Chronic Renal failure(Disease)

Definition
Chronic kidney disease is the slow loss of kidney function over time. The main
function of the kidneys is to remove wastes and excess water from the body.

Incidence
Chronic kidney disease and ESRD affect more than 2 out of every 1,000 people
in the United States.

Applied Anatomy
Risk factors & Causes
Chronic kidney disease (CKD) slowly gets worse over time. In the early stages,
there may be no symptoms. The loss of function usually takes months or years
to occur. It may be so slow that symptoms do not appear until kidney function is
less than one-tenth of normal.
The final stage of chronic kidney disease is called end-stage renal
disease (ESRD). At this stage, the kidneys are no longer able to remove enough
wastes and excess fluids from the body. The patient needs dialysis or a kidney.
Diabetes and high blood pressure are the two most common causes and
account for most cases.
Many other diseases and conditions can damage the kidneys, including:
■Autoimmune disorders (such as systemic lupus
erythematosus and scleroderma)
■Birth defects of the kidneys (such as polycystic kidney disease)
■Certain toxic chemicals
■Glomerulonephritis
■Injury or trauma
■Kidney stones and infection
■Problems with the arteries leading to or inside the kidneys
■Some pain medications and other drugs (such as cancer drugs)
■Reflux nephropathy (in which the kidneys are damaged by the backward flow
of urine)
into the kidneys
■Other kidney diseases
Symptoms
The early symptoms of chronic kidney disease are also symptoms of other
illnesses. These symptoms may be the only signs of kidney disease until the
condition is more advanced.
Symptoms may include:
■Appetite loss
■General ill feeling and fatigue
■Headaches
■Itching (pruritus) and dry skin
■Nausea
■Weight loss without trying to lose weight

Other symptoms that may develop, especially when kidney function has gotten
worse, include:
■Abnormally dark or light skin
■Bone pain
■Brain and nervous system symptoms:
■Drowsiness and confusion
■Problems concentrating or thinking
■Numbness in the hands, feet, or other areas
■Muscle twitching or cramps
■Breath odor
■Easy bruising, bleeding, or blood in the stool
■Excessive thirst
■Frequent hiccups
■Low level of sexual interest and impotence
■Menstrual periods stop (amenorrhea)
■Shortness of breath
■Sleep problems, such as insomnia, restless leg syndrome, and obstructive sleep
■apnea
■Swelling of the feet and hands (edema)
■Vomiting, typically in the morning

Pathophsiology
In response to renal injury, there is thought to be an increase in intra- glomerular
pressure with gloerular hypertrophy, as the kidney attempts to adapt to nephron
loss to maintain constant glomerular filtration
↓
Failure of renal circulation & glumerular or tubular dysfunction
↓
Damaged tubules cannot conserve sodium normally which activates rennin-
angiotensn-aldosterone system
↓
Sodium& fluid retention which leads to edema
↓
 Sudden & complete loss of kidney function
↓
Reduced blood low to kidney due to renal vasoconstriction decrease the GFR &
tubular flow
↓
Oliguria
↓
Increased circulatory overload & sodium retention
↓
Acute Renal Failure

Signs and tests

■High blood pressure is almost always present during all stages of chronic
kidney disease. A
Nervous system exam may show signs of nerve damage. The health care
provider may hear
Abnormal heart or lung sounds when listening with a stethoscope
■A urinalysis may show protein or other changes. These changes may appear 6
months to
10 or more years before symptoms appear.

Tests that check how well the kidneys are working include:
■Creatinine clearance
■Creatinine levels
■BUN

Chronic kidney disease changes the results of several other tests. Every patient
needs to have the following checked regularly, as often as every 2 - 3 months
when kidney disease gets worse:
■Albumin
■Calcium
■Cholesterol
■Complete blood count (CBC)
■Electrolytes
■Magnesium
■Phosphorous
■Potassium
■Sodium
■Causes of chronic kidney disease may be seen on:
■Abdominal CT scan
■Abdominal MRI
■Abdominal ultrasound
■Kidney biopsy
■Kidney scan
■Kidney ultrasound
This disease may also change the results of the following tests:
■Erythropoietin
■PTH
■Bone density test
■Vitamin D

Treatment
■Controlling blood pressure will slow further kidney damage.
■Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor
blockers (ARBs) are used most often.
■The goal is to keep blood pressure at or below 130/80 mmHg

Other tips for protecting the kidneys and preventing heart disease and
stroke:
■Do not smoke.
■Eat meals that is low in fat and cholesterol.
■Get regular exercise (talk to your doctor or nurse before starting to exercise).
■Take drugs to lower your cholesterol, if needed.
■Keep your blood sugar under control.
■Avoid eating too much salt or potassium.
■Always talk to your kidney doctor before taking any over-the-counter
medicine, vitamin, or herbal supplement. Make sure all of the doctors you visit
know you have chronic kidney disease.
Other treatments may include:
■Special medicines called phosphate binders, to help prevent phosphorous
levels from becoming too high
■Treatment for anemia, such as extra iron in the diet, iron pills, iron through a
vein (intravenous iron) special shots of a medicine called erythropoietin, and
blood transfusions
Extra calcium and vitamin D (always talk to your doctor before taking)
You may need to limit fluids.
■Your health care provider may recommend a low-protein diet.
■You may have to restrict salt, potassium, phosphorous, and other electrolytes.
■It is important to get enough calories when you are losing weight.
■Different treatments are available for problems with sleep or restless legs
syndrome.
■Everyone with chronic kidney disease should be up-to-date on important
vaccinations, including:
-H1N1 (swine flu) vaccine
-Hepatitis A vaccine
-Hepatitis B vaccine
-Influenza vaccine
-Pneumococcal polysaccharide vaccine (PPV)
■■When the loss of kidney function becomes more severe, you will need to
prepare for dialysis or a kidney transplant.
■When you start dialysis depends on different factors, including your lab test
results, severity of symptoms, and readiness.
■You should begin to prepare for dialysis before you need it. Learn about
dialysis and the types of dialysis therapies, and how a dialysis access is placed.
■Even people who are candidates for a kidney transplant may need dialysis
while waiting for a kidney to become available.

Expectations (prognosis)
Many people are not diagnosed with chronic kidney disease until they have lost
most of their kidney function.
There is no cure for chronic kidney disease. Untreated, it usually worsens
to end-stage renal disease. Lifelong treatment may control the symptoms of
chronic kidney disease.

Complications
■Anemia
■Bleeding from the stomach or intestines
■Bone, joint, and muscle pain
■Changes in blood sugar
■Damage to nerves of the legs and arms (peripheral neuropathy)
■Dementia
■Fluid buildup around the lungs (pleural effusion)
■Heart and blood vessel complications
■Congestive heart failure
■Coronary artery disease
■High blood pressure
■Pericarditis
■Stroke
■High phosphorous levels
■High potassium levels
■Hyperparathyroidism
■Increased risk of infections
■Liver damage or failure
■Malnutrition
■Miscarriages and infertility
■Seizures
■Swelling (edema)
■Weakening of the bones and increased risk of fractures

Prevention
Treating the condition that is causing the problem may help prevent or delay
chronic kidney disease. People who have diabetes should control their blood
sugar and blood pressure levels and should not smoke.
1)Fluid Volume Excess:-CRF
Renal disorder impairs glomerular filtration that resulted to fluid overload. With fluid volume excess, hydrostatic pressure is higher
than the usual pushing excess fluids into the interstitial spaces. Since fluids are not reabsorbed at the venous end, fluid volume
overloads the lymph system and stays in the interstitial spaces leading the patient to have edema, weight gain, pulmonary
congestion and HPN at the same time due to decrease GFR, nephron hypertrophied leading to decrease ability of the kidney to
concentrate urine and impaired excretion of fluid thus leading to oliguria/anuria

Medical Diagnosis: Renal Failure

Problem: Fluid Volume Excess RT Decreased Glomerular Filtration Rate and Sodium Retention
Assessment Nursing Diagnosis Scientific Planning Interventions Rationale Evaluation
Explanation
Subjective: (none) Fluid Volume Renal disorder Short Term: 1. Establish rapport 1. To assess Short Term:
Excess R/T impairs glomerular After 4-8 hours of precipitating and The patient shall
Objective: decrease filtration that nursing causative factors. have demonstrated
Patient Glomerular resulted to fluid interventions, behaviors to
manifested: filtration Rate and overload. With fluid patient will 2. Monitor and 2. To obtain monitor fluid status
 Edema sodium retention volume excess, demonstrate record vital signs baseline data and reduce
 Hypertension hydrostatic pressure behaviors to recurrence of fluid
 Weight gain is higher than the monitor fluid status 3. Assess possible 3. To obtain excess
 Pulmonary usual pushing and reduce risk factors baseline data
congestion (SOB, excess fluids into recurrence of fluid
DOB) the interstitial excess Long Term:
 Oliguria spaces. Since fluids 4. Monitor and 4. To note for The patient shall
 Distended jugular are not reabsorbed record vital signs. presence of have manifested
vein at the venous end, Long Term: nausea and stabilized fluid
vomiting
 Changes fluid volume After 3 days of volume AEB
in mental status overloads the nursing intervention 5. Assess patient’s balance I & O,
appetite 5. To prevent fluid
Patient may lymph system and the patient will normal VS, stable
overload and
manifest: stays in the manifest stabilize weight, and free
monitor intake
interstitial spaces fluid volume AEB from signs of
and output
leading the patient balance I & O, edema.
to have edema, normal VS, stable 6. Note 6. To monitor fluid
weight gain, weight, and free amount/rate of retention and
pulmonary from signs of fluid intake from evaluate degree
congestion and edema. all sources of excess
HPN at the same
time due to
decrease GFR, 7. Compare current 7. For presence of
nephron weight gain with crakles or
hyperthrophized admission or congestion
leading to decrease previous stated
ability of the kidney weight
to concentrate urine 8. Auscultate 8. To evaluate
and impaired breath sounds degree of excess
excretion of fluid
9. Record 9. To determine
thus leading to
occurrence of fluid retention
oliguria/anuria.
dyspnea
10. May indicate
10. Note presence of increase in fluid
edema. retention

11. Measure 11. May indicate

abdominal girth cerebral edema.
for changes.

12. Evaluate 12. To evaluate

mentation for degree of fluid
confusion and excess.
personality
changes.

13. Observe skin 13. To prevent

mucous pressure ulcers.
 membrane.
14. To monitor fluid
14. Change position and electrolyte
of client timely. imbalances

15. To lessen fluid

15. Review lab data retention and
like BUN, overload.
Creatinine,
Serum
electrolyte.

16. Restrict sodium 16. To monitor

and fluid intake if kidney function
indicated and fluid
retention.
17. Record I&O 17. Weight gain
accurately and indicates fluid
calculate fluid retention or
volume balance edema.

18. Weigh client 18. Weight gain may

indicate fluid
retention and
19. Encourage quiet, edema.
restful 19. To conserve
atmosphere. energy and lower
tissue oxygen
20. Promote overall demand.
health measure. 20. To promote
wellness.
2)Acute Pain:-CRF
optimal cell functioning the kidney excrete potentially harmful nitrogenous product-Urea, Creatinine, Uric Acid but because of the
loss of kidney excretory functions there is impaired excretion of nitrogenous waste product causing in increase in Laboratory result
of BUN, Creatinine, Uric Acid Level

Medical Diagnosis: Chronic Renal Failure

Problem: Acute Pain
Assessment Nursing Diagnosis Scientific Planning Interventions Rationale Evaluation
Explanation
Subjective: (none) Acute Pain Pain is a discomfort Short Term: 1. Establish rapport. 1. To get the Short Term:
that is caused by After 6-8 hours of cooperation of The patient shall
Objective: the stimulation of nursing the patient and have demonstrated
 Facial Grimaces the nerve endings. interventions, the SO. use of relaxation
 Guarding Any trauma that the patient will skills to relieve
behaviors kidney experience demonstrate use of 2. Monitor and pain. (Use pain
 Costovertebral (by any caused or relaxation skills to record vital signs. 2. To obtain scale here)
pain/ Flank pain factors) perceive by relieve pain. baseline data.
 Limited ROM the body as a threat, 3. Assess pt’s general
 Body weakness the body releases condition Long Term:
 Facial Mask cytokine and Long Term: The patient shall
 Narrowed Focus prostaglandin After 2-3 days of 4. Accept patient’s 3. To obtain have reported pain
description of baseline data
 Sleep causing pain which nursing relief or control.
Disturbance is felt by the patient interventions, the pain.
 Diaphoresis at his/her patient will report
4. Pain is a
 RR & BP costovertebral relief/control of
subjective
changes area/flank. pain.
experience and
cannot be felt by
(Don’t forget which other.
of the following
signs and 5. To be able to
symptoms above 5. Perform a
comprehensive compare changes
that the patient assessment of pain from previous
manifested and may ( location , onset, reports to rule
manifest) characteristics, out worsening of
frequency) underlying
condition/develo
ping
complications

6. Determine 6. To know
possible underlying
pathophysiology condition that
and causes of pain leads to pain and
possible
management
that would not
further aggravate
pain.

7. Assess patient’s 7. To know clients

perception along attitude towards
with behavioral pain and use of
and physiological specific pain and
responses. medication.

8. Perform pain 8. To rule out

assessment each worsening of
underlying
time pan occurs,
condition /
note and
development of
investigate
 changes from complication.
previous report.

9. Assess patient’s 9. To acknowledge

description of the pain
pain. experience
convey
acceptance of
client’s response
to pain.

10. Observe nonverbal 10. Observation

cues including how may/ may not be
client walks, holds congruent with
body, sits, facial verbal reports
expressions, cool indicating need
fingertips/ toes, for further
which can mean evaluation.
constricted vessels

11. Assess for referral 11. To help

pain as determine
appropriate possibility of
underlying
condition or
organ
dysfunction
requiring
 treatment.

12. Review patient’s 12. To rule out

previous worsening of
experiences with pain due to
pain and methods methods used.
found either
helpful or
unhelpful for pain
control in the past.

13. Explore method 13. Timely

for alleviation/ intervention is
control of pain. more likely to be
successful in
alleviating pain.
14. Encourage 14. To allow out let
verbalization of for emotions and
feelings about the enhance coping
pain. mechanism.

15. Provide quite 15. To prevent

environment, calm fatigue and
activities and lessen stimuli.
adequate rest
reinforce

16. Provide comfort

measures such as
back rub, change 16. To provide
position, use of nonpharmacologi
heat/ cold. c pain
 management.
17. Instruct/encourage
use of relaxation
exercise such as
focused breathing.
17. This is a form of
18. Encourage relaxation
diversional technique that
activities such as helps decrease
TV and level of pain.
socialization with
others.

18. Provides
19. Assist with self- divertionary
care activities. activities that
help block the
perception of
pain by the brain.
20. Assist in treatment
of underlying
disease process
causing pain. 19. To able to
perform ADL’s
21. Provide for and maintain
individualized good hygiene.
physical therapy/
exercise program
that can be
continued by the 20. Evaluate
client discharge effectiveness of
refer to physical therapies.
therapist. 21. To continue
 therapeutic
effect and
22. Administer wellness for the
analgesics as patient
ordered. 22. Pharmacologic
mgmt for pain

3)Altered Renal tissue perfusion-CRF

optimal cell functioning the kidney excrete potentially harmful nitrogenous product-Urea, Creatinine, Uric Acid but because of the
loss of kidney excretory functions there is impaired excretion of nitrogenous waste product causing in increase in Laboratory result
of BUN, Creatinine, Uric Acid Level

Medical Diagnosis: Chronic Renal Failure

Problem: Altered Renal Perfusion RT Glomerular Malfunction
Assessment Nursing Diagnosis Scientific Planning Interventions Rationale Evaluation
Explanation
Subjective: (none) Altered Renal For optimal cell Short Term: 1. Establish rapport 1. To get the Short Term:
Perfusion R/T functioning the After 2-3 hours of cooperation of The patient shall
Objective: Glomerular kidney excrete NI, the patient will the patient and have demonstrated
 Increase in Lab Malfunction AEB potentially harmful demonstrate SO. participation in
results (BUN, Increase in BUN, nitrogenous participation in his/her
Creatinine, Uric Creatinine and Uric product-Urea, his/her recommended
Acid Level) Acid Level 2O to Creatinine, Uric recommended 2. Monitor and record 2. To obtain treatment program
 Oliguria renal Failure. Acid but because treatment program. vital signs. baseline data
 Anuria of the loss of
 Edema kidney excretory Long Term:
 Pulmonary functions there is Long Term: The patient shall
Congestion impaired excretion After 2-3 days of 3. Assess patient’s 3. To obtain have demonstrated
 Hypertension of nitrogenous NI, the patient will general condition. baseline data. behavior/lifestyle
 Hematuria waste product demonstrate changes to prevent
 causing in increase behavior/lifestyle complications
(Don’t forget which in Laboratory result changes to prevent
of the following of BUN, complications 4. Determine factors 4. To assess
signs and Creatinine, Uric related to individual causative and
symptoms above Acid Level situation and note contributing
that the patient situation that can factors
manifested and affect all body
may manifest) system.

5. Note characteristic
of urine: measure 5. To assess for
urine specific hematuria and
gravity. proteinuria and
renal
6. Ascertain usual impairment.
voiding pattern 6. To compare with
current situation.

7. Note presence, 7. may indicate

location intensity pain on affected
duration of pain. organ

8. Note mentation 8. increase BUN

status and review and creatinine
lab result such as levels may alter
BUN and creatinine mentation
levels.

9. Monitor BP,
ascertain patient’s 9. GFR may
usual range. increase rennin
 and raise BP.
10. Observe for
dependent
generalized edema. 10. To note degree
of impairment of
11. Measure urine renal function.
output on a regular
schedule and weigh 11. To assess renal
daily. perfusion and
function.
12. Provide diet
restriction as 12. Calories to meet
indicated, while body’s need
providing adequate while restriction
calories. of protein helps
limit BUN.
13. Encourage
discussion of 13. To decrease
feelings regarding anxiety about
prognosis or long condition and
term effects of correct his
discussion. wrong ideas
about condition.
14. Identify necessary
changes in lifestyle 14. To promote
and assist client to wellness and
incorporate disease prevent further
management to progression of
ADLs. complication.

15. Assess patient 15. Stress or

emotional/psycholo depression may
gical factors be increasing the
 affecting the effect of an
current situation. illness or
depression might
be the result of
being forced into
inactivity.

16. Establish realistic 16. Enhance

activity goal with commitments to
patient. promoting
optical
outcomes.

17. Give information 17. To provide

about positive signs encouragement.
of improvement
such as improve
vital signs/
circulation.

18. Provide physiologic 18. Honestly can be

support. Maintain reassuring when
calm attitude but so much activity
admit concerns if or worries are
questioned by the apparent to the
client/SO. client or SO.

19. To establish
19. Review
 expectations of the individual goals.
patient/SO.

20. Give patient 20. To sustain

information that motivation.
provides evidence
of daily/weekly
progress.
21. To enhance
21. Encourage patient sense of well
to maintain positive being.
attitude; suggest
use of relaxation
technique such as
guided imagery as
appropriate.

22. Administer 22. For faster

medication as recovery. It is
ordered. used to treat the
client’s disease
condition.
23. Promote overall
health measure. 23. To promote
wellness.

4)Impaired Urinary elimination-CRF

Renal Failure is a problem which results to loss of kidney functions and as GFR decrease, the kidney cannot excrete nitrogenous
product and fluid causing impaired in Urinary elimination and together with prolonged use of medications such as NSAIDs this will
lead to further kidney destruction which may thus decreasing the glomerular filtration and destroying of the remaining nephrons.
This will result into inability of the kidney to concentrate urine which makes the patient to have a nursing diagnosis of impaired
urinary elimination
Medical Diagnosis: Chronic Renal Failure
Problem: Impaired Urinary Elimination RT Glomerular Malfiltration
Assessment Nursing Diagnosis Scientific Planning Interventions Rationale Evaluation
Explanation
Subjective: (none) Impaired Urinary Renal Failure is a Short Term: 1. Establish rapport. 24. To get the Short Term:
Elimination R/T problem which After 2-3 hours of cooperation of The patient shall
Objective: glomerular results to loss of nursing 2. Monitor and the patient and have demonstrated
 Increase in Lab Malfiltration AEB kidney functions interventions, the record vital signs. SO. participation in
results (BUN, Impaired excretion and as GFR patient will his/her
Creatinine, Uric of nitrogenous decrease, the verbalize 25. To obtain recommended
O baseline data.
Acid Level) products 2 Renal kidney cannot understanding of treatment program
 Oliguria Failure excrete nitrogenous condition
 Anuria product and fluid 3. Assess pt’s general 26. To know what
 Hesitancy causing impaired in condition problem and Long Term:
 Urinary Urinary elimination Long Term: interventions The patient shall
Retention and together with After 1-2 days of should be have demonstrated
prolonged use of nursing prioritize. behavior/lifestyle
(Don’t forget which medications such as interventions, the changes to prevent
of the following NSAIDs this will patient will 4. Review for 27. To assess for complications
signs and laboratory test for contributing or
lead to further participate in
changes in renal causative factors.
symptoms above kidney destruction measures to
function.
that the patient which may thus correct/compensate
manifested and may decreasing the for defects
5. Establish realistic 28. Enhance
manifest) glomerular activity goal with commitments to
filtration and client. promoting
destroying of the optimal
remaining outcomes.
nephrons. This will
result into inability
of the kidney to 6. Determine clients 29. To assess degree
concentrate urine pattern of of interference.
which makes the elimination
patient to have a
nursing diagnosis
of impaired urinary
elimination. 7. Palpate bladder 30. To assess
retention

8. Investigate pain, 31. To investigate

noting location extent of
interference
9. Determine client’s
usual daily fluid 32. To help
intake determine level
of hydration.

10. Note condition of 33. To assess level of

skin and mucous hydration.
membranes, color
of urine.
11. Observe for signs 34. To help in
of infection treating urinary
alterations
12. Encourage to
verbalize 35. Open expression
fear/concerns allows client to
deal with feelings
13. Emphasize the and begin
need to adhere problem solving.
with prescribe diet
36. To prevent
14. Emphasize aggravation of
importance of disease
having good condition.
 hygiene.
37. To promote
15. Emphasize wellness.
importance of 38. To promote
adhering to wellness
treatment
regimen

5) Altered Nutrition Less than body requirement

Due restricted foods and prescribed dietary regimen, an individual experiencing renal problem cannot maintain ideal body weight
and sufficient nutrition. At the same time patients may experience anemia due to decrease erythropoietic factor that cause
decrease in production of RBC causing anemia and fatigue

Medical Diagnosis: Chronic Renal Failure

Problem: Altered Nutrition: Less than Body Requirements RT Catabolic State, Anorexia and Malnutrition
Assessment Nursing Diagnosis Scientific Planning Interventions Rationale Evaluation
Explanation
Subjective: (none) Altered Nutrition: Due restricted Short Term: 1. Establish 1. To gain patient’s Short Term:
Less than body foods and After 6-7 hours of rapport trust. The patient shall
Objective: Requirement R/T prescribed dietary NI, the patient will have displayed
 Anorexia Catabolic state, regimen, an display 2. Assess general 2. To establish normalization of
 Anemia Anorexia and individual normalization of appearance baseline data. laboratory values
O and monitor
 Fatigue Malnutrition 2 to experiencing renal laboratory values and be free of signs
 Reported Renal Failure problem cannot and be free of signs vital signs. of malnutrition.
inadequate food maintain ideal body of malnutrition.
intake less than weight and 3. Identify 3. To assess
recommended sufficient nutrition. patient at risk contributing Long Term:
daily allowance At the same time Long Term: for factors. The patient shall
patients may After 4-5 days of malnutrition. have demonstrated
(Don’t forget which experience anemia NI, the patient will 4. Ascertain 4. To determine behaviors, lifestyle
of the following due to decrease demonstrate understanding what information changes to regain
signs and erythropoietic behaviors, lifestyle of individual to provide the and maintain an
symptoms above factor that cause change to regain nutritional patient. appropriate weight.
that the patient decrease in and maintain an needs.
manifested and may production of RBC appropriate weight.
manifest) causing anemia and 5. Assess weight,
fatigue. age, body 5. To provide
build, comparative
strength, rest baseline.
level.

6. Assist in 6. To control
developing underlying
individualized factors.
regimen.

7. Provide diet
modification
as indicated. 7. To establish a
nutritional plans.
8. Determine
whether
patient prefers
more calories 8. To establish a
in a meal. nutritional plans.

9. Avoid high in
sodium-rich
food. 9. To prevent
further increase
10. Promote in sodium level.
relaxing
 environment. 10. To enhance
intake.
11. Provide oral
care.
11. To prevent
12. Provide safety. further spread of
dental caries.

13. Maintain bed 12. To prevent

rest. injury.

14. Change
position every 13. To decrease
2 hours. metabolic
demand.

15. Position the 14. To prevent

bed into semi- ulcerations.
fowler’s
position.
15. To enhance lung
16. Limit fluid expansion.
intake as
ordered.
16. To prevent water
17. Encourage to retention.
do Passive
range of
motion 17. To have proper
exercise. circulation of
blood.
18. Encourage
early
 ambulation. 18. To prevent
muscle atrophy.
19. Regulate
Intravenous
line as 19. To maintain
Ordered. hydration status.

20. Administer 20. To prompt

Medications treatment.
as ordered.