FAR EASTERN UNIVERSITY

Nicanor Reyes Sr. St. Formerly Morayta St. Sampaloc Manila

Institute of Nursing
A CASE STUDY PRESENTATION OF

Acute Renal Failure IVP to Chronic Kidney Disease Diabetic Nephropathy

Castro Maternity and Hospital Ward Submitted By: ALCANTARA, SARAH R. ALEJO, BENALEEN B. ANGLO, JERWELYN JOY M. ARCETA, ARIANNE JEAN R. BELDA, JANET LOUISE R. CAPITULO, MARY JOY A. CONSTANTINO, JAMIE M. CORPUZ, JAMEY NESS G. CRUZ, MARIAM E. DEJELO, JONAS MARK S. DELA CRUZ, MARLAND FAITH G. BSN201- GROUP 1 Submitted to: Mrs. Flordeliza Gordo RN, MAN

Overview of the Study

Chronic Kidney Disease Chronic kidney disease occurs when one suffers from gradual and usually permanent loss of kidney function over time. This happens gradually, usually months to years. Chronic kidney disease is divided into five stages of increasing severity. The term "renal" refers to the kidney, so another name for kidney failure is "renal failure." Mild kidney disease is often called renal insufficiency. With loss of kidney function, there is an accumulation of water; waste; and toxic substances, in the body, that are normally excreted by the kidney. Loss of kidney function also causes other problems such as anemia, high blood pressure, acidosis (excessive acidity of body fluids), disorders of cholesterol and fatty acids, and bone disease. Stage 5 chronic kidney disease is also referred to as kidney failure, end-stage kidney disease, or end-stage renal disease, wherein there is total or near-total loss of kidney function. There is dangerous accumulation of water, waste, and toxic substances, and most individuals in this stage of kidney disease need dialysis or transplantation to stay alive. Diabetic nephropathy: The kidney disease associated with long-standing diabetes. Diabetic nephropathy is also called Kimmelstiel-Wilson disease (or Kimmelstiel-Wilson syndrome) or intercapillary glomerulonephritis.Diabetic nephropathy typically affects the network of tiny blood vessels (the microvasculature) in the glomerulus, a key structure in the kidney composed of capillary blood vessels. The glomerulus is critically necessary for the filtration of the blood. Proteinuria was first recognized in diabetes mellitus in the late 18th century. In the 1930s, Kimmelstiel and Wilson described the classic lesions of nodular glomerulosclerosis in diabetes associated with proteinuria and hypertension. By the 1950s, kidney disease was clearly recognized as a common complication of diabetes, with as many as 50% of patients with diabetes of more than 20 years having this complication. Currently, diabetic nephropathy is the leading cause of chronic kidney disease in the United States and other Western societies. It is also one of the most significant long-term complications in terms of morbidity and mortality for individual patients with diabetes. Diabetes is responsible for 30-40% of all end-stage renal disease (ESRD) cases in the United States. (See Prognosis.) Generally, diabetic nephropathy is considered after a routine urinalysis and screening for microalbuminuria in the setting of diabetes. Patients may have physical findings associated with long-standing diabetes mellitus. (See Clinical Presentation.) Good evidence suggests that early treatment delays or prevents the onset of diabetic nephropathy or diabetic kidney disease

I. Comprehensive Nursing Health History

A. Biographic Data Name: A.R. Address: ---------------------------Age: 63 years old Gender: Male Date of Birth: --------------------------Civil Status: Married Occupation: Farmer Nationality: Filipino Religion: Roman Catholic Name of Hospital: Castro Maternity and Medical Hospital Date of Admission: Nov. 09,2011 Room : 312 Admitting Physician: Dra. Yumul Medical Diagnosis: Acute Renal Failure IVP to Chronic Kidney Disease Diabetic Nephropathy Chief Complaint: loss of appetite with occasional vomiting and resulting body malaise

B. Past Health History Mr.AR had chicken pox when he was 15 years old, he said that his childhood illnesses was usually flu, cough and colds and was fully immunized. Then when he was 7 years old, he had right fractured arm due to fall from a Guava tree and he was brought to Philippine Orthopedic Center and was put on cast for several weeks. According to him, he does not have any allergies on food and medicine. He also mentioned that she has no foreign travels yet. Then according to his wife, 2 years ago her husband was put on ICU for 2 days and 3 days at the ward of Castro Medical Hospital due to severe back pain he had undergone ECG, blood test and other laboratory test also in the same hospital and was diagnosed to have Diabetis mellitus and was given maintenance medications. Then last January 2011, he was accidentally peck(tuka) by their rooster at his right leg and was also treated at Castro Hospital for 2 days. Also last May 2011 he was brought back to Castro Hospital due to left leg edema, he was confined for 4 days, had undergone diagnostic procedure CT scan to view his arteries & veins and was given maintenance drug of Coumadin, he was also advised to have his regular treatment every 3 months for his left leg.

C. Present History of Illness According to the clients wife, the client started to lose his appetite before the start of August 2011. He is also confused why he doesnt want to eat. And because of that he mostly wanted to eat fast food meal at Jollibee and Mcdo like grilled pork, friend chicken, palabok , french fries and burgers. D. Family History of Illness The patient belongs to the family with a history of heart attack. His parents and his eldest brother both died of heart attack. His other sibling has kidney disease. And his 5 siblings were all well and had no known illness.

Genogram

AF 68

RF 74

67

66

AR63--CLIENT

AR 36

AR 34

AGR 32

AR 29

AR 27

RF 74

= Female who died of heart attack

AF 68 AR-63

= Male who died of heart attack +

= Male with kidney disease

AR 36

= Female with no known disease

AGR 32

= Male with no known disease

II. Patterns of Functioning

1. Health Perception-Health Management Pattern Mr. AR said it was not his first time to be hospitalized since he was diagnosed to have diabetes. With regards to his immunizations, the client is fully immunized. When ask about what is a healthy person for him, he verbalized Kapag walang sakit na nararamdaman at mabuti ang paikram. When ask to rate his health status before and during hopitalization 1 as not healthy and 10 as healthiest he rated himself as 5 because of his illness, he stated Nagtataka lang din ako kung bakit ako nagkasakit ng ganeto, eh 25 years ako nagbabasketball, di pa ba exercise yun? Pati batak nga ako sa pagsasaka dati. His wife also added, Simula nung nagka diabetes sya pati yung nangyari sa paa nya, suki na kami sa hospital. The client takes his maintenance medicines for his diabetes. When asked about clients hygiene, the client verbalizes that he takes a bath twice a day. The client added, Minsan nga dalawa o talong beses ako maligo dahil na rin sa mainit ang panahon ngayon. The client brushes his teeth every morning after he wakes up and before going to sleep. INTERPRETATION ANALYSIS

2. Nutritional Metabolic Pattern According to Mr. AR he eats almost everything then he admitted, Sobrang lakas ko talaga kumain dati nakaka ubos nga ako ng isang gatang na bigas sa isang kainan lang, pati di ako mapili sa ulam, lahat halos paborito ko. He said that he is drinking coffee, bread; rice every morning, rice and viand for lunch and dinner. He said that their usual meals were fish, either fried or with soup, chicken, pork and vegetables. He is also fond of eating midnight snack, he ates cookies and biscuits and junkfoods while watching TV. He also likes fruits like mango, ponkan, grapes and his favorite fruit is banana and he doesnt like to eat apples. He also said that he is not alcoholic but he admitted that he was a heavy smoker 5 years ago. He also said that he is fond of eating lots of chocolate since his children are abroad. Her wife added, Tinatago ko nga sa kanya yung mga chocolates kasi nga bawal na, eh minsan di ko alam kung may natatakas siya. But when he started to lose his appetite few months ago, he said that his maximum rice consumption has become 2 cups of rice. As he added Siguro dahil na din sa pagtanda kaya nawalan ako ng gana kumain, nanibago nga din ako pati yung asawa ko kasi nga malakas talaga ako kumain dati. Puro sa fastfood na pagkain yung mga kinain ko nung nakaraan.

INTERPRETATION ANALYSIS

3. Elimination Pattern According to the client, he doesnt feel any discomfort when he urinates and defecates. According to the client he frequently voids when he drink a lot voids and sweats when it is too hot and when he does strenuous activities. The color of his urine is yellow, no presence of blood and he with no pain at all. He said that he defecates everyday or every other day with no pain or presence of blood either. His feces are cylindrical in shape and brown in color. INTERPRETATION ANALYSIS

4. Sleep-Rest Pattern The client said he was satisfied with his sleep and doesnt observe any problems when he is asleep and felt satisfied every time he woke up. He usually have 6-8 hours of sleep but interrupted sometimes. According to the client before he goes to sleep, he usually pray, and watch TV. He usually goes to bed at 9pm and because they have cabled television he is fond of watching movies late at night until 2am then he still woke up every 5am in the morning. Then he usually sleeps in the afternoon for 2-4 hours. 5. Activity-Exercise Pattern According to the client, his usual exercises before was playing basketball, but when he was getting older he rarely play his favorite sport. He said that, Tuwing umaga pagkagising ko Naglalakad lakad na ako sa bahay, pahangin ng konti tapoz magkakapet tinapay. Her wife stated that, Halos lagi lang siya sa bahay at ang libangan nya nga ay manuod ng TV. The client is not working anymore as a farmer because also of his age and physical abilities. 6. Cognitive-Perceptual Pattern The client can read and write. The client is a College undergraduate of Commerce at Baliuag University. According to him, he already has problems in reading or seeing sentences written in small letters so he has a reading glass. When asked about clients senses, his wife verbalizes, Okay lang yung mga mata niya nakakabasa pa naman siya pero may reading glass. Nakakabasa din siya ng text sa cellphone. He can speak and understand English tagalong and Kapampangan. He has also no problems in hearing, smelling or tasting. The wife added, Sa panlasa naman, okay lang din. Kaso ngayon, wala siyang gana kumain. INTERPRETATION ANALYSIS 7. Self Perception-Self Concept Pattern The client describes himself as a determined person. He verbalized, Ang buhay ay madali lang kung may diskarte, sipag at siyempre basta may tiwala ka sa taas. He also described

himself as a strong and God-fearing person he rated herself as 8 (1 as the lowest and 10 as the highest) as he stated Kasi ganun pa din naman tingin ko sa sarili ko, pero kahit minsan napapaisip ako bakit ako nagkasakit ng ganeto, alam ko may dahilan ang Diyos. He said that, he is not being boastful even though his family belongs to the so called rags to riches. He said that he is still living a simple and peaceful life with his family. And he is just feel so blessed and proud for what the success of all oh his children. INTERPRETATION ANALYSIS 8. Role and Relationship Pattern The client is a strict father to his children, as he stated, Ako talaga mas mahigpit sa pag didisciplina sa mga anak, tinuruan ko yung mga anak ko ng tamang diskarte sa buhay. He stated that, Pero yung main conflict talaga na nangayari sa akin bilang tatay ay yung na mura ko yung anak ko at nasabihan ko na sige mag asawa kana. Tapos ayun siya nga nag asawa agad. He said that she has no difficulty in communicating with his family, there are no language barriers, he said that he is thankful for the technology today because he can easily communicate with his offsprings abroad. He mentioned that he and her family are open especially when one member has a problem. He believed that the support coming from his family helps him to be motivated in facing his problem. His wife said that as a husband the client has been question for his loyalty she stated. Nagkaroon siya ng other woman, si Marian mga 5 years ago na yun. Ayun nagka sakit din ako nung time na yun. Then the client stated, Di ko na uulitin yun, natuto na ako. He added, Kahit lagi kami nag aaway ni Genie, mahal ko yan at nagpapasalamat ako sa lahat ng ginagawa nya para sa akin. As a grandfather, he said that he is a young at heart and a loving father to his grandchildren. INTERPRETATION ANALYSIS 9. Sexuality and Reproductive Pattern The client said that the family planning method theyve used was withdrawal , he stated, Pati plano na talaga naming mag asawa na 5 ang maging anak. Their relationship has undergone some trials 5 years ago but then was fixed immediately with the help of their family, relatives and love ones. When asked how often they make love he answered, Yung medyo bata kami madalas talaga, pero dahil nga tumatanda na din, bihira na. INTERPRETATION ANALYSIS

10. Coping Stress Tolerance Pattern The client considers his illness as a factor that gives him stress. For client, his family and friends are the persons that help him most of the time especially his children. When he feels stress all he wants to do is to PRAY, to watch TV and relax. As stated, Kapag nakakaramdam ako ng lungkot sa kanya lang ako lumalapit. Nagdadasal ako. INTERPRETATION ANALYSIS

11. Values and Beliefs Pattern The client believes in the teaching of the Catholic Church. As stated Naku active kami ng asawa ko sa Couples for Christ. He said that its part of their bonding as husband and wife. He also strongly revealed that the secret of their success in life is God, he said that ever since they met they are a very religious person, they almost went to all the known Catholic churches and attend mass there, but they are devotees of Nuestra Senora dela Paz they also enjoys being with their co church workers as they are actively participating in almost all the church activities especially when its Holy week .He said that the and he is so thankful and blessed every time his request were being herd. They are giving back their blessing by donating a dress for the said saint and attending mass in their church. INTERPRETATION ANALYSIS

Activities of Daily Living

ADL

Before Hospitalization

During Hospitalization

Interpretation and Analysis

Nutrition . Elimination

Exercise

Hygiene

Sleep and Rest Substance Abuse SEX SPIRITUALIT Y .