Galamgam, Krizia Mae M.

REQUIREMENTS:    1 NCP Drug study of 3 drugs Updates and latest issues in Hemodialysis

Patient Name: Ramberto Saavedra Age: 72

3 Drugs:    Ketosteril Calcium Carbonate Plavix

Drug name
Ketosteril Generic Name: Essential Amino Acid Dosage: 1 tablet Frequency: Daily every after breakfast Route: Oral

Action
Normalizes metabolic process, promotes recycling product exchange. Reduces ion concentration of potassium, magnesium and phosphate.


Indication
Protein energy malnutrition Prevention and treatment of conditions caused by modified or insufficient protein metabolism in chronic renal failure


Contraindication
Allergy and hypersensitivity to any content of this drug Hypercalcemia Disturbed amino acid metabolism Caution use for patient with phenylketonuria


Adverse effect
Hypercalcemia may develop

Nursing consideration
  

  

 

Evaluate for any contraindications Take drug as prescribed Warn the patient about possible side effects and how to recognize them Give with food if GI upset occurs Frequently assess for hypercalcemia

Drug name
Calcium Carbonate Dosage: 500 mg/ tab Frequency: Daily, after dinner Route: Oral

Action
Helps maintain cardiac function, blood coagulation. Helps maintain the functional integrity of the nervous and muscular system. Neutralizes or reduces gastric acidity

Indication
Dietary supplement when calcium intake is inadequate. Prevention of hypocalcemia when exchange transfusion.

Contraindication
Renal calculi Ventricular fibrillation during cardiac resuscitation Patients with the risk of digitalis toxicity Allergy to calcium Hypersensitivity to drug/class/compone nts. Hypercalcemia Hypophosphatemia Nephrolithiasis Caution if hypercalciuria Caution if dehydration Caution if renal impairment Caution if hyperparathyroidism Caution if vitamin D toxicity Caution if GI bleed Caution if GI obstruction

Adverse effect
Swelling of the mouth, face, lips, or tongue); Loss of appetite; Muscle weakness; Nausea; Slow reflexes: Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest) Vomiting Hypotension Pain Sweating Decreased blood pressure Chalky taste Mild constipation Fecal impaction Difficult or painful urination

Nursing Consideration
Assess blood pressure, ECG readings, renal function, magnesium, phosphate, and potassium concentrations. Take tablets with full glass of water 30 minutes to 1 hour after meals. Give syrup diluted in juice or water. Chew chewable tablets well before swallowing. Monitor blood pressure, ECG, renal function, magnesium, phosphate, potassium, serum, and urine calcium concentrations. Monitor for signs of hypercalcemia.

 

  

    

         

 

        

Drug name

Action

Indication

Contraindication

Adverse effect

Nursing Consideration
Asses history: (Allergy, pregnancy, lactation, bleeding disorders, recent surgery, hepatic impairment, peptic ulcer) Physical: (Skin color, temperature, lesions, orientation, reflexes, affect; P, BP,ECG) peripheral perfusion; R, adventitious sounds. Provide frequent small meals if GI upset occurs. Provide comfort measures. Arrange analgesics if headache occurs.

Plavix Generic name: Clopidogrel bisulfate Dosage: 75 mg/tab Frequency: Daily every after lunch Route:

An anti-platelet drug, that is, a drug that inhibits the ability of platelets to clump together as part of a blood clot. Inhibits platelet aggregation by blocking ADP receptors on platelets, preventing clumping of platelets.

To prevent strokes and heart attacks in persons who are at high risk. More effective than aspirin in reducing heart attacks. Treatment for patients at risk for ischemic events; recent MI, Peripheral artery disease. Treatment for patients with acute coronary syndrome.

 

 

Allergy to clopidogrel Acute pathologic bleeding ( ICP, Peptic ulcer) Lactation With bleeding disorders, recent surgery, hepatic impairment and pregnancy

         

Stomach and  intestinal bleeding probably occurs less often. Headache Dizziness Weakness and flushing Hypertension Edema  Rash Nausea Constipation Diarrhea Increased bleeding risk

 

NURSING CARE PLAN..

Assessment
Subjective: Bumaba ang BP ko nung umupo ako as verbalized by the patient. Objective: Patient looks pale has a prolonged capillary refill. Blood pressure of 100/80.

Nursing Diagnosis
Risk for Injury related to Altered Mobility

Scientific Analysis
Injury as a result of environmen tal conditions interacting with the individual s adaptive and defensive resources.

Plan of care
To provide patient the knowledg e about the contribut ing factors and some intervent ions used to reduce the factors given.

Nursing Intervention
1. Provide information regarding the disease that may result in increased risk of injury. 2. Discuss the importance of self-monitoring and the need for supervision. 3. Identify interventions of safety devices to promote safe physical environment and patient safety. 4. Ascertain knowledge of safety needs or injury prevention and motivation to prevent injury. 5. Review previously determined factors that can contribute to the occurrence of injury. 6. Perform thorough assessments regarding safety issues when planning for client care and/ or preparing for discharge from care.

Rationale
1. To promote safe physical environment and individual safety. 2. To prevent incidents that may result in carelessness and increased the risk. 3. To help reduce/ prevent factors that may contribute to the occurrence of injury. 4. To prevent injury in home, community and work setting. 5. It can help to determine need for evaluation of intentional injury/ living environment. 6. Failure to accurately assess and intervene or refer these issues can place the client at needless risk and creates negligence issues for the healthcare practitioner.

Evaluation
After the procedure the patient: 1. Verbalized understanding factors that can contribute to possibility of injury and take steps to correct situation. 2. Be free of injury. 3. Modify environment as indicated to enhance safety. 3. Demonstrate behaviors and changes in activities to reduce the risk factors and protect self from injury.

Hemodialysis Adequacy Maintaining life, but not health When hemodialysis treatments were first used to replace renal function, no one knew how much dialysis therapy was needed to keep the patients healthy. Doctors knew that they had to maintain the blood levels of certain substances, such as potassium, within a specific range to keep their patients alive. The early pioneers of dialysis quickly mastered the technology to effectively manage these essential tasks. However, after the patients had been on dialysis for a few months, doctors found it was a much bigger challenge to keep these early hemodialysis patients healthy in the long run. When kidneys fail, dialysis is necessary to remove waste products such as urea from the blood. By itself, urea is only mildly toxic, but a high urea level means that the levels of many other waste products that are more harmful and not as easily measured are also building up. To see whether dialysis is removing enough urea, the dialysis clinic should periodically normally once a month test a patient s blood to measure dialysis adequacy. Blood is sampled at the start of dialysis and at the end. The levels of urea in the two blood samples are then compared. Two methods are generally used to assess dialysis adequacy, URR and Kt/V. What is the URR? URR stands for urea reduction ratio, meaning the reduction in urea as a result of dialysis. The URR is one measure of how effectively a dialysis treatment removed waste products from the body and is commonly expressed as a percentage. The URR is usually measured only once every 12 to 14 treatments, which is once a month. The URR may vary considerably from treatment to treatment. Therefore, a single value below 65 percent should not be of great concern, but a patient s average URR should exceed 65 percent. What is the Kt/V? Kt/V is another way of measuring dialysis adequacy. In this measurement,
y y y y

K stands for the dialyzer clearance, the rate at which blood passes through the dialyzer, expressed in milliliters per minute (mL/min) t stands for time

Kt, the top part of the fraction, is clearance multiplied by time, representing the volume of fluid completely cleared of urea during a single treatment V, the bottom part of the fraction, is the volume of water a patient s body contains

Currently used formulas to measure dialysis adequacy such as KT/V and URR failed to reflect the actual medical conditions and the clinical outcome for dialysis patients. Patients still having multiple intradialytic complications such as cramps, nausea, vomiting, headaches, fatigue, hypotensive episodes during dialysis, hangover after dialysis, patients remain fluid overloaded with subsequent poor blood pressure control, left ventricular hypertrophy, and high cardiovascular mortality. Despite
providing the recommended spKt/Vurea of 1.3 per treatment, short dialysis with rapid ultrafiltration is associated with multiple intradialytic and interdialytic complications. Patients experience cramps, nausea, vomiting, headaches, fatigue, hypotensive episodes during dialysis, and hangover after dialysis; patients remain fluid overloaded with subsequent poor blood pressure control, left ventricular hypertrophy, diastolic dysfunction, and high cardiovascular mortality.

According to Webster's dictionary, optimal means most desirable or satisfactory; adequate means sufficient for a specific requirement or barely sufficient or satisfactory. Optimal dialysis is the method of dialysis yielding results that cannot be further improved. Optimal dialysis should be our goal. Dialysis sessions should be long and frequent enough to provide excellent intra- and interdialytic tolerance of hemodialysis, normalization of serum calcium and phosphorus, blood pressure control, normal myocardial morphology and function, and hormonal balance, and to eliminate all, even subtle, uremic symptoms. . Present data,

unexpectedly, show that high efficiency dialysis adequacy, measured by urea clearance,

is not significantly reduced by Hb normalization. Attention should be paid in the removal

of other small molecular weight substances, like phosphate and creatinine, which is

reported significantly diminished.