1 PALLETE

Good morning, ma’am! I’m Jeshan Beltran your student nurse from Davao Doctors College, May I know your name please? And birthday?

So far ma’am kamusta atong pamiti?

Mag check kog vital signs nimo ma’am ha.

BP 180/100

PR 108 bpm elevated

RR 39 cpm

Temperature 37.5

O2 sat 89%

Maam naa koy mga pangutana maam ha regarding sa imong condition, kani maam para ni makabuhat tab ug mas maayo nga assessment sa
imong condition aron maka plano pud ta ug care na fit sa imong condition maam, okay lang po ba maam?

THE BODY ( HEALTH ASESSMENT & PHYSICAL ASSESSMENT)

1. )Ano po bang health concern natin ngayon ma’am?
2. ) Ano po yung mga maobserbahan natin sa patient ma’am?
Edema - kailan po ba nag simula yung pamamaga sa parte ng katawan niyapo tsaka saang parte po yung mga namamaga?
Uremic frost- kailan po nag simula yung puntik puntik na puti?
Abdominal Girth- kailan po nagkaroon ng burot sa tiyan ang patient natin?
3. ) Kailan po ba yung pinaka unang beses nagpa dialysis ang asawa niyo? Tsaka huling beses na nagpa dialysis siya?
4. ) Kamusta naman po ang activities ngpapa niyo maam? Active po ba siya or madali lang po ba siya mapagod?
5. ) Kamusta naman po ang pag tulog niya ma’am? Ilang unan po ba yung ginagamit niya ma’am? Kapag natutulog maam nahihirapan po
ba siyang huminga?
6. ) Ano pong mga bisyo ng asawa ninyo ma’am?
TYPE: SMOKE
GAANO KADALAS:EVERYDAY
GAANO KARAMI:10 STICKS PER DAY
GAANO KATAGAL: 25 YEARS
TYPE: ALCOHOL
GAANO KADALAS:3X A WEEK
GAANO KARAMI:
GAANO KATAGAL:9 YEARS
7. ) Ma’am ano po yung trabaho ng asawa ninyo ma’am?: Retired Government employee
8. ) May history po ba ng mga sakit ang pamilya ng pasyente natin ma’am sa parents o sa mga kapatid ng asawa ninyo ma’am pwede ko
po ba malaman kung ano yung mga sakit? At kailan po?
10.) May history po ba ng Diabetes/HPTN ang patient?
11. Sa imong urination maam, gaano ka frequent ang imong pag ihi maam?Unsa imong feeling pagmag ihi maam? Ang color maam? Daghan
ba maam?

LABORATORY

Lab result Meaning Nursing consideration

CBC

●
●
HGB: 6g/dL⬇️ ⬇️
RBC:3.79 million/mm³ ● Indicates na hindi maka transport ng encourage the patient to eat foods that are high in
mabuti ang oxygen sa tissues, kaya po protein and iron, such as liver, egg yolk, beef, and
hindi maka function ng mabuti ang body dried fruits such as prunes and apricots.
natin properly.

● WBC: 15,600 cells/mm3 ⬆️

● Indicates na may infection po Encourage patient to take antibiotics ordered by the
doctor

Liver function test

● Promoting Rest
LIVER FUNCTION TEST
-Position bed for maximal respiratory efficiency;
● SGPT- 55 IU/L (HIGH)- Liver Damage/Ascites provide oxygen
➢ Indicates may problem sa liver natin. -Encourage patient to increase activity gradually
● PHOSPHATE ALKALINE- 222IU/L (HIGH) - HYPOPHOSPHATEMIA and plan rest with activity and mild exercise.
➢ Indicates na increase ang phosphate sa blood, so sobraan ang phosphate ma'am
hindi po yan healthy sa body natin, toxic po siya if sobraan kay indication na may ● Improving Nutritional Status
problem sa kidney.
● TOTAL PROTEIN-7.8g/dL (HIGH) Low salt low fat diet
➢ pagtaas ng protein sa blood ma'am kay hindi rin siya healthy sa body. Bale, toxic din
 siya sa katawan natin maam. nSince, protein is waste product din po pag sobraan.
● ALBUMIN- 3.0 (LOW)(ALBUMINURIA)
➢ sign of kidney disease and means that you have too much albumin in your urine.
Albumin is a protein found in the blood. A healthy kidney doesn't let albumin pass from
the blood into the urine. A damaged kidney lets some albumin pass into the urine.
● GLOBULIN- 4.8g/dL(HIGH)
➢ High levels may indicate infection, inflammatory disease or immune disorders.

ELECTROLYTES

●
●
⬆️
K+: 5.9
SODIUM- 139mEq/L
● Administer electrolyte replacements as
prescribed.
● POTASSIUM- 5.9 mEq/L (HIGH) - HYPERKALEMIA ● Oral or IV administration of electrolytes
➢ ang potassium ma'am important yan para sa muscle contraction bale if mataas ang potassium may be prescribed to keep electrolyte
kay mag over contract ang muscles maam hindi na maka rest bale madamage ang kidney. So balance for patients at risk for
affected din po ang heart maam deikado po sa heart problems kay mag sige na lang man imbalances maintaining fluid volume at
contract hindi na maka rest. a functional level, patient exhibits
normal laboratory values, demonstrates
➢ INTERVENTION:
appropriate changes in lifestyle and
1. Monitor EKG
behaviors including eating patterns and
2. Cardiac monitor para macheck if there are any abnormal heart rhythms food quantity/quality
3. Restrict food rich in Potassium: Potatoes, strawberry,banana,spinach,oranges
4. Meds:Kayexalaet = oral or rectal to decrease Potassium

RENAL FUNCTION

● BUN- 110mg/d (HIGH)

➢ increase UREA sa blood , yang UREA ma'am kay protein din yan siya bale, pag increase ang
BUN indication po na hindi nag function properly ang kidney mo. So ang purpose man sa
kidney kay mag filter ng mga waste product so maging toxic na sa body if mag accumulate na
siya sa blood.
● CREATININE- 7.8mg/dL
➢ Ang crea din po maam kay waste product rin yan bale pag elevated creatinine level signifies
impaired kidney function or kidney disease. As the kidneys become impaired for any reason,
the creatinine level in the blood will rise due to poor clearance of creatinine by the kidneys.
Abnormally high levels of creatinine thus warn of possible malfunction or failure of the kidneys.
➢ ito po kasi ang measurement ma’am or indication para malaman if naka filter ba yung
glomerulus ng maayos
➢ Pansin niyo man ma’am no kay may puti puti sa skin niyo nag develop ang tawag jan kay
Uremic Frost kasi since nag build up naman ang urea sa blood mo ang portal of exit niya sa
 skin mo kaya imbes na masecrete mo siya through urine.

GFR

● GFR: 1 5mL/min ⬇️
➢ Ang GFR po maam kay measurement yan para malaman if naga filter ba properly ang kidney
mo ng mga waste products, ions, water sa blood kay need man talaga ma excrete ang waste
products para di matoxic ang body tsaka to maintain balance or homeostasis sa katawan
natin.
➢ In your case po na decrease po ang GFR ninyo ibig sabihin nasa STAGE 4 po kayo ng chronic
kidney disease so there is severe loss of renal function which means may build up na po ng
waste sa body niyo maam.

CBG

● ⬇️
CBG: 205mg/dL (Corticosteroid-binding globulin)
○ Purpose:a protein primarily produced in the liver that attaches to cortisol, a hormone with
numerous functions, including maintaining blood sugar levels, protecting the body from
stress, and suppressing inflammation

BLOOD TYPING

● O
Group O: The plasma contains both anti-A and anti-B antibodies, but the surface
of the red blood cells does not contain any A or B antigens. Since these
antigens are not present, a person with any ABO blood type can receive this
type of blood

LIPID PROFILE

● Cholesterol: 210 mg/dL ⬆️

○ Tungod sa taas imong bp maam ug tungod pud sa imong pag sigeg inom
○ fatty deposits in your blood vessels. Eventually, these deposits grow, making it difficult for
enough blood to flow through your arteries
○ eating high levels of saturated fat. smoking – a chemical called acrolin, found in cigarettes,
stops HDL transporting cholesterol from fatty deposits to the liver, leading to narrowing of the

● Triglycerides: 236 mg/dL ⬆️

arteries (atherosclerosis) having diabetes or high blood pressure (hypertension

○ increase the risk of heart disease and stroke

○ causes of high triglycerides are obesity and poorly controlled diabetes
● HDL:36 mg/dL ⬇️
○ Smoking, carrying too many pounds, and lack of physical activity tend to lower HDL

Whole abdomen:
● Moderate Diffuse Ascites, Right Lower Quadrant
○ condition in which fluid collects in spaces within your abdomen
○ caused by liver scarring (taking too much alcohol and smoking)
■ damaged liver has trouble removing toxins from your body

X-RAY
● Pneumonia
○ Gi pakita sa x-ray na naay fluid build up sa imong lungs maam, sabay pud atong pag
auscultate ganina maam kay naka dungog pud ta ug crackles na naga show ug fluid build up

EKG
● Hyperkalemia
○ Cardiac arrythmia, magsige ug pump ang atong blood maka cause na siya ug stress

Blood Gas Analysis

● Metabolic Acidosis PH 7.10L
○ Increase ang waste sa blood
○ Kung pansin niyo ma’am kay ang paghinga ng patient kay mabilis na malalim ang kanyang
paghinga so compensatory mechanism yan ng respiratory natin para malabas yung carbon
dioxide , ang carbon dioxide baya ma'am kay acid.

URINE ANALYSIS
● Color light yellow
● Reaction- Acidic
● Sugar-++ 2 pus
➢ Glycosuria is a condition in which a person's urine contains more sugar, or glucose, than it
should. It typically occurs due to high blood sugar levels or kidney damage. Glycosuria is a
common symptom of both type 1 diabetes and type 2 diabetes. Renal glycosuria occurs
when a person's kidneys are damaged.
➢ Urinary Output: 200cc/hr in 24 hours (oliguria)
➢ The kidneys lose their ability to filter enough waste products from the blood and to regulate the body's
balance of salt and water. Eventually, the kidneys slow their production of urine, or stop producing it
completely. Waste products and water accumulate in the body

HEMODIALYSIS
 ● 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. This is done with minor surgery, usually to your arm
● Caring for AV fistula:
■ keep your vascular access clean at all times.
■ Look for signs of infection, such as:
● Pain,Redness, Swelling, Fever,
■ Avoid putting pressure on your access area by:
● Not sleeping or resting on your access area
● Not carrying bags or heavy objects across your access area
● Not wearing tight clothes or jewelry around your access area
■ For routine blood tests, ask for your blood to be taken from your other arm
(whichever arm does not have your vascular access in it).

If you notice any signs of infection or any problems with any type of vascular access, contact
your doctor, nurse or dialysis center right away.

BLOOD TRANSFUSION
● A blood transfusion provides blood or blood components if you've lost blood due to an injury, during
surgery or have certain medical conditions that affect blood or its components
● Relay the signs and symptoms of a transfusion reaction. If these occur, the patient should notify their
RN during the transfusion:
■ Rash, itching, elevated temperature, chest/back/headache, chills, sweats,
increased heart rate, increased respiratory rate, decreased urine output, blood in
urine, nausea, or vomiting

X-RAY CHEST APA VIEW

● IMPRESSION: Pneumonia.
➢ Pneumonia is an infection that inflames your lungs' air sacs (alveoli). The air sacs may fill up
with fluid or pus, causing symptoms such as a cough, fever, chills and trouble breathing.
➢ Viruses, bacteria, and fungi can all cause pneumonia.

2 MEDICATION
Time Meds Purpose Nursing Management
7am ● Regular insulin This will help you to control you blood sugar level.
10U SQ STAT
I’ll inject this just under your skin.
(effective and safe in suppressing postprandial
hyperglycemia in type 2 diabetes patients with
severe renal insufficiency Moreover, renal
impairment does not affect the pharmacokinetics
of insulin analogs in a clinically significant
manner, as demonstrated for insulin aspart)
● Glipizide This medicine it also help control your blood sugar
(Minidiab) 5mg 1 level by helping your pancreas produce insulin.
tab OD
Glipizide is metabolized by the liver into several
inactive metabolites and its clearance and
elimination half-life are not affected by a
reduction in the estimated GFR (eGFR), so dose
adjustments are not necessary in patients with
CKD 22. Therefore, glipizide is the SU of choice
in patients with CKD.
Glipizide is metabolized in the liver to inactive
metabolites. About 60% of the dose is recovered
in urine. Its clearance and half-life are unaffected
by renal insufficiency
SIDE EFFECTS:
Dizziness- this medication can cause low blood
sugar (hypoglycemia)
● Furosemide Furosemide is given to help treat fluid retention
(Lasix) 40mg IVTT (edema) and swelling that is caused by
congestive heart failure, liver disease, kidney
disease, or other medical conditions. It works by
● Use a different place each time
you give an injection.
● Do not inject into the same place
two times in a row.
● Do not inject this medicine into
skin that is damaged, tender,
bruised, pitted, thickened, scaly, or
has a scar or hard lump.
● After using regular insulin, you
should eat a meal within 30
minutes.
● assess for signs of hypoglycemic
reactions (sweating, hunger,
weakness)
● explain to the patient that this
medication controls hyperglycemia
and not cure it
● Avoid getting up too fast from a
sitting or lying position, or you may
feel dizzy.
● Avoid becoming dehydrated.
 Q8 (7am, 3pm, acting on the kidneys to increase the flow of ● Follow your doctor's instructions
11pm) urine about the type and amount of
liquids you should drink while you
furosemide in chronic renal patients with
are taking furosemide.
residual diuresis could increase urinary volume
● Drinking alcohol with this medicine
and sodium excretion
can cause side effects.
This medicine is diuretics which means it will expel
the water inside your body.

This will help you to remove the excess water in your

body which result you to pee including the
electrolytes inside your body such as potassium,
calcium, and any other electrolytes responsible for
our nerve and muscle function.

● Metformin The use of metformin among people with type 2 ● Metformin should be taken with
500mg/tab 1tab diabetes who have chronic kidney disease (CKD) meals to help reduce stomach or
BID (7:00 am) is associated with a reduced risk of death and bowel side effects that may occur
end-stage renal disease (ESRD) during the first few weeks of
treatment.
Metformin is widely viewed as the best initial
● Swallow the tablet or
pharmacological option to lower glucose
extended-release tablet whole with
concentrations in patients with type 2 diabetes
mellitus and regulates renal support
a full glass of water.
● Do not crush, break, or chew it.
This will also help to control your blood sugar level.
(moa) decreases hepatic production of glucose.
decreases intestinal absorption of glucose, improves
insulin insensitivity

Side effects

abdominal or stomach discomfort, decreased

appetite, diarrhea, fast, shallow breathing
● Captopril Captopril alone or in combination with
25mg/tab PO OD furosemide has an antihypertensive effect in
(7am) patients with chronic renal failure and
hypertension; alleviates hypertension induced
renal damage and inflamation, lower glomerular
capillary pressure, decrease proteinuria
This Captopril it will help you to lower your blood
pressure. And help you kidney function.
● Amlodipine amlodipine significantly decreased the blood
(Norvasc) 10mg pressure while causing little or no aggravation of
1tab OD renal dysfunction in hypertensive patients with
renal impairment.
age and in fact are used to treat high blood
pressure and slow the progression of chronic
kidney disease (CKD). Has protective effect on
the kidney
This Amlodipine ma’am it will help you to lower your
blood pressure.
If you would ask why there’s a lot of hypertensive
drugs given to you, because we’re aiming a lower
blood pressure to achieving this goal requires 2 or
more antihypertensive medications, and also it slow
down the progression of kidney disease.
● Drink this medicine ma’am before you
eat.
● Caution patient to change positions
slowly to minimize orthostatic
hypotension.
● Instruct patient to take captopril as
directed at the same time each day,
even if feeling well. Take missed
doses as soon as remembered but
not if almost time for next dose.
● May cause dizziness. Caution patient
to avoid driving and other activities
requiring alertness until response to
medication is known.
● Report significant swelling of face or
extremities.
● Take care to have support when
standing & walking due to possible
dose-related
light-headedness/dizziness.
● Sodium moderate renal failure led to reduced protein
bicarbonate 1tab catabolism, reduced ammonia production, and
TID tubular damage
correct metabolic acidosis in chronic kidney
disease
It will help decrease your acid in your blood and
urine.
● Liverprime 1cap Liverprime is a nutritional supplement that
BID (8:00 am, 8pm) contains a silybin-phosphatidylcholine complex
that protects the liver by conserving glutathione
in the cells.
helps maintain liver health and prevent fatty liver.
Because you have CKD stage 4, toxics begin to build
up in your body eventually this led to liver failure.
SIDE EFFECTS:
nausea, heartburn, dyspepsia, and transient
headache.
● Calcium carbonate used for the treatment of hyperphosphatemia,
500mg 1tab TID normalizing phosphate concentrations in
given at the patients with CKD. It can also be used as a
beginning of the calcium supplement in these patients. Calcium
meal carbonate combines with dietary phosphate to
form insoluble calcium phosphate, which is
excreted in feces
kidney has an inability to excrete dietary
intake (vitamins, protein and fats)
● Chew the tablet thoroughly. Drink
water.
● Not milk or dairy products because it
may result in milk-alkali syndrome
(which will increase your calcium
resulting in hypercalcemia which will
result in nausea, increase heart rate,
increase BP DEHYDRATION.
● the patient missed a dose, just take
the next dose as needed. Do not
double the dose.
● Avoid eating too much of spinach,
cereals, dairy products because it will
increase your calcium and cause
hypercalcemia. (increase in calcium) –
excrete in the urine resulting in
hypercalciuria and kidney stones.
● Take calcium carbonate exactly as
directed.
● When using this medicine as a dietary
supplement, take it with food or
 Beginning of meals because it will also join following meals. Chewable tablets
with the food absorption and at the same should be chewed thoroughly before
time malabas si phosphate via stool being swallowed; do not swallow them
Calcium and phosphate are both minerals whole.
that are important for you to be healthy.
Together, they help build strong bones and
teeth, and also play a role in cell and nerve
function.
phosphate builds up in your body and binds
to calcium

● Multivitamins 1tab people with chronic kidney disease (CKD) often

OD cannot get all the recommended vitamins for
varying health reasons. People with CKD have
greater requirements for some water soluble
vitamins.

● Epoetin beta The availability of recombinant human
10,000 IU 3X a erythropoietin (rHuEPO) has greatly changed the
week for 2 weeks management of anemia in CKD patients. Besides
then decrease to improving hemoglobin levels, rHuEPO therapy
4000 IU per week has been demonstrated to significantly improve
quality of life and decrease morbidity and
mortality in patients with CKD.
SIDE EFFECTS:
Inform me ma’am if you see paleness in your
skin, dyspnea and fatigue.
Ensure patients know they should report any
headaches, as sudden migraine-like pain is a
warning of a hypertensive crisis.
- Patients who miss a dose should not try to
make this up.

Sweating - Taking a single excess dose of this

medication is a cause for concern and taking
Coldness too high a dose over a period of time can
increase the likelihood of adverse effects
 ● Salbutamol 1 neb is concluded that the administration of
q8 (8am, 3pm, salbutamol by inhalation is a simple, safe and
11pm) reasonably effective method for treatment of
hyperkalaemia in renal failure.
-for safe and reasonably effective method for
treatment of hyperkalaemia in renal failure. Lower
serum potassium levels, and relaxes the heart and
relaxes the smooth muscles of the lungs
● Open your mouth and breathe in
slowly and deeply (like yawning), and
at the same time firmly press down
once on the top of the canister. Hold
your breath for about 10 seconds,
then breathe out slowly. If you are
supposed to use more than one puff,
wait 1 minute before inhaling the
second puff.

● Place the mask in your nose and

mouth. so that all the medicine goes
into your lungs.

● Breath through your mouth and nose

● Maintain O2 3lpm (O2 sat 94%)

Oxygen therapy it will help you ma’am to breath easily and normalize your oxygen saturation.

● CBR w/o BRP

To avoid any injury such as fall because you are anemic and you have low hemoglobin, your heart and brain may not get enough oxygen to
work properly.

Side rails.

Secure 3 units of fresh whole blood

In case your severe anemia progress, there’s available blood to transfused to prevent severe anemia.

NMNGT

Blood transfusion is given to treat low red blood cell count, also called anaemia. Kidney failure is an important cause of anaemia. If the blood
count is too low, despite giving you iron replacement and the erythropoietin (EPO) hormone e.g. Aranesp, you may need a transfusion.
1:30 ● N-acetylcysteine 1
pm tab @ bedtime
Start Ceftriaxone
1gm/vial, 1.5g q12 ANST
Before I administer this
ma’am, I’ll perform skin test
po to make sure that you
are not allergic to this
medication.
BRAND NAME: Biogesic
GENERIC: Paracetamol Relief of mild-to-moderate pain; treatment of fever.
DOSAGE: 500mg 1 tab
ROUTE: Oral
FREQUENCY:
protect the kidney from injury induced by - signs include pulmonary symptoms
contrast media, ischemia, and toxins. (tightness in the throat and chest,
wheezing, cough, dyspnea) and skin
act as an antioxidant to inhibit ischemic cell reactions (rash, pruritus, urticaria).
death in the kidney. antioxidant effects also have - Notify physician or nursing staff
been used to treat conditions associated with immediately if these reactions occur.
oxidative stress.
used to thin mucus in the lungs.
side effects
- dizziness
- nausea
considered a safe antibiotic for patients with - Assess for potassium levels
renal insufficiency, since it is excreted via both - monitor heart rate rhythm
haptic and renal pathways.
- Drink plenty of liquids to keep your
-MOA- used for the treatment of bacterial kidneys working properly while
infections in various locations, such as in the using ceftriaxone. Use this
respiratory tract, skin, soft tissue, and urinary tract medicine for the full prescribed
Side effects: length of time, even if your
- dizziness symptoms quickly improve.
- dry mouth Skipping doses can increase your
risk of infection that is resistant to
medication
PRE BT MEDS 30 MINS BEFORE BT
SE: Hypersensitivity
● Assess patient’s fever or pain: type of pain,
location, intensity, duration, temperature, and
diaphoresis.
 ● Assess allergic reactions: rash, urticaria; if
these occur, drug may have to be
discontinued.
● Teach patient to recognize signs of chronic
overdose: bleeding, bruising, malaise, fever,
sore throat
● Tell patient to notify prescriber for pain/ fever
lasting for more than 3 days.
BRAND NAME:Benadryl
GENERIC: SE: Hypersensitivity to histamines
● Common antihistamine for allergies ● Give full dose 30 mins prior.
Diphenhydramine
DOSAGE:50mg/ cap 1 ● Has high sedative,anticholinergic and antiemetic ● Inform patient that the medication can cause
cap effects drowsiness.
ROUTE: Oral
FREQUENCY: ● Avoid activity requiring mental alertness
For allergic reactions
● Use sun protection because it may cause
with or without food
photosensitivity
● Avoid drinking alcohol
BRAND NAME: Hydrocort ● the promotion of anti-inflammatory genes.
GENERIC:Hydrocortiso ● Hydrocortisone has a wide therapeutic index 8 and ● Monitor and report signs of peptic ulcer,
ne
DOSAGE:100mg/vial a moderate duration of action. including heartburn, nausea, vomiting blood,
ROUTE: IVTT ● Reduce pain, swelling, itching tarry stools, and loss of appetite.
FREQUENCY: ● treat inflammation, status asthmaticus, acute and ● Monitor signs of hypersensitivity reactions or
chronic adrenal insufficiency anaphylaxis, including pulmonary symptoms
(tightness in the throat and chest, wheezing,
cough, dyspnea) or skin reaction.
● (rash, pruritus, urticaria).
POST BT MEDS

BRAND NAME:Lasix ● loop diuretic used to treat hypertension and edema

GENERIC:Furosemide in congestive heart failure, liver cirrhosis, renal
DOSAGE:40/amp ● Assess fluid status.
ROUTE:IVTT disease, and hypertension. ● Monitor daily weight, intake and output
FREQUENCY: ● for the treatment of edema associated with congestive ratios, amount and location of edema, lung
heart failure, cirrhosis of the liver, and renal disease,
including the nephrotic syndrome sounds, skin turgor, and mucous
 membranes.
● Notify health care professional if thirst, dry
mouth, lethargy, weakness, hypotension, or
oliguria occurs.Monitor BP and pulse before
and during administration.

ENDORSEMENT

Good afternoon sir endorsement…. on room 143

Pt. Marcos
55 yrs old, Male
Under the service of Dr. Beng Gow
Came in due to deep, rapid, shallow breathing, mental delirium and confused.
With admitting diagnosis of Severe anemia, hyperkalemia, Metabolic acidosis, CAP-MR, CKD-ESRD secondary to DM type 2 and hypertension
No known allergies
VS and NVS q2
CBRw/o BRP ta ani kay patient
Strict I&O monitoring q6
Restrict fluid intake to 1L/day lang ta ani niya
On low salt low fat diet, diabetic diet, and low potassium and low protein diet.
Weight pt daily
With on going IVF of PNSS 1L @KVO rate ot follow bottle number 2 same fluid and at the same rate.
Maintain O2 sat @3LPM until O2 sat of 94%

Labs:
CBC
HGB: 6g/dL ⬇️
RBC:3.79 million/mm³ ⬇️⬆️
WBC: 15,600 cells/mm3

SGPT: 55 IU/L ⬆️
Liver Function Test

⬆️
Albumin: 3.0g/dL⬇️⬆️
Alkaline Phosphatase: 222IU/L

Globulin: 4.8g/dL

⬆️
Electrolytes
K+: 5.9

⬆️⬆️
BST
Fasting 240 mg/dL
Randon 315mg/dL
RFT
BUN:110 mg/dL ⬆️ ⬆️
GFR: 5mL/min
CBG: 205mg/dL
⬇️⬇️
Creatinine: 7.8mg/dL

Blood typing:
O
Whole abdomen:
Moderate Diffuse Ascites, Right Lower Quadrant

Lipid Profile
Cholesterol: 210 mg/dL ⬆️⬆️
⬇️
Triglycerides: 236 mg/dL
HDL:36 mg/dL

UA naa na ang result attached na sa pt.’s chart

CXR done
ECG 12L done
FBS 240 taas jud mao nang gi place si patient sa diabetic diet
Lipid profile done taas attached napud sa chart sa pt.
Ultrasound whole abdomen done with impression of moderate diffuse ascites, marking place in RLQ
CBG ni patient 205… naka q6 ta ani, pre-meals
With covid 19 antigen test napud- negative

Meds ni patient
Glipizide (Minidiab) 5mg 1 tab OD (7am)
Furosemide (Lasix) 40mg IVTT Q8 (7am, 3pm, 11pm)
Metformin 500mg/tab 1tab BID (7:00 am, 7PM)
Captopril 25mg/tab PO OD (7am)
Amlodipine (Norvasc) 10mg 1tab OD
Sodium bicarbonate 1tab TID (7am, 3pm, 11pm)
Liverprime 1cap BID (8:00 am, 8pm)
Calcium carbonate 500mg 1tab TID given at the beginning of the meal
Multivitamins 1tab OD
Salbutamol 1 neb q8 (8am, 3pm, 11pm)
Ceftriaxone 1gm/vial, 1.5g q12
N-acetylcysteine 1 tab @ bedtime in preparation sa iyang dialysis ugma. And secure napud ang consent for dialysis ugma. Attached pt. chart.
Pati ang order ni doc for HD.

To secure 3 units of fresh whole blood w/ pt blood type, O, aware na ang pt ug ang watcher ani. Mao lng end of endorsement. Thank you!