonization and risk of ascending UTI. Prevents atelectasis and mobilizes secretions to redue risk of pulmonary infections.

Reference: Medical Surgical 1st edition by Udan

Assessed skin integrity

Excoriations from scratching

may become secondarily infected. Monitored vital signs Fever with increased pulse and a respiration is typical of increase metabolic rate resulting from inflammatory process, although sepsis can occur without a febrile response.

DRUG NAME BRAND: Docard

CLASSIFICATION

MECHANISM OF ACTION Exogenously administered, it produces direct stimulation of beta-1 receptors and variable stimulations.

INDICATION/ CONTRAINDICATION Indications: Correction of hemodynamic imbalances present in renal failure. Contraindications: Uncorrected tachyarrythmias or ventricular fibrillation.

SIDE EFFECTS

NURSING CONSIDERATIONS 1.]Monitor vital signs and ECG during infusion. If BP drops 30mmHg stop infusion and report to physician. 2.]Assess for oxygenation and perfusion deficit: dyspnea, cyanosis, decrease BP, chest pain, dizziness. 3.]Assess patients GI complaints: nausea and vomiting. 4.]Monitor BP closely for sudden drop after drug is stopped.

Sympathomimetic

GENERIC: Dopamine HCL

DOSAGE: 2 amp in D5W 250cc @ 10 mgtts/min titrate by increment of 3 mgtts/ min

Nausea, vomiting, tachycardia, anginal pain, palpitation, dysnea, headache, hypotension, hypertension, vasoconstriction, decrease urine output, dyspnea.

DRUG NAME BRAND:

CLASSIFICATION

MECHANISM OF ACTION

INDICATION/ CONTRAINDICATION

SIDE EFFECTS

NURSING CONSIDERATIONS 1.]Assess respiratory and pulse rate. 2.]Monitor fluid balance. NURSING CONSIDERATIONS 3.]Assess for the symptoms of alkalosis. 1. ]Assess V/S. 4.]Teach patient 2. ]Use a tuberculin about sodium or restricted diet. insulin syringe for accuracy of measurement. 3. ]Keep in cold location, preferably a refrigerator. 4. Do not freeze. 5. ]Observe closely for S&S of hyper- or hypoglycemia until dosage established. 6.] Monitor BP, BS, LDL, cholesterol and HbA1c.

Alkalinizing agent, Antacid, Electrolyte

GENERIC: DRUG NAME Sodium bicarbonate BRAND: Humulin R DOSAGE: 650mg 1tab TIDGENERIC: Insulin injection (Regular insulin)

Increases plasma Indications: Metabolic bicarbonate, alkalosis Treatment of metabolic (dizziness, which excess acidosis. buffers H ion cramps, thirst, concentration; anorexia, N & V, reverses CLASSIFICATION MECHANISM OF INDICATION/ tetany, seizures). SIDE Contraindications: metabolic Paravenous ACTION CONTRAINDICATION EFFECTS acidosis. administration Edema, hypertension, may lead to tissue severe kidney Insulin product, anti- Increases glucose Indications: Hypoglycemia, necrosis. diabetic agent transport across insufficiency, insulin Moderate to severe hypoventilation. muscle and fat cell resistance, diabetic ketoacidosis or local and membranes to hyperosmolar reduce glucose generalized hyperglycemia regular allergic level. insulin. Mild diabetic reaction. ketoacidosis. Newly diagnosed diabetes.

Contraindications: Hypoglycemia. Hypersensitivity to insulin.

DOSAGE: 6 u IV now

DRUG NAME BRAND:

CLASSIFICATION

MECHANISM OF ACTION

INDICATION/ CONTRAINDICATIO N Indications: Diabetes mellitus. In combination with sulfonylureas to treat high blood glucose n adults over 65 years of age.

SIDE EFFECTS

NURSING CONSIDERATIONS 1. ]Document disease onset, level of control previous agents trialed, and the outcome. 2.] Monitor VS, CBC, HbA1c, U/A; microalbumin and renal function studies. 3. ]Review signs and symptoms of hypoglycemia and appropriate management. 4. ]Continue BP control, diet and exercise for disease control.

Rapid-acting Facilitates the insulin, Anti diabetic transport of Humalog agent glucose into mix 25 cardiac and skeletal muscle and adipose GENERIC: tissue. It also increases Insulin lispro synthesis of injection glycogen in the liver. DOSAGE: 25 u SQ 10 mins BB, 12 u SQ 10 mins BS

Hypersensitivity to insulin.

Contraindications: Use during episodes of hypoglycemia. Hypersensitivity to insulin lispro.

DRUG NAME BRAND: Encifer GENERIC: Iron sucrose

CLASSIFICATION Vitamins & Minerals

MECHANISM OF ACTION Hematinic. Iron sucrose is dissociated by the reticuloendoth elial system into iron and sucrose. Encifer iron component appears to distribute mainly in the blood and to some extent in the extravascular fluid.

INDICATION/ CONTRAINDICATION Indications:

SIDE EFFECTS

NURSING CONSIDERATIONS 1. ]Watch for serious hypersensitivity reactions of iron sucrose. 2. ]Medication is administered 1 to 3 times/wk. Do not administer more than 3 times/wk. 3. ]For IV administration only.

DOSAGE: Amp 20 mg/mL (brown, sterile, aqueous soln) x 5's.

Hypotension, chest pain, hypertension, Treatment of iron hypervolemia, CHF, deficiency anemia in cramps, the following patients: musculoskeletal Hemodialysis pain, diarrhea, Dependent Chronic nausea, vomiting, Kidney Disease (HDD- abdominal pain, CKD) patients receiving elevated liver an erythropoietin. enzymes, skin irritation, pruritis, Contraindications: application site reaction, dizziness, Patients with evidence dyspnea, of iron overload, in pneumonia, cough, patients with known headache, fever, hypersensitivity to iron asthenia, malaise. sucrose or any of its inactive components . and in patients with anemia not caused by iron deficiency.

DRUG NAME BRAND: Dormicum GENERIC: Midazolam DOSAGE: 15mg tab OD

CLASSIFICATION Hypnotics & Sedatives

MECHANISM OF ACTION Depresses the limbic system and reticular formation (subcortical level of CNS) by increasing or facilitating the inhibitory neurotransmitt er activity of GABA.

INDICATION/ CONTRAINDICATION Indication: Disturbances of sleep

SIDE EFFECTS Amnesic episodes

NURSING CONSIDERATIONS 1]. Monitor blood pressure, heart rate and rhythm, respiration, airway integrity,arterial oxygen, saturation,. Emergency equipment shoud be nearby. 2.] Its onset of action is 1 hour.The action lasts for 2-6 hours. 3. ]Dormicum is given may be slower in the elderly than in younger adults. 4. ]Inform patient that drug may cause amnesia.

Contraindication: Hypersensitivity .

DRUG NAME BRAND: Iberet folate

CLASSIFICATION

MECHANISM OF ACTION Component of hemoglobin for oxygen transport; enzymes for energy metabolism.

INDICATION/ CONTRAINDICATIO N Indications: Supplement for diet. . Contraindications: Thalassemia, sideroblastic anemia, hemochromatosis & hemosiderosis. Children.

SIDE EFFECTS

NURSING CONSIDERATIONS 1.] Document indication for therapy. 2. ]Assess metabolic panel and vitamin levels as indicated. 3. ]List agents prescribes to ensure none interact or impact vitamin absorption. 4. ]Take with food for best absorption.

Vitamins and minerals

Nausea, constipation, diarrhea or stomach pain.

GENERIC: Multivitami n with iron

DOSAGE: 1 tab OD

DRUG NAME BRAND: Minitran GENERIC: Nitroglyceri n patch

CLASSIFICATIO N anti angina

MECHANISM OF ACTION Reduces cardiac oxygen demand by decreasing left ventricular end diastolic pressure (pre -load) and to lesser extent systemic vascular resistance (after load). Also increases blood flow through the collateral coronary vessels.

INDICATION/ CONTRAINDICA TION Indications: Prophylaxis of angina, hypertension Contraindication s: Severe anemia, increase intracranial pressure, allergy to adhesives, hypersensitivity to nitrates and orthostatic hypotension.

SIDE EFFECTS Orthostatic hypotension, tachycardia, palpitation, rash.

NURSING CONTRAINDICATIONS 1.] Assess location, duration, intensity,and precipitating factors of the patients angina pain. 2.]Evaluate therapeutic effectiveness (cardiac status) and adverse response (hypotension, arrhythmias) 3.]Dosed should be reduced gradually when discontinuing after longterm therapy. 4.]Apply transdermal (TD) patches to area without hair: press hard to adhere if patch becomes dislodged, apply a new one. 5.Do not discontinue abruptly. 6.]Closely monitor vital signs. 7.] Use caution when near a microwave oven, leaking radiation may heat

DOSAGE: 5 mg OACW x 16 h

DRUG NAME BRAND:

CLASSIFICATION MECHANISM INDICATION/ OF ACTION CONTRAINDICATION Anti-infectives (Quinolones) Indications: Infection of the kidneys, and urinary tract, genital organs, abdomen, and skin.

SIDE EFFECTS Nausea, diarrhea, abdominal pain, anorexia, dizziness, headache, very rarely, insomnia, peripheral, sweating, convulsion.

NURSING CONTRAINDICATIONS 1.]Assess renal function before and during therapy: urine output, BUN and creatinine.

Inhibits bacterial Ciprobay DNA gyrase thus preventing replication in GENERIC: susceptible bacteria DRUG CLASSIFICATION MECHANISM Ciprofloxacin NAME OF ACTION BRAND: Loop diuretics Acts in the thick Burinex ascending DOSAGE: limb of the loop of Henle, 500 mg 1 where it tab OD GENERIC: inhibits the co-transport Bumetanide of sodium, potassium, and chloride DOSAGE: from the luminal 1 mg tab filtrate. OD Increases excretion of water, sodium, potassium, calcium and chloride; decreases DRUG CLASSIFICATION uric acid MECHANISM secretion; and NAME OF ACTION cause no BRAND: Calcium Channel Possible change in Blocker slight urinary pH. Norvasc decrease in myocardial contractility. GENERIC: CO is increased;

Contraindications: INDICATION/ SIDE EFFECTS CONTRAINDICATION Hypersensitivity to Indications: Electrolyte & fluid ciprofloxacin on other changes: Excess quinolones Hypertension. water loss, dehydration electrolyte depletion Contraindications: including hypokalemia Anuria. Hepatic coma hyponatremia, or severe electrolyte hypovolemia, depletion. thromboembolism , circulation collapse.

2.]Assess for possible adverse reactions: G.U: interstitial NURSING nephritis. CONTRAINDICATIONS 1.] Monitor electrolytes, 3. ]Document indication liver and renal function for therapy, type, studies: causes for low onset, potassium and characteristic of symptoms 2.] Monitor VS. Repeat duiresis may cause 4. ]Assess patient for dehydration and s/sxs circulatory collapse before and of infection (especially in the during treatment elderly.) fever, characteristic of 3.]Assess BP before urine and during therapy with patient lying, standing, and sitting as appropriate; orthostatic hypotension can occur rapidly.

INDICATION/ CONTRAINDICATION Indication: Hypertension Contraindication: Sick sinus syndrome; second-third degree atrio ventricular (AV)

4.]Advise the patient to take the medication in SIDE EFFECTS the morning. NURSING CONTRAINDICATIONS Headache, fatigue, lethargy, dizziness, depression, paresthesia,hallucination, malaise, anxiety, tremor, vertigo, migraine, amnesia, nausea, 1.]Teach patient to use as directed even if feeling better. 2.]Monitor Vs , ECG, CBC

DRUG NAME BRAND: Catapres

CLASSIFICA TION Antihypertensi ve (centrallyactive drug)

MECHANISM OF ACTION Stimulates centrally alpha adrenergic receptors, to inhibit sympathetic cadio accelerator and vaso constrictor centers.

INDICATION/ CONTRAINDICAT ION Indications: Management of all grades of hypertension. Contraindications: Hypersensitivity to clonidine

SIDE EFFECTS

NURSING CONTRAINDICATIONS 1.] Perform eenal studies:protein, BUN, creatinine: watch for increased levels that may indicate nephritic syndrome: polyuria, oliguria, frequency. 2.]Monitor input and output. 3.]Advise patient to use caution when changing position. 4.]Teach patient not to skip or discontinue medication without consulting physician.

GENERIC: Clonidine hydrochlorid e DOSAGE: 150 mg /tab 1 tab BID

Drowsiness, sedation, confusion, dizziness, headache, fatigue, malaise, nightmares,nervousen ess, restlessness, anxiety, mental depression,dry mouth, severe hypotension.

DRUG NAME BRAND: Kalcinate

CLASSIFICA TION Calcium Salt

MECHANISM OF ACTION Essential for maintaining normal function of nerves, muscles, the skeletal system, and permeability of cell membranes and capillaries.

INDICATION/ CONTRAINDICATION Indications: Management of hypocalcemia, hypocalcemic tetany, hyperkalemia with cardiac toxicity.

SIDE EFFECTS

NURSING CONTRAINDICATION S 1.]If a precipitate is noted in the syringe do not use. 2.]IV rate should not exceed 0.5-2 ml / min. 3.]Monitor calcium levels and renal function.

GENERIC: Calcium Gluconate

Venous irritation, tingling sensation, feeling of oppression or heat, chalky taste, fatigue, GI symptoms (anorexia, IV, nausea and vomiting, abdominal pain, dry mouth, thirst)

Contraindications: Digitalized clients, sarcoidosis, renal or cardiac disease, ventricular fibrillation. Cancer clients with bone metastases, renal calculi, hypophosphatemia, hypercalcemia

DOSAGE: 1amp SIVP

DRUG NAME CLASSIFICATION BRAND: Plavix Antiplatelet drug (anticoagulant thrombolytic) MECHANISM OF ACTION Blocks ADP receptors, which prevent fibrinogen binding at that site and thereby reduce the possibility of platelet adhesion and aggregation. INDICATION/ CONTRAINDICATION Indication: Reduction of atherosclerotic events in patients with atherosclerosis. Treatment of patients suffering from non-ST segment elevation. Contraindication: Hypersensitivity. Severe liver impairment. SIDE EFFECTS GI bleeding, bruising, hematoma, epistaxis, hematuria, eye bleeding, intracranial bleeding, GI disturbances, diarrhea, rush. NURSING CONSIDERATION 1.]Assess for symptoms of stroke, MI during treatment 2.]Monitor signs of bleeding; hemoglobin and hematocrit periodically 3.]Monitor liver function studies: AST, ALT, bilirubin, creatinine if patients is on long-term therapy; thrombocytopenia, neutropenia may occour.

GENERIC: Clopidogrel DOSAGE: 75mg/tab tab only

DRUG NAME Brand Name: Humulin-N

MECHANISM OF ACTION Decreases blood glucose by transport of glucose into cells and the conversion of glucose to glycogen indirectly increases blood pyruvate and lactate, decreases phosphate and potassium.

INDICATION / SIDE EFFECTS CONTRAINDICATION Indication: Management of type1 DM or insulin dependent diabetis mellitus and type 2 diabetis mellitus which cannot be controlled by diet, exercise or weight reduction alone. Contraindication: Hypoglecemia , hypersensitivity reactions.IV administration of insulin suspension, diabetic coma. Insulin resistance; allergic reactions that include redness, pain, itching, swelling or inflammation. Hypoglycemia, temporary visual impairment. Insulin administration may cause insulin antibodies to form.

NURSING CONSIDERATION 1. Obtain patient history, including drug history and any know allergies. 2. Monitor fasting blood glucose, 2 hours after meals; also glycosylated Hgb may be measured to identify treatment effectiveness. 3. Monitor urine ketones during illness; insulin requirements may increase during stress, illness. 4. Monitor body weight periodically; changes in weight may necessitate changes in insulin dose.

Generic Name:

5. Assess for hypoglycemic reaction that can occur during peak time.