Republic of the

Philippines
Mindanao State
University
College of Health
Sciences Marawi
City

Written Report
For Women with Chronic Renal Disease

Submitted by:
Neshren Pananggolo
Shahaya Solaiman
Alyzza Macadindang

NSG124 - GgHh

Submitted To:
Prof. Donnabelle Lumbatan-Abdullah

February 06, 2023

Chronic Renal Disease
- CKD is a condition in which the kidneys are damaged and cannot
filter blood as well as they should. Because of this, excess fluid and waste
from blood remain in the body and may cause other health problems, such
as heart disease and stroke.

Signs and Symptoms:

Physical Assessment:

General - Patients with moderate or severe chronic kidney disease sometimes appear
pale, wasted, or ill. Deep (Kussmaul) respiration suggests hyperventilation in response to
metabolic acidosis with acidemia. Patients with nephrotic syndrome and fluid overload
can present with periorbital swelling and edema of extremities.

HEENT - Head - symmetrical, proportion to the body, normocephalic.

Eyes - both sclera are white, pupils are eaual and round.
Ears - symmetrical ears, no pain upon palpation.
Nose - symmetrical, no tenderness, masses or lesions when palpated.
Throat - no difficulty of swallowing, no lesions
INTEGUMENTARY - Chronic kidney disease can cause any of the following:

 Xerosis due to sebaceous and eccrine sweat gland atrophy

 Pallor due to anemia
 Hyperpigmentation due to melanin deposition
 Sallow or yellow-brown skin due to urochrome deposition
 Petechiae or ecchymoses due to platelet dysfunction
 Excoriation due to itching caused by hyperphosphatemia or uremia
 Uremic frost, the deposition of white-to-tan urea crystals on the skin after sweat
evaporation, is rare.

CARDIOVASCULAR- Chest expansion upon breathing and shortness of breath.

RESPIRATORY - Pericardial and pleuritic friction rubs may be signs of uremia.

Patients can present with lung crackles secondary to pulmonary edema from fluid
retention in acute or chronic kidney disease.

GASTROINTESTINAL -Vomiting, poor appetite, nausea and anorexia.

NEUROLOGICAL - Asterixis can be detected in handwriting or by observation of

outstretched hands maximally extended at the wrists; after several seconds in this
position, a hand flap in the flexor direction is asterixis. Asterixis suggests one of the
following:

 Chronic kidney disease

 Chronic liver failure
 Carbon dioxide narcosis
 Toxic encephalopathy

MUSCULOSKELETAL - Equal muscles on each side of the body, no tremors.

REPRODUCTIVE - CKD results in menstrual irregularities, and infertility.

EXCRETORY - Lack of urine, increase in urge to urine, missed periods or early onset
of menopause.

LABORATORY TEST AND PROCEDURE:

 a blood test that checks how well your kidneys are filtering your blood, called GFR.
GFR stands for glomerular filtration rate.

Your health care provider will use a blood test to check your kidney function. The results
of the test mean the following:
  a GFR of 60 or more is in the normal range. Ask your health care provider when
your GFR should be checked again.
 a GFR of less than 60 may mean you have kidney disease. Talk with your health
care provider about how to keep your kidney health at this level.
 a GFR of 15 or less is called kidney failure. Most people below this level need
dialysis or a kidney transplant. Talk with your health care provider about your
treatment options.

 a urine test to check for albumin. Albumin is a protein that can pass into the urine
when the kidneys are damaged.

Dipstick test for albumin. A provider uses a urine sample to look for albumin in your
urine. You collect the urine sample in a container in a health care provider’s office or lab.
For the test, a provider places a strip of chemically treated paper, called a dipstick, into
the urine. The dipstick changes color if albumin is present in the urine.
PATHOPHYSIOLOGY:

MEDICAL MANAGEMENT:

The goal of management is to maintain kidney function and homeostasis for as long as
possible.

 Nutritional therapy. Dietary intervention includes careful regulation of protein intake,

fluid intake to balance fluid losses, sodium intake to balance sodium losses, and
some restriction of potassium.

 Dialysis. Dialysis is usually initiated if the patient cannot maintain a reasonable

lifestyle with conservative treatment.

 Lifestyle changes – to help you stay as healthy as possible

DRUG MANAGEMENT:

 High blood pressure medications. People with kidney disease can have worsening
high blood pressure. Your doctor might recommend medications to lower your blood
pressure — commonly angiotensin-converting enzyme (ACE) inhibitors or
angiotensin II receptor blockers — and to preserve kidney function. High blood
pressure medications can initially decrease kidney function and change electrolyte
levels, so you might need frequent blood tests to monitor your condition. Your
doctor may also recommend a water pill (diuretic) and a low-salt diet.

 Medications to relieve swelling. People with chronic kidney disease often retain
fluids. This can lead to swelling in the legs as well as high blood pressure.
 Medications called diuretics can help maintain the balance of fluids in your body.

 Medications to treat anemia. Supplements of the hormone erythropoietin

(uh-rith-roe-POI-uh-tin), sometimes with added iron, help produce more red blood
cells. This might relieve fatigue and weakness associated with anemia.

 Medications to lower cholesterol levels. Your doctor might recommend medications

called statins to lower your cholesterol. People with chronic kidney disease often
have high levels of bad cholesterol, which can increase the risk of heart disease.

 Medications to protect your bones. Calcium and vitamin D supplements can help
prevent weak bones and lower your risk of fracture. You might also take medication
known as a phosphate binder to lower the amount of phosphate in your blood and
protect your blood vessels from damage by calcium deposits (calcification).

 A lower protein diet to minimize waste products in your blood. As your body
processes protein from foods, it creates waste products that your kidneys must filter
from your blood. To reduce the amount of work your kidneys must do, your doctor
might recommend eating less protein. A registered dietitian can suggest ways to
lower your protein intake while still eating a healthy diet.

SURGICAL MANAGEMENT:

People with chronic kidney failure have two treatment choices.

 DIALYSIS - Dialysis is a procedure to remove waste products and excess fluid

from the blood when the kidneys stop working properly. It often involves diverting
blood to a machine to be cleaned.

 RENAL TRANSPLANT - A kidney transplant is a procedure where a new

donor kidney is placed in your body. This is typically done to treat kidney failure.
NURSING MANAGEMENT:

 Monitor vital sign

 Maintain homeostasis
 Provide information about disease process/prognosis and treatment needs.
 Anticipate patient needs.
 Instruct the client to inform the nurse if she was in pain.
 Determine when patient last voided.
Assessment Diagnosis Planning Intervention Rationale Evaluation
Objectives: Excess fluid - Patient will 1. Monitor and - To obtain Goal met as
volume related demonstrate record vital baseline data manifested by
- Weight to decreased behaviors to signs. patient was able to
gain urine output, monitor fluid - Assess demonstrate
dietary excesses, status and 2. Assess patient’s behaviors to monitor
- Edema and retention of reduce patient’s appetite appetite fluid status and
sodium and recurrence of reduce recurrence of
-Hypertensi water. fluid excess. 3. Note - To prevent fluid excess stabilize
on amount/rate of fluid overload fluid volume AEB
- Patient will fluid intake from and monitor balance l & O,
- Shortness manifest all sources intake and normal VS, stable
of breath stabilize fluid output weight, and free
volume AEB 4. Compare from signs of
balance I & current weight - To monitor edema.
O, normal gain with fluid retention
VS, stable admission or and evaluate
weight, and previous stated degree of excess
free from weight
signs of - To evaluate
edema. 5. Record degree of excess
occurrence of
dyspnea - To determine
fluid retention
6. Note
presence of - To evaluate
edema. degree of fluid
excess.
7. Observe
skin mucous - To lessen
membrane. fluid retention
and overload.
8. Restrict
sodium and fluid
intake if
indicated - Weight gain
indicates fluid
9. Weigh client retention or
edema.
Assessment Diagnosis Planning Intervention Rationale Evaluation

Objectives: Acute Pain - Patient will 1. Monitor and record - To obtain After the nursing
related to demonstrate vital signs and assess baseline data intervention, the
- trauma that use of pt’s general condition goal is met
Generalized the kidney relaxation - Pain is a through
edema experience skills to 2. Accept patient’s subjective verbalization of
perceive by relieve pain. description of pain. experience and being free from
- the body as cannot be felt acute distress
Hypertensio a threat, the - Patient will 3. Perform a by other. and feels much
n body report comprehensive more
releases relief/control assessment of pain - To be able to comfortable.
- Weakness cytokine and of pain. ( location , onset, compare
prostaglandi characteristics, changes from Patient was able
- Sleep n causing frequency) previous to followed
disturbance pain which reports to rule prescribed
is felt by the 4. Observe nonverbal out worsening pharmacologic
- Distraction patient at his cues including how of underlying algermin and
Behavior flank area. client walks, holds condition/devel demonstrated
body, sits, facial oping use of relaxation
expressions, cool complications skills,
fingertips/ toes, which diversional
can mean constricted - Observation activities and
vessels may/ may not comfort
be congruent measures such
5. Review patient’s with verbal as change of
previous experiences reports position and
with pain and methods indicating need back rub.
found either helpful or for further
unhelpful for pain evaluation.
control in the past.
- To rule out
6. Provide comfort worsening of
measures such as back pain due to
rub, change position, methods used.
use of heat/ cold.
- To provide
7. Provide for non-pharmacol
individualized ogic pain
physical therapy/ management.
exercise program that
can be continued by - To continue
the client discharge therapeutic
refer to physical effect and
therapist. wellness for
8. Administer the patient
analgesics as ordered.
-
Pharmacologic
mgmt for pain
Assessment Diagnosis Planning Intervention Rationale Evaluation
Objectives: Imbalance - Patient will 1. Assess - To establish After the
Nutrition: Less display general baseline data nursing
- Weight loss than Body normalization appearance and intervention,
- Poor muscle Requirements of laboratory monitor vital - To provide the client was
tone related to values and be signs. comparative able to
-Nausea and anorexia, free of signs of baseline. understand the
vomiting nausea, malnutrition. 2. Assess importance of
- Fatigue vomiting, weight, age, - To establish a proper diet. The
- altered oral dietary - Patient will body build, nutritional patient was able
mucous restrictions, and demonstrate strength, rest plans. to provide oral
membranes altered oral behaviors, level. care and also
mucous lifestyle change maintain the
membranes. to regain and 3. Provide diet - To prevent expected
maintain an modification as further increase weight.
appropriate indicated. in sodium level.
weight.
4. Avoid high in - To prevent
sodium-rich further spread
food. of dental caries.

5. Provide oral - To prevent

care. ulcerations.

6. Change - To prevent
position every 2 water retention.
hours.
- To have
7. Limit fluid proper
intake as circulation of
ordered. blood.

8. Encourage to - To prevent
do Passive muscle atrophy.
range of motion
exercise.
- To prompt
9. Encourage treatment.
early
ambulation.

1o. Administer
Medications as
ordered.
REFERENCES:

 Sparks, M. E. (n.d.). Chronic renal failure, surgical management.

https://www.slideshare.net/kernic1/chronic-renal-failure-surgical-management

 Managing Chronic Kidney Disease. (2022, August 29). National Institute of

Diabetes and Digestive and Kidney Diseases.

https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-diseas

e-ckd/managing

 Chronic kidney disease - Diagnosis and treatment - Mayo Clinic. (2021, September

3).https://www.mayoclinic.org/diseases-conditions/chronic-kidney-disease/diagnosis

-treatment/drc-20354527

 Home-Based Care for CKD for High-Risk Populations : Clinical Journal of the

American Society of Nephrology. (n.d.). LWW.

https://journals.lww.com/cjasn/pages/articleviewer.aspx?year=2018

 Chronic Kidney Disease Tests & Diagnosis. (2022, November 18). National Institute

of Diabetes and Digestive and Kidney Diseases.

https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-diseas

e-ckd/tests-diagnosis