Alvarez, Case Study CKD

Lyceum of the Philippines UniversityCapitol Site,
Batangas CityTel. 043 723-0706 loc. 166
Lyceum of the Philippines University –

Batangas
College of Nursing
Medical Ward Clinical Duty at

Batangas Provincial hospital
Case Analysis
of
Chronic Kidney Disease
By:
Carl zen vincel alvarez
GENERAL OBJECTIVES
The study was conducted in order to develop the necessary skills needed to
provide quality, efficient, and to the extent of the caliber of excellence in nursing
care, through the application of critical thinking, ability to conceptualize a
condition from both objective and subjective standpoint, and to cater the
proliferation of the body of knowledge that we, student nurses must possess and
hone to its sharpest condition. This study focuses on developing and rendering
nursing care toward a 22-year-old patient diagnosed with Chronic Kidney
disease. Connected to this is the analysis of the condition, how it came to be, its
pathophysiology. With all this taken into perspective, all this compels the student
nurses to develop a comprehensive plan of action and intervention of care in
order to provide quality nursing care and ensure optimal health and well-being.
SPECIFIC OBJECTIVES
●Define Chronic Kidney Disease and its causes, risk factors, signs and
symptoms, the pattern of development, and foreseeable management
●Identify the drugs of choice and their mode of action, specific to the client
●Formulate possible health care plans and intervention of care that extends
outside the hospital
●Provide health teaching and guidance towards care of patient after provision of
institutional care
●Provide an evidenced-based nursing care practice and perform nursing
responsibilities
●Apply theoretical knowledge in performing nursing responsibilities
Exhibit positive approach and attitude towards the provision of nursing care
INTRODUCTION
● Hypertension is common in patients with chronic kidney disease (CKD). The

prevalence ranges from 60% to 90% depending on the stage of CKD and its
cause. The mechanisms of hypertension in CKD include volume overload,
sympathetic overactivity, salt retention, endothelial dysfunction, and alterations in
hormonal systems that regulate blood pressure (BP). Hypertension remains a
leading attributed cause of end-stage kidney disease (ESKD) in the United
States. Uncontrolled hypertension is also associated with higher risk for
cardiovascular (CV) morbidity and mortality. In this Core Curriculum, we review
the pathophysiology, diagnosis, and management of hypertension in patients
with CKD.
PATIENT’S PROFILE
Name: Marasigan, Hermogenes
Address: Calaca batangas
Age: 73
Gender: Male
Phone Number: 09061106270
Religion: Roman catholic
Status: Single
Birthdate: 04/19/1950
Place of birth:
Ethnic Background: Filipino
Educational level: —--
Occupation:
Primary or Secondary Language: Tagalog
Support Person: Jasmine pones
Hospital Number: —--
Diagnosis: Admitting Diagnosis: Chronic Kidney Disease to Hypertensive

I. PHYSICAL ASSESSMENT
GENERAL SURVEY
PHYSICAL ASSESSMENT
Date September 28,2023
Vital Signs BP: 150/80 mmHg
CR: 88 bpm
RR: 21 bpm
T: 36.4°C
O2 Sat: 95%
Body Parts Methods Findings Analysis
HEENT .
Neck
Chest and Lungs

Abdomen
ANATOMY AND PHYSIOLOGY
Hypertension is a frequent condition encountered

during kidney disease development and a leading
cause in its progression. Hallmark factors
contributing to hypertension constitute a
complexity of events that progress chronic kidney
disease (CKD) into end-stage renal disease (ESRD).
Multiple crosstalk mechanisms are involved in
sustaining the inevitable high blood pressure (BP)
state in CKD, and these play an important role in the pathogenesis of increased
cardiovascular (CV) events associated with CKD. The present review discusses relevant
contributory mechanisms underpinning the promotion of hypertension and their
consequent eventuation to renal damage and CV disease. In particular, salt and volume
expansion, sympathetic nervous system (SNS) hyperactivity, upregulated renin–
angiotensin–aldosterone system (RAAS), oxidative stress, vascular remodeling, endothelial
dysfunction, and a range of mediators and signaling molecules which are thought to play a
role in this concert of events are emphasized. As the control of high BP via therapeutic
interventions can represent the key strategy to not only reduce BP but also the CV burden
in kidney disease, evidence for major

strategic pathways that can alleviate the
progression of hypertensive kidney
disease are highlighted.
PATHOPHYSIOLOGY
LABORATORY AND DIAGNOSTIC EXAMINATIONS

PROCEDURE PERFORMED: BLOOD CHEMISTRY
Blood chemistry tests are one of

the most common tests performed to
detect and identify a wide variety of
medical conditions, and these are also
basic to complex parameters that help doctors evaluate how well organ systems are
functioning during general physicals and in-depth examinations. A blood chemistry test
is a test with a blood specimen that measures the concentration of certain chemicals in
a blood. Blood chemistry tests provide important information about how well your
kidneys, liver and other organs are working. Abnormal levels of substances in your
blood can be a sign of disease or a side effect of treatment. sick. Blood chemistry tests
are used to help diagnose and monitor many medical conditions before, during, and
after treatment.
Test Result Normal Values Significance
Red blood cells 3.15 4.35 A low RBC can affect the body's
ability to transport oxygen and
nutrients around the
cardiovascular system. It can cause
fatigue, dizziness, and heart
palpitations. The most common
form of anemia is iron deficiency
anemia. This can result from blood
loss, malnutrition, or kidney
problems.
A low Hemoglobin affects your

Hemoglobin 101 13.8 body's ability to produce red blood
cells, your hemoglobin levels may
drop. When your hemoglobin level
is low, it means your body isn't
getting enough oxygen, making you
feel very tired and weak.
Hematocrit 0.292 38.3% to 48.6% A low Hematocrit Blood loss affects

the number red blood cells. Fewer
red blood cells mean lower
hematocrit levels. Leukemia: You
have fewer red blood cells than
normal because leukemia cells in
Segmenters 0.710
your bone marrow are displacing

healthy red blood cells
2,500-6,000 High Segmenters The body is

under stress. Infection,
inflammation, stress, and vigorous
exercise can cause increased
Lymphocytes 0.191 neutrophil levels (neutrophilia). In
response to these insults,
neutrophil reserves in the bone
marrow are released. These spikes
are generally short-term.
1,000 - 4,800
A low Lymphocytes are higher risk
of infection. Lymphopenia
symptoms can range from mild to
serious and are correlated to the
severity of the lymphopenia as well
as its duration. Some people have
no symptoms
Monocytes 0.062
A high monocyte count is a

500/mm3
potential sign of many different
medical conditions. It's often linked
to infectious diseases like
mononucleosis or an autoimmune
disease like lupus. Some
medications can cause
Eosinophils 0.035 monocytosis. It's also linked to
conditions such as blood disorders
and certain cancers
30-350
A High Eosinophils are often
cells/microliter
linked to a variety of disorders. A
high eosinophil count may be due
to: Adrenal gland deficiency.
Allergic disease, including hay

fever.
Drug Study
NURSING CARE PLAN (FDAR)

NURSE’S NOTES
Date/Shift Time Nurse’s Notes
Feb 20, 2023 3pm to 11pm F: Elevated Blood pressure
D:VS: HR - 88, BP - 140/90, RR - 19, Temp - 36.2, O2Sat - 98%
A: Vital signs taken and recorded
Measured intake and output
Provided calrm and restful surroundings
Educated patient a stress management and relaxation technique.
R: Latest BP: 140/90
Advincula, Erryl Justine O.
Date/Shift Time Nurse’s Notes
Feb 21, 2023 3pm to 11pm F: For hemodialysis
D: > V/S: BP - 140/100, RR - 19, PR - 75
With IJ catheter intact
With heplock intact
A: > V/S taken and recorded
Placed patient in a comfortable position
Bedside care done
Provided calm and restful surroundings
NPI done
R: Sent to hemodialysis
Feb 22, 2023 3-11pm F: Altered sleeping pattern
D:V/S as follows: BP-130/90 RR-20 PR-88 o2sar-96 Tem-36.4
Patient verbalized “hindi ako makatulog ng ayos lalo na sa gabi”.
A: Monitored vital sign
Placed patient in a comfortable position
Provided calm and restful surroundings
Advised patient not to take a naps during day time
I and O taken and recorded
R: The patient was able to verbalize control of pain as evidenced by

decreased in pain scale from 4 to 1 out of 10
PROGNOSIS
The prognosis of chronic kidney

disease depends on a number of
factors, and for some people, it can progress to kidney failure. For some though, it
never causes any problems. One of the major factors relating to the overall prognosis
will relate to the underlying cause of the patient’s chronic kidney disease. The life
expectancy for a person receiving dialysis is around 5–10 years, though many live for
20–30 years. People who receive a donor kidney from a living donor tend to go 15–20
years before
needing a new kidney. Donor kidneys from deceased donors tend to last 10–15
years before needing to be replaced..
DISCHARGE PLANNING
Medications:
● Continue oral medications as prescribed.
Environment:
● Advised patient and partner to have a clean and sleep-conducive environment,
comfortable room temperature, and appropriate ventilation and lighting.
● Inform the significant other to pay attention to the patient's safety at home in
order to speed up recovery, minimize potential infection sources, and ensure that
family members are aware of the patient's need for assistance.
● Encourage the patient to do light stretching exercises and walk daily to relieve
tension in the body.
● Advised patient to take a break from exhausting work and promote a relaxing
environment.
Treatment:
● Advise the patient to have an
adequate rest for faster recovery.
● Instructed the patient to increase her oral fluid intake.
● Informed patient to avoid lifting heavy object
Hygiene:
● Instructed the patient to wash his hands before and after eating.
● Reiterated the importance of hand washing to avoid infection
Outpatient:
● Instructed patient and significant other to do a follow-up check-up or contact the
physician if recurrences and other issues occur.
Diet:
● Instructed significant other to give support to the patient by giving her the best
option of healthy foods that will make her motivated to eat and enjoy them at the
same time.
● Advised patient to avoid salty and sodium rich foods as it causes the body to
retain fluids.m
● Suggested to patient to reduce or limit alcohol intake.
Spiritual:
● Advised patient to continue spiritual practices, so long as it does not put the
patient’s health into compromise.
CONCLUSION
If left untreated, CKD can progress to kidney failure and early cardiovascular
disease. When the kidneys stop working, dialysis or kidney transplant is needed for
survival. Kidney failure treated with dialysis or kidney transplant is called end-stage
renal disease (ESRD).
II. PROPOSED ACTIONS AND RECOMMENDATIONS

The most important step you can take to treat kidney disease is to control your
blood pressure. High blood pressure can damage your kidneys. You can protect your
kidneys by keeping your blood pressure at or less than the goal set by your health care
provider. For most people, the blood pressure goal is less than 140/90 mm Hg.
Work with your health care provider to develop a plan to meet your blood
pressure goals. Steps you can take to meet your blood pressure goals may include
eating heart-healthy and low-sodium meals, quitting smoking, being active, getting
enough sleep, and taking your medicines as prescribed.

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Lyceum of the Philippines UniversityCapitol Site,

Batangas CityTel. 043 723-0706 loc. 166

Lyceum of the Philippines University –

Medical Ward Clinical Duty at

Chronic Kidney Disease

● Hypertension is common in patients with chronic kidney disease (CKD). The

Address: Calaca batangas

Phone Number: 09061106270

Religion: Roman catholic

Ethnic Background: Filipino

Educational level: —--

Primary or Secondary Language: Tagalog

Support Person: Jasmine pones

Hospital Number: —--

Diagnosis: Admitting Diagnosis: Chronic Kidney Disease to Hypertensive

Date September 28,2023

Vital Signs BP: 150/80 mmHg

Body Parts Methods Findings Analysis

Chest and Lungs

ANATOMY AND PHYSIOLOGY

Hypertension is a frequent condition encountered

in kidney disease, evidence for major

LABORATORY AND DIAGNOSTIC EXAMINATIONS

Blood chemistry tests are one of

Test Result Normal Values Significance

A low Hemoglobin affects your

Hematocrit 0.292 38.3% to 48.6% A low Hematocrit Blood loss affects

your bone marrow are displacing

2,500-6,000 High Segmenters The body is

A high monocyte count is a

Allergic disease, including hay

NURSING CARE PLAN (FDAR)

Date/Shift Time Nurse’s Notes

Feb 20, 2023 3pm to 11pm F: Elevated Blood pressure

D:VS: HR - 88, BP - 140/90, RR - 19, Temp - 36.2, O2Sat - 98%

A: Vital signs taken and recorded

Measured intake and output

Provided calrm and restful surroundings

Educated patient a stress management and relaxation technique.

R: Latest BP: 140/90

Advincula, Erryl Justine O.

Date/Shift Time Nurse’s Notes

Feb 21, 2023 3pm to 11pm F: For hemodialysis

D: > V/S: BP - 140/100, RR - 19, PR - 75

With IJ catheter intact

With heplock intact

A: > V/S taken and recorded

Placed patient in a comfortable position

Bedside care done

Provided calm and restful surroundings

Feb 22, 2023 3-11pm F: Altered sleeping pattern

D:V/S as follows: BP-130/90 RR-20 PR-88 o2sar-96 Tem-36.4

Patient verbalized “hindi ako makatulog ng ayos lalo na sa gabi”.

A: Monitored vital sign

Placed patient in a comfortable position

Provided calm and restful surroundings

Advised patient not to take a naps during day time

I and O taken and recorded

R: The patient was able to verbalize control of pain as evidenced by

The prognosis of chronic kidney

II. PROPOSED ACTIONS AND RECOMMENDATIONS

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