Gabales, Audrie Allyson H.

BSN 3F CS7 CRF CASE PRE

INTRODUCTION

Chronic kidney disease includes conditions that damage your kidneys and decrease their
ability to keep you healthy by doing the jobs listed. If kidney disease gets worse, wastes
can build to high levels in your blood and make you feel sick. You may develop
complications like high blood pressure, anemia (low blood count), weak bones, poor
nutritional health and nerve damage. Also, kidney disease increases your risk of having
heart and blood vessel disease. These problems may happen slowly over a long period
of time. Chronic kidney disease may be caused by diabetes, high blood pressure and
other disorders. Early detection and treatment can often keep chronic kidney disease
from getting worse. When kidney disease progresses, it may eventually lead to kidney
failure, which requires dialysis or a kidney transplant to maintain life.

Chronic kidney disease (CKD) has been recognized as a leading public health problem
worldwide. The global estimated prevalence of CKD is 13.4% (11.7-15.1%), and patients
with end-stage kidney disease (ESKD) needing renal replacement therapy is estimated
between 4.902 and 7.083 million. One Filipino develops chronic renal failure every hour
or about 120 Filipinos per million population per year. Based on the Philippine Renal
Disease Registry, there are 28, 215 Filipinos who are currently undergoing dialysis. Of
the number, 941 are in Region 6 (Western Visayas), including 478 patients in 12 dialysis
centers in Negros Occidental.

Objectives:
General Objectives
At the end of this case study the students will be able to obtain knowledge about
Chronic Renal Failure, nursing management, skills and attitude on providing care and
health teaching to the client.
Specific Objectives
A. Knowledge
 To define Chronic Renal Failure.
 To be able to know the pathophysiological basis of Chronic Renal Failure.
 To determine the signs and symptoms on the current health history and
other manifestations of the patient.
 To know laboratory and diagnostic tests the patient had undergone.
B. Skills
 Demonstrate communication skills in educating clients with Chronic Renal
Failure and their significant others.
 To better understand the medication given to the patient.
 To explain to the patient the cause or reason of having Chronic Renal
Failure laboratory examination and drug administration.
 C. Attitude
 To formulate a discharge plan and prognosis for continuous health care
even at home and recommendation for future further researches.
 To organize patient’s data to establish good background information.
 Identify therapeutic methods in caring for a client with Chronic Renal
Failure.

PATIENT’S DATA
Biographic Data
Client’s Name: N/A
Address: N/A
Age: 45y/o
Sex: Female
Civil Status: Married
Occupation: N/A
Religion: N/A
Source of information: Patient
Attending Physician: N/A
Admitting Impression: Chronic Renal Failure
Date & Time of admission: N/A

Chief Complain
Fever and chills. Painful voiding in small amounts with burning sensation after
urinating.
Vital Signs
T: 38.9 degrees Celsius
BP: 160/100 mmHg
PR: 80 bpm
RR: 24 breaths per minute
SaO2: 98%

Symptoms Manifested
 Fever
 Chills
 Painful Voiding in small amounts with burning sensation
 Facial Edema
 Hypertension
 Frequent urination (hazy)
 Low back pain
PAST AND PRESENT MEDICAL HISTORY

A. History of Present Illness

The patient was referred to the hospital because of impaired renal failure
(chronic renal failure). Her reason for the visit was 2 days of fever, puffiness on
face 2 days ago and hypertension. Experiencing frequent urination in a small
amount of hazy urine with low back pain 3 days prior to admission.

B. Past Medical History

She was diagnosed with hypertension 1year ago and has maintenance for her
blood pressure. Been diagnosed with recurrent UTI 2 years back and was given
ciprofloxacin. Two of her elder sisters were diagnosed with renal failure and 1
of them died. Hypertension ran in the family. The patient is taking amlodipine
(Norvasc) 5mg/tab once a day as maintenance for her blood pressure. With No
known allergies to medications

C. Social History
The patient is married for 10yrs and is a housewife with two children. She likes
to eat junk foods, noodles and soda since she was 10 years old. She has no
physical activity.

PATHOPHYSIOLOGY
Anatomy and Physiology
The kidneys are the primary functional organ of the renal system. They are essential
in homeostatic functions such as the regulation of electrolytes, maintenance of acid–
base balance, and the regulation of blood pressure (by maintaining salt and water
balance). They serve the body as a natural filter of the blood and remove wastes
that are excreted through the urine.

They are also responsible for the reabsorption of water, glucose, and amino acids,
and will maintain the balance of these molecules in the body. In addition, the
kidneys produce hormones including calcitriol, erythropoietin, and the enzyme
renin, which are involved in renal and hematological physiological processes.
The kidneys are a pair of bean-shaped, brown organs about the size of your fist.
They are covered by the renal capsule, which is a tough capsule of fibrous
connective tissue. Adhering to the surface of each kidney are two layers of fat to
help cushion them.
 The asymmetry within the abdominal cavity caused by the liver typically results in
the right kidney being slightly lower than the left, and left kidney being located
slightly more medial than the right. The right kidney sits just below the diaphragm
and posterior to the liver, the left below the diaphragm and posterior to the spleen.

Etiology
The two main causes of chronic kidney disease are diabetes and high blood pressure,
which are responsible for up to two-thirds of the cases. Diabetes happens when your
blood sugar is too high, causing damage to many organs in your body, including the
kidneys and heart, as well as blood vessels, nerves and eyes.

Symptomatology
 weight loss and poor appetite
 swollen ankles, feet or hands – as a result of water retention (oedema)
 shortness of breath
 tiredness
 blood in your pee (urine)
 an increased need to pee – particularly at night
 difficulty sleeping (insomnia)
 itchy skin
 muscle cramps
 feeling sick
 headaches
 erectile dysfunction in men