G.

Arunaj 2015

FACULTY OF NURSING

BACHELOR OF SCIENCE IN NURSING (POST

REGISTRATION)

ASSIGNMENT COVER PAGE

Student’s Name GOPALASINGAM ARUNAJ

Student’s ID LC0007000016 Student’s NRIC

Year/Semester 1ST year / 2nd semester Lecturer’s Name Mr. Regidor

Faculty LINCOLN UNIVERSITY COLLEGE

Programme BACHELOR OF SCIENCE IN NURSING

Subject Name Clinical Practice 2 (LBNS 2207).

Assignment Title case study on chronic kidney disease

No. of Page
(excluding this page) 39

Required words 2000 Actual # of words 8390

Date submitted Due Date

Soft copy included Yes / No

DECLARATION BY STUDENTS:
I certify that this assignment is my own work in my own words. All resources have been
acknowledged and the content has not been previously submitted for assessment to LINCOLN
or elsewhere. I also confirm that I have kept a copy of this assignment.

Signed: Date:

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G.Arunaj 2015

A case study of a chronic kidney disease patient admitted to the BH Nintavur

By GOPALASINGAM ARUNAJ, RN, BSN
Student, Lincoln University College, Malaysia
Table of contents
1.0 OBECTIVES OF CASE STUDY
1.1 GENERAL OBJECTIVES…………………
1.2 SPECIFIC OBJECTIVES………………….
2.0 BIOGRAPHIC DATA
2.1.1 HEALTH HISTORY………….
2.1.1.1 DEMOGRAPHIC DATA………….
2.1.1.2 CHIEF COMPLAINTS…………….
2.1.1.3 HISTORY OF PRESENT ILLNESS…………
2.1.1.4 HISTORY OF PAST ILLNESS…………….
2.1.2 FAMILY HISTORY……………
2.1.3 HEALTH SEEKING PRACTICE……………
2.1.4 PERSONAL HISTORY…………….
2.2 SOCIO-ECONOMIC STATUS……………...
3.0 ENVIRONMENTAL FACTOR
4.0 DEVELOPMENTAL NEED AND TASK COMPARING WITH NORMAL ADULT
CLIENTS
4.1 Robert Havighurst’s Developmental Tasks…………
4.2 Eric Erikson’s Developmental Task……………
5.0 Physical Assessment
6.0 FINDINGS

7.0 DEFINITION, CAUSE AND PATHOPHYSIOLOGY OF CLIENTS DISEASES

8.0 Stages of chronic kidney disease

8.1 COMPARISON OF…………..
8.2 SIGNS AND SYMPTOMS…………..
8.3 INVESTIGATION……………..
8.4 COMPARISON OF MEDICAL MANAGEMENT………….
8.5 COMPARISON OF SURGICAL MANAGEMENT………….
8.6 COMPARISON OF NURSING MANAGEMENT……….

9.0 DRUGS CARD OF MEDICINES

10.0 SUMMARY OF CLIENT DAILY PROGRESS REPORT IN HOSPITAL
11.0 DIVERSIONAL THERAPY USED FOR CLIENT
12.0 APPLICATION OF NURSING THEORIES
13.0 APPLICATION OF THEORY ON MY PATIENT
14.0 NURSING CARE PLAN
15.0 DISCHARGE TEACHING
16.0 WHAT I LEARNED FROM THIS CASE STUDY
17.0 CONCLUSIONS AND SUMMARY OF CASE STUDY
18.0 REFERENCES
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G.Arunaj 2015

1.0 OBECTIVES OF CASE STUDY

1.1 GENERAL OBJECTIVES:-

The general objective of the case study is to gather the comprehensive knowledge about the disease to
gain the practical exercise about the Adult Health Problem and also to gain Practical experience working
with a patient having chronic kidney disease and to give holistic patient care according to their need.

1.2 SPECIFIC OBJECTIVES:-

The specific objectives of the case study are given below:-

 To assess the patient and find out need of patient according to nursing process.
 establish a nurse-client relationship to the client, as well as to the family by rendering a
therapeutic nurse-patient relationship;
 gather adequate information to be used in the development of the study
 present the clients personal data;
 illustrate the patient’s family tree and trace significant diseases which may be of relevance to the
study
 trace the health history of the client and the family by collecting information both of the past and
present illnesses;
 To provide holistic nursing care to the client to all ages using nursing process.
 To manage promptly as necessary to built up comfort.
 To provide psychological support to the patient
 To apply knowledge from the science, nursing theory and other related courses to plan and
implement nursing care.
 To provide continuous care till discharge and follow-up care.
 Counsel and make aware the patient party about importance of continuity of medicine and
psychological support to prevent from worsens.
 To provide the discharge teaching to the patient and family member.

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G.Arunaj 2015
2.0 BIOGRAPHIC DATA

2.1.1 HEALTH HISTORY

2.1.1.1. DEMOGRAPHIC DATA

 NAME: laxman kumar
 AGE: 68yrs
 SEX: male
 ADDRESS: 56, vanniyar road , Attappalam
 RELIGION: Hindu
 EDUCATION iliterate
 DATE OF ADMISSION: 2015/6/6
 DATE OF DISCHARGE: 2015/6/17
 IP NO. : 2821/210
 OCCUPATION: farmer
 MARITAL STATUS: married
 ATTENDING DOCTOR: Dr. A.Akil Ahamed
 INFORMATION SOURCE: patient and his son
 DIAGNOSIS: CKD
 BLOOD GROUP: A +ve
 BED NO: 5
 WARD: Surgical

2.1.1.2 CHIEF COMPLAINTS: Swelling of legs, face for 2 days

2.1.1.3 HISTORY OF PRESENT ILLNESS: According to the patient’s, he come for haemodialysis,
due to increased shortness of breath during dialysis he was admitted in the Surgical ward. His general
condition is ill looking and oriented with time place and person.

2.1.1.4 HISTORY OF PAST ILLNESS:

 According to the patient’s party, he is undergoing regular dialysis and is under
antihypertensive medicine.

 ALLERGIES
According to the patient, he doesn’t have any allergic reaction to any factors.
.
PREVIOUS HOSPITALIZATION: Batticalloa general teaching hospital for the diagnosis of CKD

 OPERATIONS OR SPECIAL TREATMENT: no any

2.1.2 FAMILY HISTORY:

 Type of family: joint
 No. of Family Members: 8
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G.Arunaj 2015

Table 1 Family Medical history

DISEASE FATHER’S RELATION MOTHER’S RELATION

Tuberculosis Absent Absent
Cancer Absent Absent
Heart disease Absent Absent
Jaundice Absent Absent
Epilepsy Absent Absent
Psychological Absent Absent
Hypertension Present Present

2.1.3 HEALTH SEEKING PRACTICE: He belongs to literate family, According to laxman kumar ,
they were not dependent in superstitious beliefs. If someone becomes ill in their family they take
homemade medicine then some times go to hospital.

2.1.4 PERSONAL HISTORY:

 Health Habits:
Smoker but has left 1-2 months ago, Non alcoholic,
Non vegetarian.
No food allergy.
Maintain personal hygiene
Religion belief and worship kuldeuta.
 Dietry history:
Non vegetarian.
Foods like egg-curry, rice, daal etc.

2.1 SOCIO-ECONOMIC STATUS:

He belongs to middleclass family. The major source of income is

farming and business. They are the permanent residence of
Attappalam. They are well satisfied with their economic status.
They have very good inter relationship in the community.

3.0 ENVIRONMENTAL FACTOR:

 Housing Pattern: Well facilitated

 Waste disposal: They are practicing collective approach to manage the waste
product. Such as temporary container, burning and making compost manure. The
people from Attappalam also come to take waste from there home.

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G.Arunaj 2015
 Pollution and noise: his house is near the road , so he is very much affected by the
noise of the vehicle and the air pollution caused by the vehicle.

4.0 DEVELOPMENTAL NEED AND TASK COMPARING WITH NORMAL ADULT

CLIENTS

4.1 Robert Havighurst’s Developmental Tasks

Developmental Description Passed or

Tasks Failed
1. Adjusting to Older adults also Passed
decreasing physical have to adjust to
strength and health decreasing physical
strength and health.
The prevalence of
chronic and acute
diseases increase in
old age. Thus, older
adults may be
confronted with life
situations that are
characterized by not
being in perfect
health,serious illness
and dependency on
people.
2. Adjusting to A central Passed
retirement and developmental task
reduced income that characterized the
transition into old
age is adjustment to
retirement. The
period after
retirement has to be
filled with new
projects, but is
characterized by few
valid cultural
guidelines. The
achievement of this
task may be
obstructed by the
management of
another task, living
in a reduced income
after retirement.

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G.Arunaj 2015
3. Adjusting to death Older adults may Failed
of a spouse become caregivers to
their spouses. Some
older adults have to
adjust to the death of
their spouses. After
they have lived with
a spouse for many
decades, widowhood
may force older
people to adjust to
loneliness, moving to
a smaller place,and
learning about
business matters.
4. Establishing an The development of Passed
explicit affiliation a large part of the
with one's aged group population into old
age is historically
recent phenomenon
to modern cities.
Thus, advancements
understanding of the
aging process may
lead to identifying
further
developmental tasks
associated with gains
and purposeful lives
for adults.
5. Meeting social and Older people might Passed
civil obligations accumulate
knowledge about
life, and thus may
contribute to the
development of
younger people and
the society.
6. Establishing Oder adults are Passed
satisfactory physical generally challenged
living arrangements to create positive
sense of their lives as
a whole. The feeling
that life has order
and meaning results
in happiness.
 
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4.2 Eric Erikson’s Developmental Task

Integrity vs. Despair

 
                  Erikson felt that much of life is preparing for the middle adulthood stage and the last stage
recovering from it. Perhaps that is because as older adults we can often look back on our lives with
happiness and are contented, feeling fulfilled with a deep sense that life has meaning and we've made
contribution to life, a feeling Erikson called integrity. On the other hand, some adults may reach this
stage and despair at their experiences and perceived failure.
                  My patient achieved happiness and contentment in his life based on his actions and speeches.
He is faithful and devoted to his religion. He is ready to accept death completely and he has shared his
experiences to his beloved grandchildren. Even though he accepted death fully but his faith and love for
his worshipped God never changed.

5.0 Physical Assessment

Name: Mr.laxman kumar

Ward: Surgical Ward
Bed: 5 Age: 68 yrs
Sex: male
Civil Status: Married

Vital Signs
Axillary T=97 degree F, PR= 90/ min, RR= 22/ min, BP= 150/80 mmHg.
General survey
Height= 5 ft and 8 inches, weight= 56 kilos,. No signs of distress noted upon assessment, able to
smile, cooperate well, responsive to questions, conscious and alert, conversant. Well oriented. Show
calmness during the examination. He has no IVF infused, and was asleep at initial assessment.
Skin
Skin is brown in color, rough, dry and warm. He has good skin turgor. Brownish discolorations
that resemble wrinkles are observed on face.
Head
Skull is round in shape, symmetrical. No masses noted. Facial movement is symmetrical,
alopecia. Scalp is clear from dandruff and lice. No scars and wounds noted.

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G.Arunaj 2015
Eyes
Has symmetrical eyebrows movement, shape and hair distribution. Eyebrows have same color
with hair. Eyelashes are evenly distributed and curled outward. Eyelids have no discharges and
bilaterally blink. Upper lid covers the small portion of the iris and cornea. Lacrimal duct openings
(puncta) are evident at nasal ends of upper and lower lid with no tenderness noted. Palpebral conjunctiva
are pinkish in color while the pupils constricted to light, round in shape. He is able to rotate eyes and has
coordinated eye movements.
Ears
Auricle has same color with the skin, has symmetrical shape and located a little bit higher than
the eye. Pinnas are symmetrical with no lesions noted. He has wet cerumen noted on both ears when
pulled down and back for better visualization. he is able to hear on both ears.

Nose
Nose has uniform color and symmetrical in shape. Nasal hairs are very evident when light is
flashed through the nasal passageways; its color is black. No nasal flaring observed upon respiration.
Both nares are patent, air moves freely as client breathes through the nares. Nasal septum is straight and
in midline. Nasal mucosa is pinkish in color, has no discharges and no lesions. No tenderness of sinuses
noted.
Mouth
Lips are a little brownish in color, dry and has cracks. Tongue is in midline, pinkish in color with
thin whitish coating on top. Able to move tongue freely (up & down, side to side). Soft palate is light
pink in color while hard palate is lighter in color. Gums are pinkish in color. Plagues are present on his
teeth
Pharynx
Uvula is found well placed in midline of soft palate. Mucosa is pinkish in color. Tonsils are not
inflamed.
Neck
Trachea is in midline. No tenderness of thyroid noted. No enlargement of the neck noted. he is
able to flex and extend neck and move it laterally (L and R).
Chest and Lungs

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G.Arunaj 2015
Breathing pattern is regular. Anteroposterior diameter to transverse diameter is in 1:2. Respiratory
excursion is symmetrical (thumb separates to 2-3cm). No tenderness, lump, Presence of breath sound in
all area of lungs

Heart and Central Vessels

Heart sounds are regular. Pulsation of heart is heard in 4 anatomical areas but more audible in
apical area upon auscultation.
Back and Extremities
Peripheral pulses are symmetrical and regular. Nails are long and untrimmed, pinkish in color, and have
a capillary refill time of 2 sec. after blanching; and no clubbing of fingernails were noted.. His hands are
a little rough. Muscle strength is equal on both sides of the upper and lower extremities. He is able to
stand and walk on both feet independently, and his movements are well coordinated. Toes point straight
ahead. And he is able to sit up straight.
Abdomen
His abdomen’s color is same with the rest of the part of the body. His umbilicus is coated with
blackish dirt.
Neurologic Assessment
Cranial Nerves: able to identify aromas by smelling with eyes closed; able to see objects; pupil
constricted to light sensation; able to move eyeball downward and laterally; able to blink eyes; able to
smile, raise eyebrows, puff cheeks and close eyes; able to respond to questions being heard;) has rough
and vibrating sound; able to shrug shoulders, elevate and flex arms and legs against resistance; able to
protrude tongue and move it side to side.

6.0 FINDINGS:

 Skin is dry and rough

 Alopecia of hair
 wet cerumen noted on both ears
 plaques are present
 Nails are long and untrimmed

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7.0 DEFINITION, CAUSE AND PATHOPHYSIOLOGY OF CLIENTS DISEASES.

Definition:
Chronic kidney disease (CKD), also known as chronic renal disease, is a progressive loss of renal
function over a period of months or years in which the body’s ability to maintain metabolic and fluid
and electrolyte balance fails, resulting in uremia or azotemia. In this condition, the GFR falls below 10%
of the normal rate.

Causes:
 Heredity
 Glomerular dysfunction
 Diabetic nephropathy
 Hypertension
 Glomerulonephritis
 Polycystic kidney disease
 Urinary tract obstruction
 Bladder tumour
 Urethral obstruction
 Hypertensive nephrosclerosis (hardening of the kidney)

Other causes:
 Hiv infection
 Kidney stones
 Chronic kidney infections and certain cancers
 Regular use of anti – inflammatory drugs
 Vesicoureteral reflux ( a urinary tract problem in which urine travels the wrong way back
towards kidney)

8.0 Stages of chronic kidney disease

STAGE DESCRIPTION GFR ML/MIN

1. Slight kidney damage with More than 90
normal or increased
filtration
2. Mild decrease in kidney 60-89
function
3. Moderate decrease in 30-59
kidney function
4. Severe decrease in kidney 15-29
disease
5. Kidney failure Less than 15 or dialysis

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 G.Arunaj 2015
Predisposing Factors
Genetics Pathophysiology:
Age >40

Decrease insulin
Precipitating production/sensitivity
Environment(intrapartal)
Toxin/Virus
Obesity
Decrease Serum Potasium

Increased Osmolarity Elevated Serum Glucose

due to Glucose

Chronic elevation of
Polydipsia Polyuria Polyphagia Serum Glucose

Weight loss

Small vessel Accelerated Impaired immune

Diabetic neuropathy Diabetic retinopathy
disease atherosclerosis function

Hypertension
Symmetrical loss of sensation

Diabetic nephropathy Infection

Coronary artery disease
Numbness and paresthesia

Loss of vision
Wasting of intrinsic muscles
End-stage renal failure Delayed wound healing
Increase LDL levels

Autonomic neuropathy

Impotence
Dry, cracked skin
Diabetic foot ulceration

Neurogenic bladder
Charcot changes in joints Gastroparesis
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4) COMPARISON OF:

8.1 SIGNS AND SYMPTOMS

 Neurologic
ACCORDING TO BOOK ACCORDING TO PATIENT
 Weakness and fatigue  Present
 Confusion  Present
 Inability to concentrate  Absent
 Seizures  Absent
 Restlessness of legs  Present
 Burning to soles of feet  Present
 Behavior changes  Present

 integumetry

ACCORDING TO BOOK ACCORDING TO PATIENT

 Dry, flaky skin  Present
 Thin, brittle nails  Present
 Thinning hair  Absent

 cardiovascular

 ACCORDING TO BOOK ACCORDING TO PATIENT

 Hypertension  Present
 Pitting edema  Present
 Periorbital edema  Present

 pulmonary

ACCORDING TO BOOK ACCORDING TO PATIENT

 Shortness of breath  Present
 Tachypnea  present
 Kussmaul- type respiration  Present

 G.I

ACCORDING TO BOOK ACCORDING TO PATIENT

 Metallic taste  Absent
 Anorexia, nausea  Absent
 Vomiting, constipation/ diarrhea  Present

 Hematologic

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G.Arunaj 2015
ACCORDING TO BOOK ACCORDING TO PATIENT
 Anemia  Present

 Reproductive

ACCORDING TO BOOK ACCORDING TO PATIENT

 Amenorrhea  Absent
 Infertility  Absent
 Testicular atrophy  Absent

 Musculoskeletal

ACCORDING TO BOOK ACCORDING TO PATIENT

 Muscle cramps  Present
 Loss of muscle strength  Present
 Bone pain  Present
 Bone fracture  Absent

8.2 INVESTIGATION

ACCORDING TO BOOK ACCORDING TO PATIENT

Laboratory test: Blood urea: 119.0 mg/dl
Creatinine:9.1
Na+:139.o
K+:5.2 meq/r
Serum albumin:2.8gm/dl
Hb:9.6gm%
Glucose f:120 mg/dl
Glucose pp : 141mg/dl
USG Done but report was not available
Biopsy Done but report was not available
KUB film Not done
It is an ultrasound-based diagnostic medical
imaging technique used to visualize muscles,
tendons, and many internal organs, to capture
their size, structure and any
pathological lesions 
with real time tomographic images.

Normal Size in cm:

Left Kidney Right Kidney
10.8 +- Length 9.7 +-
0.8 0.7
4.2 + - Width 4.3 +-
0.5 0.5
4.8 +- Thick 3.9 +-
0.5 0.5
1.5 C. Thick 1.5

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8.3 COMPARISON OF MEDICAL MANAGEMENT
The goal of management is to maintain kidney function and homeostasis for as long as possible.
Because of the great deterioration of renal function, the duration of management may vary from months
to years. Nothing can be done to prevent or delay the fatal outcome.
ACCORDING TO BOOK
 Control of urinary volume: fluids
are forced since kidney has lessened
ability to concentrate solids. more
fluids about 2litres is needed to
excrete waste. Sometimes
frusemide may be required to
increase urine production.
 Control of nausea and vomiting:
anorexia, nausea and vomiting tend
to develop when the cretinine
clearance falls below 5ml/min. so
reduction in protein is required to
improve nausea. Blood: 0.8-1.4
mg/dL is the normal. Due to
impaired kidney function, creatinine
in the blood elevates.
 Antiseizure agents
 Antihypertensive agents:
hypertension is managed by
intravascular volume control and a
variety of anti- hypertensive agents.
 Control of hyperkalaemia will be
treated with I/V glucose and insulin
in a ratio of 3 gm Glucose to 1 unit
soluble insulin.
 Control of anemia: blood
transfusion are frequently required.
 Accurate record of input and output
chart should be maintained
ACCORDING TO PATIENT
 My patient was prescribed to drink
lee than 500 ml water in a day.Tab
lasix 40 mg, po, od, is given to my
patient.
 Creatinine clearance rate was 10.g
mg/dl on 4/2, 8.5 mg/dl on 068/4/6,
9.7mg/dl on 068/4/9.
 Since my patient didn’t develop any
kind of seizure. So antiseizure
agents were not used.
 Tab nifedipine 10 mg,tds was given
to my patient to control
hypertension.

 Since my patient didn’t develop
anemia so bllod transfusion was not
done.
 Input and output chart was
maintained.
 4/6 : 200ml total input and 200ml
was total output
 4/7: 350ml was total input and 250
mi was total output
 4/8: 500ml total input and 350ml
total output
 4/9: 530ml was total intake and 150
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G.Arunaj 2015
 Other therapy: dialysis
It is usually initiated when
the patient cannot maintain a
reasonable lifestyle with
conservative treatment.
8.4 COMPARISON OF SURGICAL MANAGEMENT
ACCORDING TO BOOK
 Kidney transplantation: it involves
transplanting a kidney from a living donor
to a recipient who has ESRD. The success
rate increases if kidney transplantation
from a living donor is performed before
dialysis is initiated.
ml was total output
 4/10: 450ml total input and 300ml
total output
 4/11: 400 ml total input and 300 ml
total output
 My patient is undergoing regular
dialysis, 2-3 times in a week
ACCORDING TO PATIENT
 Kidney transplantation cannot be
performed in my patient because of
hypertension and slow wound healing due
to diabetes mellitus.
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8.5 COMPARISON OF NURSING MANAGE MENT

The patient with chronic renal failure requires astute nursing care to avoid the complications of reduced
renal failure and the stresses and anxieties of dealing with a life threatening illness.

ACCORDING TO BOOK ACCORDING TO PATIENT

 Nursing care is directed toward assessing
fluid status and identifying potential source
of imbalance
 Implement a dietary program to ensure
proper nutritional intake within the limits
of the treatment regimen.
 Promote positive feelings by encouraging
increased self care
 Provide explanations and information to
the patient and family concerning ESRD,
treatment options and potential
complications
 Nurse must be familiar with various drugs
and their side effects
 Provide emotional support to the patient
and his family because of the numerous
changes experienced.
As a nurse I assessed the fluid status of my patient
by monitoring input and output record closely.
My patient was prescribed to have fluid less than
500ml/day and was on renal diet. As a nurse I
closely observe the dietary pattern of my patient
I encouraged my patient to perform his activity of
daily living by himself and promoted the positive
feelings.
As a nurse I provided explanation to the patient
and his family members about his treatment
options and potential complications.
As a nurse I provided information to my patient
regarding various drugs used in it.
I provided my patient and his family emotional
support so that anxiety and tension is relieved to
some extent.

9.0 DRUGS CARD OF MEDICINES

My patient has used the following drug:-

 Tab nifedipine 10mg, tds
 Tab lasix 40mg, od
 Tab pantop 40 mg
 Diclofenac gel
 Tab domel 1 tab
 Tab haloperidol

1. Tab nifedipine

Therapeutic class: antianginal, antihypertensive, calcium channel blocker

Action :antihypertensive agent that inhibits calcium ion movement across cell membranes, depressing
contraction of cardiac and vascular smooth muscles
Therapeutic effect: decreases blood pressure
Indication: chronic stable angina, hypertension
Contra- indication: severe hypotension

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G.Arunaj 2015
Side effects: peripheral edema, headache, dizziness, (occasional): nausea, muscle cramps and pain,
dyspnea, cough (rare): hypotension, rash, constipation, sexual difficulties
Nursing management: administer on an empty stomach
Do not crush or chew sustained release dosage forms

2. Furosemide
Novosimide; PMS-Furosimide
Classification: Loop diuretics
Indications: Edema d/t heart failure, hepatic impairment
or renal disease. Hypertension.
Action: Inhibits the reabsorption of sodium and chloride from
the loop of Henle and distal renal tubule. Increases renal
excretion of water, sodium, chloride, magnesium, potassium, and calcium. Effectiveness persists in
impaired renal function. Decreased blood pressure.
Dosage: 1 tablet, 200 mg
Contraindication: Hypersensitivity; Cross-sensitivity with thiazides and sulfonamides may occur;
Hepatic coma or anuria; Some liquid products may contain alcohol, avoid in patients with alcohol
intolerance.
Precautions: Severe liver disease; electrolyte depression
Side effects: CNS – blurred vision, dizziness, head ache, vertigo
EENT – hearing loss, tinnitus
CV – hypotension
GI – anorexia, constipation, diarrhea, dry mouth, nausea, vomiting
GU – excessive urination
Derm – photosensitivity, rash
F and E – dehydration
Nursing Responsibilities:
1. Assess fluid status. Notify physician or other health care professional if thirst, dry mouth,
hypotension, or oliguria occurs.
2. Monitor blood pressure and pulse before and during administration.
3. Monitor blood glucose closely; may cause increased blood glucose level.

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G.Arunaj 2015
4. Caution patient to change positions slowly to minimize orthostatic hypotension.
5. Advise patient to contact health care professional immediately if muscle weakness, cramps,
nausea, dizziness and numbness occurs.
6. Caution older patients or their caregivers about increased risk for falls.

3. tab pantop
Generic name: pantoprazole
Functional class: proton pump inhibitor

Action: it inhibits the secretion of hcl in the stomach by specific action on the proton pumps of the
patietal cells.

Dose and routes:

Adult: 40 mg/day (PO)
In pathological hypersecretory conditions: adult I/V 80 mg over 12 hours

Indication:
Peptic ulcer,zollinger ellison syndrome, NSAIDS associated peptic ulcer

Contraindication: lactation, hypersensitivity to drug

Side effects:
CNS: headache, insomnia, mental depression, confusion
GI system: diarrhea, abdominal pain, constipation
INTEG: rash, peripheral edema
Muscular system: myalgia( pain in the muscles)

4. diclofenac gel
therapeutic class: NSAID, antipyretic, non narcotic analgesic
action: NSAID that inhibits prostaglandin synthesis reducing the intensity of pain
therapeutic effect: produces analgesic and anti-inflammatory effects
indication: osteoarthritis, rheumatoid arthritis, pain, primary dysmennorrhea
contra indication: hypersensitivity to aspirin, diclofenac
side effects: headache, abdominal cramps, constipation, diarrhea, nausea

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G.Arunaj 2015
5. Domperidone
Motilium (1 tab, 100 mg)
Classification: Anti-emetic and anti-vertigo
Mode of Action: Domperidone is a dopamine-receptor blocking agent. Its action on the dopamine-
receptors in the chemo-emetic trigger zone produces an anti-emetic effect.
Interactions:
 Concomitant administration of anti-cholinergic drugs may inhibit the anti-dyspeptic effects of
MOTILIUM.
 Anti-muscarinic agents and opioid analgesics may antagonize the effect of MOTILIUM
 MOTILIUM suppresses the peripheral effects (digestive disorders, nausea and vomiting) of
dopaminergic agonists.
 Since MOTILIUM has gastro-kinetic effects, it could influence the absorption of concomitant
orally administered medicines, particularly those with sustained release or enteric coated
formulations.
 As MOTILIUM interferes with serum prolactin levels, it may interfere with other
hypoprolactinaemic agents and with some diagnostic tests.
 Antacids and anti-secretory agents lower the oral bioavailability of domperidone. They should be
taken after meals and not before meals, i.e. they should not be taken simultaneously with
MOTILIUM.
 Reduced gastric acidity impairs the absorption of domperidone.
Oral bioavailability is decreased by prior administration of cimetidine or sodium bicarbonate
Side Effects:
 Allergic reactions, such as rash or urticaria, have been reported.
 Abdominal cramps have been reported.
 Reversible raised serum prolactin levels have been observed which may lead to gynaecomastia.
 Where the blood brain barrier is not fully developed (mainly in young babies) or is impaired, the
possible occurrence of neurological side-effects cannot be totally excluded
Nursing Responsibilities:
1. Assess for extra-pyramidal effects such as jerking and tongue protrusion.
2. Check for hypotension.

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G.Arunaj 2015
6. Haloperidol
Therapeutic class: antipsychotic
Action: an antipsychotics agent that competitively block postsynaptic dopamine receptors
Therapeutic effect: produces tranquilizing effect
Indication: treatment of psychotic disorders
Contra indication: CNS depression, hepatic disease
Side effects: blured vision, constipation, dry mouth, peripheral edema, difficulty urinating,
decreased thirst, dizziness, drowsiness
Nursing consideration:
4.0 take with food or milk
5.0 donot mix liquid formulation with coffee or tea
6.0 use a sunscreen during sun exposure to prevent burns

7. inj. Novapid 4 units

Func class: antidiabetic
Chem.. class: exogenous unmodified insulin

Action: decreases blood glucose, by transport of glucose into cells and the conversion of glucose to
glycogen, indirectly increases blood pyruvate and lactate, decreases phosphate and potassium

Uses: DM type 1 and 2

Doses and routes:

Adult: subcut dosage individualized, give within 15 min before or 20 min after starting a meal

Side effects:
EENT: blurred vision, dry mouth
INTEG: flushing, swelling, redness
META: hypoglycemia
SYST: anaphylaxis

Contraindication: hypersensitivity to protamine

Precaution: pregnancy
Nursing Interventions:
1. Assess for symptoms of hypoglycemia such as: anxiety, restlessness, tingling in hands, feet,
lips or tongue, chills, cold sweat, confusion, pale skin, difficulty in concentration,
drowsiness, excessive hunger, head ache, irritability, nightmares or trouble sleeping, nausea,.
2. Assess for symptoms of hyperglycemia: confusion, drowsiness, flushed and dry skin, rapid
deep breathing, polyuria, loss of appetite, nausea & vomiting, unusual thirst.

21
G.Arunaj 2015
3. Monitor body weight periodically. Changes in weight may necessitate changes in insulin
dose.
4. Monitor blood glucose every 6 hours during therapy.
6. Store insulin in refrigerator. Do not use if cloudy, discolored or unusually viscous.
7. Rotate site of infection.
8. Instruct patient on proper techniques for administration.
9. Explain to the patient that this medication controls hyperglycemia but does not cure
diabetes.
10.0) SUMMARY OF CLIENT DAILY PROGRESS REPORT IN HOSPITAL

DATE TIME TEMPERATU PULSE RESPIR BP SUMMARY

RE ATION
04/O8/068 2am 98 degree F 80/m 20/m 200/80mm Pt’s g/c is seems
of hg satisfactory, vital
signs monitored
6pm 97.6 degree F 88/m 28/m 210/80 with rise in blood
mm of hg pressure. Prescribed
medicine carried
out. Input and output
chart maintained.
Paln for
haemodialysis
tomorrow. No any
complain from the
patient side.
04/09/068 12:30p 98 degree F 82/m 24/m 210/100
m mm of hg
1:20p 98 degree F 90/m 20/m 210/100 pt’s g/c seems
m mm of hg satisfactory. Vital
signs are taken and
recorded with rise in
blood pressure.
haemodialysis done.
Patient in normal
diet. Prescribed
medication carried
out. No any specific
complain from
patient side.
04/10/068 2pm 98 degree F 100/m 22/m 200/90
mm of hg
6pm 101.6 degree F 110/m 24/m 210/80 Pt’s g/c is satisfactory.
mm of hg Vital signs are taken
22
G.Arunaj 2015
and recorded with rise
in blood pressure and
temperature. Tab
paracetamol and cold
compresses given to
the patient.All
prescribed medication
was carried out.
Patient is on normal
diet.
04/11/068 10am 97 degree f 90/m 20/m 210/90
mm of hg

2pm 97 degree f 88/m 20/m 210/90 Pt’s general

mm of hg condition is
satisfactory. Vital
signs are taken with
rise in blood pressure.
prescribed medicine
carried out. Normal
bowel and bladder
habit. Patient
complain is dry and
itching over skin of
hands and legs. So he
is in dermatology
consultation.
Dermatology
department
prescribed him
coconut oilto apply in
itching and dry areas
three times a day.
04/12/068 10 am 97 degree f 92/ min 20/min 180/80 pt’s g/c seems satisfactory.
mm of hg Vital signs are taken and
recorded with rise in blood
pressure. haemodialysis
done through left femoral
vein. Put the sand bag
pressure at the femoral site
for 2 hours. Patient in
normal diet. Prescribed
medication carried out. No
any specific complain from
patient side.
2pm 98 degree f 88/min 20/min 180/70
mm of hg
04/13/068 10am 98 degree f 80/min 22/min 150/90 Patient general condition
mm of hg seems satisfactory. Vital
23
G.Arunaj 2015
signs taken with rise in
blood pressure. Prescribed
medicine carried out.
Normal bladder habit but
bowel habit is disturbed.no
any such complain from
patient side
04/14/068 10 am 97 degree f 80/ min 20/min 140/80 Patient general condition
mm of hg seems satisfactory. Patient
general condition seems
satisfactory. Vital signs
taken with rise in blood
pressure. Prescribed
medicine carried out.
Normal bowel and bladder
habit. No any itching on the
patient’s skin
2pm 98 degree f 76/min 20/min 170/70
mm of hg
04/15/068 10am 98 degree f 78/min 22/min 190/80 pt’s g/c seems satisfactory.
mm of hg Vital signs are taken and
recorded with rise in blood
pressure. haemodialysis
done through left femoral
vein.dialysis three times a
week that is on
Sunday,Wednesday and
Friday. Patient in normal
diet. Prescribed medication
carried out. No any specific
complain from patient side.
04/16/068 10 am 97 degree f 80/ min 20/min 190/70
mm of hg
2pm 98 degree f 88/min 20/min 180/60 Pt’s g/c is improved. Vital
mm of hg signs taken with rise in
blood pressure. All
prescribed medication was
carried out. . Discharge on
o4/17/068.
04/17/068 10am 98 degree f 90/min 22/min 180/70 Patient general condition
mm of hg seems fair. Vital signs are
taken and recorded with
rise in blood
pressure.prescribed
medicine carried
out,normal bowel and
bladder habit.dialysis three
times a week. That is on

24
G.Arunaj 2015
Sunday, Wednesday and
Friday. Follow up on
medical out patient
department on Monday or
Thursday.

11.0 DIVERSIONAL THERAPY USED FOR CLIENT

Diversional therapies are used to divert one’s thoughts from life stresses or to fill time.
I have used the following aspects of diversional therapy to overcome his situation.

 Physical therapy: deep breathing and coughing exercise was encouraged to perform. Proper
position of the patient was maintained so that she can feel relaxed and comfortable.

 Group therapy: I gave many examples of other people having the same disease condition and
also introduced him with some of them so that he can realize that many others have and share
problems which are very similar to their own problems and that they are not alone in their
suffering.

 Relaxation training: I encouraged my patient for performing yoga and meditation as relaxation
produces physiological effect that are opposite to those anxiety, that is slow heart rate, increased
peripheral blood flow.

 Psychological therapy: I encourage my patient to express his feelings and attitude, and
communicate with the care takers as well as the family members. Because of this his
psychological depression can be reduced and he feels better.

 Medicine therapy: I provided his medicine to relieve his pain and for his better recovery.

 Recreational therapy: according to this therapy, I encouraged my patient to listen songs of his
choice. I also encouraged him to sing songs as he loves to listen and sing old melody filmy songs
songs. Beside these I also encouraged my patient to read magazines, newspaper, listen radio, etc.
so that it would help patient diverse his mind away from his anxiety and depression.

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G.Arunaj 2015

12.0 APPLICATION OF NURSING THEORIES

Virginia Henderson’s Independent Theory:
In 1955, Henderson formulated unique function of nursing, she purposed 14
components of Basic nursing care. The components are as follows:
 Breathe normally.
 Eat and drink adequately
 Eliminate body wastes
 Move and maintain desirable postures.
 Sleep and rest
 Select suitable clothes- dress and undress
 Maintain body temperature within normal range by adjusting clothing and modifying the
environment.
 Keep the body clean and well groomed and protect the integument.
 Avoid danger in the environment and avoid injuring others.
 Communicate with others in expressing emotions, needs, fear or opinion.
 Worship according to one’s faith.
 Play or participate in various forms of recreation.
 Learn, discover or satisfy the curiosity that leads to normal developmental and health and
use of the available facilities.

13.0 APPLICATION OF THEORY ON MY PATIENT

 Breath normally:- I encourage my patient to do deep breathing and coughing

exercise. This helps to promote lung expansion and gases extent and also help to
loosen and bring out secretion.
 Eat and drink adequately:- I encourage my patient to eat and drink adequately
according to body needs and the patient food habit was well maintained.he was
prescribed to have fluid less than 500ml/day
 Eliminate body waste:- My patient bowel and bladder habit was normal so his
eliminate body waste pattern was well maintained.
 Move and maintain desirable posture:- I helped my patient to move and maintain
the desirable position
 Sleep and rest: I encouraged patient to take a adequate rest and sleep according to
body need and disease condition for a positive health.
 Select suitable clothe and dress:- Suitable clothe was selected.
 Body cleanliness:- I encourage my patient to keep her body clean.
 Avoid danger in the environment and avoid injuring others: sometimes my patient
shows aggressive behavior so antipsychotics drugs were prescribed to my patient
to avoid danger in the environment and also to avoid injuring others.
 Communicate with others in expressing emotions, needs, fear or opinion:- As my
patient was able to communicate, his communication pattern was maintaining.
 Worship according to one’s faith
 Play or participate in various forms of recreation:- This component help me
inspire my patient to write new poems, story and jokes.

26
 G.Arunaj 2015

14.0 NURSING CARE PLAN

ASSESSMENT DIAGNOSIS GOAL PLANNING IMPLEMENTATI RATIONAL EVALUATI

ON ON
Subjective data: Excess fluid Patient -assess weight, -weight, lung -To determine the My goal
patient says volume will lung sounds and sounds and fluid volume so that was fully
that, “my hands related to maintai extremities for extremities was treatment met as
and face are fluid n fluid presence of assessed for parameters can be patient is
swelling” accumulatio volume edema presence of identified. free of
n between status edema. peripheral
objective data: dialysis within -monitor intake -input and -Intake is limited edema.
patient’s face treatments. establis and output. output was and must be
and hand was hed Some patient monitored. monitored to
swelling paramet continue to prevent fluid
ers. urinate small volume overload.
amounts, but it
is inadequate to
clear all waste
products.
-monitor -laboratory data -nitrogenous waste
laboratory data: was monitored and electrolytes
blood accumulate
urea,nitrogen,ser between treatments.
um Anemia and blood
creatinine,sodiu losses associated
m,potassium,cal with hemodialysis
cium,hb,etc are complications
associated with
-teach pt the -fluid kidney failure.
need for restrictions -to prevent excess
maintaining between intake, which can
fluid restrictions treatment was lead to
between maintained. hypervolemia
treatment
-teach pt the -the need for -sodium intake
need for restricting stimulates thirst
restricting sodium intake which can lead to
sodium intake was teached. excessive fluid
intake and
subsequent
hypervolemia.

ASSESSMENT DIAGNOSIS GOAL PLANNING IMPLEMENTATI RATIONAL EVALUATI

27
 G.Arunaj 2015
ON ON
Subjective data: Risk for Patient -inspect skin -skin was -indicates areas of My goal
patient says skin will for changes in inspect for poor was fully
that, “my hand integrity maintai colour,turgor,va changes in circulation/breakdo met as
and face are related to n an scularity,note colour, turgor, wn that may lead to patient
swelling” alterations intact redness vasclarity. infection. maintain
in skin skin -monitor fluid - fluid intake -detects presence of an intact
objective data: turgor intake and and hydration ofdehydration or skin.
patient’s hand (edema) hydration of skin and mucous overhydration that
and face was skin and mucous membranes was affect circulation
swelling membranes monitored. and tissue integrity
-inspect at the cellular level.
dependent areas -dependent areas -edematous tissues
for edema. for edema was are prone to
Elevate legs as inspected and breakdown.
indicated. legs was Elevation promotes
elevated as venous return,
indicated. limiting venous
stasis,edema
- provide formation.
soothing skin -soothing skin -lotions and
care. Restrict care was ointment may be
use of soaps. provided and desired to relieve
Apply ointments creams, dry,cracked skin.
or creams. ointments was
-keep linens dry, applied.
wrinkles free -linens were -reduces dermal
kept dry and irritation and risk of
-investigate wrinkles free. skin breakdown.
reports of - reports of -although dialysis
itching itching was has largely
investigated eliminated skin
problems associated
with uremic
frost,itching can
occur because the
skin is an excretory
route for waste
- suggest products.
wearing loose - loose fitting -prevents direct
fitting cotton cotton garments dermal irritation
garments were suggested and promotes
to wear. evaporation of
moisture on the
skin.

28
 G.Arunaj 2015

ASSESSMENT DIAGNOSIS GOAL PLANNING IMPLEMENTATI RATIONAL EVALUATI

ON ON

Subjective data: Risk for Patient -assess skin , -nothing -signs of local My goal
patient says injury will be nothing redness,local infection, which was fully
that, “I have related to free of redness,swelling warmth,tenderne can progress to met as
itching in my infection infectio ,local ss and skin was sepsis if untreated patient did
neck” n warmth,tendern assessed not
ess develop
objective data: -avoid -Aseptic -prevents any sign
patient’s neck contamination technique and introduction of of
was red. of assess site. masks were organisms that can infection
Use aseptic applied when cause infection.
technique and changing
masks when dressings and
applying/changi when
ng dressings and starting/complet
when ing dialysis
starting/complet process.
ing dialysis
process.
-monitor -signs of - signs of
temperature, infection/sepsis infection/sepsis
note presence of requiring requiring prompt
fever,chills prompt medical medical
intervention. intervention
-culture the -blood samples -determine presence
site/obtain blood were obtained of pathogens
samples as
indicated
-administer -Medicines were -Prompt treatment
medicines as administer as of infection may
indicated indicated. save access, prevent
sepsis

ASSESSMENT DIAGNOSIS GOAL PLANNING IMPLEMENTATI RATIONAL EVALUATI

ON ON

29
 G.Arunaj 2015
Subjective data: Situational Patient - monitor -patients -to determine the My goal
patient says low self will patients response to effect of health was fully
that, “I can’t do esteem mainati response to illness and status changes so met as
anything, I am related to n illness and treatments were that appropriate patient
useless” chronic positive treatments monitored. interventions can be verbalizes
kidney body planned acceptanc
objective data: failure image -allow patient to -patient was -grieving is a e of
patient looks requiring grieve over his allowed to necessary part of treatment
depressed machine losses grieve over his recovery regimen
dependency losses as part of
-acknowledge -patient grief -demonstrate lifestyle
patients grief about being empathy and
about being dependent on a validates the
dependent on a machine was patients feeling
machine acknowledged
-support -strengths,self -Patients
strengths,self confidence, undergoing dialysis
confidence,deter determination are not disabled in
mination and and motivation all aspects of life.
motivation to to live was Many live nearly
live supported. normal lives while
maintaining
treatment schedule
-help pt to -pt was helped -pt may tend to
develop or to develop withdraw from
continue interest beyond social activities
interests beyond dialysis and because of their
dialysis and return to as near new schedule and
return to as near normal life as feelings of
normal life as possible loss,focusing on
possible other interests will
help the pt place
less focus on his
dependency
-monitor for -excessive -there may be
excessive concerns about indications of
concerns about losses, suicidal
losses,depressio depression was ideation,which
n monitored needs to be
identified and
treated quickly

ASSESSMENT DIAGNOSIS GOAL PLANNING IMPLEMENTATI RATIONAL EVALUATI

ON ON

Subjective data: Disturbed Patient - assess extent - impairment in -uremic syndrome’s My goal

30
 G.Arunaj 2015
patient says thought will of impairment in thinking ability, effect can begin was fully
that, “I can’t do processes mainati thinking ability, memory and with minor met as
anything, I am related to n memory and orientation was confusion, patient
useless” accumulatio optimal orientation assessed irritability
n of toxins level of -provide -quiet/calm -minimizes
objective data: mentati quiet/calm environment environmental
patient looks on environment was provided stimuli and reduces
depressed confusion
-reorient to -reorientation to -provides clues to
surroundings, surroundings aid in recognition
person. Provide and person of reality
calendars, along with
clocks, outside calendars, clock
window was provided
-present reality -reality was -confrontation
concisely,briefly present potentiates
and do not consicely defensive reaction
challenge and may lead to pt
thinking mistrust and
heightened denial
of reality
-communicate -information -may aid in
information in was reducing confusion
simple, short communicated and increases
sentences. in simple and possibility that
Repeat short sentences. communications
explanation as Explanations will be understood
necessary was repeated as
necessary
-promote -adequate rest -sleep deprivation
adequate rest and sleep was may further impair
and sleep provided cognitive abilities
-prepare for - patient was -marked
dialysis prepared for deterioration of
dialysis thought processes
may indicate
worsening of
azothemia &
g/c,requiring
prompt intervention
to regain
homeostasis

15.0 DISCHARGE TEACHING:-

Categories Plan Rationale
31
G.Arunaj 2015
 Instruct patient to take prescribed
Medication medications regularly and comply with
the treatment regimen prescribed by the
physician.
 Teach patient regarding the names of
the drug, its dosage, time
administration, its contraindication and
side effects.
 Inform patient and significant others not
to take drugs not prescribed by the
physician.
 Instruct the patient to check for the
expiration date of the drug before taking
it.
 Do not administer any other drug with
same action without the physician’s
prescription.
 Educate the patient and the significant
others about the expected responses of
drug to the body, side effects, adverse
effects that may possibly seen into the
patient.
 Instruct the significant others to report
any remarkable adverse reactions or
any appearance of side effects noted.
Exercise  Explain to patient the significance of
regular exercise like walking
stretching. If unable to mobilize alone,
instruct the watcher to give assistance
all the time. Encourage to use crutches
or any device for support. Stretching
-Compliance to appropriate
medication and treatment
prevents further complications
and resistance to antibiotics and
promote continuous recovery of
optimal health.
-The patient has the right to know
of
his drug’s therapeutic effects as
well as its adverse effects. He
also has the right to gain
awareness about why is it given
to him.
-Drug interactions may occur
which may be fatal to patient’s
current situation.
-Checking for the expiration date
of the drug before administering it
ensures it potency and safety. It
also prevents any unwanted
reactions like hypersensitivity.
-Non-prescription drug may have
antagonistic or synergistic effects
if taken with other drugs.
-To be geared up of enough
information that may lead to
immediate medical responses.
-For immediate remedial action
response and to prevent any
complicated reactions.
-Exercises promote proper blood
and circulation and prevent arterial and
venous stasis thus lessens platelet
coagulation to aged people. Older
people have weakened blood
vessel walls which can cause any
32
G.Arunaj 2015
upper extremities also promote healthy
living. Also instruct patient to perform
passive range of motion.
 Teach patient to wait for 1 to 2 hours
after eating before performing any
physical activities.
Instruct the patient to practice deep
breathing exercise.
Treatment  Instruct patient to comply with his
medication treatment like the continuous
use of beta blocker Metoprolol for
control of hypertension and Insulin for
diabetes mellitus.
 Instruct client to seek medical help if any
unusualties are felt such as tingling
sensation or paresthesia, fatigue and
body malaise, dizziness, headaches,
irritability, tremors, diaphoresis, etc.
 As part of long-time treatment, advise
patient to wear medical alert bracelet all
the time and wherever he goes. It
contains the patient’s name, disease
condition, address and contact person.
 Advise to have a family member take
your blood pressure to check if you’re
maintaining a stable blood pressure.
alteration in blood flow.
Also exercise prevents atrophy of
the muscles.
-Older people has slower digestion
rate, thus they need to conserve
more oxygen which will be
necessary for digestion of food.
Activities must be limited to
decrease oxygen demand by
organs and tissues other than the
digestive system.
-Deep breathing exercises promote
thoracic expansion which allows air
to enter the respiratory tract and
provide oxygen to the alveoli to
avoid atelectasis or lung collapse
due to increase fluid pressure in
the pleural space.
-Maintenance meds should not be
forgotten to achieve highest
therapeutic effect.
-These unusualties may be
indicative of worsening condition.
-Medical alert bracelet provides
basic information about the client in
case of accidents.
-Monitor of blood pressure is
significant for evaluating the
medication’s effectiveness.
33
G.Arunaj 2015
 Since the client has his own glucose -Glucose monitoring is a big factor
monitor, tell client to continue monitoring in the management of diabetes
blood glucose level, and immediately mellitus.
seek for medical help if level is
abnormally high.
Hygiene  Instruct patient to practice foot care to -Proper foot care prevents injury to
prevent ulceration and formation of feet and toes.
gangrenous tissues to the lower
extremities.

- Check and carefully wash your feet

every day.

-Do not wear shoes that are too small or

socks that do not fit right inside your
shoes.

-Soak your feet in warm soapy water for

10 minutes before cutting your nails.
Trim your toenails straight across to
prevent ingrown toenails. You may also
file down your toenails. Do not cut your
nails into the corners or close to the skin.
You should not dig under or around the
nail.

-Proper bathing eliminates

 Emphasize the importance of bathing
proliferation of germs and bacteria
everyday. Wash genitals with mild soap.
in the body. Mild soap does not
irritate the skin and the genitals.

 Instruct client to maintain good oral -Tooth brushing prevents build up

hygiene. of plaques and cavities.
 Instruct to wear clean clothes and -Dirty or improperly washed
underwear. underwear may become a
sanctuary for microbial growth.
Microbes may enter the genitals
and might worsen the client’s
UTI/Cystitis.
Out-Patient  Encourage patient to undergo physical -A Physical Therapist is a source of

34
G.Arunaj 2015
Referral therapy sessions.
 Advise to have check-ups after discharge.
 Advise to have regular laboratory exams
for creatinine, albumin, sodium,
potassium and calcium.
 Encourage to undergo ABG Test every
month or once every 2 months.
information to understand age-
related changes and offer
assistance for regaining lost
abilities or develop new ones.
Physical therapy can be applied to
the client’s condition: arthritis,
urinary and fecal incontinence,
amputation, and cardiac and
pulmonary disorders. It can :
a). increase, restore or maintain
range of motion, physical strength,
flexibility, coordination, balance
and endurance
b.) aids adaptations to make the
home accessible and safe
teach positioning, transfers, and
walking skills
c.) promote maximum function and
independence within an individual's
capability
d.) increase overall fitness through
exercise programs
e.) prevent further decline in
functional abilities through
education, energy conservation
techniques, joint protection, and
use of assistive devices to promote
independence
f.) improve sensation, joint
proprioception
g.) reduce pain
-Serves as an evaluation process
to note if condition has progressed
to better or worse.
-To assess for renal function.
35
G.Arunaj 2015
Diet  Instruct client to avoid simple sugars.
Take energy from complex carbohydrates
like unpolished rice, bread and
vegetables.
 Encourage patient to eat fibrous foods
like fruits and vegetables. But do not eat
too much as it can irritate the GI tract and
causes bleeding. Other examples of
sources of fiber are: whole grains, cereals
and legumes.
 Limit intake of purine rich foods such as
liver, beef kidneys, brains and meat
extracts. Encourage to eat in moderate
amount: asparagus, cauliflower, spinach,
mushrooms, green peas, dried peas and
beans.
16.0 WHAT I LEARNED FROM THIS CASE STUDY:-
-Simple sugars easily break down
and enter the blood stream.
Complex carbohydrates can
sustain the body’s energy
requirement for a longer time
because they are not broken down
easily.
-A diet rich in fiber relieves
constipation. It adds bulk to the
excreta and facilities expulsion.
-Accumulation of uric acid in the
joints causes arthritis. Uric acid is
the by product of purine break
down in the liver. Because of renal
malfunction, uric acid is retained in
the blood stream and is shunted to
connective tissues.
36
G.Arunaj 2015
Case study is the comprehensive study of one selected patient and comparative study with books. During
my case study, I learned the following things.

i. About the disease:-

I got opportunity to read and gain comprehensive knowledge through various books, literatures,
teachers, doctors, ward staffs, colleagues and via. Secondary internet. I also obtained a comprehensive
knowledge on the disease its treatment and management.

ii. About the patient:-

My patient was a open book to learn for me, as I got an opportunity in learning through
involving patients care, treatment, diversional therapy and teaching not only from patient but also from
his family member. I learned personal quality of patient and use the information in treating her. I also
taught the families, socio cultural, economical, religious and traditional beliefs of the patient which
influence her health.

iii. About nursing care:-

I applied holistic approach while giving nursing care to the patient. I followed the theorie of
Henderson in providing nursing care and I gained more knowledge and skill.

iv. About documentation.

17.0 CONCLUSIONS AND SUMMARY OF CASE STUDY

37
G.Arunaj 2015
My patient name is mr. laxman pandit , 68yrs old, male with the diagnosis of Chronic kidney
disease.
Chronic kidney disease (CKD), also known as chronic renal disease, is a progressive loss of renal
function over a period of months or years

 Heredity
 Glomerular dysfunction
 Diabetic nephropathy
 Hypertension
 Glomerulonephritis
 Polycystic kidney disease
 Urinary tract obstruction
 Bladder tumour
 Urethral obstruction
 Hypertensive nephrosclerosis (hardening of the kidney) are some of the causes of chronic kidney
disease
The clinical features of ESRD are: weakness and fatigue, confusion, seizures, burning soles of
feet, thin, brittle nails, hypertension,periorbital oedema,etc

It can be investigate through laboratory test such as cbc, urinalysis, blood urea ,ultrasonography,
kub film etc.
During my case study, I provided health education, applied different diversional measures, treatment,
investigation, diet, personnel hygiene etc. I feel great pleasure whenever patient and his family get
treatment satisfaction and getting better. His general condition was improved so he was discharged.

18.0 REFERENCES

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G.Arunaj 2015
 Nursing care plan, Marilynn E. Doengs, Mary. Francesmoorhoose, Alice C. Geissles. Murs 6th
edition
 Rai lalita “nursing concept theories and principles”; 1st edition
 Helth learning materials centre Tu, institute of medicine, maharajgunj, ktm, textbook of adult
helath nursing
 Mosby’s nursing drug reference,2007
 Phipps Monahan and sands marek neighbors”medical surgical nursing health and illness
perspectives” 7th edition, page 1260 to 1271
 A Lippincott manual ”the Washington manual of medical therapeutics”,33rd edition, page 430 to
433
 http://www.emedicinehealth.com/chronic_kidney_disease/page2_em.htm
 http://www.ehttp://www.emedicinehealth.com/chronic_kidney_disease/
page4_em.htmmedicinehealth.com/chronic_kidney_disease/article_em.htm
 http://en.wikipedia.org/wiki/Chronic_kidney_disease

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