S.S.

AGRAWAL COLLEGE OF NURSING

TRAINING COLLEGE AND RESEARCH
CENTER,NAVSARI.

SUB – ADVANCE NURSING PRACTICE

TOPIC – Medical Case study on chronic kidney disease

SUBMITTED TO, SUBMITTED BY,

MRS.KHYATI PATEL MS AVNI PATEL
ASSISTANT PROFESSOR 1st YEAR M.SC (N)
SSAGCON,NAVSARI SSAGCON,NAVSARI

DATE OF SUBMISSION
19-4-21

OUTLINE
 Introduction
 History collection
 Physical Examination
 Investigation
 Pharmacological management
 Anatomy and physiology
 Disease condition
 Introduction
 Definition
 Causes
 Risk factor
 Types
 Pathophysiology
 Sign & symptoms
 Diagnostic evaluation
 Medical management
 Surgical management
 Diet
 Nursing management
 Theory application
 Complication
 Nursing process
 Complication
 Health education
 Summary
 Conclusion
 Bibliography

INTRODUCTION
 Name-Patel Avni c.

Class- First year M.sc Nursing

Topic- Medical case study on chronic kidney disease

Date-

Introduction

As a part of our clinical experience in medical surgical nursing ,we posted in

Hospital
Navsari and we posted for training.I selected one patient for my case study
requirement.

HISTORY COLLECTION
INFORMATION DATA
Name- Mr Laxman kumar Nayka
Age-68 year
Sex- Male
Address- santadevi road,Navsari
Religion-Hindu
Education-iliterate
Date of admission-18-8-21
Occupation-farmer
Marital status-married
Ward num-07
Diagnosis-chronic kidney disease

CHIEF COMPLAINT
Mr. Laxamanbhai having chest pain
Fever
Weakness
Loss of appetite
Severe vomiting
Weight loss
Muscle weakness

HISTORY OF PRESENT MEDICAL ILLNESS

Mr.laxamanbhai having present complaints are:

 Tachycardia
 Fever
 Weakness
 Vomiting
 Bodyache
 Loss of appetite

HISTORY OF PRESENT SURGICAL ILLNESS

No any significant data about present surgical illness.

HISTORY OF PAST MEDICAL ILLNESS

Patient is undergoing regular dialysis and is under antihypertensive medicine.patient having

hypetension since 3 years,
Trauma,injury- no any significant data about trauma or injury.
Hospitalization-3-4 times patient admitted in the hospital for the treatment of kidney
disease,and intervally he admitted for dialysis for 3-4 hours.
Childhood disease and immunization-no any significant data about childhood disease ,patient
taken all the vaccine like tetanus,hepatits,mumps,rubella,pertusis.

FAMILY HISTORY
KEY

Reenaben Lakshmanbhai (52year) Male

(52 year)

Harshil (35 year) Fe Female

Patient
FAMILY COMPOSITION

Name of Ag sex Educatio occupatio Incom Relationshipwit Healt

the family e n n e h pt h
member status
1.laxamanbha 68yr male 4th pass farmer 10000 patient ill
i
2.Reenaben 56yr femal illterate housewife - wife healthy
e
3.Harshil 35 yr male B.com clerk 1,20,ooo son healthy

FAMILY HISTORY

Mr. laxamanbhai living in a nuclear family. No any hereditary disorder present in their
family.All the members are well cooperate with each other.according to patient they were not
dependent in superstitious beliefs.if someone become ill in their family they take home
remedies and then go to the hospital.

PERSONAL HISTORY
Mr Laxamanbhai is looking poorly nourished,skin colour is yellow,he has a bad habit of
alcoholism.he is a non vegetarian .
Personal hygiene:
Oral hygiene-once a time
Bath- once in a day daily.
Sleep and rest- 7 hours/day
Elimination:
Bowel per day : regular
Urine frequency: 1600ml/day
Mobility and exercise:
He is not doing exercise.
Environmental History:
Type of house-pakka
Ventilation-good
Water supply-municipality
Electricity-good
Drainage-closed drainage
Cooking-separate kitchen
Location of house-In city
Pet animals-No

PHYSICAL EXAMINATION

GENERAL HEALTH:
 Nourishment-poorly nourished
 Body built-normally built
 Health-ill
 Activity-dull
 Facial expression-dull
 Level of consciousness-conscious
Height-4 feet 6 inch
Weight-56kg
Temperature-99 degree c
Pulse-90 beats/min
Respiration-22 breath/min
Blood pressure-150/80mm/Hg

HEAD AND FACE:

 Hair-Black
 Scalp-dandruff present,no injury,
 Skull-normal in shape
 Face – slight edema
 Sinuses-no swelling,tenerness
EYES:
 Eye brow-symmetrical
 Eyelashes-no any infection
 Eye lid-no edema
 Eye ball-euqally reaction to the light
 Conunctiva-pale
 Sclera-whitish
 Lens-opaque
 Vision-normal
EAR:
 External ear- no discharge
 Tympanic membrane-normal
 Hearing acuity-normal
 Drainage from ear-no discharge ,pus
 Hearing aid-not used
NOSE:
 Location- centrally located
 Nasal deviation-not found
 Bleeding-no
 Patency of the nostrils-patented
 Condition of nasal mucosa-pale in colour
 Flaring nostrils-not presented
 Inflammation-not found
 Nasal polyps-not found
MOUTH:
 Lips-dry
 Oral cavity-pale mucous membrane of oral cavity
 Teeth-normal
 Tounge-slightly dry and coated tounge
 Vocal cord,uvula and tonsils-not enlarged and inflammed
 Speech disorder-not presented
NECK:
 Movement-full and smooth range of movement
 Jugular vein-not enlarged
 Condition of thyroid-no enlargement of thyroid gland
CHEST:
 Respiratory rate-22 breath/min
 Depth of respiration –normal depth
 Quality of respiration- dyspnoea in lying position
CHEST INSPECTION:
- Lateral diameter is wider than anterior posterior diameter
- Sternum is located at the midline
- Even expansion of the chest during breathing
- No intercostals retraction
CHEST PALPATION:
- No tenderness,lump or depression along the ribs.
Percussion
- Deep resonant sound heard all over the lungs.
Auscultation
- Breath sounds are heard in all areas of the lungs
- Inspiration longer than expiration
- No rhonchi,wheezing sounds was presented

HEART
 Pulse rate-90 beats/min
 Character of pulse-Increase
 Blood pressure-150/80mm/hg
 Varicosities-absent
 Visible external jugular veins-absent
 Systolic or diastolic murmur-absent

ABDOMEN
 Size and shape of abdomen-distended abdomen
 Inspection-no lesion
 Palpation-,tenderness in right hypocardium , superficial masses
 Shifting dullness-present
 Distended abdominal veins-slightly
 Fluid thrill-present
  Abdominal girth-33 inch
 Bowel sound-present

GENITAL AREA
 Lesion or tumors of rectal area-not found
 Abnormalities of genito urinary area-not found
 Urinary bladder -distended

EXTREMITIES
 Motor strength and mobility-slightly reduced
 Enlargement and stiffness of joint-not present
 Range of motion-active

COMFORT,SLEEP AND REST

 Location of pain-right hypochondrium ,tenderness

INVESTIGATION

Laboratory data Normal value Patient value

Hematocrit 35-45% 38%
Hemoglobin 12-16gm/dl 11gm/dl
Cholesterol <200 mg/dl 180mg/dl
HDL <40 low/>60 high <60
LDL <100-optimal <80
triglyceride <150 normal <160
Total lymphocyte count 1500-1800cells/mm3 1700cells/mm3
Albumin 3.5-5.0gm/dl 4mg/dl
glucose 85-125mg/dl 90mg/dl
creatinine 0.6-1.2mg% 0.8mg%

 Serum creatinine-7.70mg/dl
 Blood urea-106.3mg/dl
 GFR-10
 Peripheral smear test-normocytic hypochromic
 Parathyroid hormone-479pg/ml
URINE ANALYSIS
 Appearance- clear
 Sp.Gravity-1.005
 Protein-present,sugar-present,pus cells-15-20hpf
 Epithelial cells-6-8

KUB FILM : It is an ultrasound based diagnostic medical imaging techniue used to visualize
muscles,tendons and many internal organs,to capture their size ,structure and any
pathological lesions .

 Serum albumin-2.8 gm/dl

 HB-9.6gm%
 Glucose f- 120mg/dl
 Glucose pp-141mg/dl
PHARMACOLOGICAL MANAGEMENT

SR NO DRUG DOSE ROUTE ACTION

1 Tab nifedipine 10mg oral Calcium channel blocker
2 Tab lasix 200mg oral Loop diuretic
3 Tab pantop 40mg oral Proton pump inhibitor
4 Diclofenac gel 30g Topical analgesic
5 Tab domel 10mg Oral antiemetic
6 Tab atenolol 50mg Oral Beta blocker
7 captopril 25mg Oral Angiotensin converting
enzyme
DRUG NAME DOSE,ROUTE ACTION INDICATION CONTRAINDICATI SIDE EFFECT NURSING
ON RESPONSIBILITIE
S
Tab nifedipine Dose Nifedipine is a Chronic stable Severe hypotension Peripheral Assess the patient
peripheral angina edema condition.
10 mg arterial Headche
vasodilator hypertension Dizziness Administer on an
Route which acts Nausea empty stomach.
directly on Muscle cramps
Oral vascular smooth Dyspnea Do not crush or chew
muscle. The Cough sustanied release
binding dosage forms.
of nifedipine to
voltage- Monitor vital signs
dependent and
possibly
receptor-
operated
channels in
vascular smooth
muscle results in
an inhibition of
calcium influx
through these
channels.
DRUG DOSE,ROUT ACTION INDICATIO CONTRAINDICATI SIDE NURSING
NAME E N ON EFFECT RESPONSIBILITI
ES
Tab lasix Dose Furosemide works by blocking the Edema Hypersensitivity Blurred Assess fluid
absorption of sodium, chloride, and water Heart Cross sensitivity vision status
200 mg from the filtered fluid in the kidney failure with thiazides Dizziness
tubules, causing a profound increase in the Renal Hepatic coma Headche Monitor blood
Route output of urine (diuresis). The onset disease anuria Vertigo Pressure.
of action after oral administration is within hypertensio Hearing
Oral one hour, and the diuresis lasts about 6-8 n loss Monitor blood
hours. Hypotensio glucose.
n
Excessive Assess
urination hemodynamic
status

Check the
propeer dosage

Maintain the
rights of the
patient.
 DRUG DOSE,ROUTE ACTION INDICATION CONTRAINDICATION SIDE EFFECT NURSING
NAME RESPONSIBILITIES
Tab Dose The mechanism of Peptic ulcer Lactation Headche Assess fluid
pantop action of pantoprazole is to inhibit the Zollinger status
40mg final step in gastric acid production. In the ellison Hypersensitivity to Insomnia
gastric parietal cell of the syndrome drug Monitor blood
Route stomach, pantoprazole covalently binds to NSAIDS Mental Pressure.
the H+/K+ ATP pump to inhibit gastric associated depression
oral acid and basal acid secretion. The covalent peptic ulcer Monitor blood
binding prevents acid secretion for up to Confusion glucose.
24 hours and longer.
Rash Assess
hemodynamic
status

Check the
propeer dosage

Maintain the
rights of the
patient.
ANATOMY AND PHYSIOLOGY
KIDNEY
The kidneys are two reddish-brown bean-shaped organs found in vertebrates. They are
located on the left and right in the retroperitoneal space, and in adult humans are about 12
centimetres (4 1⁄2 inches) in length. They receive blood from the paired renal arteries; blood
exits into the paired renal veins. Each kidney is attached to a ureter, a tube that carries
excreted urine to the bladder. The word “renal” is an adjective meaning “relating to the
kidneys”, and its roots are French or late Latin. Whereas according to some opinions, "renal"
should be replaced with "kidney" in scientific writings such as "kidney artery", other experts
have advocated preserving the use of renal as appropriate including in "renal artery.
The nephron is the structural and functional unit of the kidney. Each adult human kidney
contains around 1 million nephrons, while a mouse kidney contains only about 12,500
nephrons. The kidney participates in the control of the volume of various body fluids,
fluid osmolality, acid–base balance, various electrolyte concentrations, and removal of toxins.
Filtration occurs in the glomerulus: one-fifth of the blood volume that enters the kidneys is
filtered. Examples of substances reabsorbed are solute-
free water, sodium, bicarbonate, glucose, and amino acids. Examples of substances secreted
are hydrogen, ammonium, potassium and uric acid. The kidneys also carry out functions
independent of the nephron. For example, they convert a precursor of vitamin D to its active
form, calcitriol; and synthesize the hormones erythropoietin and renin.
MICROSCOPIC STRUCTURE OF THE KIDNEY

GROSS STRUCTURE OF KIDNEY

GROSS ANATOMY
The functional substance, or parenchyma, of the kidney is divided into two major structures:
the outer renal cortex and the inner renal medulla. Grossly, these structures take the shape of
eight to 18 cone-shaped renal lobes, each containing renal cortex surrounding a portion of
medulla called a renal pyramid.[13] Between the renal pyramids are projections of cortex
called renal columns. Nephrons, the urine-producing functional structures of the kidney, span
the cortex and medulla. The initial filtering portion of a nephron is the renal corpuscle, which
is located in the cortex. This is followed by a renal tubule that passes from the cortex deep
into the medullary pyramids. Part of the renal cortex, a medullary ray is a collection of renal
tubules that drain into a single collecting duct.

BLOOD SUPPLY
The kidneys receive blood from the renal arteries, left and right, which branch directly from
the abdominal aorta. Despite their relatively small size, the kidneys receive approximately
20% of the cardiac output. Each renal artery branches into segmental arteries, dividing further
into interlobar arteries, which penetrate the renal capsule and extend through the renal
columns between the renal pyramids.

NERVE SUPPLY
The kidney and nervous system communicate via the renal plexus, whose fibers course along
the renal arteries to reach each kidney.[15] Input from the sympathetic nervous
system triggers vasoconstriction in the kidney, thereby reducing renal blood flow. The kidney
also receives input from the parasympathetic nervous system, by way of the renal branches of
the vagus nerve; the function of this is yet unclear.

MICROANATOMY

 Kidney glomerulus parietal cell

 Kidney glomerulus podocyte
 Kidney proximal tubule brush border cell
 Loop of Henle thin segment cell
 Thick ascending limb cell
 Kidney distal tubule cell
 Collecting duct principal cell
 Collecting duct intercalated cell
 Interstitial kidney cells

FUNCTION
CHRONIC KIDNEY DISEASE

INTRODUCTION

Chronic kidney disease includes conditions that damage your kidneys and decrease their
ability to keep you healthy by doing the jobs listed. If kidney disease gets worse, wastes can
build to high levels in your blood and make you feel sick. You may develop complications
like high blood pressure, anemia (low blood count), weak bones, poor nutritional health and
nerve damage. Also, kidney disease increases your risk of having heart and blood vessel
disease. These problems may happen slowly over a long period of time. Chronic kidney
disease may be caused by diabetes, high blood pressure and other disorders. Early detection
and treatment can often keep chronic kidney disease from getting worse. When kidney
disease progresses, it may eventually lead to kidney failure, which requires dialysis or a
kidney transplant to maintain life.

DEFINITION
Chronic kidney disease,also known as chronic renal disease,is a progressive loss of renal
function over a period of months or years in which the bodys 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

Chronic kidney disease occurs when a disease or condition impairs kidney function, causing
kidney damage to worsen over several months or years.

Diseases and conditions that cause chronic kidney disease include:

 Type 1 or type 2 diabetes

 High blood pressure

 Glomerulonephritis (gloe-mer-u-low-nuh-FRY-tis), an inflammation of the kidney's

filtering units (glomeruli)

 Interstitial nephritis (in-tur-STISH-ul nuh-FRY-tis), an inflammation of the kidney's

tubules and surrounding structures

 Polycystic kidney disease

 Prolonged obstruction of the urinary tract, from conditions such as enlarged prostate,
kidney stones and some cancers

 Vesicoureteral (ves-ih-koe-yoo-REE-tur-ul) reflux, a condition that causes urine to back

up into your kidneys

 Recurrent kidney infection, also called pyelonephritis (pie-uh-low-nuh-FRY-tis

RISK FACTOR

Factors that may increase your risk of chronic kidney disease include:

 Diabetes

 High blood pressure

 Heart and blood vessel (cardiovascular) disease

 Smoking

 Obesity
  Being African-American, Native American or Asian-American

 Family history of kidney disease

 Abnormal kidney structure

 Older age

CAUSES AND RISK FACTOR

BOOK PICTURE CLIENT PICTURE
Diabetes type 1 and 2
High blood pressure present
Glomerulonephritis
Polycstic kidney disease
Recurrent kidney infection present
Smoking
Obesity
age
 STAGES OF CHRONIC KIDNEY DISEASE
Below shows the five stages of CKD and GFR for each stage:
 Stage 1 with normal or high GFR (GFR > 90 mL/min)
 Stage 2 Mild CKD (GFR = 60-89 mL/min)
 Stage 3A Moderate CKD (GFR = 45-59 mL/min)
 Stage 3B Moderate CKD (GFR = 30-44 mL/min)
 Stage 4 Severe CKD (GFR = 15-29 mL/min)
 Stage 5 End Stage CKD (GFR <15 mL/min)

PATHOPHYSIOLOGY
Due to etiological factor

Accumulation of nitrogenous waste products

( decrease in glomerular filtration rate)

Acidosis
( Decrease ammonia synthesis)
( Impaired bicarbonate reabsorption)
(Decrease net acid excretion)
 Sodium retention
( Excessive renin production,oliguria)

Sodium wasting
( solute diuresis,tubular damage)

Chronic renal failure is caused by a progressive decline in all kidney functions, ending with
terminal kidney damage. During this time, there is modulation and adaptation in the still-
functional glomeruli, which keeps the kidneys functioning normally for as long as possible.

CLINICAL MANIFESTATIONS
 Neurologic
BOOK PICTURE CLIENT PICTURE
 Weakness and fatigue  Present
 confusion
 Inability to concentrate
 Seizures
 Restlessness of legs  present
 Burning to soles of feet
 Behavior changes

 Integumentry
BOOK PICTURE CLIENT PICTURE
 Dry,flaky skin  present
 Thin,brittle nails
 Thinning Hair

 Cardiovascular
BOOK PICTURE CLIENT PICTURE
 Hypertension  present
 Pitting edema
 Periorbital edema

 Pulmonary
BOOK PICTURE CLIENT PICTURE
 Shortness of breath
  Tachypnea  present
 Kussmaul –type respiration

 GI
BOOK PICTURE CLIENT PICTURE
 Metallic taste
 Anorexia,nausea  Present
 vomiting  present

 Hematologic
BOOK PICTURE CLIENT PICTURE
 anemia

 Musculoskeletal
 Loss of muscle
 Bone pain  present
 Bone fracture

DIAGNOSTIC EVALUATION
  Blood tests. Kidney function tests look for the level of waste products, such as
creatinine and urea, in your blood.

 Urine tests. Analyzing a sample of your urine may reveal abnormalities that point to
chronic kidney failure and help identify the cause of chronic kidney disease.

 Imaging tests. Your doctor may use ultrasound to assess your kidneys' structure and
size. Other imaging tests may be used in some cases.

 Removing a sample of kidney tissue for testing. Your doctor may recommend a
kidney biopsy to remove a sample of kidney tissue. Kidney biopsy is often done with
local anesthesia using a long, thin needle that's inserted through your skin and into your
kidney. The biopsy sample is sent to a lab for testing to help determine what's causing
your kidney problem.

Kidney biopsy

BOOK PICTURE CLIENT PICTURE

Blood test 

Urine test 

Imaging test 

Kidney biopsy 
MEDICAL MANAGEMENT

The goals of chronic kidney disease treatment are:

 To prevent the further deterioration

 To alleviate symptoms
 To improve the performance of daily activities and quality of life

MEDICATION

High blood pressure medications. People with kidney disease may experience
worsening high blood pressure. Your doctor may 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
may need frequent blood tests to monitor your condition. Your doctor will likely also
recommend a water pill (diuretic) and a low-salt diet.

Medications to lower cholesterol levels. Your doctor may recommend medications

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

Medications to treat anemia. In certain situations, your doctor may recommend

supplements of the hormone erythropoietin (uh-rith-roe-POI-uh-tin), sometimes with
added iron. Erythropoietin supplements aid in production of more red blood cells, which
may relieve fatigue and weakness associated with anemia.
 Medications to relieve swelling. People with chronic kidney disease may 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 protect your bones. Your doctor may prescribe calcium and vitamin D
supplements to prevent weak bones and lower your risk of fracture. You may 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 may
recommend eating less protein. Your doctor may also ask you to meet with a dietitian
who can suggest ways to lower your protein intake while still eating a healthy diet.

BOOK PICTURE CLIENT PICTURE

Calcium channel blocker 
Loop diuretic 
Proton pump inhibitor 
analgesic 
antiemetic 
Beta blocker 
Angiotensin converting enzyme 

SURGICAL MANAGEMENT

HEMODIALYSIS

Hemodialysis is the most common type of dialysis. This process uses an artificial kidney
(hemodialyzer) to remove waste and extra fluid from the blood. The blood is removed from
the body and filtered through the artificial kidney. The filtered blood is then returned to the
body with the help of a dialysis machine.
To get the blood to flow to the artificial kidney, your doctor will perform surgery to create an
entrance point (vascular access) into your blood vessels. The three types of entrance points
are:

 Arteriovenous (AV) fistula. This type connects an artery and a vein. It’s the
preferred option.

 AV graft. This type is a looped tube.

 Vascular access catheter. This may be inserted into the large vein in your neck.

Both the AV fistula and AV graft are designed for long-term dialysis treatments. People who
receive AV fistulas are healed and ready to begin hemodialysis two to three months after
their surgery. People who receive AV grafts are ready in two to three weeks. Catheters are
designed for short-term or temporary use.

Hemodialysis treatments usually last three to five hours and are performed three times per
week. However, hemodialysis treatment can also be completed in shorter, more frequent
sessions.

Most hemodialysis treatments are performed at a hospital, doctor’s office, or dialysis center.
The length of treatment depends on your body size, the amount of waste in your body, and
the current state of your health.

After you’ve been on hemodialysis for an extended period of time, your doctor may feel that
you’re ready to give yourself dialysis treatments at home. This option is more common for
people who need long-term treatment.

Risks associated with hemodialysis

Hemodialysis risks include:

 low blood pressure

 anemia, or not having enough red blood cells

 muscle cramping

 difficulty sleeping
 itching

 high blood potassium levels

 pericarditis, an inflammation of the membrane around the heart

 sepsis

 bacteremia, or a bloodstream infection

 irregular heartbeat

 sudden cardiac death, the leading cause of death in people undergoing dialysis

DIALYSIS
 KIDNEY TRANSPLANTATION

A kidney transplant is a surgical procedure to place a healthy kidney from a living or

deceased donor into a person whose kidneys no longer function properly.

The kidneys are two bean-shaped organs located on each side of the spine just below the rib
cage. Each is about the size of a fist. Their main function is to filter and remove waste,
minerals and fluid from the blood by producing urine.

When your kidneys lose this filtering ability, harmful levels of fluid and waste accumulate in
your body, which can raise your blood pressure and result in kidney failure (end-stage kidney
disease). End-stage renal disease occurs when the kidneys have lost about 90% of their ability
to function normally.

Common causes of end-stage kidney disease include:

 Diabetes

 Chronic, uncontrolled high blood pressure

  Chronic glomerulonephritis — an inflammation and eventual scarring of the tiny filters
within your kidneys (glomeruli)

 Polycystic kidney disease

People with end-stage renal disease need to have waste removed from their bloodstream via a
machine (dialysis) or a kidney transplant to stay alive.

NURSING MANAGEMENT
Nurses care for adults with various stages of CKD in a variety of inpatient and outpatient
settings. Regardless of CKD stage, the three main nursing care goals are:

 prevent or slow disease progression.

 promote physical and psychosocial well-being.
 monitor disease and treatment complications.

1.Assessing fluid status and identifying potential sources of imbalance.

2.implementing a dietary programme to ensure proper nutritional intake.

3.Promoting positive feelings by encouraging increased self care and greater independence.
4.provide explanations and information to the patient and family concerning ESRD,treatment
options and potential complications.

5.provide emotional support to the patient and family.

6.auscultate heart and lung sounds.evaluate presence of peripheral edema,vascular

congestion,and reports of dyspnea.

7.monitor body vital sign.

8.assess presence and degree of hypertension and give antihypertensive drugs if need.

9.encourage adequate calorie intake,especially from carbohydrate,regulating protien intake

according to level of renal function and avoid sodium and potassium.

THEORY APPLICATION

 VIRGINIA HENDERSONS INDEPENDENCE THEORY

Henders defined nursing as ,” the unique function of the nurse is to assist the
individual ,sick or well,in the performance of those activities contributing to health or its
recovery that he would perform unaided if he had the necessary strength will or
knowledge.and to do this in such a way as to help him gain independence of such assistance
as soon as possible.

The 14 basic components of nursing care

1. Breathe normally.
2.Eat and drink adequately.
3.Eliminate body waste.
4.Move and maintain desirable postures,
5.sleep and rest
6.select suitable clothes dress and undress
7.maintain body temperature within normal range by adjusting clothing and modifying
environment.
8. keep the body clean and well groomed and protect the integument.
9.Avoid dangers in the environment and avoid injuring others.
10. communicate with others in expressing emotions ,needs,fear, or opinions.
11.worship according to ones faith.
12.work in such a way that there is a sense of accomplihsment.
13.play or participate in various forms of recreation.
14.learn,discover,or satisfy the curiosity that leads to normal development and health and use
the available health facilities.

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 adeuately-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 pattern is not good.

 Move and maintain desirable posture- I helped my patient to move and maintain the
desirable position.

 Sleep & rest- I encouraged patient to take a adequate rest and sleep according to body
need and disease condition for a positive health.

 Select suitable cloth and dress-suitable cloth was seleccted

 Body cleanliness-I encourage my patient to keep her body clean.

 Avoid danger in the environment and avoid injuring others-sometimes my patient is

shows aggressive behaviour.

 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 ones faith

 Play or participate in various forms of recreation-this component help me inspire my

patient to write new poems,story and jokes.
NURSING PROCESS

 Fluid volume excess related to decrease glomerular filteration rate and sodium
retention as evidenced by Edema.

 Impaired renal perfusion related to glomerular malfunction as evidenced by

hypertension.

 Impaired urinary elimination related to failing glomerular filtration AEB

impaired excretion of nitrogenous products secondary to renal failure as
evidenced by increase in lab result( BUN,creatinine,uric acid level)

 Risk for decrease cardiac output related to fluid imbalance affecting

circulating volume,myocardial workload and systemic vascular resistance.

 Risk for impaired skin integrity related to alteration in skin turgor

(edema/dehydration)

 Risk for ineffective protection related to abnormal blood profile ( suppressed

erythropoietin production/secretion

Other possible diagnosis

 Activity intolerance related to generalized weakness as evidenced by patient
is not able to do their work without assistance.

 Distrub body image related to biophysical and psychosocial factors as

evidenced by negative feelings about own body,multiple stressors,and
engagement in school activities.

 Anticipatory grieving related to perceived potential loss of

physiopsychosocial well being by child as evidenced by expression of distress
of possible loss and impending kidney failure.

 Risk for infection related to uremia

 Risk for injury related to renal failure

ASSESSMENT NURSING OBECTIVES NURSING IMPLIMENTATION EVALUATION
DIAGNOSIS INTYERVENTION

Subjective data: Fluid volume excess
related to decrease
patient says,” I’m
glomerular filteration
having fluid rate and sodium
collection in retention as evidenced
by Edema.
extremities.
To reduce the Assess the patient Assessed the patient After providing all the
volume of fluid condition. condition nursing care clients
fluid volume level is
reduced gradually.
note amount/rate of noted amount/rate of
fluid intake from all fluid intake from all
sources. sources.

Auscultate breath Auscultated breath

Objective sound sound

By physical
Note presence of Noted presence of edema
edema
examination

Observe skin mucous

Observed skin mucous
membrane
membrane
.
ASSESSMENT NURSING OBECTIVES NURSING IMPLIMENTATION EVALUATION
DIAGNOSIS INTYERVENTION

Subjective data: Impaired renal To maintain the Assessed the patient . Assessed the patient
After providing all the
perfusion related to normal renal flow. condition condition nursing care the clients
patient says,”my
glomerular malfunction clients blood pressure
blood pressure is as evidenced by is gradually decrease
high hypertension. MonitoredBP,ascertain MonitoredBP,ascertain slowly.
patients usual range patients usual range

Objective Observed for dependent Observed for dependent

generalized edema generalized edema

By physical
Measured urine output Measured urine output
examination on a regular schedule on a regular schedule
and weight daily and weight daily

(vital sign)
Administered Administered
medication as per medication as per
BP- doctors order. doctors order
140/80mm/hg
ASSESSMENT NURSING OBECTIVES NURSING IMPLIMENTATION EVALUATION
DIAGNOSIS INTYERVENTION

Subjective data: Impaired urinary Client will participate Assess the patient Assessed the patient After providing all the
elimination related to in measure to condition. condition. nursing care clients
patient says,”I am
failing glomerular correct/compensate for urinary pattern is
not able to pass filtration AEB impaired defects. improve somewhat.
urine properly excretion of nitrogenous Review for laboratory Reviewed for laboratory
products secondary to test for changes in renal test for changes in renal
renal failure as function. function.
evidenced by increase in
lab result
Objective
( BUN,creatinine) Palpate the bladder Palpated the bladder
data:

Observe for signs of Observed for signs of

By lab report infection. infection.

(creatinine,BU Emphasize the need to Emphasized the need to

adhere with prescribe adhere with prescribe
N) diet. diet.

.
 ASSESSMENT NURSING OBECTIVES NURSING IMPLIMENTATION EVALUATION
DIAGNOSIS INTYERVENTION

Risk for decreased Maintain cardiac Assess the patient Assessed the patient After providing all the
Objective cardiac output related to output as evidenced by condition. condition. nursing care
fluid imbalances bp and heart rate clientscardiac output
data: affecting circulating within patients normal improve somewhat..
volume,myocardial range. Assess the presence and Assessed the presence
workload,and systemic degree of hypertension and degree of
Vital sign vascularresistance. hypertension

(decrease heart Investigate reports of

chest Investigated reports of
rate) pain,noting,location and chest
radiation pain,noting,location and
radiation

Evaluate hear sounds

Evaluated hear sounds

Assess the activity level

Assessed the activity
.
level
 ASSESSMENT NURSING OBECTIVES NURSING IMPLIMENTATION EVALUATION
DIAGNOSIS INTYERVENTION

Risk for injury related To prevent from Assess the patient Assessed the patient After providing all the
Objective to renal failure infection condition. condition. nursing care reduce the
chances of infection
data:
Monitor RBC,HCT,Hgb Monitored
and administer uron and RBC,HCT,Hgb and
Increase WBC
transfusion of packed administer uron and
red blood cells. transfusion of packed red
count blood cells.

Assess the presence of

acidosis by pH Assessed the presence of
acidosis by pH

Educate about to take

less protein and water Educated about to take
intake less protein and water
intake

Educate the family

member about dialysis Educated the family
member about dialysis

.
 HEALTH EDUCATION

 Try not to wear yourself out or get overly fatigued.

 Get plenty of rest and get more sleep at night.
 Move around, walk as you can, and bend your legs to prevent getting blood clots when you
rest for a long period of time.
 Weigh yourself every day. Do this at the same time of day and in the same kind of clothes.
Keep a record of your daily weights.
 Take your medicines exactly as directed.
 Keep all medical appointments.
 Take steps to control high blood pressure or diabetes. Talk with your healthcare provider for
advice.
 Talk with your healthcare provider about dialysis. This procedure may help if your chronic
kidney disease is progressing to end stage renal disease

Follow-up care
Follow up with your healthcare provider, or as advised

When to call your healthcare provider

Call your healthcare provider right away if you have any of the following:

 Chest pain (call 911)

 Trouble eating or drinking
 Weight loss of more than 2 pounds (0.9 kg) in 24 hours or more than 5 pounds
(2.27 kg) in 7 days
 Little or no urine output
 Trouble breathing
 Muscle aches
 Fever of 100.4°F ( 38°C) or higher, or as advised by your healthcare provider
 Blood in your urine or stool
 Bloody discharge from your nose, mouth, or ears
 Severe headache or a seizure
 Vomiting
 Swelling of legs or ankles
 COMPLICATION

Some of the common complications of CKD include anemia, bone disease, heart disease,
high potassium, high calcium and fluid buildup.
 Gout.
 Anemia.
 Metabolic acidosis.
 Secondary hyperparathyroidism.
 Bone disease and high phosphorus (hyperphosphatemia)
 Heart disease.
 High potassium (hyperkalemia)
 Fluid buildup

DIET
 Diet changes
Always discuss your diet with your healthcare provider before making any changes. Some
people find the required dietary changes overwhelming and confusing. If it feels like that to
you or your family members, ask your provider to meet with a registered dietitian to get help
managing the changes to your diet.

Salt (sodium) in your diet

 Based on your condition, you may be told to eat 1,500 mg or less of sodium daily
 Limit processed foods such as:
o Frozen dinners and packaged meals
o Canned fish and meats
o Pickled foods
o Salted snacks
o Lunch meats
o Sauces
o Most cheeses
o Fast foods
 Don't add salt to your food while cooking or before eating at the table.
 Eat unprocessed foods to lower the sodium, such as:
o Fresh turkey and chicken
o Lean beef
o Unsalted tuna
o Fresh fish
o Fresh vegetables and fruits
 Season foods with fresh herbs, garlic, onions, citrus, flavored vinegar, and sodium-free spice
blends instead of salt when cooking.
 Don't use salt substitutes that are high in potassium. Ask your healthcare provider or a
registered dietitian which salt substitutes to use.
 Don't drink softened water, because of the sodium content. Make sure to read the label on
bottled water for sodium content.
 Don't take over-the-counter (OTC) medicines that contain sodium bicarbonate or sodium
carbonate. Read labels carefully. If you aren't certain about an OTC medicine, talk with the
pharmacist before using it.

Potassium in your diet

 Based on your condition, you may be told to eat less than 1,500 mg to 2,700 mg of potassium
daily.
 Always drain canned foods such as vegetables, fruits, and meats before serving.
 Don't eat whole-grain breads, wheat bran, and granolas.
 Don't eat milk, buttermilk, and yogurt.
 Don't eat nuts, seeds, peanut butter, dried beans, and peas.
 Don't eat fig cookies, chocolate, and molasses.
 Don't use salt substitutes that are high in potassium. Ask your healthcare provider or a
registered dietitian which salt substitutes to use.

Protein in your diet

 Based on your condition, your healthcare provider will talk with you about why you should
limit protein in your diet.
 Cut back on protein. Eat less meat, milk products, yogurt, eggs, and cheese.

Phosphorus in your diet

 Don't drink beer, cocoa, dark colas, ale, chocolate drinks, and canned ice teas.
 Don't eat cheese, milk, ice cream, pudding, and yogurt.
 Don't eat liver (beef, chicken), organ meats, oysters, crayfish, and sardines.
 Don't eat beans (soy, kidney, black, garbanzo, and northern), peas (chick and split), bran
cereals, nuts, and caramels.
Eat small meals often that are high in fiber and calories. You may be told to limit how much
fluid you drink.
SUMMARY
In this assignment I had included the following topic:
 Introduction
 History collection
 Physical Examination
 Investigation
 Pharmacological management
 Anatomy and physiology
 Disease condition
 Introduction
 Definition
 Causes
 Risk factor
 Types
 Pathophysiology
 Sign & symptoms
 Diagnostic evaluation
 Medical management
 Surgical management
 Diet
 Nursing management
 Theory application
 Complication
 Nursing process
 Complication
 Health education
 Summary
 Conclusion
 Bibliography
CONCLUSION
Longstanding disease of the kidneys leading to renal failure.
The kidneys filter waste and excess fluid from the blood. As kidneys fail, waste builds up.
Symptoms develop slowly and aren't specific to the disease. Some people have no symptoms
at all and are diagnosed by a lab test.
Medication helps manage symptoms. In later stages, filtering the blood with a machine
(dialysis) or a transplant may be required.
BIBLIOGRAPHY
1. Black J.M & Matassarin E(1997),MEDICAL SURGICAL NURSING:Clinical
Management for continuity of care.J.B.Lippincott.co

2. Smeltzer S.C.&Bare,B(2003) BRUNNER & SUDDARTHS TEXTBOOK OF

MEDICAL SURGICAL NURSING (10th edition).

3. Brunner & siddharts, ‘’ TEXTBOOK OF MEDICAL SURGICAL NURSING’’

Jaypee Brothers medical publishers(p) LTD,13th edition

4.F.A.Davis,”DRUG GUIDE FOR NURSES,” 9th edition, Nursing Robert Martone

Publication.

5.Javed Ansari and Davinder Kaur, ‘’TEXTBOOK OF MEDICAL SURGICAL

NURSING- 1’’, first edition, pee vee publication, 2015

6.Ksum Samant,"MEDICAL SURGICAL NURSING," 3rd edition, Vora medicak

Publication.

7.Kochuthresiamma Thomas," MEDICAL SURGICAL NURSING -I," 1st edition,

Jaypee publication.
8.Ross and Wilson’’ANATOMY AND PHYSIOLOGY,” 12TH edition, jaypee
Publication.