Chronic Kidney Disease 2⁰ to Diabetes Mellitus II related to Hypertension, Anemia 2° to Nephropathy

Group 1

GROUP 1

Arceo, Mari Aguirre, Kim Leonard Bermudez, Joanna Marie Bongkingki, Janela Cassandra De Guzman, Fredaline Dayle De Guzman, Maria Cristina

Desvarro, Eric
Domingo, Jennifer Leyva, Allan Mario

Seminiano, Haidy
Socias, Christian Anthony

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OUR LOVELY CLINICAL INSTRUCTOR .

Angelica Hernandez .Mrs.

Introduction

I. Background of the study
Presenting a case of Patient H.F., 51 year-old female admitted on the 24th of September , 2012 at 7:30 PM with baseline vital signs of T- 37.1 °C, PR-92bpm, RR-23 bpm, and a BP of 160/90mmHg. The patient was admitted to the Mandaluyong City Medical Center, and was given a final diagnosis of Chronic Kidney Disease 2⁰ to Diabetes Mellitus II related to Hypertension, Anemia 2° to Nephropathy Diabetes mellitus (DM) is a set of related diseases in which the body cannot regulate the amount of sugar (specifically, glucose) in the blood. The blood delivers glucose to provide the body with energy to perform all of a person's daily activities.

The liver converts the food a person eats into glucose. The glucose is then released into the bloodstream. In a healthy person, the blood glucose level is regulated by several hormones, primarily insulin. Insulin is produced by the pancreas, a small organ between the stomach and liver. The pancreas also makes other important enzymes released directly into the gut that helps digest food. Insulin allows glucose to move out of the blood into cells throughout the body where it is used for fuel. People with diabetes either do not produce enough insulin (type 1 diabetes) or cannot use insulin properly (type 2 diabetes), or both (which occurs with several forms of diabetes). In diabetes, glucose in the blood cannot move efficiently into cells, so blood glucose levels remain high. This not only starves all the cells that need the glucose for fuel, but also harms certain organs and tissues exposed to the high glucose levels.

Type 2 diabetes (T2D): Although the pancreas still secretes insulin, the body of someone with type 2 diabetes is partially or completely unable to use this insulin. This is sometimes referred to as insulin resistance. The pancreas tries to overcome this resistance by secreting more and more insulin. People with insulin resistance develop type 2 diabetes when they fail to secrete enough insulin to cope with their higher demands. At least 90% of adult individuals with diabetes have type 2 diabetes. Type 2 diabetes is typically diagnosed in adulthood, usually after age 45 years. It used to be called adult-onset diabetes mellitus, or non-insulindependent diabetes mellitus. These names are no longer used because type 2 diabetes does occur in younger people, and some people with type 2 diabetes require insulin therapy. Type 2 diabetes is usually controlled with diet, weight loss, exercise, and oral medications. However, more than half of all people with type 2 diabetes require insulin to control their blood sugar levels at some point in the course of their illness.

To know the anatomy and physiology of the pancreas and the associated organs. To know the appropriate nursing intervention in accordance with its scientific rationales. its signs and symptoms and its further complications. 4. RATIONALE FOR CHOOSING THE CASE 1. 3. To know the appropriate medical management in the treatment of the disease.A. To know the pathophysiology of Diabetes Mellitus Type 2. . 2.

The students will enhance their knowledge on the disease process and its effect to the human body. The students will be able to formulate appropriate Nursing Care plan based on the client’s presented health problems and risks and effectively improve/alleviate client’s health condition. OBJECTIVES OF THE STUDY This case study aims to identify and determine general health problems and needs of the patient with a diagnosis Chronic Kidney Disease 2⁰ to Diabetes Mellitus II related to Hypertension. Specific Objectives: The students will be able to improve their skills in conducting appropriate assessment on the client’s health condition. . This work also intends to promote health and medical understanding of such condition through the application of nursing process and skills. Anemia 2° to Nephropathy.B. The students will be able to formulate a scientific-based pathophysiology based on the client’s health history and presenting signs and symptoms.

adverse reactions and mechanism of action on why it was prescribed to the patient and specific nursing considerations. .  The students will be able to expand their knowledge on the drugs through identification of its indication.  The students will be able to render quality care to patients guided with scientific based rationale. side effects. The students will be able to utilize the nursing process and critical thinking skills in the management and care of the common problems of the patient.

ASSESSMENT Client’s Profile • Name • • • • • • • Age Gender Birth Date Civil status Occupation Nationality Religion : : : : : : : : Patient F. 51 years old Female December 22.H. 1960 Married Housewife Filipino Catholic .

• Date of Admission • • Time of admission Admitting Diagnosis : : : September 24. Chief Complaint : Generalized body weakness . 2012 N/A Chronic Kidney Disease 2⁰ to Diabetes Mellitus II related to Hypertension. Anemia 2° to Nephropathy B.

2012. Symptoms persisted which prompted consult. Glucovance 2. generalized body weakness and easy fatigability. DM Type II for ten years Peripheral Vascular Disease  Accidents Hospitalization Medications taken : : : N/A Last hospitalization: July. client experienced loss of Appetite.C.5 mg Losartan 50mg . Past Medical History : Three days prior to admission. History of Present Illness : D.

Family History Legends Grandfather Grandmother Father Mother Patient Brother 1 Sister Brother 2 Hypertension Diabetes Heart Disease Deceased .E.

Family History The following figure shows the family genogram of the patient.F Male Female Nephropathy . Fatherside Grandfather Grandmother Motherside Grandfather Grandmother Father Mother LEGEND: Deceased Diabetes Mellitus Colon Cancer Hypertension Husband Patient H.E.

she perceived herself as an unhealthy person. She becomes more aware of her condition and states that she will try her best to follow the advised diet. she knows that being healthy is important. She drinks alcoholic beverages occasionally and does not smoke.F. . DM Diet. low fat. During hospitalization. the client states that she loves to eat. but she is not fond of doing exercise. Her perception of a healthy person is anyone who can perform their daily task and one who doesn’t have a disease. Nutrition and Metabolism Before hospitalization. When the patient is hospitalized. She loves to eat everything including those foods that are not advisable for her to eat. Gordon’s Functional Health Pattern • Health Perception and Health Management Before hospitalization. the client is advised to be on a Low salt.

24 Hour Diet-Recall Meal Breakfast Food Rice Chicken Breast Coffee Lunch Lugaw with egg Orange juice Quantity Half cup Small serving 1 cup 1 bowl 1 glass (250 ml) .

walking is her only activity. client normally gets 6-7 hours of sleep. She does not have any difficulty sleeping. Whenever she is doing something like cleaning the house or washing the chores. the client defecates brownish. She also stated that she perspires just right. Activity – Exercise Before hospitalization. During hospitalization. formed stool 6-7 times a week. she gets tired easily. . She claimed that hospitalization affects her sleeping pattern. During hospitalization. client’s household chores serve as her way of exercising.• Elimination Prior to hospitalization. client stated that she defecates once in every two days and she urinates 6-7 times per shift. • Sleep – Rest Prior to hospitalization. She urinates clear-yellowish urine 6-7times a day. she cannot sleep comfortably and wakes up easily.

Upon hospitalization. She states that prior to hospitalization. • Role Relationship Pattern Prior to hospitalization. Client claimed that her memory hasn’t changed even during hospitalization. She is able to follow instructions. She perceives herself as a healthy person. Self Perception / Self Concept Client claimed that she was already satisfied with her life. she perceives herself as a loving wife and mother. client sees herself as unhealthy. The client presently feels the support of her family and she is happy about it. She has no hearing problems. people and date. She and her husband take part in decision-making. Upon hospitalization. client lives with her husband and they have 7 children.Cognitive – Perceptual The client can recall past memories when being asked. client’s husband takes responsibility in decision-making. Their child supports their financial needs. They have open communication with each other. place. . The client is oriented with time.

Despite of their age. During hospitalization. client claimed that she becomes closer to God and that she never forgets to pray for her faster recovery. Client’s usual cause of stress is misunderstanding with her husband and children. Client would just vent out to her husband and try to sleep. Value – Belief The client states that she is a religious person and usually goes to church every Sunday. She easily gets irritated with arguments and cries whenever depressed.Sexuality – Reproductive The client stated that they do not practice family planning ever since. During hospitalization. . • Coping – Stress – Tolerance Prior to hospitalization. client doesn’t engage with sexual activity anymore. The couple engages in sexual activity once or twice a month. they’re still able to maintain a satisfying sexual relationship. During hospitalization. she claims that she gets stressed whenever she experiences body weakness.

axillary with a regular pulse rate of 75 bpm. The respiratory rate is 34 cpm. place and person. Anthropometric Measurements Her height is 5’2” and her weight is 136 lbs (upon admission). . 129lbs (upon referral).G. Vital Signs Her temperature is 37. Client appears to be physically weak upon assessment. Physical Examination General Survey The patient’s body built is proportionate with coordinated posture and gait.1 º C. Client is lethargic but coherent and oriented to time. deep and her bp is 180/110 mmHg taken in a lying position.

. thick and silky. She has dry skin. cool upon touch and show poor turgor.Skin Her skin color is pale. has symmetrical facial features. Hair Her hair is evenly distributed. Nails Her nails are convex 160 º in curvature and angle. has smooth contour.She has no edema. There is no presence of infestations. There is presence of sparse leg hair. Skull and Face The skull is normocephalic. The surrounding tissues are intact and capillary refills in 4 seconds. The texture is smooth with pale nail beds. with venoclysis on right metacarpal vein .

. eyelashes are equally distributed. Her eye is coordinated in extraocular movement and she is able to read newspaper. Sinuses are not tender. Ears and Hearing The pinna of her ears has a uniform skin color and symmetrical. The ear canal has presence of dry cerumen . She has symmetrical gross smell. PERRLA. and eyes close symmetrically and have 15-20 involuntary blinks. intact skin. Its mucosa is dry but has no discharges.Eye Structures and Visual Acuity Her eyebrows are evenly distributed.The tympanic membrane is pearly gray and the hearing acuity is intact. Nose and Sinuses She has symmetrical nasolabial fold. There is a presence of peritorbital edema on both eyes. Her septum is in midline. non-deviated and has no perforation. It is both patent. She has pale conjunctiva and has transparent cornea.

The respiratory excursion is full and symmetric. 1right. Her palate is light pink and smooth with uvula is in midline. full range of motion and equal muscle strength. She has 4 missing teeth. pale and with few lesions. lower molar. the thyroid gland is not visible with a symmetrical carotid pulse.Mouth and Oropharynx Her lips are dry. pinkish. The trachea is in midline. Tongue is in midline. 1st right. The gag reflex is intact. the spine is aligned with a smooth skin. upper premolar. Neck Her neck muscles are equal in size with a coordinated movement. . smooth and movable. The lymph nodes are not palpable. The shape and symmetry of the thorax and lungs is symmetrical. 2nd left. Thorax and Lungs Her breathing pattern is rapid and deep. The oropharynx is also pink and smooth. The jugular veins are not visible. 3rd left. upper lateral incisor. Tonsils are not inflamed. lower molar.

firm muscle tone with equal muscle strength. Her range of motion is limited. The bowel sounds are normoactive with a tymphanic percussion and relaxed palpation. Upper and Lower Extremities The upper and lower extremities have an equal muscle size. The skin is smooth with round areola. The nipples are round. Abdomen The abdomen contour is rounded and the symmetry is symmetrical. .Breast and Axilla Her breast and axilla’s shape is rounded.

H. Laboratory and Diagnostic Study .

PROBLEM IDENTIFICATION .

The tapered left side extends slightly upward (called the body of the pancreas) and ends near the spleen (called the tail). The right side of the organ (called the head) is the widest part of the organ and lies in the curve of the duodenum (the first section of the small Intestine).The pancreas are made up of two types of tissue: . Anatomy of Pancreas The pancreas is an elongated.A. tapered organ located across the ba ck of theabdomen. behind the stomach.

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The hormones secreted by the endocrine tissue in the pancreas are insulin and glucagon (which regulate the level of glucose in the blood). When they enter the duodenum. Endocrine tissue the endocrine tissue. and acids in the duodenum.Exocrine tissue the exocrine tissue secretes digestive enzymes. which consists of the islets of Langerhans. and somatostatin (which prevents the release of the other two hormones. they are activated. fats. . The exocrine tissue also secretes bicarbonate to neutralize stomach acid in the duodenum. secretes hormones into the bloodstream. These enzymes travel down the pancreatic duct into the bile duct in an inactive form. proteins. These enzymes are secreted into network of ducts that join the main pancreatic duct. Functions of the pancreas: The pancreas has digestive and hormonal functions: The enzymes secreted by the exocrine tissue in the pancreas help break down carbohydrates. which runs the length of the pancreas.

controlling blood pressure. and stimulating the production of red blood cells. but also by balancing levels of electrolytes in the body. not only by filtering the blood and getting rid of waste products.Anatomy of kidney The kidneys play key roles in body function. .

(The term “renal" is derived from the Latin name for kidney. They filter waste products of body metabolism. If oxygen levels fall. a hormone that stimulates the bone marrow to make red blood cells. . the concentrations of electrolytes like sodium and potassium.The kidneys are located in the abdomen toward the back. normally one of each side of the spine. erythropoietin levels rise and the body starts to manufacture more red blood cells. and the acid-base balance of the body. like urea from protein metabolism and uric acid from DNA breakdown. They get their blood supply through the renal arteries directly from the aorta and send blood back to the heart via the renal veins to the vena cava.)The kidneys have the ability to monitor the amount of body fluid. Special cells in the kidney monitor the oxygen concentration in blood.Kidneys are also the source of erythropoietin in the body. Two waste products in the blood can be measured: blood urea nitrogen (BUN) and creatinine (Cr).

Eventually. however. Formerly known as adult onset diabetes. or the hormone is not stimulating the glucose uptake in muscles and tissues required for energy. and a sedentary lifestyle. In this type the pancreas has not ceased to produce insulin. Other risk factors. or in combination with tablets that reduce the amount of blood glucose. The result is a build-up of glucose in blood and urine. but the quantity is insufficient. . it usually affects people aged over 40 and progresses gradually. such as increasing age. There are two main types of blood glucose-reducing drugs: sulphonylureas work mainly by stimulating the pancreas’s islet cells (known as the islets of Langerhans) to produce more insulin and iguanids increase the effectiveness of insulin on cells.Diabetes Mellitus Diabetes Mellitus type 2 is the most common form of Diabetes. Non-insulin dependent diabetes mellitus can often be controlled initially by diet alone. probably contribute to its increased incidence in developed countries. patients may need insulin injections. obesity. non-insulin dependent diabetes mellitus tends to run in families. Although the cause of this malfunctioning is unclear.

.Signs and Symptoms with Rationale Diabetes Mellitus  HYPERGLYCEMIA (INCREASED BLOOD SUGAR LEVEL) May be due to lack of physiologically active insulin that transportsglucose from extracellular to intracellular leading to accumulation of glucose in the intravascular space. The glucose is not utilized by the body and it remains in the blood streams.  POLYDIPSIA Increased thirst and fluid intake. This may be due to the activation of thethirst center in the hypothalamus resulting form the intracellular dehydrat ion or volume depletion. This may be due to the osmotic diuretic effect of the glucose.  POLYURIA Increased frequency of urination. wherein it attracts water during urination.

which results to the excretion of glucose in the urine. POLYPHAGIA Increased hunger and food intake. This may be due to the decrease glucose uptake by the cells leading the stimulation of the satiety center in the hypothalamus resulting to the ‘hunger sensation. making it to its normal state. GASTROPARESIS (Stomach fullness) .”  WEAKNESS/ FATIGUE This is due to the decreased glucose uptake by the cells leading to decreased energy production. Due to the excess glucose ad compared to the kidney threshold. Glucose was filtered out and excreted in the urine.  GLYCOSURIA The kidney filters the blood.

The stomach fails to empty properly and is likely due to the generalized neuropathy.  NAUSEA/ VOMITING Due to stomach fullness. CONSTIPATION and BLOATING This is due to changes in nerves and damages the blood vessels that carry oxygen and nutrients to the nerves. . there will be an involuntary emptying of stomach contents that are forcefully expelled by the mouth. high blood glucose can damage the vagus nerve. Over time.  PALE Due to decreased production of erythropoietin. A compensatory mechanism due to acidity of body because of decrease excretion of metabolic waste.

Pathophysiology .B.

Problem List .C.

PLANNING .

Problem Prioritization NURSING PROBLEM RANK 1 2 JUSTIFICATION 3 .A.

Discharge Planning Medication  Instruct the patient the importance of regularly taking of prescribed home medications.  Advise the patient not to miss the intake of medication given by his physician. .  Instruct the patient to continue with follow up medical care. Amlodipine 10mg 1 tab / OD Cefuroxime 500 mg 1 tab / BID NaHCO3 1 tab / TID CaCO3 1 tab / TID Ferrous sulfate + Folic acid 1 tab / OD Insulin  Ensure safety by providing health teaching about the side effects and adverse effects of the drug.C.

 Instruct the patient to continue home medication. whereas aerobic exercise may help control blood pressure and lipid level. <4.  Explain renal dialysis and Transplantation.Exercise and Environment  Encourage the patient mild exercise such as walking it is best to start slowly and more as the patient get stronger. Exercising can make the heart stronger. Phosphate binders and dietary phosphorus restriction are indicated to keep phosphate. .  Instruct the patient to comply with the medication regimens prescribed by the physician and the life style adjustment on her diet and exercise. Resistance training in particular helps reduce the catabolic effects of a low-protein (0.5 mg/dL. Exercise can benefit patient with CKD/DM Nephropathy. Treatment  Since the patient due to the loss of renal erythropoietin production and should be treated with supplement iron and synthetic erythropoietin to reach a target hemoglobin of 11-12g/ dL. lower blood pressure and keep healthy.6g/kg/day) diet.

 Instruct the patient to limit fluid intake.  Encourage the patient also have to Monitor of blood glucose levels. fresh or frozen vegetables. Respirations. intake and output and weight) and record keeping. Processed or prepared foods should be avoided. basic foods such as lean meat. . especially if patient is losing weight.  Help the patient/ Family learn self-observational skills (Temperature. potassium. phosphorus and other electrolytes. and whole grained breads.  Explain the benefits of consuming simple. Pulse. getting enough calories. Blood Pressure.  Instruct the patient regarding limiting the amount of salt (sodium).Health Teaching  Encourage the patient also have adequate rest periods and to have an adequate sleep of at least of 8-10hrs.  Encourage the patient to eat a low-protein diet.

 Explain avoidance of infection. Out patient  Instruct the patient to come back for follow up check-up.  Emphasize the need to be present in medical procedure schedule. It should include food eaten. Encourage the patient keep a food diary for several days. portion size. . and time of consumption so that together you can modify the diet as needed.

 Sodium Restriction  Patient with CKD are often salt-sensitive. and vitamin C levels are also often low in DM.Diet  Low total and animal protein  A prolonged high-protein intake is accompanied by an increase in GFR. riboflavin and especially pyridoxine. . responding to elevated intakes of sodium chloride with increase in glomerular filtration and proteinuria. 4 which in turn may cause intraglomerular hypertension and eventual loss of renal function.  Water-Soluble Vitamins  Low-protein diets may increase the risk for deficiency of thiamine.

Dietary and supplemental source of fiber may be helpful for reducing the build up of nitrogenous waste products in the blood that cause many symptoms of uremia.  Limit sodium.g. and correction may prevent activation of key pathogenic mechanism in cardiovascular disease. potassium. .  Maintain on low salt and low fat. Myocardial cell hypertrophy and Proliferation and the renin-angiotensin system).  Limit fluid intake. Inflammation. Vitamin D Supplementation Deficiency of vitamin D is present early in the course of DM.  A Diet in Fiber and Low in saturated Fat and cholesterol Most patients with Chronic Kidney Disease die from cardiovascular causes before developing DM Nephropathy. (e. phosphorus and other electrolytes.

The following table is a proposed 1 week diet of the patient: Sunday Monday Tuesday Wednesd Thursday ay Oatmeal Orange juice Brown Rice 1/2cup 1 serving of tinolang manok Grape juice 1 glass 1 ¼ cup fiber one Original cereal 1 ¼ cup Skim milk slice of melon and strawberrie Friday Saturday Breakfast Cereals Apple slices Fresh Bread w/ milk tuna spread Pineapple juice. 1 cup Prepared Oatmeal ¼ cup Skim milk 2 tbsp. low fat 2 slices of wheat bread Watermelon 2 servings A glass of Orange juice . Seedless raisins 1 servings of oranges 2 oz cheddar cheese.

hardboiled eggs & Orange. Jam 2 large Hardboiled eggs 1 medium Orange.Sunday LUNCH Toast. of ripe Glass of Mayonn 1 glass of Kiwifruit water aise Orange Glass of juice 2 leaves water lettuce 2 servings of apple slices 2 serving of pinakbet 2 servings of tortang talong Steam rice 1 cup Pineapple juice 2 servings of slices melon . cut into segments 100g Non-fat fruit yogurt Glass of Water 1 serving of sinigang Steam rice na bangus a with 90g tuna. 1 cup scramble canned Brown 1 glass of s egg 2 in water Rice 2 servings 1/2cup servings 1 tbsp. Slices (340 calories) 1 slice whole wheat toast Monday Tuesday Wednesd ay Brown Steam 2 slices Rice rice 1 whole 1/2cup cup wheat Chicken Ampalay bread (280 calories) 2 servings of Papaya slice Thursday Friday Saturday 2 tsp.

steamed Tuesday Wednesd ay 1 1 servings serving Pesang s of chopsue dalag y with miso Brown Rice ½ cup Brown Rice ½ cup Thursday 1 servings Shrimp sinigang With vegetables Brown Rice ½ cup Pineapple Friday Saturday 1 servings 100 g Paksiw chicken na isda breast. skinless Vegetabl cooked es salad with tuna 1 cup medium Orange grain juice brown rice (cooked) 2 cups Green beans. boneless. Brown skinless Rice ½ cooked cup 2 servings Brown Rice ½ cup of Papaya 2 servings of ripe mangoe s juice slice Glass of water . 1 servings boneless.Sunday Monday 100 g DINNER chicken breast.

 Encourage the patient to seek the LORD’s guidance and pray in times of hopeless.Spiritual Counseling  Encourage the patient not to lose hope and have faith in GOD. .

IMPLEMENTATION .

Insufficient oxygen may be a result of coronary artery blockage or spasm. Calcium channel blocker.A. Drug Study GENERIC NAME BRANDNAME CLASSIFICATION : : : Amlodipine Norvasc Cardiovascular agent . blocking calcium transport relaxes artery muscles and dilates coronary arteries and other arteries of the body. DOSAGE : 10 mg 1 tab//OD DRUG ACTION : These medications block the transport of calcium into the smooth muscle cells lining the coronary arteries and other arteries of the body. Since calcium is important in muscle contraction. antihypertensive agent. Amlodipine is also used in the treatment of high blood pressure. . Amlodipine is used for the treatment and prevention of angina resulting from coronary spasm as well as from exertion. or because of physical exertion which increases heart oxygen demand in a patient with coronary artery narrowing. INDICATION : Chest pain or heart pain (angina) occurs because of insufficient oxygen delivered to the heart muscles.

flushing.ADVERSE REACTION: The two most common side effects are headache and edema (swelling) of the lower extremities. fatigue. .  Monitor for S&S of dose-related peripheral or facial edema. Report postural hypotension. BP reduction is greatest after peak levels of amlodipine are achieved 6–9 h following oral doses. Less common side effects include dizziness.  Monitor BP with postural changes. nausea.  Monitor more frequently when additional anti hypertensives or diuretics are added. and palpitations NURSING RESPONSIBILITY:  Monitor BP for therapeutic effectiveness.

gonorrhea. thrombophlebitis. eosinophilia . ear infections. and urinary tract infections. anorexia. CONTRAINDICATION : Contraindicated in patients hypersensitive to drug or other cephalosporin. sinusitis.GENERIC NAME : Cefuroxime BRANDNAME : Zinacef CLASSIFICATION : Cephalosporin DOSAGE : 500mg 1 tab//BID DRUG ACTION : Decreases or control the infection. INDICATION : For the treatment of many different types of bacterial infections such as bronchitis. tonsillitis. skin infections. GI: diarrhea. transient neutropenia. Hematologic: hemolytic anemia. vomiting. thrombocytopenia. CV: phlebitis.

 Monitor I&O rates and pattern: Especially important in severely ill patients receiving high doses. Report any significant changes. before therapy is initiated. Discontinue drug and report their appearance promptly. . penicillins. and history ofallergies. particularly to drugs.  Report onset of loose stools or diarrhea  Monitor for manifestations of hypersensitivity.NURSING RESPONSIBILITY:  Determine history of hypersensitivity reactions to cephalosporins.

Following oral administration of this medication. Renal failure. Sodium and water retention. Hypokalemia. Metabolic alkalosis. Citrocarbonate. Flatulence. Hypernatremia. Gastric distention. alkalinizing agent DOSAGE : 1 tab//TID DRUG ACTION : Sodium Bicarbonate acts as an alkalinizing agent by releasing bicarbonate ions. Edema. Bell-Ans. Excessive chloride loss.NaHCO3 bakinSoda. it releases bicarbonate which is capable of neutralizing gastric acid. Patients on sodium restricted diet. Irritation at IV site. Hypocalcemia. Severe abdominal pain of unknown cause especially if associated with fever. Tetany DRUG BRANDNAME : : . It is not recommended as an antidote following ingestion of strong mineral acids. INDICATION : > Management of metabolic acidosis >Used to alkalinize urine and promote excretion of certain drugs in over dosage situations. Neut. >Used as an antacid CONTRAINDICATION : Metabolic or respiratory alkalosis Hypocalcemia. Soda Mint CLASSIFICATION : antiulcer agents.

hypertension. • Signs of acidosis should be assessed such as disorientation. difficulty breathing or dyspnea. irritability. tetany and altered breathing pattern. tachycardia.NURSING RESPONSIBILITY: • Assess the client’s fluid balance throughout the therapy. weakness. • Symptoms of fluid overload should be reported such as hypertension. fever. • Assess for alkalosis by monitoring the client for confusion. paresthesia. rales or crackles and frothy sputum. flushed skin and mental irritability. • Hypernatremia clinical manifestations should be assessed and monitored which includes: edema. headache. weight gain. . dyspnea and hyperventilation. edema.

• Hypokalemia should also be assessed by monitoring signs and symptoms such as: weakness. U wave on ECG. • Tablets must be taken with a full glass of water. fatigue. acid-base balance and renal function before and throughout the therapy. polyuria and polydipsia. bicarbonate concentrations. sodium. • Monitor the client’s serum calcium. . serum osmolarity. • For clients taking the medication as a treatment for peptic ulcers it may be administered 1 and 3 hours after meals and at bedtime. arrhythmias. potassium.

metabolic alkalosis. Gastric hypersecretion and acid rebound (with prolonged use).DRUG CLASSIFICATION : CaCO3 Calcium Carbonate : Class of calcium-containing preparations. flatulence. tissue-calcification. DOSAGE : 500mg 1tab//TID DRUG ACTION : Decreases total acid load of GI tract. hypercalcaemia. Increase esophageal sphincter tone. Patients with suspected digoxin toxicity. hypercalcaemia. NURSING RESPONSIBILITY:  Administer as antacid 1 hour after meal and at bed time Administer as supplement 1½ hrs after meal and at bed time Advice patient to increase fluids to 2L unless contraindicated . INDICATION : Antacid. CONTRAINDICATION : Patients with Ca renal calculi or history of renal calculi. osteoporosis. Constipation. Used as dietary supplements. hypophosphataemia. calcium supplement. milk-alkali syndrome.

swelling of hands and feet and hypotension occurs. . N & V. dyspnea. Instruct patient to avoid concurrent use of alcohol or OTC medicine without consulting the physician. Caution patient to make position changes slowly to minimize orthostatic hypotension. Dizziness. Nasal Congestion. CHF. INDICATION : Prevention and treatment of iron deficiency anemia. Flushing NURSING RESPONSIBILITY : Advice patient to take medicine as prescribed. Dyspnea.DRUG : FeSO4 + Folic CLASSIFICATION : Iron preparation DOSAGE : 1tab//OD DRUG ACTION : Elevates the serum iron concentration on which then helps to form high or trapped in the reticulo endothelial cells for storage and eventual conversion to a usable form of iron. Advise patient to consult physician if irregular heartbeat. Dietary supplement for iron. Muscle cramps. CONTRAINDICATION : Hypersensitivity. Severe Hypotension. Hypotension. MI.

after administration due reflex tachycardia. regular exercise. .  Encourage patient to comply with additional intervention for hypertension like proper diet. Inform patient that angina attacks may occur 30 min. and lifestyle changes and stress management.

DOSAGE : 2.GENERIC NAME : Glipizide BRANDNAME : Glucotrol CLASSIFICATION : It belongs to the sulfonylurea class of drugs which also includes glimepiride (Amaryl). and the liver produces too much glucose. Glipizide reduces blood glucose by stimulating the pancreas to produce more insulin INDICATION : Glipizide is used together with diet and exercise to reduce blood glucose in patients with type 2 diabetes. glyburide (Micronase. tolbutamide (Orinase) and tolazamide (Tolinase). in type 2 diabetes the pancreas is unable to produce the increased amounts of insulin that are necessary to overcome the resistance. . In addition. Diabeta).5mg 1tab//OD DRUG ACTION : Patients with type 2 diabetes have high glucose (sugar) levels in their blood because the cells in their bodies are resistant to the glucose-removing effect of the insulin.

or signs of an allergic reaction. sole therapy of type 1 diabetes or diabetes complicated by pregnancy. such as dizziness. if severe GI upset occurs or more than 15 mg/day is required. diabetes complicated by fever. However. acidosis. type 1 diabetes. and nervousness. dose may be divided and given before meals. ketosis. diarrhea. coma (insulin is indicated). major surgery. shortness of breath. including chest pain. Side effects of glipizide are possible.CONTRAINDICATION : Contraindicated with allergy to sulfonylureas. these side effects are minor and easily treated by you or your healthcare provider. some glipizide side effects should be reported to your doctor.  Monitor urine or serum glucose levels frequently to determine drug effectiveness and dosage. In many cases. serious hepatic impairment. . NURSING RESPONSIBILITY: Give drug 30 min before breakfast. severe trauma. severe infections. serious renal impairment. diabetes with ketoacidosis.

Course in the ward September 24. K. With on going IVF PNSS 1L x 6° regulated as ordered. . CXR Diet: Diabetic diet/ low fat. low salt Exercise/Activity: Ambulatory Treatment: (not yet handled) A Patient 51 yr. FeSO4 + FA 1 tab TID. Na. Treatment given D50-50 1 vial TIV NaHCO3 or CaCO3 500 mg / tab TID. U/A. 2012 (7:45pm) Diagnostic Procedure: CBC. Received by a wheel chair. Endorsed by ER nurse and transferred to bed safely with (+) generalized body weakness and (+) dyspnea. RBS. Clonidine 75 mg/tab PRN for BP ≥ 140 / 90mmHg it is administered by NOD. old female admitted to FMW under charity.C. BUN. Crea .

September 25 2012 (12: 45pm) Diagnostic Procedure: CBG. Informed in ROD and referred accordingly. BT s/p Diet: Low Salt. . Diabetic diet Exercise/Activity: Ambulatory Treatment: (not yet handled) CBG monitored And done cross matched for BT. V/ S q4° monitored and recorded. Low Fat diet.

Diabetic diet Ambulatory Exercise/Activity: Treatment: (not yet handled) With venoclysis PNSS 1l x 12° regulated as ordered.September 25 2012 (12: 45pm) Diagnostic Procedure: Diet: CBG Low Salt. . Low Fat diet.

Pre-BT meds given prior to first unit of PRBC. 2012 (6:00pm) Diagnostic Procedure: Diet: Repeat U/A . For BT 1“U” and 2 “U” PRBC properly typed and crossed matched. . paracetamol 500 mg/tab 1 tab PO and Diphenhydramine 25 mg/IV given by the NOD. Low Fat diet. Low Salt. Cefuroxime 500 mg/ 1 tab BID. BT.CBC TID . Repeated CBC for 2nd “U” of BT. Each unit to run for 4 hours with 4 hours intervals.September 27. Diabetic diet Ambulatory Exercise/Activity: Treatment: (not yet handled) Hooked and regulated IVF PNSS 1L x KVO.

Diabetic diet Ambulatory Exercise/Activity: Treatment: (not yet handled) With the same venoclysis regulated @ desired amount. Administered plasil 10 mg TIV q 8° PRN for vomiting. Done repeated UTZ.September 28. 2012 Diagnostic Procedure: Diet: Hgb & Hct. Low Salt. Low Fat diet. Given furosemide 80 mg TIV for BT. .

Hct & Hgb Low Salt. After the last PRBC has been transfused.September 29. CBC and Hgb & Hct repeated. given by the NOD. Treatment of NaHCO3 1 tab TID Amlodipine 10 g/ 1 tab OD.5 mg/ 1 tab OD CaCO3 500 mg/ 1 tab TID . Cefuroxime 500 mg/ 1 tab BID x 5 days . Glipizide 2. Low Fat diet. . Diabetic diet Exercise/Activity: Ambulatory Treatment: (not yet handled) Transfused 3 “U” PRBC with IVF PNSS 1l x KVO. FeSO4 + Folic 1 tab TID . 2012 (2:00pm) Diagnostic Procedure: Diet: Repeat CBC.

NaHCO3 1 tab TID.September 30. . 2012 (2:00pm) Diagnostic Procedure: Diet: ABG Low Salt. Diabetic diet Exercise/Activity: Ambulatory Treatment: (not yet handled) With the same venoclysis and regulated at the same ordered. Low Fat diet. Cefuroxime 500 mg/ 1 tab BID x 5 days . FeSO4 + Folic 1 tab OD . Treatment given is Amlodipine 10 g/ 1 tab OD. given by the NOD. Glipizide 2.5 mg/ 1 tab OD CaCO3 500 mg/ 1 tab TID .

V/S taken and recorded.October 1. I & O measured and recorded. on DM diet. 2012 (2:00pm) Diagnostic Procedure: Diet: Repeat CBC . given. Due meds. CBG. low fat. . Na . K . low salt. Diabetic diet Exercise/Activity: Ambulatory Treatment: (not yet handled) Client is conscious and coherent. Low Fat diet. Urinalysis Low Salt.

EVALUATION .

This study also aims to widen the knowledge about the problem known in the pathophysiology of the study. Her chief complaint generalized body weakness. Patients having this kind of condition serve as a challenge not just in the health care system but also in the field of nursing. who was admitted at the Mandaluyong City Medical Center and was diagnosed with Chronic Kidney Disease 2⁰ to Diabetes Mellitus II related to Hypertension. the appropriate interventions and management for patient who are under this condition. The patient examined by her attending physician. More than caring. caring is the essential component of nursing the best way to help patient is to render a service that is honesty and full of compassion.A. We as a student nurse of BSN level 4 (Old curriculum) Group 1A and 1B have decided to make a study regarding her condition. . her suspicious and concern about her condition led her to seek for medical assistance together with her relatives. Summary This study is about 51 year old women. Anemia 2° to Nephropathy. Her diagnosis is worthy to study to find out how she end up on having that kind of condition with her permission and blessing.

As the Student nurses tried their best in rendering the ideal and not just the ordinary care that can be seen in the hospital now days.B. medical procedure and Laboratory results. specific. Actual and probable health problems to determine based from the highest to the least priority in order to prevent further complications caused by conditions. Conclusion This data was studied and gathered by the BSN 4 (Old Curriculum) Group 1A and 1B to present a simple but yet concise information based on case study presentation. Nursing interventions was rendered to give the proper care that client needed. and time bounded. realistic. attainable. Nursing care plans to classified using SMART. measurable. Students were able to identify causes of patient condition with the use of different taught of the group base on the knowledge gain. Nursing students were able to apply the proper nursing action to the patient during assessment. Students were able to formulate a scientific based pathophysiology that is parallel with the patient condition from the risk factors to the disease process manifesting signs and symptoms based on the physical assessment. .

classifications. We need to assure that obligation to our patient is not just giving the medication and preparing it but to know the essential classification of the drugs and its effectiveness that soon will help to the patient for their fast recovery. indications. side effects and adverse reaction and most importantly the appropriate nursing considerations. We future nurse need to know that in giving medications prioritizing the 10R’s is needed to avoid medication error.We. . contraindications. the nursing students determined the actions.

REFERENCES .

(8th Edition) Philippines. (8th Edition. (2007) Kozier & Erb’s Fundamentals of Nursing: Concepts. B..com (2010) Philippines Index of Medical Specialties (123rd Edition 2010) . Vol. Wolters Kluwer Health & Lippincott Williams &Wilkins  Doenges.A. et al. Process & Practice.et al.Davis Company Brunner and Suddharts. Pearson Education Inc. Lippin Colt Williams and Wilkins. (2008) Nurse’s Pocket Guide:Diagnoses.com Kozier.  MIMS.Creativehealthinstitute. Moorhouse. E. Philadelphia. LTD. et. Prentice Hall  Smeltzer.F.. 1).(12th Edition). Essentials of Human Anatomy and Physiology. Prioritized Interventions and Rationales. & Alice Murr. M.F. (2006).al (2010).. Suzanne C. Medical-Surgical Nursing. (2008) Textbook of Medical-Surgical Nursing (11th Edition) PhiladelpiaWolters Kluwer.Pearson Education South Asia PTE. Marilynn. Philippines. (11th Edition).MOSBY’S Clinical Nursing (4th edition) Saunders manual of Nursing Care http://www. Taiwan. Marieb.