Case Study: Renal and Urinary Disorder

Guide Questions

1. What will be your focused physical priority assessment before you start
your care?
In this case study, my focus priority assessment are the following.
a. First, I will monitor client’s vital signs like blood pressure, heart rate,
temperature and most especially if signs of respiratory distress or
increased respiratory effort. A great example of an increased
respiratory effort are distended neck veins. Supplemental oxygen
therapy might be administered immediately as prescribed if so
happens.
b. Second, client’s medical and family history of illness should be
assessed.
c. Third, I should look for any signs for dehydration such as thirst, poor
skin turgor, dry lips and sunken-appearing eyes.
d. Fourth, intake and output of client should be noted. Not only should
the amount of urine be monitored but also for its color and odor.
e. Lastly, client’s weight should be assessed daily. Weight gain indicates
fluid retention or edema.

2. Make an interpretation/Inferences in every laboratory results of the

client.

Potassium 6.0 mmol/L Patient X’s potassium concentration

level is elevated and is beyond
normal range. This indicates
“hyperkalemia”. Having a blood
potassium level higher than 6.0
mmol/L can be dangerous and
usually requires immediate
treatment.
Urea 64.9 mmol/L A high BUN value can mean kidney
 injury or disease is present. Kidney
damage can be caused by diabetes
or high blood pressure that directly
affects the kidneys
Creatinine 924 umol/L
ABG with O2
5L/min
pH 7.173 Blood pH of the client is acidic. A
pH higher than 7 is alkaline or
basic. Acidosis is when your blood
pH drops below 7.35 and becomes
too acidic
PCO2 25.9mmHg Client’s PC02 is below the normal
range of 35-45 mmHg. Low PCO2
indicates alkalosis and increased in
ventilation.
PO2 81.7 mmHg The given, 81.7 mmHg P02 is
within 80 to 100 mmHg, which is
the normal range. This represents
the "amount" of oxygen that is
dissolved in each 100 ml of the
arterial blood.
HCO3 12.8 mmol/L Normal value is 24 to 28 a low
finding may cause a condition
called metabolic acidosis, or too
much acid in the body. A wide
range of conditions, including
diarrhea, kidney disease, and liver
failure, can cause metabolic
acidosis.
Seeing client’s ABG results
indicates metabolic acidosis.

3. Identify at least 5 priority problems and make a Nursing care plan.

 Nursing Care Plans

CUES NURSING OBJECTIVES INTERVENTION RATIONALE EVALUATION

DIAGNOSIS

Subjective: Impaired gas Short-term: Independent Short-term:

“Di ko katarong og exchange related to After 8 hours of  Assess respiratory  Rapid and shallow After 8 hours of
ginhawa. Mura kog altered oxygen comprehensive rate, depth, and breathing patterns comprehensive
gaapas.” as verbalized supply as evidence nursing intervention, effort, including the and hypoventilation nursing intervention
by the client by wheezes upon the client will: use of accessory affect gas the client:
auscultation muscles, nasal exchange.
-Demonstrate flaring, and -Demonstrated
Objective: improved respiratory abnormal improved respiratory
 RR: 36 bpm rate breathing patterns. rate
 O2 sat: 92%
- Have no signs of -Has no signs of
 Pale in color excessive respiratory  Elevate head of  It allows increased excessive respiratory
 Dyspnea effort the bed to semi- thoracic capacity, effort.
Fowler’s position full descent of
 Lungs
Long-term: (head of bed at 45 diaphragm, and Long-term:
wheezing upon After 3-5 days of degrees when increased lung After 3-5 days of
auscultation nursing intervention supine) as expansion nursing intervention
the client will be able tolerated. preventing the the client:
to: abdominal
contents from -Manifested clear
-Manifest clear lung crowding. lung field or absence
field or absence of of wheezing upon
wheezing upon  Suction is required auscultation
auscultation  Suction when when cough is
needed ineffective for - Maintained optimal
-Maintain optimal gas expectoration of gas exchange as
exchange as secretions evidenced by usual
evidenced by usual mental status,
mental status,  Presence of unlabored
unlabored  Auscultate breath wheezes may respirations at 12-20
sounds, noting
 respirations at 12-20 areas of decreased indicate per minute.
per minute. airflow of presence bronchospasm or
-Maintain oximetry of adventitious retained secretions - Maintained oximetry
results within normal sound. results within normal
range, blood gases range, blood gases
within normal range,  Provide  Anxiety increases within normal range,
and baseline HR for reassurance and dyspnea, and baseline HR for
patient. reduce anxiety. respiratory rate, patient.
and work of
Dependent breathing.
 Encourage or
assist with  Ambulation
ambulation as per facilitates lung
physician’s order. expansion,
secretion
clearance, and
stimulates deep
breathing.
 Administer
prescribed dose of  Provides oxygen
supplemental support to patient.
oxygen

 Administer  Nurse should

medications as check for doctor’s
prescribed. order and follow
the prescribed
medication.

CUES NURSING OBJECTIVES INTERVENTIONS RATIONALE EVALUATION

DIAGNOSIS
Subjective: Risk for decreased Short-term: Independent: Independent: Short-term Goals:
“Pag maglihok ko cardiac output related After 8-hours of  Assess heart  Most patients have After 8-hours of
mafeel nako ng to increased vascular nursing rate and blood compensatory nursing interventions,
light-headed kay ko. vasoconstriction interventions, the pressure. tachycardia and the patient was:
Malipong jud ko.” patient will: significantly low blood
As verbalized by pressure in response  Able to
the patient. -Demonstrate to reduced cardiac decrease to
adequate cardiac output. normal range
Objective: output as evidenced  Note skin color,  Cold, clammy, and her cardiac
by blood pressure temperature, and pale skin is secondary output as
 BP: 200/100 and pulse rate and to a compensatory
moisture. evidenced by
mmHg rhythm within increase in normal blood
 Pale in color normal parameters. sympathetic nervous pressure,
system stimulation pulse rate,
and low cardiac and rhythm.
output and oxygen
desaturation. Long-term:
Long-term:  Weak pulses are After 3 weeks of
After 3 week of present in
 Check for nursing interventions,
nursing reduced stroke
peripheral the patient was able
interventions, the volume and cardiac
pulses, including to:
patient will be able output. Capillary refill
to: capillary refill.
is sometimes slow or -Maintain her blood
absent. pressure, pulse rate
-Maintain her blood
and rhythm within
pressure, pulse rate  Fatigue and exertional normal range.
and rhythm within  Assess for
reports dyspnea are common
normal range. problems with low
of fatigue and -Tolerate physical
reduced activity cardiac output states. activities without
-Tolerate activity Close monitoring of
tolerance. lightheadedness
without the patient’s response
lightheadedness serves as a guide for
optimal progression of
activity.

 Inspect fluid  Compromised

balance and regulatory
 weight gain. mechanisms may
Weigh patient result in fluid and
regularly prior to sodium retention;
breakfast. Weight is an indicator
of fluid balance.
 Provide
adequate rest  Rest decreases
periods metabolic rate,
decreasing
myocardial and
oxygen demand.
Dependent:
 Administer Dependent:
antihypertensive  Drugs will help in
drugs and lowering Px’s
medications as blood pressure
prescribed by the
physician.

CUES NURSING OBJECTIVES INTERVENTIONS RATIONALE EVALUATION

DIAGNOSIS
Subjective: Short-term: Independent: Short-term:
Fluid Volume
“Ga hubag ni siya Excess related to After 8 hours of  Elevate edematous After 8 hours of
tapos mulawom jud ni sodium retention as comprehensive  Elevation increases comprehensive NSG
extremities, &
siya kung pisliton.”as manifested by NSG interventions venous return to the interventions the px:
handle with care.
verbalized by the presence the client will: heart & in turn,
patient. of edema in both decreases edema. -Maintained HR 60 to
lower extremities. Edematous skin is 100 beats/min
-Maintain HR 60 to more susceptible to -Verbalized
Objective: 100 beats/min. injury. awareness of
 Advise/aid with causative factors and
 Bilateral -Verbalize  Repositioning behaviours essential
repositioning q2h if
awareness of prevents fluid to correct fluid
edema the patient.
causative factors accumulation in -Verbalized
 BP: 200/100 and behaviours dependent areas. understanding of
essential to correct  Educate patient
mmHg and family measures that can be
fluid excess.  Information is key to taken to treat or
members about the managing problems.
cause of condition prevent fluid volume
-Verbalize It heightens excess.
understanding of & how to prevent it, compliance with the
measures that can including giving treatment plan.
be taken to treat or importance of
proper nutrition, Long-term:
prevent fluid volume
excess. hydration, & diet
modification. After a 2 weeks of
comprehensive NSG
Long-term: interventions the px
Dependent:
had:
After 2 weeks of
comprehensive  Limit sodium  Restriction of
intake as -A balanced intake
NSG interventions sodium aids in and output and stable
the px will: prescribed by the decreasing fluid
physician weight.
retention.
-Have a balanced
intake and output  Administer  Diuretics aids in the
and stable weight. diuretics as excretion of excess
prescribed and body fluids.
provide health
education about
 the medication.

CUES NURSING OBJECTIVES INTERVENTIONS RATIONALE EVALUATION

DIAGNOSIS
Subjective: Risk for electrolyte Short-term: Independent: Short-term:
imbalance r/t renal
“Gaapas ko sakong failure After 8 hours of  Monitoring heart After 8 hours of
ginhawa tapos comprehensive  Potassium excess comprehensive NSG
rate and rhythm. Be
gakalipong ko. Gusto NSG interventions depresses interventions the px:
aware that cardiac
nako matulog sa the client will: myocardial
arrest can occur.
nurse.” conduction. -Had a normal
Bradycardia can respiratory rate within
-Normal respiratory progress to cardiac 12-20 bpm
Objective: rate 12-20 bpm fibrillation and
arrest. - Verbalized feeling of
 Monitor respiratory
 RR: 36 bpm -Verbalize feeling of  Clients may relief from shortness
rate and depth.
relief from shortness hypoventilate and of breath.
 Potassium: 6.0 Encourage deep
of breath. retain carbon
breathing and
mmol/L dioxide resulting in Long-term:
coughing exercise.
respiratory acidosis.
 Notably Elevate the head of
Long-term: Muscular weakness After a 1 week of
the bed.
lethargic can affect comprehensive NSG
After 1 week of respiratory muscles interventions the px
 Dyspnea
comprehensive and lead to had:
NSG interventions respiratory
the px will: complications. . -A balanced intake
 Monitor urine and output
-Have a balanced  In renal failure,
intake and output output. potassium is -Displayed normal
retained because of results of blood
-Display blood improper excretion. pressure and
pressure, and Potassium is laboratory results and
 laboratory results contraindicated if lethargy and
within the normal oliguria or anuria is disorientation was
limit and absence of present. absent.
lethargy and
disorientation.  Identify and  Facilitates the
discontinue dietary reduction of
sources of potassium levels
potassium, such as and may prevent
beans, dark leafy recurrence of
greens, potatoes, hyperkalemia.
squash, yogurt,
fish, avocados,
mushrooms, and
bananas.

Dependent:
 Administer loop
diuretics such as  This promotes renal
furosemide (Lasix) clearance and
as prescribed by potassium excretion
physician.

Collaborative:
 Obtain laboratory
results of patient  Evaluate therapy
from lab personnel needs and
healthcare team. effectiveness.

CUES NURSING OBJECTIVES INTERVENTIONS RATIONALE EVALUATION

DIAGNOSIS
Subjective: Activity intolerance Short-term: Independent: Short-term:
related to low
“Di nako kaya oxygen supply as After 8 hours of  Investigate the After 8 hours of
maglihok kay dali manifested by comprehensive  Causative factors comprehensive NSG
patient’s perception
rako hanguson unya lethargy NSG interventions may be temporary interventions the px:
of causes of activity
luya pud akong the client will: or permanent as
intolerance.
lawas.” well as physical or - Had a normal
psychological. respiratory rate within
-Have a normal Determining the 12-20 bpm
Objective: respiratory rate 12- cause can help
20 bpm guide the nurse - Verbalized feeling of
 RR: 36 bpm during the nursing relief from shortness
-Verbalize feeling of intervention. of breath.
 Weak in  Have the patient
relief from shortness  Helps in increasing
perform the activity
appearance of breath. the tolerance for the
more slowly, in a
activity. - Demonstrated
 Pale in color longer time with
-Demonstrate improved range of
more rest or
 Notably improved range of motion,
pauses, or with
motion
lethargic assistance if
necessary. . Long-term:
 Dyspnea
Long-term: After a 2 weeks of
 Refrain from comprehensive NSG
After 2 weeks of interventions the px:
comprehensive performing  Patient with limited
NSG interventions nonessential activity tolerance
activities or - Tolerated
the px will: need to prioritize ambulation without
procedures. important tasks first. assistance.
-Be able tolerate
ambulation without - Experienced no sign
assistance. of intolerance such as
respiratory
-Experience no sign compromise
of intolerance such
as respiratory  Assist with ADLs
compromise while avoiding  Assisting the patient
patient with ADLs allows
dependency. conservation of
 energy. Carefully
balance provision of
assistance;
facilitating
progressive
endurance will
ultimately enhance
the patient’s activity
tolerance and self-
esteem.
Dependent:

 Administer
supplemental  This gives oxygen
oxygen prn support especially
when Px is in
respiratory distress
4. Analyze the possible medical and surgical management for the client
Upon assessment client has a respiratory rate of 36 bpm and is noted to have
shortness of breath. For this case, immediate supplemental oxygen should be
prescribed and administered. On the other hand, it was found that she is
hypertensive and has diabetes mellitus for 10 years already. Client must
adhere to drug regimens as prescribed to maintain her blood glucose and
blood pressure to prevent further more complication. According to Nguyen
Quang et’ al, first-line medications used in the treatment of hypertension
include diuretics, angiotensin-converting enzyme (ACE) inhibitors or
angiotensin receptor blockers (ARBs), beta-blockers, and calcium channel
blockers (CCBs). Some patients will require 2 or more antihypertensive
medications to achieve their BP target. Medications to lower cholesterol levels
may be recommend called statins to lower cholesterol. People with chronic
kidney disease often experience high levels of bad cholesterol.
For surgical management of end-stage renal failure, treatment option may
include hemodialysis, peritoneal dialysis or renal transplant. According to
Kidney.org, hemodialysis is a procedure where a dialysis machine and a
special filter called an artificial kidney, or a dialyzer, are used to clean your
blood. To get your blood into the dialyzer, the doctor needs to make an
access, or entrance, into your blood vessels. If the client will undergo
peritoneal dialysis, some fluid is put into the abdomen. This fluid will absorb
the chemicals, other waste, and extra fluid that your kidneys usually remove.
After a while, this extra fluid drains out of your body. In many cases, patient
be able to learn how to put this fluid in and drain it yourself, which means that
you can perform peritoneal dialysis yourself, without needing to visit the
doctor's office or a dialysis center. (MedicinePlus. 2018) On the other hand,
renal transplant is a surgery done to replace a diseased kidney with a healthy
kidney from a donor. The kidney may come from a deceased organ donor or
from a living donor.
 Bibliography

Nguyen Q. et’al. (2015). Hypertension Management: An Update. Retrieved on Sept.

9, 2020 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4106550/

National Kidney. (2019). Hemodialysis. Retrieved on Sept. 9, 2020 at

https://www.kidney.org/atoz/content/hemodialysis

The Johns Hopkins Hospital, and Johns Hopkins Health System. (2020). Kidney
Transplant. https://www.hopkinsmedicine.org/health/treatment-tests-and-
therapies/kidneytransplant#:~:text=A%20kidney%20transplant%20is%20a,is
%20called%20a%20living%20transplant.