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Medical Diagnosis: Chronic Renal Failure Problem: Altered Renal Perfusion RT Glomerular Malfunction Assessment Subjective: (none) Objective:

Increase in Lab results (BUN, Creatinine, Uric Acid Level) Oliguria Anuria Edema Pulmonary Congestion Hypertension Hematuria (Dont forget which of the following signs and symptoms above that the patient manifested and may manifest) Nursing Diagnosis Altered Renal Perfusion R/T Glomerular Malfunction AEB Increase in BUN, Creatinine and Uric Acid Level 2O to renal Failure. Scientific Explanation For 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 Planning Short Term: After 2-3 hours of NI, the patient will demonstrate participation in his/her recommended treatment program. Long Term: After 2-3 days of NI, the patient will demonstrate behavior/lifestyle changes to prevent complications Interventions 1. Establish rapport Rationale 1. To get the cooperation of the patient and SO. 2. To obtain baseline data Evaluation Short Term: The patient shall have demonstrated participation in his/her recommended treatment program Long Term: The patient shall have demonstrated behavior/lifestyle changes to prevent complications

2. Monitor and record vital signs.

3. Assess patients general condition.

3. To obtain baseline data.

4. Determine factors related to individual situation and note situation that can affect all body system. 5. Note characteristic of urine: measure urine specific gravity. 6. Ascertain usual

4. To assess causative and contributing factors

5. To assess for hematuria and proteinuria and renal impairment. 6. To compare with current

voiding pattern

situation. 7. may indicate pain on affected organ 8. increase BUN and creatinine levels may alter mentation

7. Note presence, location intensity duration of pain. 8. Note mentation status and review lab result such as BUN and creatinine levels. 9. Monitor BP, ascertain patients usual range. 10.Observe for dependent generalized edema. 11.Measure urine output on a regular schedule and weigh daily. 12.Provide diet restriction as indicated, while providing adequate

9. GFR may increase rennin and raise BP. 10.To note degree of impairment of renal function. 11.To assess renal perfusion and function. 12.Calories to meet bodys need while restriction of

calories. 13.Encourage discussion of feelings regarding prognosis or long term effects of discussion. 14.Identify necessary changes in lifestyle and assist client to incorporate disease management to ADLs. 15.Assess patient emotional/psych ological factors affecting the current situation.

protein helps limit BUN. 13.To decrease anxiety about condition and correct his wrong ideas about condition. 14.To promote wellness and prevent further progression of complication. 15.Stress or depression may be increasing the effect of an illness or depression might be the result of being forced into inactivity. 16.Enhance commitments to promoting optical outcomes.

16.Establish realistic activity goal with patient.

17.Give information about positive signs of improvement such as improve vital signs/ circulation. 18.Provide physiologic support. Maintain calm attitude but admit concerns if questioned by the client/SO.

17.To provide encourageme nt.

18.Honestly can be reassuring when so much activity or worries are apparent to the client or SO.

19.Review expectations of the patient/SO. 20.Give patient information that provides evidence of daily/weekly progress. 21.Encourage patient to maintain positive attitude;

19.To establish individual goals. 20.To sustain motivation.

21.To enhance sense of well being.

suggest use of relaxation technique such as guided imagery as appropriate. 22.Administer medication as ordered. 23.Promote overall health measure. 22.For faster recovery. It is used to treat the clients disease condition. 23.To promote wellness.