1.

INTRODUCTION (SELF):-

As per my clinical posting I was posted in the Dialysis ward in AGMC & GBP Hospital.
During my clinical posting I was found a patient who was suffering from generalized
weekness, drowsiness,breathing difficulty, oedematous foot,nausea,hiccup,pallor and doctor
diagnosed him as Chronic kidney Disease. I had taken this diagnosis for my case
presentation.

2. IDENTIFICATION DATA OF PATIENT:-

Name of thepatient:Mrs Manisha Debnath

W/O: Jiban Das.

Age:44 yrs

Gender:Female

Religion:Hindu

Educational Status: HS +2 Stage

Occupation: Nurse

Income: 66000/-

Marital status: Married

Address: Panisagar, North tripura

Ward:Dialysis Ward.

C.R.No:

DateofAdmission:

Diagnosis:Chronic Kidney Disease (CKD).

Informants: Patient &Patient’s family members.

Date of care started: 02/12/2023

Date of care ended:

3. CHIEF COMPLAINS WITH DURATION:

He was admitted to the hospital with the complaints of he, drowsiness, generalized weakness,
anaemia with breathing difficulty, nausea and hiccups

4. HISTORY OF PRESENT ILLNESS:

Present Medical History:

My patient was admitted in Dialysis ward of AGMC & GBP hospital on 09/10/23, with a
complaint of generalized weakness, anaemia with breathing difficulty nausea and on further
investigation from the family members accompanying the patient, it was found that the
patient had high BP, High Creatinine level for the past 9 years a. On the day of his
admission, he complained of generalized weakness, breathing difficulty drowsiness, nausea
and hiccups during the day,

Present Surgical History:

Nothing significant.

5. HISTORY OF PAST ILLNESS:

Past Medical History: She had high BP, for past 9 years from her 2 nd pregnancy period. she
had past history of hospitalization due to anaemia and blood transfusion done.

Past Surgical History: Patient is not having any significant history of surgery.

6. FAMILY HISTORY:

Types of Family: Nuclear

No. of family members:4(four)

History of Illness: Suffering from high B.P parents of the patient.

Relationship among the family members: Good

Family Chart:
Sl. Name of the Age/ Relation Educatio Occupation Marital Health
No. family Gender with n status Status
members patient
1. Jiban Das 47 years Self BA GOVT. Married Healthy
Male EMPLOYEE
2. Manisha 44 years wife HS passed GOVT. Married unhealthy
Debnath Male EMPLOYEE
3. Jyothi Das 15 years Daughter- NINE Student unmarried Healthy
Female
4. Jahar Das 9 years son THREE Student unmarried Healthy
Female

Family Tree:

Key points

Lt. Jahar Das Lt. Jayanti Das Female patient

(Father in Law) (Mother in law) Female

Mr.Jiban Das Mrs.Manisha Debnath Male

(Male) ( Female)

Ms. Jyoti Das Mr. Jahar Das

( Daughter) ( Son)

7. PERSONAL HISTORY:
Nutritional Status: Malnourished

Habits: She is having no bad habits.

Hygiene: Maintained properly

Allergens: She is having allergy on dust

Sleeping Pattern: She is having the habit of sleeping for 6-7 hours.

Bowel and Bladder Pattern: She passes stool and urine according to his body requirement.

Activities of Daily Living: Dull due to illness.

8. SOCIO-ECONOMIC HISTORY:

Head of the family:Mr.Jiban Das .

Income: Approximately Rs. 130000/- per month

House Type:Pucca

Location: Urban

Water supply: Tap water

Electricity: Available

Ventilation: Good

Sanitation:Pucca

Drainage System:Pucca

9. PHYSICAL EXAMINATION:

Height:160cm.

Weight:52 kg.

VITAL SIGNS:

Vital Signs Patient’s Value Normal value Remarks

Temperature 97.8 F 98.6 F Normal
 Pulse 88 beats/min. 60-100 beats/min Normal
Respiration 22 breaths/min. 16-24 breaths/min Normal
Blood Pressure 130/90 mm-Hg. 120/80 mm-Hg. Normotension

GENERAL APPEARANCE:

Body Built: Moderate

Nourishment: Under nourished

Appearance: Dull

Health: Unhealthy

Activity: The patient is able to do her personal activity but don’t active in other work.

MENTAL STATUS:

Look: Stretch and tired in facial look

Orientation: Patient is oriented

Judgement: Impaired

POSTURE:

Body curves: No hypnosis, lordosis, scoliosis is present

Movement: Patient is having weakness.

SKIN:

Colour: Brown

Texture: Dry

Temp.: 980 F

Pigmentation: Absent
HEAD TO TOE EXAMINATION:

HEAD:

Scalp:Dandruff is present, but there is no lesion/wound

Hair distribution:Equally distributed

Hair colour: Black

Hair texture:Thin

EYES:

Eyebrows: Symmetrical

Eyelids: No edema, lesions are present

Eyelashes: Normally distributed, there is no infection

Conjunctiva: Pale

Sclera: Normal

Cornea: Corneal ulcer absent

Pupillary Reaction: Reacted to light

Vision: Clear Vission

Use of glasses: No

NOSE:

External nose: There is no discharge

Nostrils: Nasal flaring absent

Nasal Septum: No deviation is there

Patency: Normal

Sense of Smell: Cannot assess

EARS:

External ear: There is no cerumen, discharge

Placement: Bilaterally symmetrical

Shape and size: Normal

Hearing ability: Normal

Use of hearing aids: Nothing significant

MOUTH AND THROAT:

Lips: Dry

Odour of the mouth: Halitosis present

Gums: No gingivitis, scurvy present

Teeth: Dental carries is present

Throat and Pharynx: There is no redness, enlarge tonsils

NECK:

Lymph Nodes: There is no enlarged lymph node

Thyroid Gland: No enlargement

Range of Motion: Patient can’t perform active ROM

CHEST:

Inspection:
Shape & Symmetry: Normal
Respiratory rate: 22 breaths/min.
Movements: Normal
Palpation:
There are no enlarged lymph nodes in the breast
Percussion:

There is no fluid accumulation in the chest

Auscultation:

Breath Sound: Wheezing sound absent

Heart Sound: S1 and S2 sound heard.

ABDOMEN:

Inspection: There are no skin rashes, scar mark, lesions, and ascites. Abdominal
distension is present.
Auscultation: Bowel sound auscultated
Palpation: No organomegaly, splenomegaly found.
Percussion: There is no fluid accumulation but gas present.

EXTREMITIES:

Upper extremities: Syndactyl and polydactyl absent, there is no clubbing of fingers.

Lower extremities: Syndactyl and polydactyl absent, there is no clubbing of fingers.

There is ankle oedema present

Range of Motion: Patient perform active range of motion .

BACK:
 Spine continuity normal, no kyphosis, lordosis, scoliosis present.
 There is no decubitus ulcer.
GENITALS AND RECTUM:

Infection: No infection
Secretion: Absent
Sphincter control: Normal
Haemorrhoids: Absent.

10. NEUROLOGICAL TEST:

Co-ordination test: Normal
Reflexes: Flexion is present and withdraws extremities against painful stimulus
Equilibrium: Balance of the body is disturbed.
Sensation: Patient is reacted to painful stimulus.
11. GCS
a. Eye opening [4] b. Verbal response [5] c. Motor response [6]
 Spontaneously (4)  Oriented (5)  Obey command (6)
 To speech (3)  Confused (4)  Localize pain (5)
 To pain (2)  Inappropriate words (3)  Flexion to pain (4)
 None (1)  Incomprehensible  Abnormal flexion (3)
sound (2)  Extension to pain (2)
 None (1)  None (1)
GCS Score:
Mild: 13-15
Moderate: 9-12
Severe: 3-8
In case of my patient
Eye opening-
To speech: 3
Verbal response-
Confused:4
Motor response-
Obey command:5.
Therefore, Glasgow Coma Scale score is 12 (Moderate)
12. INVESTIGATIONS:

Sl. Name of the Investigation Patient’s value Normal Value

No
.
01. Serum Urea 135 mg/dl 15-40 mg/dl
02. Serum Creatinine 12.9 mg/dl 0.6-1.5 mg/dl
03. TLC 8.8×103 cells/mm3 4000-11000 cells/mm3
04. SGPT (ALT) 19 IU/L 5-40 IU/L
05. SGOT (AST) 35 IU/L 5-40 IU/L
06. Serum Alkaline Phosphate(ALP) 85 IU/L 50-280 IU/L
07. Serum Na+ 141mEq/L 135-145 mEq/L
08. Serum K+ 3.5mEq/L 3.5-5.5 mEq/L
09. Blood glucose (Fasting) 121 mg/dl 90-110 mg/dl
10. Blood glucose (Post Prandial) 349mg/dl 80-140mg/dl
11. Hb% 6.2 g/dl 14-18 g/dl
12. HIV Non-reactive
13. HBsAg Non-reactive
HCV Non-reactive

Sl. Name of the Investigation Patient’s value Remarks

No.
01. Chest X-ray No consolidation seen. Normal, no infection
presents in the lung.

02. CT-scan Polycystic inflamed kidney. CKD

03. ECG 101 U/L Normal.

11. MEDICATION:

Sl. Dose,
No Drug name Action Route
. Frequency
1 Tab.Nodosis500 It is used to treat chronic kidney disease kidney 500mg, ,
BDPC
2 Inj. Pantop Pantoprazole exerts its stomach acid-suppressing 40 mg, IV, OD
effects by preventing the final step in gastric acid
production by covalently binding to sulfhydryl
groups of cysteines found on the (H+, K+)-ATPase
enzyme at the secretory surface of gastric parietal
cell.
3 Inj. Neomit Ondansetron is a serotonin-3 (5-hydroxytryptamine- 4 mg, IV, OD.
3, 5-HT3) receptor antagonist, have been shown to
have a good antiemetic effect in patients receiving
chemotherapy and in situations with vomiting after
surgery 1). Ondansetron is one of the best known 5-
HT3 receptor antagonists, blocking receptors at vagal
and sympathetic nerves and the chemoreceptor
triggering zone 2). However, 5-HT3 receptor
antagonists not only inhibit transmission of signals to
the CNS, they also decrease intestinal motility,
presumably by interfering with serotonergic
neurotransmission within the enteric nervous system
(ENS) and blocking the initiation of reflexes 3).
Ondansetron effects are thought to be on both
peripheral and central nerves. One part is to reduce
the activity of the vagus nerve, which is a nerve that
activates the vomiting center in the medulla
oblongata; the other is a blockage of serotonin
receptors in the chemoreceptor trigger zone.
4 Inj. Xone Ceftriaxone selectively and irreversibly inhibits 1gm., IV, TDS
bacterial cell wall synthesis by binding to
 transpeptidases, also called transamidases, which are
penicillin-binding proteins (PBPs) that catalyze the
cross-linking of the peptidoglycan polymers forming
the bacterial cell wall.

5 Tab.Liofen 10 Tourette's syndrome (aLiofen 10 Tablet 10's is used 10mg,TDS,PO

off-label to treat hiccups or nervous problem which
causes people to make uncontrollable sudden
movements or sounds).

----DISEASE CONDITION----

INTRODUCTION:

Chronic kidney disease (CKD) is an umbrella term that describes kidney damage or a
decrease in the glomerular filtration rate (GFR) for 3 or more months’ is associated with
decreased quality of life, increased health care expenditures, and pre- mature death. Untreated
CKD can result in end-stage renal disease (ESRD) and necessitate renal replacement therapy
(dialysis or kidney transplantation). Risk factors include cardiovascular disease, diabetes,
hypertension, and obesity. Recent research reported that 16.8% of the U.S. population aged
20 years and older have CKD.Diabetes is the primary cause of CKD. Between 25% and 40%
of patients with type 1 diabetes and 5% to 40% of those with type 2 diabetes develop kidney
damage (Thomas & Atkins, 2006). Diabetes is the leading cause of renal failure in patients
starting renal replacement therapy. The second leading cause is hypertension, followed by
glomerulonephritis and pyelonephritis; polycystic, hereditary, or congenital disorders; and
renal cancers
STAGES OF CKD:

1. Reduced renal reserve: It is asymptomatic. 75% nephron reduce their function.

2. Renal insufficiency: Patient reports polyuria and nocturia. Kidneys become unable to
concentrate urine.

3. ESRD: It is the final stage. All the functions of kidneys are impaired. Dialysis becomes
necessary.Total electrolyte imbalance occurs.

ANATOMY OF KIDNEY:

The kidneys are paired retroperitoneal structures that are normally located between the
transverse processes of T12-L3vertebrae, with the left kidney typically somewhat more
superior in position than the right. The upper poles are normally oriented more medially and
posteriorly than the internally, the kidneys have an intricate and unique structure. The renal
parenchyma can be divided into two main areas the outer cortex and inner medulla. The
cortex extends into the medulla, dividing it into triangular shapes - these are known as renal
pyramids. A kidney contains over 1 million functioning units called nephrons. Each nephron
is composed of a glomerulus and tubule. The glomerulus acts to filter the blood free of cells
and large proteins, producing an ultrafiltrate composed of the other smaller circulating
elements.
External and Internal Features of Kidney

• It has a convex and concave border.

• Towards the inner concave side, a notch called the hilum is present through which the renal
artery enters the kidney and the renal vein and ureter leave.

• The outer layer of the kidney is a tough capsule.

• On the inside, the kidney is divided into an outer renal cortex and an inner renal medulla.

• The hilum extends inside the kidney into a funnel-like space called the renal pelvis.

• The renal pelvis has projections called calyces (sing: calyx).

• The medulla is divided into medullary pyramids, which project into the calyces.

• Between the medullary pyramids, the cortex extends as renal columns called Columns of
Bertini.

• The kidney is made up of millions of smaller units called nephrons which are also the
functional units.
Function

• The most important function of the kidney is to filter the blood for urine formation.

• It excretes metabolic wastes like urea and uric into the urine.

• It secretes a number of hormones and enzymes such as:

Erythropoietin: It is released in response to hypoxia

• Renin: It controls blood pressure by regulation of angiotensin and aldosterone

• Calcitriol: It helps in the absorption of calcium in the intestines

• It maintains the acid-base balance of the body by reabsorbing bicarbonate from urine and
excreting hydrogen ions and acid ions into the urine.

• It also maintains the water and salt levels of the body by working together with the pituitary
gland.

RISK FACTOR:

BOOK PICTURE PATIENT PICTURE

 Low Birth Weight.
 Family History  History of Pregnancy induced
 History of smoking. hypertension
 History of renal injury, if any.  Eclampsia.
 Advanced age.  HTN
 Peripheral artery disease.
 Diabetes Mellitus (DM)
 Hypertension
 Heart failure
 Kidney diseases
 Liver diseases
 Prolong use of nephrotoxic drugs.
CAUSES:

BOOK PICTURE PATIENT PICTURE

 Recurring pyelonephritis
 Polycystic kidney disease  Polycystic kidney
 Autoimmune disorders, such as systemic disease
lupus erythematosus.
 Hardening of the arteries, which can
damage blood vessels in the kidney.
 Urinary tract blockages and reflux, due
to frequent infections, stones, or an
anatomical abnormality that happened at
birth.
 Excessive use of medications that are
metabolized through the kidneys.
 Injury to kidney.
 Reflux nephropathy.

PATHOPHYSIOLOGY:

Antigen (group A beta-hemolytic streptococcus)

Antigen-antibody product

Deposition of antigen-antibody complex in glomerulus

Increased production of epithelial cells lining the glomerulus

 Leukocyte infiltration of the glomerulus

Thickening of the glomerular filtration membrane

Scarring and loss of glomerular filtration membrane

Decreased glomerular filtration rate (GFR)

CLINICAL MANIFESTATION:

BOOK PICTURE PATIENT PICTURE

 Abnormal levels of  Increased level of urea and
k+,Na+,Calcium,urea and creatitine level.
creatinine.  Nausea
 Metabolic acidosis.  Muscle weakness
 Anemia  Little confused
 Anorexia
 Nausea .
 Muscle and bone weekness
 Hypertension
 Pulmonary edema
 Pleural effusion
 Fluid overload
 Decrease urine output
 Memory impairement.
DIAGNOSTIC STUDIES:

BOOK PICTURE PATIENT PICTURE

 Medical History
 Physical examination
 Blood test
 CT scan
 Echocardiogram
 USG
 History collection done
 Physical examination done
 Blood investigation done
 X-ray
 CT Scan
 ECG

COMPLICATION:

BOOK PICTURE PATIENT PICTURE

 Fluid retention  Anemia
 Hyperkalemia
 Anemia
 Heart diseases
 Weight loss
 Seizures
 Stroke
 HTN
 Erectile dysfunction
 Pericarditis
 Decreased immune response
MEDICAL MANAGEMENT:

BOOK PICTURE PATIENT PICTURE

 Erythropoietin  NODOSIS 500mg,BD
 B complex vitamins  Erythropoietin 4000IU,OD
 Phosphate binders  Tab.liofen 10mg,TDS
 IV iron agents
 Immunosupressants
 ACB and ARB inhibitors.
SURGICAL MANAGEMENT:

BOOK PICTURE PATIENT PICTURE

 Nephrectomy •Not yet done.
 Pyeloplasty
 AV fistula access

NURSING MANAGEMENT:-

Nursing theorists and their work have a significant impact on nurse education and clinical
practice. They can be applied both in theoretical research and used practically in diverse
interventions aimed at the improvement of patient care quality and patient outcomes. One of the
theories most commonly employed in practice is Dorothea Orem’s Self-Care Deficit Theory of
Nursing. Orem received her nursing diploma in the 1930s and started her career at Providence
Hospital School of Nursing in Washington (Berbiglia&Banfield, 2014). In the following decades,
she received her BS and MS degrees in Nursing Education. She worked throughout the country
following her goal to improve nursing in general hospitals.
Theory application
Mrs admitted in the hospital . she was severely week, so he can’t do care himself due to her
condition. She needs support from others to perform daily living activities.
So, I applied Dorothea Orem’s Self-Care Deficit Theory for my patient while caring her to
improve hes health status by setting the goals with both the nurse and the patient’s mutual
understanding.

According to Dorothea Orem the conceptual framework is-

SELF CARE

SELF CARE SELF CARE

AGENCY DEFICIT DEMANDS

NURSING
AGENCY

In my patient’s condition the framework are as following:

 SELF CARE

SELF CARE CAPABILITIES Therapeutic Self

1.Poor Activity level Care demand
2.Poor Nutrition 1.Activity
3.Anorexia 2.Communication
4.Nausea,weekness 3.Self Care
5.Self care deficit 4.Nutrition
6.Risk for Bed sore 5.Skin care

NURSING CAPABILITIES
1.Improve Activity level
2.Improve Appetite,reduce nausea and
vomitting
3.Reduce Risk for bed sore

NURSING ASSESSMENT SHEET:

 Problems Need Nursing Diagnosis

 Poor activity level  Improve the activity level  Impaired physical mobility related to
 Self-care deficit  Improve the quality daily hemiparesis(due to severe weakness),
 Poor nutrition living activity loss of balance and coordination

 Anorexia, nausea,  Improve the appetite, .

weakness reduce nausea & weakness  Self-care deficit: bathing, dressing,

 Risk for bed sore  Reduce the risk of bed sore toileting related to weakness.
 Imbalanced nutrition less than body
requirement related to altered level of
consciousness as evidenced by reduce
body weight.
 Risk for impaired skin integrity
related to prolonged immobilization.
Assesment Diagnosis Goal Intervention Implementation Evaluation

-Speak slowly, -Spoke slowly,

Subjective Impaired ve Facilitating
with patient with patient Patients
data: rbal communicati
through using through using communicati
Patient communicat on.
visual cues and visual cues and on is
relatives ion related
gestures; be gestures; be improving
complaints to brain
consistent, and consistent, and gradually
that he has damage.
repeat as repeat as necessary.
difficulty in
necessary. -Spoke directly to
talking.
-Speak directly to the patient while
the patient while facing him.
facing him. -Given plenty of
Objective
data: -Give plenty of time for response,

Patient has time for response, and reinforce

producing and reinforce attempts as well as

inappropriate attempts as well as correct responses.

words. correct responses. -

-Minimize Minimizedprovidin
providing g distractions to the
distractions to the patient.
patient.

-Use alternative -Used alternative

methods of methods of
communication communication
other than verbal, other than verbal,
such as written such as written
words, gestures, or words, gestures, or
pictures. pictures.
Subjective Impaired ve Facilitating -Speak slowly, -Spoke slowly, Patient’s
data: rbal communicati with patient with patient communicati
Patient communicat on through using through using on process is
relatives ion related visual cues and visual cues and improved
complaints to brain gestures; be gestures; be gradually.
that he damage. consistent, and consistent, and
hasdifficulty repeat as repeat as necessary.
in talking. necessary. -Spoke directly to
-Speak directly to the patient while
the patient while facing him.
Objective
facing him. -Given plenty of
data:
Patient has
-Give plenty of time for response,
time for response, and reinforce
producing
and reinforce attempts as well as
inappropriate
attempts as well as correct responses.
words.
correct responses. -
-Minimize Minimizedprovidin
providing g distractions to the
distractions to the patient.
patient.

-Use alternative -Used alternative

methods of methods of
communication communication
other than verbal, other than verbal,
such as written such as written
words, gestures, or words, gestures, or
pictures. pictures.
Assessment Diagnosis Goal Intervention Implementation Evaluation

Subjective Self-care Fostering -Teach the patient -Taught the patient Patient’s
data: deficit: independenc relatives to use non relatives to use non communicati
Patient bathing, e affected side for affected side for on process is
relatives dressing, activities of daily activities of daily improved
complaints toileting living (ADLs) but living (ADLs) but gradually.
that he related to not to neglect not to neglect
hasdifficulty hemiparesis/ affected side. affected side.
in talking. weekness.
-Encourage the -Encouraged the
family to provide family to provide
clothing a size clothing a size
Objective
larger than patient larger than patient
data:
wears, with front wears, with front
Patient has
closures, and closures, Velcro,
producing
stretch fabric.
inappropriate
words.
-Teach the patient
relatives to dress -Taught the patient
the patient while relatives to dress
sitting to maintain the patient while
balance. sitting to maintain

-Make sure balance.

personal care -Made sure

items, urinal, and personal care items,
commode are urinal, and
nearby and that commode are
patient obtains nearby and that
assistance with patient obtains
transfers and other assistance with
activities as transfers and other
needed. activities as needed
NURSES NOTE:-

Sl. Date Time Activity Performed Remarks

No
.
01 02/10/23 9am-  Bed making done. Gain knowledge
12.30pm  Maintained good IPR with the about the patient’s
patient’s family members. condition.
 Monitored vital signs.
 Administered medications.

02 03/10/23 9am-  Bed making done.

12.30pm Gain little
 Monitored vital signs.
knowledge about
 Administered medications.
his disease &
 Provided health education about the
treatment process.
disease and treatment process.

 Bed making done.

03 04/10/23 9am- Patient’s relatives
 Monitored vital signs.
12.30pm feel comfort.
 Provided back care.
 Provided psychological support to the
patient party.
HEALTH EDUCATION:

Regarding dietary management:

To lower the risk of stroke, follow these guidelines:
 Avoid oily fast foods and eat a variety of foods.
 Maintain a healthy weight by balancing the calories with physical activity.
 Choose more whole grains, vegetables and fruits.
 Choose foods low in saturated fat and cholesterol.
 Choose foods with moderate amounts of added sugar.
 Choose foods with moderate amounts of salt (sodium).
 If anyone drink alcoholic beverages, consult with physician and do so in moderation.
Practical tips for getting started on a healthier diet and lifestyle:
 Be realistic: Make one or two small changes every month and stick to them, such as
including a fruit and/or vegetable with each meal.
 Be adventurous: Expand tastes and try a greater variety of foods.
 Be flexible: Balance what an individual eat and the physical activity over several
days.
 Seek assistance from a registered dietician (RD) to help guide in making these
significant lifestyle changes toward healthier eating.
Regarding home management:
 Prevention of subsequent strokes, increase of GRBS, health promotion, and follow-up
care
 Prevention of and signs and symptoms of complications
 Medication teaching
 Safety measures
 Adaptive strategies and use of assistive devices for ADLs
 Nutrition-diet, swallowing techniques, tube feeding administration
 Elimination-bowel and bladder programs, catheter use
 Exercise and activities, recreation and diversion
 Socialization, support groups, and community resources
Regarding rehabilitation:
Physical activities might include:
 Motor-skill exercises: Exercises can help improve muscle strength and coordination
throughout the body. These can include muscles used for balance, walking and even
swallowing.
 Mobility training: Client might learn to use mobility aids, such as a walker, canes,
wheelchair or ankle brace. The ankle brace can stabilize and strengthen ankle to help
support body's weight while he/she relearn to walk.
 Constraint-induced therapy: An unaffected limb is restrained while the client practice
moving the affected limb to help improve its function. This therapy is sometimes called
forced-use therapy.
 Range-of-motion therapy: Certain exercises and treatments can ease muscle tension
(spasticity) and help in regain range of motion.

Cognitive and emotional activities might include:

 Therapy for cognitive disorders: Occupational therapy and speech therapy can help the
client with lost cognitive abilities, such as memory, processing, problem-solving, social
skills, judgment and safety awareness.
 Therapy for communication disorders: Speech therapy can help to regain lost abilities
in speaking, listening, writing and comprehension.
 Psychological evaluation and treatment: Client’s emotional adjustment might be tested.
He/she might also have counselling or participate in a support group.

Medication:

 Advised the patient relatives to give medicine at proper time without forgetting.
 Encouraged the patient relatives to complete the full dose as ordered by the
physician/surgeon and to encourage him to promote activity level.

Follow up care:

 Advised the patient relatives to bring the patient for regular check-up.
 Advised the family members to provide physical, psychological support to the patient.
 Encourage the patient relatives to provide a quiet and calm environment.
RESEARCH FINDINGS:

Abstract

Background:Acute kidney injury (AKI) is a major global health problem. We aim to evaluate
the epidemiology, risk factors and outcomes of AKI episodes in our single centre.

Methodology:We prospectively identified 422 AKI and acute on chronic kidney disease
episodes in 404 patients meeting KDIGO definitions using electronic medical records and
clinical data from 15th July to 22nd October 2016, excluding patients with baseline estimated
GFR (eGFR) of < 15mL / m * in . Patients were followed up till 6 months after AKI
diagnosis.

Results:The mean age was 65.8 ± 14.1. Majority of patients were male (58.2%) of Chinese
ethnicity (68.8%). One hundred and thirty-two patients (32.6%) were diagnosed in acute care
units. Seventy- five percent of patients developed AKI during admission in a non-Renal
specialty. Mean baseline eGFR was 50.2 +27.7 mL/min. Mean creatinine at AKI diagnosis
was 297 plus/minus 161 mu*mol / L . Renal consultations were initiated at KDIGO Stages 1,
2 and 3 in 58.9, 24.5 and 16.6% of patients, respectively. Three hundred and ten (76.7%)
patients had a single etiology of AKI with the 3 most common etiologies of AKI being pre-
renal (27.7%), sepsis-associated (25.5%) and ischemic acute tubular necrosis (15.3%). One
hundred and nine (27%) patients received acute renal replacement therapy. In-hospital
mortality was 20.3%. Six-month mortality post-AKI event was 9.4%. On survival analysis,
patients with KDIGO Stage 3 AKI had significantly shorter survival than other stages.

Conclusion:AKI is associated with significant in- hospital to 6-month mortality. This

signifies the pressing need for AKI prevention, early detection and intervention in mitigating
reversible risk factors in order to optimize clinical outcomes.
CONCLUSION:-
As per my clinical posting I had posted in the Dialysis ward and during my posting I got a
patient with Chronic Kidney Disease (CKD). I have given care as per the need of the patient
and it will help me to deal with the same kind of patient in future.
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