College of Nursing

Telephone No. (043) 723-0706 loc. 109/110

Lyceum of the Philippines University – Batangas

College of Nursing

Medical Ward Clinical Duty at

Batangas Medical Center

Case Analysis

of

CHRONIC KIDNEY DISEASE

By:

Espiritu, Leslee Amor

BSN IV-2 D

October 5, 2023

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TABLE OF CONTENTS

I. Introduction 3

II. Clinical History 5

III. Physical Assessment 7

IV. Anatomy and Physiology 8

V. Pathophysiology 11

VI. Laboratory and Diagnostic Examinations 12

VII. Drug Study 14

VIII. Nursing Care Plan (FDAR) 22

IX. Prognosis 23

X. Discharge Planning 24

XI. Proposed Actions and Recommendations 25

XII. References 26

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I. INTRODUCTION

CKD is a condition in which the kidneys cannot filter blood as efficiently

as they should. Because of this, excess fluid and debris from blood remain
in the body and may cause other health problems, such as heart disease
and stroke. CKD may also result in anemia or a low number of red blood
cells, an increased incidence of infections, low calcium levels, high
potassium levels, and high phosphorus levels in the blood, appetite loss or
consuming less, depression, or a diminished quality of life. The severity of
the condition can vary. The condition typically worsens with time, although
treatment has been shown to delay progression. CKD can progress to renal
failure and cardiovascular disease if left untreated. To survive kidney failure,
dialysis or a kidney transplant are required. End-stage renal disease
(ESRD) refers to kidney failure treated with dialysis or transplantation.
Kidney diseases, notably chronic kidney disease (CKD), have become a
major health concern in the United States, ranking among the top causes of
death and healthcare burden. Disturbingly, about 37 million U.S. adults have
CKD, with many undiagnosed, and a substantial 40% of those with severely
reduced kidney function are unaware of their condition. In the Philippines,
its prevalence is 35.94%, which is much higher than estimated global rates.
Each day, 360 individuals commence dialysis for kidney failure,
highlighting the pressing need for early detection and intervention. Diabetes
and high blood pressure are the primary contributors, responsible for 75%
of new kidney failure cases. This situation calls for collaborative efforts to
address kidney diseases' rising prevalence, emphasizing education,
lifestyle changes, and early detection.
The risk factors of CKD include diabetes, high blood pressure, heart
disease, family history of CKD, and obesity. In the patient of this case study,
the probable risk factors are the elevated blood pressure. Patients with CKD
may not feel ill or notice any symptoms. The only way to find out for sure if
you have CKD is through specific blood and urine tests. These tests include

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measurement of both the creatinine level in the blood and protein in the
urine.

General Objectives

This case study seeks to provide a framework for the evaluation and analysis
of chronic kidney disease in order to pave the way for the holistic nature of nursing
practice and provide a perspective that encourages the enhancement of patient care.
This research will also assist nursing students in broadening their understanding of
the disease and acquiring vital information regarding the comprehensive nursing care
provided to the patient.

Specific Objectives

In order to achieve the optimum level of health and wellness, this study aims
to:

• Introduce the patient’s profile and clinical history.

• Present and correlate anatomy and physiology, and pathophysiology
related to this case.
• Interpret and analyze the patient’s laboratory test results.
• Discuss drug studies regarding the medications given to the patient.
• Formulate patient’s nursing care and discharge plan.
• Propound proposed actions and recommendations.
• Identify appropriate nursing interventions to implement for a client with
Placental abruption.
• Guide the patient in achieving and maintaining optimum health.
• Apply theoretical knowledge in performing nursing responsibilities.
• Provide safe evidence-based nursing care.
• Exhibit positive approach and attitude in the provision of nursing care.

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II. CLINICAL HISTORY

Name Patient M Age 35

Diagnosis Chronic Kidney Disease Hospital No.

Ward/RM Medical/RM1C-2

CLINICAL APPRAISAL

History of • The patient experienced shortness of breath and not feeling well
Present
prompted consultation.
Health
Concern
Past Health Past Medical & Surgical History
History • No known allergies to food, medication, or vaccination.

• The patient has a history of hypertension.

• No maintenance medication.

• No other history of surgery aside from Normal Delivery.

Family History
• The patient stated her family history of hypertension, diabetes
mellitus, and kidney diseases.

Lifestyle and • Has good relationship to her family.

Health
Practices • Previous diets contained high caloric intake and high-cholesterol
diet.

• Does not consume alcohol nor take illicit drugs.

• Does not smoke cigarette.

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Name Patient M Age 35

Diagnosis Chronic Kidney Disease Hospital No.

Ward/RM Medical/RM1C-2

CLINICAL APPRAISAL
Review of General condition
Systems for • Patient is sitting on bed, and was conscious, alert, cooperative, oriented to
Current Health time, place, and person.
Problem • There was no puffiness in her face. Her palm was warm, no clubbing, no
fungal infection between the fingers.
• Peripheral edema noted in all extremities with pulse noted.
• No fungal infection in the toes.
Head & Neck
Inspection
• Conjunctiva is pale with white sclera but no sign of jaundice.
• Lips is dry
• Thyroid gland are not enlarged.
Cardiovascular System
Palpation
• The peripheral pulse was present and appreciated.
Respiratory System
Inspection
• The chest moved symmetrically with respiration with no deformity seen.
Abdominal Examination
Inspection
• On examination, the abdomen was not distended.
• The umbilicus was centrally located.
Extremities
Inspection and Palpation
• Non-pitting edema is present.
• Skin is warm on upper and lower limbs.
Central Nervous System
• Mental status: She was alert and conscious, orientated to time, place and
person. Her memory function was intact. She was not in a state of confusion.
Developmental
Level Stage 7: Generativity vs. stagnation
This stage takes place during middle adulthood, between the approximate ages of 30
and 64. It comes before the eighth and final stage of development in Erikson's theory,
which is integrity vs. despair.

During this stage, middle-aged adults strive to create or nurture things that will outlast
them, often by parenting children or fostering positive changes that benefit others.
Contributing to society and doing things to promote future generations are important
needs at the generativity vs. stagnation stage of development.

It's important to note that life events at this stage tend to be less age-specific than they
are during early- and late-stage life. The major events that contribute to this stage
(such as marriage, work, and child-rearing) can occur at any point during the broad
span of middle adulthood.

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III. PHYSICAL ASSESSMENT

Name Patient M Age 35

Diagnosis Chronic Kidney Disease Hospital No.

Ward/RM Medical/RM1C-
2

General Survey
• Patient is sitting on bed, and was conscious, alert, cooperative, oriented to time, place, and
person.
• There was no puffiness in her face. Her palm was warm, no clubbing, no fungal infection between
the fingers.
• Peripheral edema noted in all extremities with pulse noted.
• No fungal infection in the toes.

PHYSICAL ASSESSMENT
Date October 2, 2023
Vital Signs BP – 150/100
HR – 90
RR – 22
Temp – 36.7
O2 sat – 97%
Body Parts Methods Findings Analysis
Head & Neck Inspection • Conjunctiva is pale Normal – Clear, moist
with white sclera and smooth
• Conjunctiva but no sign of
jaundice.

• Mouth • Lips is dry Normal – smooth and

moist without lesions

• Thyroid gland are Normal – Landmarks are

• Thyroid not enlarged. positioned midline

Cardiovascular System

• Peripheral • The peripheral Normal – the rate should

pulses Palpation pulse was present be 60-100 bpm. Edema
and appreciated. is present.

Respiratory System
• Chest Inspection • The chest moved Normal – chest is
symmetrically with midline at lateral line
respiration with no
deformity seen.

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Abdominal Inspection • Abdomen was not

Examination distended. Normal – abdominal
• umbilicus was should not be distended
centrally located.

Extremities Inspection and • Non-pitting edema Not Normal - is usually

Palpation is present. a sign of an underlying
condition.

• Skin is warm on Normal - Increased

upper and lower blood flow to an area of
limbs the body can make it
feel warm,
Central Nervous Inspection • Mental status: She Normal – normal state
System was alert and of consciousness;
conscious, comprises state of
orientated to time, wakefulness,
place and person. awareness, and
• Her memory alertness
function was intact.
She was not in a
state of confusion

IV. ANATOMY AND PHYSIOLOGY

The kidneys are vital organs in the human body

responsible for various essential functions, including
blood filtration, waste removal, regulation of fluid
balance, electrolyte balance, and blood pressure
regulation.

Anatomy of the Kidneys

External anatomy
An adult kidney typically measures 12cm long,
6cm wide and 3cm deep (Mahadevan, 2019).
Spatially, however, due to the size and positioning of
the liver within the upper right quadrant of the
abdominal cavity, the right kidney is typically 2mm
shorter, 8g lighter and sits slightly lower than the left
(Kalucki et al, 2020).

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Each kidney is surrounded by three main layers. From outermost to innermost, the
layers are as follows:
• Renal fascia – a thin layer of connective tissue that attaches the kidney to
surrounding tissue, including that of the abdominal wall, providing structural
support
• Adipose capsule – perirenal fat that protects the kidney from trauma and helps
maintain its positioning within the abdominal cavity
• Renal capsule – connective tissue that helps maintain the kidney’s structural
integrity and shape, protecting its internal tissue (Cook et al, 2021b).
Internal anatomy
The internal structure of the kidney is generally considered to comprise three main
regions: the renal cortex, renal medulla and renal pelvis.
• Renal Cortex - The outermost layer
of the kidney, known as the renal cortex,
contains nephrons, the functional units of
the kidneys. Nephrons are responsible for
filtering blood and producing urine.
• Renal Medulla - The renal medulla is
located beneath the renal cortex and
consists of renal pyramids, which are
triangular-shaped structures. Each
pyramid contains collecting ducts that
transport urine to the renal pelvis.
• Renal Pelvis - The renal pelvis is a funnel-shaped structure at the center of the
kidney that collects urine from the collecting ducts. Urine then flows from the
renal pelvis into the ureter, which carries it to the bladder.

Physiology of the Kidneys

• Filtration - The primary function of the kidneys is to filter blood and remove
waste products, excess ions, and water. This occurs within the nephrons, where
blood is filtered through a network of capillaries called the glomerulus. The

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filtrate, which includes water, electrolytes, and waste substances, enters the
renal tubules.
• Reabsorption - Most of the filtrate is reabsorbed as it passes through the renal
tubules. This process selectively reabsorbs essential substances like glucose,
amino acids, and ions (sodium, potassium) back into the bloodstream.
Reabsorption helps maintain the body's electrolyte balance and prevent the
loss of vital nutrients.
• Secretion - In addition to reabsorption, the kidneys also secrete certain
substances (e.g., hydrogen ions and potassium ions) into the renal tubules to
help regulate acid-base balance and electrolyte levels in the blood.
• Concentration of Urine - The kidneys have the remarkable ability to adjust the
concentration of urine based on the body's hydration status. This process
occurs in the collecting ducts, where the concentration of urine is regulated by
the hormone antidiuretic hormone (ADH), also known as vasopressin.
• Blood Pressure Regulation - The renin-angiotensin-aldosterone system
(RAAS) is a hormonal system that the kidneys play a crucial role in. It helps
regulate blood pressure by controlling blood volume and blood vessel
constriction.
• Erythropoiesis Regulation - The kidneys produce and release erythropoietin,
a hormone that stimulates the bone marrow to produce red blood cells
(erythrocytes). This hormone release is triggered when the kidneys detect low
oxygen levels in the blood.
• Metabolism of Vitamin D - The kidneys are involved in converting inactive
vitamin D into its active form, which is necessary for calcium absorption in the
intestines and bone health.

In summary, the kidneys are complex organs with multiple critical functions in
maintaining homeostasis within the body. Their role in filtration, reabsorption,
secretion, urine concentration, blood pressure regulation, erythropoiesis, and
vitamin D metabolism underscores their vital importance to overall health and well-
being.

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V. PATHOPHYSIOLOGY

Chronic kidney Disease (CKD) is a progressive condition marked by a gradual decline

in renal function over time. It can have a variety of underlying causes and is typically
categorized into stages based on the estimated glomerular filtration rate (eGFR), a
measurement of kidney function. CKD often begins with some form of kidney damage,
which can be caused by a variety of factors, including hypertension (high blood pressure),
diabetes, glomerulonephritis, polycystic kidney disease, and certain medications or toxins.
This initial damage can impair the kidneys' ability to filter waste products and excess fluids
from the blood effectively. In response to the initial injury, the kidneys undergo a series of
inflammatory processes. Chronic inflammation can lead to the accumulation of scar tissue
or fibrosis within the renal parenchyma (the functional part of the kidney). This fibrosis
gradually replaces healthy kidney tissue and impairs the kidneys' ability to function
properly. As fibrosis progresses, the glomerular filtration rate (GFR), which measures the
rate at which blood is filtered by the kidneys, decreases. This means that the kidneys
become less efficient at removing waste products and excess fluid from the bloodstream.
The GFR is used to stage CKD, with lower GFR values indicating more advanced stages
of the disease.

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VI. LABORATORY AND DIAGNOSTIC EXAMINATIONS

Name Patient M Age 35

Diagnosis Chronic Kidney Disease Hospital No.

Ward/RM Medical/RM1C-
2

LABORATORY EXAMINATION
Date October 1, 2023
HEMATOLOGY

Laboratory Exam Normal Values Result Significance

Complete Blood Count

Erythrocyte 4.2 – 5.4 x 10^12/l 1.76 Below Normal Range –

indicating low blood count and
anemia
Hgb 120-140 gms/l 51 Below Normal Range –
low amount of iron-rich
protein in RBC
Hct 0.37 – 0.47 vol % 0.146 Below Normal Range –
insufficient measure of portion
in blood
Leukocyte 4.5 – 11.0 x 10^9/L 8.38 Within Normal Range

Neutrophil 0.37-0.72% 0.775 Above Normal Range –

indicating that the body is
fighting a bacteria, fungi, or
foreign debris
Lymphocyte 0.20-0.50% 0.125 Below Normal Range –
indicating that the patient is at
risk for viral infection
Monocyte 0.0-0.014% 0.067 Above Normal Range –
indicating possible enhanced
mobilization from the bone
marrow or increased
monopoiesis
Eosinophil 0.0-0.6% 0.029 Within Normal Range

Basophils 0.0-0.01% 0.004 Within Normal Range

Thrombocyte 150-400 x 10^9/L 166 Within Normal Range

MCH 27.0-31.0 pg 29.0 Within Normal Range

MCV 80.0-96.0 fL 83.0 Within Normal Range

MCHC 0.32-036 0.35 Within Normal Range

RDW 11.5-14.5% 12.4 Within Normal Range

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MPV RNF 10.6 ---

ABO Type “O”

RH Type Positive

Prothrombin Time
Patient 11.5-16.0 sec 15.0 Within Normal Range
Activity 70-100% 98.5 Within Normal Range
INR 0.80-1.95 1.01 Within Normal Range
Partial Thromboplastin
Patient 26-35 sec 33.0 Within Normal Range
CLINICAL CHEMISTRY
Random Blood Sugar 4.40 – 7.80 mmol/L 6.47 Within Normal Range
Blood Urea Nitrogen 2.1 – 7.1 mmol/L 54.5 Above Normal Range –
indicates that the kidneys
are not working well
Creatinine 46 – 92 umol/L 1887 Above Normal Range –
indicates kidney problems
SGPT/ALT Less than 35 U/L 39.75 Above Normal Range –
indicates liver injury
SGOT/AST 15 – 46 U/L 24.96 Within Normal Range
Albumin 35 – 50 g/L 32.5 Below Normal Range –
may indicate liver, kidney,
or inflammatory disease
Sodium 135 – 148 mmol/L 127.1 Below Normal Range –
indicates hyponatremia
Potassium 3.5 – 5.5 mmol/L 6.60 Above Normal Range –
indicates hyperkalemia
Chloride 98.0 – 107 mmol/L 90.5 Below Normal Range –
indicates hypochloremia
Ionized Calcium 2.10 – 2.57 mmol/L 0.84 Below Normal Range –
indicates hypocalcemia
Magnesium 0.7 – 1.00 mmol/L 0.8 Within Normal Range
Phosphorus 0.81 – 1.45 mmol/L 3.92 Above Normal Range –
indicates
hyperphosphatemia

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VII. Drug Study

Drug Name Classification Indication Contraindication Side Nursing Monitoring

and Mechanism Effects/Adverse Responsibilities Parameters
of Actions Reaction
Brand Name: Bronchodilator, To prevent and Hypersensitivity to CNS: dizziness, >Follow >ECG
Salbutamol antiasthmatic relieve drug/class/component excitement, manufacturer’s >I&O
Generic Name: bronchospasm. headache, directions supplied >Serum
Albuterol Mechanism of hyperactivity, with inhalation electrolytes
Action: insomnia drugs.
Dosage: Relaxes smooth CV: hypertension, >Teach patient
4 doses muscles by palpitations, signs and
stimulating tachycardia, symptoms of
Route: beta2-receptors, chest pain hypersensitivity
Inhalation thereby causing EENT: reaction and
bronchodilation conjunctivitis, dry paradoxical
Frequency: and vasodilation and irritated bronchospasm. Tell
Q6h throat, pharyngitis him to stop taking
GI: nausea, drug immediately
vomiting, and contact
anorexia, prescriber if these
heartburn, GI occur.
distress, dry >Advise patient to
mouth establish effective
Metabolic: bedtime routine
hypokalemia and to take drug
well before
Musculoskeletal: bedtime to
muscle cramps minimize
Respiratory: insomnia.
cough, dyspnea,

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wheezing,
paradoxical
bronchospasm
Skin: pallor,
urticaria,
rash,angioedema,
flushing, sweating
Other: tooth
discoloration,
increased
appetite,
hypersensitivity
reaction

Classification Side
Nursing Monitoring
Drug Name and Mechanism Indication Contraindication Effects/Adverse
Responsibilities Parameters
of Actions Reaction
Brand Name: Electrolyte Used to control >Bowel obstruction • >Headache >Verify patient’s >Vital Signs
Renvela modifier high blood levels >Hypersensitivity • >Heartburn name. >ANST
of phosphorus in to sevelamer >Observe the >I and O
• >Diarrhea
Generic Name: Lowers the people with carbonate, rights in >Serum
Sevelamer phosphate chronic kidney sevelamer • >Nausea medication electrolyte
concentration in disease who are •
hydrochloride, or to >Vomiting administration. levels
Dosage: the serum. on dialysis. any of the • >Stomach Pain >Assess patient
800mg 1 tab excipients. • >New Or for GI side effects.
Worsening >Assist patient
Route: Constipation when mobilizing.
Oral >Advise adequate
• >Gas fluid intake.
Frequency:
TID

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Drug Name Classification Indication Contraindication Side Nursing Monitoring

and Effects/Adverse Responsibilities Parameters
Mechanism of Reaction
Actions
Brand Name: Diuretics; Furosemide is >Hypersensitivity Side Effects >Observe the >Vital Signs
Lasix Furosemide is a utilized to treat to furosemide >Feeling thirsty rights in >Intake and
potent diuretic fluid retention and sulfonamides >Dry mouth medication Output
Generic Name: and anthranilic brought on by >Anuria >Headache administration. >Creatinine
Furosemide acid derivative. heart failure, >Renal failure >Dizziness >Provide a sleep >Serum
It primarily kidney disease, >Hypovolaemia >Fatigue conducive Cholesterol and
Dosage: inhibits the or liver disease. >Dehydration >Nausea and environment. Triglycerides
20mg reabsorption of Water retention >Hypotension vomiting >Assist patient >BUN
sodium and can manifest as >Comatose or >Diarrhea when mobilizing. >Electrolytes
Route: chloride in the swollen feet, pre-comatose >Constipation >Offer the patient
IV ascending loop ankles, lower states associated some ice chips if
of Henle and the legs, and wrists, with liver cirrhosis Adverse Reactions available.
Frequency: proximal and as well as or >Nephrotoxicity >Advise patient to
BID distal renal shortness of encephalopathy >Orthostatic increase fluid
tubules. In breath. >Addison’s Hypotension intake.
addition, it disease >Ototoxicity >Suggest high
inhibits the >Porphyria >Photosensitivity fiber diet to the
chloride-binding >Digitalis >Blurred vision patient if with
cotransport intoxication >Urinary retention constipation.
system, causing >Hemoconcentration >Advise a low salt,
its natriuretic >Increased low fat diet.
effect. creatinine, serum >Advise patient to
cholesterol and report any signs of
triglycerides, blood adverse reaction
urea, and urine to the healthcare
volume. provider
immediately.

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>Electrolyte
deficiencies
>Muscle spasms
>Rashes, pruritus,
urticaria

Classification Side
Nursing Monitoring
Drug Name and Mechanism Indication Contraindication Effects/Adverse
Responsibilities Parameters
of Actions Reaction
Brand Name: Haematopoietic Treatment of Hypersensitivity to Headache, low >Observe rights of >BP
Eposino Agents; anemia, albumin (human) fever, fatigue. Skin medication >Fluid and
Generic Name: antianemic especially renal or mammalian cell- rash/urticaria. administration Electrolytes
Epoetin anemia from derived products; HTN, exacerbation >Assess blood >BUN,
renal function uncontrolled of existing HTN & pressure before uric acid,
Dosage:4,000 insufficiency hypertension. hypertensive initiation. creatinine,
units including encephalopathy. >Assess serum phosphorus,
Route: hemodialysis & Increased blood iron potassium
SC non- viscosity, hepatic before and during
Frequency: hemodialysis of impairment, therapy
2x/week chronic renal increased GOP & >Establish
failure. GPT. Nausea, baseline.
vomiting, anorexia CBC
& diarrhea. >Initiate seizure
precautions
>Assess CBC
routinely.

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Classification and Side Nursing Monitoring

Mechanism of Effects/Adverse Responsibilities Parameters
Drug Name Actions Indication Contraindication Reaction
Brand Name: Antacid; Increases For the treatment >Hypersensitivity, >Belching >Observation For >Fluid and Electrolyte
plasma of metabolic or The Development Of
Sodium bicarbonate, respiratory alkalosis, >Pulmonary Cardiopulmonary >Vital signs
Bicarbonate metabolic Edema
buffers excess acidosis hypocalcemia, Complications In >I and O
Generic Name: hydrogen ion excessive chloride >Hypokalemia Addition To
which may occur
concentration, and loss from vomiting or Neurologic
Sodium due >Dehydration
raises blood pH, GI suctioning. Assessment.
Bicarbonate thereby reversing to underlying
>Patients at risk of >Impaired Kidney >Observe Rights Of
the clinical cause
Dosage: developing diuretic- Function Medication
manifestations of such as severe induced
acidosis. renal Administration
650mg 1 tab hypochloremic >Swelling Of
disease, acidosis Hands, Ankles, And >Measure I&O
Route: uncontrolled Feet
>Hypercarbic Accurately And
Oral diabetes, acidosis Record To Achieve
>Dizziness
circulatory >Unknown Proper Fluid Balance.
Frequency: >Muscle Aches
insufficiency due abdominal
TID to • pain >Signs Of Kidney
shock or severe Problems
• dehydration.
>Chest Pain
>Mental/Mood
Changes

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Classification and Side

Nursing Monitoring
Mechanism of Effects/Adverse
Drug Name Indication Contraindication Responsibilities Parameters
Actions Reaction
Brand Name: >Calcium Used in the >Hypersensitivity >Vomiting >Observe rights of >Vital Signs
carbonate is management and medication
Calci-Aid classified as a treatment of low >Renal Calculus >Dry Mouth administration. >Fluid and Electrolyte
Generic Name: calcium calcium conditions >High Urine >Increased
supplement, >Instruct patient on > Hemodynamics
Calcium Levels Urination foods that contain
Calcium Carbonate antacid, and > Parathyroid
phosphate binder. >Elevated Serum >Loss Of Appetite vitamin d and hormone
Dosage: Calcium encourage adequate
>Ionic compound >Upset Stomach intake.
500mg 1 tab >Low Serum
used as a calcium
supplement or Phosphate >Provide ice chips for
Route:
antacid used for dry mouth.
Oral >Achlorhydria
the symptomatic >Encourage
Frequency: relief of heartburn, >Suspected adequate fluid intake.
acid indigestion, Digoxin Toxicity
BID and sour stomach.

Drug Name Classification and Indication Contraindication Side Nursing Monitoring

Mechanism of Effects/Adverse Responsibilities Parameters
Actions Reaction
Brand Name: Glucose and For treatment of Hypoglycemia. Redness, swelling, > Regularly assess >Serum and urine
Insulin Preparation; hyperkalemia Hypersensitivity to & itching to site, the patient's blood glucose
Enhances the active electrolyte glucose levels using a >Serum electrolytes
Generic Name: potassium uptake substance imbalance glucometer as >I & O
1 vial D5050 + 10by cells to Hypokalemia ordered. >Caloric intake
units RI decrease the >Administer
serum medication as
Dosage: concentration. prescribed.

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4 doses >Inform patient the

signs and symptoms
Route: of
IV hypo/hyperglycemia
and what to do in
Frequency: these situations.
Q6 > Promote safe insulin
storage and disposal
of sharps containers
for used needles.
>Ensure patient’s
well-being.

Drug Name Classification and Indication Contraindication Side Nursing Monitoring

Mechanism of Effects/Adverse Responsibilities Parameters
Actions Reaction
Brand Name: Used to treat and Used for the Alcohol level in the -Seizures in epileptic >Advise the patient to >Vital signs
Hemarate FA prevent iron treatment, control, body, allergies, pre- patients receiving take only one tablet >Hemoglobin
deficiency anemia. prevention, & existing diseases, phenobarbital, once a day. >Level of
Generic Name: improvement of and current health primidone, or >Also, remind patient Consiousness
FeSO4 + FA the following conditions diphenylhydantoin to take the tablet 1 >I and O
diseases, -Stomach upset and hour before or 2 hours
Dosage: conditions and pain after meals
1 tab symptoms: -Constipation >Advise patient that in
-Anemia -Diarrhea case a dose is
Route: -Treatment of -Nausea missed, use it as soon
Oral megaloblastic -Vomiting as noticed. But do not
anemias due to a -Allergic reactions use extra dose to
Frequency: deficiency of folic -Anorexia make up for a missed
OD acid dose.

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-Treatment of -Abdominal
anemias of distention
nutritional origin, -Flatulence
pregnancy, -Bitter or bad taste
infancy, or -Altered sleep
childhood patterns
-Difficulty in
concentrating
-Irritability
-Overactivity
-Excitement
-Mental depression
-Confusion
-Impaired judgment
-Decreased vitamin
b12 serum levels
-Decreased
diphenylhydantoin
serum levels in
folate-deficient
patients

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VIII. Nursing Care Plan

Name Patient M Age 35

Diagnosis Chronic Kidney Disease Hospital No.

Ward/RM Medical/RM1C-2

NURSE’S NOTES
Date/Shift Time Nurse’s Notes
October 2, 2023 4 pm Focus: Elevated Blood Pressure
(3-11pm) Data: Received patient sitting in her bed, awake, alert, and coherent.
• With Heplock intact.
• VS taken as follows:
• BP 150/100 mmHg
• HR 90 bpm
• O2 97%
• RR 22 cpm
• T 36.7 degree Celsius
Action: Vital signs taken and recorded.
• Referred BP (150/100mmHg) to NOD.
• Encouraged patient to maintain a renal diet.
• Provided comfort measure such as elevation of bed to
decrease discomfort.
• Instructed relaxation techniques.
• Assisted patient to comfortable position.
• Intake and Output measured and recorded.
Response: Latest BP:150/110mmHg
Leslee Amor Espiritu, SN
October 2, 2023, 11:00 PM
October 3, 2023 4 pm Focus: Peripheral edema
(3-11pm) Data: Received patient sitting in her bed, awake, alert, and coherent.
• With Heplock intact.
• With non-pitting edema on extremities
• VS as follows
• BP 180/100 mmHg
• HR 107 bpm
• O2 95%
• RR 25 cpm
• T 37.0 degrees Celsius
Action: Vital signs taken and recorded.
• Referred BP (180/110mmHg) to NOD.
• Renal diet advised.
• Encouraged adequate rest
• Assisted patient to comfortable position.
• Handled edematous extremities with care.
• Administered oral fluids with caution.
• Due medications given per doctor’s order.
• Intake and output measured and recorded.
Response: Patient still has peripheral edema.
Leslee Amor Espiritu, SN
October 3, 2023, 11:00 PM
October 4, 2023 4 pm Focus: Abdominal Pain
Data: Received patient lying in bed, alert, awake, and coherent.

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• With heplock intact.

• With ongoing blood transfusion of 250cc
• Patient complains of abdominal pain
• With abdominal guarding
• VS as follows
• BP 150/110mmHg
• HR 94 bpm
• O2 97%
• RR 23 cpm
• T 37.0 degree Celsius
Action: Vital signs taken and recorded.
• Referred BP (150/110mmHg) to NOD.
• Assisted patient to comfortable position.
• Encouraged patient to limit body movement.
• Ensured adequate hydration.
• Promoted relaxation techniques.
• Due medications given per doctor’s order.
• Intake and output measured and recorded.
Response: No abdominal pain noted.
Leslee Amor Espiritu, SN
October 4, 2023, 11:00 PM

IX. PROGNOSIS

Chronic kidney disease is often incurable, but its progression can often be delayed
or stopped with appropriate medical care and lifestyle modifications. Managing CKD
and enhancing long-term outcomes requires routine monitoring of kidney function and
close collaboration with healthcare providers. The prognosis for each individual with
CKD can vary greatly; therefore, it is essential for patients to work closely with their
healthcare team to comprehend their unique situation and develop individualized
treatment plans. Early detection and intervention can significantly improve the long-
term prognosis of chronic kidney disease (CKD).

For patient M, the prognosis is guarded. A guarded prognosis is when the person
formulating the opinion simply does not have enough information to know or to foretell
what the outcome may be. The patient is adherent to her medications. However, not
enough information regarding the patient’s state is known.

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X. DISCHARGE PLANNING

Discharging Patient M, 35 years old with diagnosis of chronic kidney disease.

Medications
• Ensure the patient continues taking prescribed medications for CKD,
including blood pressure-lowering medications like ACE inhibitors or ARBs,
and medications to manage complications such as anemia.
• Review medication dosages, timing, and potential side effects to promote
adherence.
Environment
• Advise the patient to maintain a clean and hygienic living space to reduce
the risk of infections.
• Encourage the removal of any environmental toxins or allergens that may
affect their overall health.
Treatment
• Schedule regular follow-up appointments with a nephrologist or kidney
specialist to monitor kidney function and adjust the treatment plan as
needed.
• Coordinate with a registered dietitian or nutritionist for ongoing dietary
guidance and meal planning.
• Monitor and manage any complications that may arise during the course of
CKD.
• Discuss potential renal replacement therapy options (e.g., dialysis or
transplantation) if CKD progresses to a severe stage.

Hygiene
Emphasize the importance of good hygiene practices, including handwashing and
wound care, to prevent infections.
Educate the patient on the significance of oral hygiene and regular dental check-
ups, as oral health can impact overall well-being.
Outpatient referral
• Provide information about available support groups and counseling services
for individuals living with CKD.
• Offer resources for mental health support, as dealing with a chronic illness
can be emotionally challenging.

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Diet
• Offer dietary counseling to help the patient follow a kidney-friendly diet,
which includes monitoring sodium, potassium, and phosphorus intake.
• Educate the patient on portion control and balanced nutrition to maintain
overall health.
• Emphasize the importance of staying well-hydrated without overloading on
fluids.
Spiritual
• Address the patient's spiritual and emotional needs by connecting them with
spiritual counselors or chaplains, if desired.
• Encourage the patient to engage in practices that promote emotional and
mental well-being, such as mindfulness or meditation.

XI. PROPOSED ACTION AND RECOMMENDATION

It is imperative for a patient who has been diagnosed with chronic kidney
disease (CKD) to take a preventative stance in order to properly manage the condition.
One course of action that is highly suggested is working closely with a healthcare
professional who specializes in nephrology in order to formulate an individualized
treatment strategy. This approach should involve regular monitoring of kidney function
by blood tests, keeping a diet that is kidney-friendly with minimal intake of salt,
potassium, and phosphorus, regulating blood pressure and blood sugar if appropriate,
and being as hydrated as possible.

Because smoking and drinking too much alcohol both contribute to a decline in
kidney function, the patient should be strongly advised to abstain from both of these
activities. Managing chronic kidney disease can be made easier by participating in
regular physical exercise and enlisting the help of a qualified dietitian or nutritionist for
guidance and support.

Individuals who are diagnosed with CKD have the ability to greatly boost their
quality of life and delay the progression of the disease if they adhere to this all-
encompassing approach and keep an open line of communication with their healthcare
team.

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XIII. References
• CDC. (2021, March 9). Chronic Kidney Disease Basics | Chronic Kidney
Disease Initiative | CDC. Www.cdc.gov.
https://www.cdc.gov/kidneydisease/basics.html#:~:text=CKD%20is%20a%20c
ondition%20in
• Audrei, J., Orpilla, L., Jason, M., Tria, C., & Virgilio, J. (2023). Gaps and
challenges in the provision of treatment for patients with end-stage renal
disease: perspectives from the Philippines. The Lancet Regional Health -
Western Pacific, 100889–100889.
https://doi.org/10.1016/j.lanwpc.2023.100889
• Mcleod, S. (2023, August 2). Erik Erikson’s Stages of Psychosocial
Development. Simply Psychology; Simply Scholar.
https://www.simplypsychology.org/Erik-Erikson.html
• Taylor, J. (2023, January 23). Renal system 1: the anatomy and physiology of
the kidneys. Nursing Times. https://www.nursingtimes.net/clinical-
archive/renal/renal-system-1-the-anatomy-and-physiology-of-the-kidneys-23-
01-2023/
• Shade191. (2023, July 11). Understanding Chronic Kidney Disease: Causes,
Symptoms, and Treatments. Manual of Medicine.
https://manualofmedicine.com/topics/nephrology-and-urology/chronic-kidney-
disease-causes-symptoms-treatments/
• What is the prognosis of chronic kidney disease? (2022, October 21). Top
Doctors. https://www.topdoctors.co.uk/medical-articles/what-is-the-prognosis-
of-chronic-kidney-
disease#:~:text=The%20prognosis%20of%20chronic%20kidney%20disease
%20depends%20on%20a%20number
• Vocational and Rehabilitation Prognosis. (2018, August 26). Stokes &
Associates. https://www.stokes-associates.com/blog/2019/1/2/vocational-and-
rehabilitation-prognosis#:~:text=A%20prognosis%20is%20the%20foretelling

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