Learning Packet 1 – NCM 112

Assessment No. 1
1. Explain what Allen’s Test is and enumerate the nursing consideration in performing
this procedure.
Answer: Allen's test is used to check the blood supply in the hand before taking blood from
the radial artery or inserting a needle into it. By checking to see if the radial and ulnar
arteries are open, this test is used to see if there is enough blood flow around the hand. The
Allen test evaluates if ulnar circulation is poor or lacking. Once poor or missing ulnar
circulation has been identified, the radial artery supplying arterial blood to that hand should
not be punctured again.
Nursing Consideration in Performing Allen’s Test:
1. Nurse should know about the client and communicate with them about what will be the
procedure to be done and its purpose. It is important to put a patient's mind at ease by
explaining why the test is being done and what will happen during it. Most patients have had
their veins pricked before, but they might not know that an arterial stick is different.
2.. Get comfortable or make sure that you are in a comfortable place before conducting the
procedure. Frequent puncture of a single spot raises the risk of arterial hemorrhage, scarring,
or laceration. Patients requiring repeated punctures should utilize other puncture sites with
caution.
3. Nurse while performing the procedure may instruct the client to clench his or her fist or if
the patient cannot clench their fist, nurse may assist the patient to close their hand. Through
this,, it will remove as much blood from the hand as possible.
4.. Open the client's hand while exerting occlusive pressure to both arteries. The fingers and
palm of the hand should be pale and discolored, indicating a deficiency of arterial blood flow.
2. If the urine concentration of a patient is high, what is the expected result of the urine
specific gravity? Increased or decreased?
Answer: If the urine concentration of a patient is high, there is an expected result of a high
urine specific gravity. It may be caused of some factors such as inadequate fluid intake, loss
of too much fluid due to vomiting, sweating or diarrhea, and loss of substances such as sugar
or protein in the form of urine.
3. What other diagnostic tests can be performed to assess fluid and electrolyte, and acid
base imbalances?
Answer: Some of the diagnostic tests can be performed to assess fluid and electrolyte, and
acid base imbalances are:
 BUN. The blood urea nitrogen (BUN) test is a common blood test that shows
significant information about the health of your kidneys.
 Hematocrit. A blood test that measures how much of your blood is made up of red
blood cells.
  Physical examination. Signs and symptoms can be checked through physical
examination.
 Serum electrolyte levels. Electrolyte levels should be measured to determine the
presence of an imbalance.
 ABG analysis. An arterial blood gas analysis (ABG) measures the balance of oxygen
and carbon dioxide in your blood to see how well your lungs are working.
 ECG.
4. What are the expected laboratory results for patients with renal failure?
Answer:
Serum Creatinine - Creatinine is a muscle waste product. Age and size affect blood creatinine
levels. Creatinine levels above 1.2 for women and 1.4 for males may indicate renal disease.
Creatinine rises as kidney disease worsens.
Glomerular Filtration Rate (GFR) - This test measures how effectively the kidneys filter
blood wastes and extra fluid. Age and gender are used to compute serum creatinine. Age
affects GFR (as you get older it can decrease). GFR is above 90. Below 60 GFR indicates
poor renal function. Once the GFR drops below 15, dialysis or a kidney transplant may be
needed.
Blood Urea Nitrogen (BUN) - Urea nitrogen arises from protein breakdown. Normal BUN is
7-20. BUN increases as renal function declines.
Urine Protein - When your kidneys are damaged, protein leaks into your urine. A simple test
can be done to detect protein in your urine. Persistent protein in the urine is an early sign of
chronic kidney disease.
Microalbumin Urine Test - Healthy kidneys filter blood, leaving protein. Unhealthy kidneys
cannot separate albumin from wastes. At initially, only a small amount of protein leaks into
the urine, too little to test with a dipstick. Greater than 30 mg/L but less than 300 mg/L is
considered as microalbuminuria, higher than 300 mg/L is called macroalbuminuria.

Assessment No. 2
1. Differentiate between Hemodialysis and Peritoneal Dialysis using a table. Include the
nursing considerations of both procedures.

Hemodialysis Peritoneal Dialysis

 A type of dialysis that uses a machine  A dialysis that removes waste products
with a special filter that cleans the blood. from the blood or cleans the blood. But,
The machine is called as dialyzer. peritoneal dialysis does not have a
 Patient’s blood flows from a dialysis machine to clean the blood.
 access point into the dialyzer filtering  Peritoneal dialysis uses the lining on the
the blood through a membrane. inside of the belly as a natural filter for
 The waste products in the blood pass blood.
through the membrane and are cleaned  The dialysate flows through a catheter
through a fluid called dialysate. into part of the abdomen or the
 Ideal for patients with less kidney peritoneum to be specific that acts a
function. natural filter.
 Not ideal for patients who are obese or do
have abdominal scarring.
Nursing Considerations
Before the procedure Before the procedure
1. Allow the client to void. 1. Check the client’s weight, note any
2. Document the client’s weight. difference.
3. Obtain vital signs as baseline. 2. Assess for complications.
4. Check the medications history of the 3. Check for signs of bleeding and status of
patient before the procedure. the fistula.
During During
1. Obtain vital signs periodically between 1. Monitor the level of electrolytes.
30 minutes. 2. Obtain samples of return dialysate for
2. Observe proper body alignment, allow culture
frequent position changes. 3. Compare the client’s weight before and
3. Monitor for episodes of nausea and after the procedure
vomiting which may occur during the 4. Monitor the vital signs every 30 minutes
procedure. and report any deviations
4. Monitor for signs of bleeding by taking 5. Provide proper positioning for the
clotting time about 1 hour before the client dialysate to return from the peritoneal
comes off the machine. Observe clotting cavity. Place the patient in semi-Fowler’s
time at 30 to 90 minutes while on dialysis position.
(Normal value: 6 – 10 minutes)
After
1. Check the client’s weight, note any
difference.
2. Assess for complications.
3. Check for signs of bleeding and status of
the fistula.

2. What are the nursing considerations in giving diuretics?

Answer:
1. Check for drug allergies, fluid and electrolyte imbalances, hepatorenal disorders, glucose
tolerance abnormalities, etc. to prevent complications.
2.. Perform a thorough physical assessment before pharmacological therapy to establish
baseline data, determine effectiveness, and evaluate side effects.
3. Inspect skin (edema, turgor) to detect hydration condition and drug therapy effectiveness.
4. Evaluate fluid transport and hydration by assessing cardiopulmonary status (blood
pressure, pulse rate, heart and lung sounds, etc.). Also, heart and lungs are monitored.
5. Obtain a precise body weight to serve as a baseline for monitoring fluid balance.
6. Evaluate fluid balance and renal function by monitoring intake, output, and voiding.
7. Assess liver health for medication metabolism issues.
8. Monitor laboratory testing (serum electrolyte levels, notably potassium and calcium, uric
acid, and glucose levels) to detect drug's effect.
9. Check liver and kidney function tests for dose adjustments and harmful consequences.

Assessment No. 3
Situation: One of the patient’s significant others went to the station and told the nurse
that her patients IVF is not flowing.
a. As a nurse what will be your initial management?
Initial management is to check the site of the IV to check any signs and symptoms why the
IV fluid is not flowing. It may be checked through the sluggish rate of flow, if the infusion
site is cool or pale or swollen or patient may complain that they is pain in the infusion site.
b. What are the possible reasons for sluggish flow rate?
Possible reasons for sluggish flow rate or it can be cause by turning tubing, small clots,
phlebitis, or infection at the site, infiltration of the IV cannula, or a problem with the needle
leaning against the wall of the vessel and cutting off IV flow.
c. What will be your management if there is sluggish flow rate but the IV site is still
patent?
If the flow is slow, you can pull back on the catheter a little and turn it, or you can lift and
lower the catheter a little. If it works, a small piece of gauze may be put under the needle to
keep it in place. But if the problem is not with the way the IV is set up or the equipment, the
IV will be taken out and put back in a different vein so that the IV therapy can be given safely
and effectively.