Documentos de Académico
Documentos de Profesional
Documentos de Cultura
INTRODUCTION
A. Brief Description
Chronic kidney disease (CKD), also known as chronic renal disease, is a progressive
loss of renal function over a period of months or years. The symptoms of worsening kidney
function are unspecific, and might include feeling generally unwell and experiencing a reduced
appetite. Often, chronic kidney disease is diagnosed as a result of screening of people known to
be at risk of kidney problems, such as those with high blood pressure or diabetes and those with
a blood relative with chronic kidney disease. Chronic kidney disease may also be identified
when it leads to one of its recognized complications, such as cardiovascular disease, anemia or
pericarditis.
Chronic kidney disease is identified by a blood test for creatinine. Higher levels of
creatinine indicate a falling glomerular filtration rate and as a result a decreased capability of the
kidneys to excrete waste products. Creatinine levels may be normal in the early stages of CKD,
and the condition is discovered if urinalysis (testing of a urine sample) shows that the kidney is
allowing the loss of protein or red blood cells into the urine. To fully investigate the underlying
cause of kidney damage, various forms of medical imaging, blood tests and often renal biopsy
(removing a small sample of kidney tissue) are employed to find out if there is a reversible
cause for the kidney malfunction. Recent professional guidelines classify the severity of chronic
kidney disease in five stages, with stage 1 being the mildest and usually causing few symptoms
and stage 5 being a severe illness with poor life expectancy if untreated. Stage 5 CKD is also
called established chronic kidney disease and is synonymous with the now outdated terms end-
stage renal disease (ESRD), chronic kidney failure (CKF) or chronic renal failure (CRF).
There is no specific treatment unequivocally shown to slow the worsening of chronic
kidney disease. If there is an underlying cause to CKD, such as vasculitis, this may be treated
directly with treatments aimed to slow the damage. In more advanced stages, treatments may
be required for anemia and bone disease. Severe CKD requires one of the forms of renal
replacement therapy; this may be a form of dialysis, but ideally constitutes a kidney transplant.
B. Statistics
a. International
An Estimated 26 Million Adults in the United States have Chronic Kidney Disease (CKD).
Among the key findings in the CDC Chronic Kidney Disease (CKD) Surveillance Report:
• In 1999–2006, among (National Health and Nutrition Examination Survey) NHANES
survey participants, <5% of those with kidney disease stages 1 or 2 (mild disease)
reported being aware of having CKD; of those with CKD stage 3 (moderate disease),
awareness was only about 7.5%; for stage 4 (severe disease), awareness was still only
less than half (about 40%).
• Among those with CKD stage 3 or 4, younger (15%) and male (13%) participants and
those who were non-Hispanic black (21%) had the greatest levels of awareness relative
to their counterparts.
• Awareness rates for CKD stage 3 or 4 were higher in those with comorbid diagnoses of
diabetes and hypertension, but still quite low (20% and 12%, respectively).
• Persons with CKD in the community are unlikely to be aware of their disease and seek
appropriate treatment.
II. OBJECTIVES
A. General Objectives
At the end of the clinical exposure, we should be able to attain and enhance our
knowledge, skills and attitude to provide nursing care to our patient with chronic kidney failure.
B. Specific Objectives
During the exposure, we should be able to:
Cognitive:
Discover how the patient acquired the disease through the nursing health history,
physical examinations, and some other some other factors that may contribute in relation
to chronic kidney failure and be able to assess, organize and validate those data
efficiently.
Understand chronic kidney disease, its causes and pathophysiology.
Design a plan of care for patient with chronic kidney disease (CKD).
To be able to formulate those data into nursing diagnoses that may aid in the patient’s
current health condition.
To be able to set priorities and goal outcomes in collaboration with the patient.
To be able to document patient responses to care and verbal reports, if any.
Skills:
Conduct physical assessment and organize data efficiently.
Perform nursing procedures effectively and correctly to attain his optimum level of
wellness.
Attitude:
To be able to establish rapport with the patient and folks.
To be able to develop respect and trust.
III. ANATOMY AND PHYSIOLOGY OF THE DISEASE
Regulation of volume
Except for the primitive marine cyclostome Myxine, all modern vertebrates, whether
marine, fresh-water, or terrestrial, have concentrations of salt in their blood only one-third or
one-half that of seawater. The early development of the glomerulus can be viewed as a device
responding to the need for regulating the volume of body fluids. Hence, in a hypotonic fresh-
water environment the osmotic influx of water through gills and other permeable body surfaces
would be kept in balance by a simple autoregulatory system whereby a rising volume of blood
results in increased hydrostatic pressure which in turn elevates the rate of glomerular filtration.
Similar devices are found in fresh-water invertebrates where water may be pumped out either
as the result of work done by the heart, contractile vacuoles, or cilia found in such specialized
“kidneys” as flame bulbs, solenocytes, or nephridia that extract excess water from the body
cavity rather than from the circulatory system. Hence, these structures which maintain constant
water content for the invertebrate animal by balancing osmotic influx with hydrostatic output
have the same basic parameters as those in vertebrates that regulate the formation of lymph
across the endothelial walls of capillaries.
Electrolyte balance
A system that regulates volume by producing an ultrafiltrate of blood plasma must
conserve inorganic ions and other essential plasma constituents. The salt-conserving operation
appears to be a primary function of the renal tubules which encapsulate the glomerulus. As the
filtrate passes along their length toward the exterior, inorganic electrolytes are extracted from
them through highly specific active cellular resorptive processes which restore plasma
constituents to the circulatory system.
Movement of water
Concentration gradients of water are attained across cells of renal tubules by water
following the active movement of salt or other solute. Where water is free to follow the active
resorption of sodium and covering anions, as in the proximal tubule, an osmotic condition
prevails. Where water is not free to follow salt as in the distal segment in the absence of
antidiuretic hormone, a hypotonic tubular fluid results.
Nitrogenous end products
Of the major categories of organic foodstuffs, end products of carbohydrate and lipid
metabolism are easily eliminated mainly in the form of carbon dioxide and water. Proteins,
however, are more difficult to eliminate because the primary derivative of their metabolism,
ammonia, is a relatively toxic compound. For animals living in an aquatic environment ammonia
can be eliminated rapidly by simple diffusion through the gills. However, when ammonia is not
free to diffuse into an effectively limitless aquatic environment, its toxicity presents a problem,
particularly to embryos of terrestrial forms that develop wholly within tightly encapsulated
eggshells or cases. For these forms the detoxication of ammonia is an indispensable
requirement for survival. During evolution of the vertebrates two energy-dependent biosynthetic
pathways arose which incorporated potentially toxic ammonia into urea and uric acid molecules,
respectively. Both of these compounds are relatively harmless, even in high concentrations, but
the former needs a relatively large amount of water to ensure its elimination, and uric acid
requires a specific energy-demanding tubular secretory process to ensure its efficient excretion.
Urine concentration
The unique functional feature of the mammalian kidney is its ability to concentrate urine.
Human urine can have four times the osmotic concentration of plasma, and some desert rats
that survive on a diet of seeds without drinking any water have urine/plasma concentration
ratios as high as 17. More aquatic forms such as the beaver have correspondingly poor
concentrating ability.
The concentration operation depends on the existence of a decreasing gradient of solute
concentration that extends from the tips of the papillae in the inner medulla of the kidney
outward toward the cortex. The high concentration of medullary solute is achieved by a double
hairpin countercurrent multiplier system which is powered by the active removal of salt from
urine while it traverses the ascending limb of Henle's loop (Fig. 2). The salt is redelivered to the
tip of the medulla after it has diffused back into the descending limb of Henle's loop. In this way
a hypertonic condition is established in fluid surrounding the terminations of the collecting ducts.
Urine is concentrated by an entirely passive process as water leaves the lumen of collecting
ducts to come into equilibrium with the hypertonic fluid surrounding its terminations.
IV. VITAL INFORMATION
Name (initials): R.E.B
Age: 52 years old
Sex: Male
Address: Estonilo Subdivision, Roxas City
Civil Status: Married
Religion: Roman Catholic
Occupation: Government Employee
Date and Time admitted: September 8, 2009 at 10:45 pm
Ward: Saint Joseph Ward (SJW)
Chief Complaint: Difficulty of Breathing
Admitting Diagnosis: Acute LV dysfunction, CKD; Pneumonia – high risk
Final Diagnosis: Chronic Kidney Disease
Attending Physician/s: Dr. R. Blancaver, Dr. Obligacion
V. CLINICAL ASSESSMENT
A. Nursing History
Mr. R.E.B is a chronic smoker and an excessive alcohol drinker. He plays card games
for his past time activity at around 5 o’clock at the afternoon while playing cards, he experienced
sudden chest pain, and he did not mind the pain but continue playing cards. At around 8:30 pm
after dinner while smoking, he said to his wife that the pain is much more painful that it was just
recently then after an hour, Mr. R.E.B experience difficulty of breathing, and was brought in to
the hospital.
Current medications: diazepam (Valium) for anxiety disorders, tremor muscle and
muscle spasm; Erythromycin for respiratory tract infections and pneumonia; clonidine
(Catapres) for hypertension; doxofylline (Ansimar) for bronchial asthma and pulmonary
diseases; isosorbide-5-mononitrate (Angistad) for heart pain, severe weakness of the heart
muscle and high blood pressure; acetylcysteine (Fluimucil) for respiratory infections and acute
and chronic bronchitis and bronchial asthma; clopidogrel (Plavix) for preventing myocardial
infarction and acute coronary syndrome; nitroglycerin (Transderm – Nitro) for angina pectoris;
clindamycin (Clindamycin Hydrochloride) for respiratory tract infections; meloxicam (Mobic) for
flank pain.
B. Past Health Problem / Status
Past Illnesses: Mr. R.E.B is a 52 year old male suffering from hypertension, diabetes
mellitus type – 2 and base on his laboratory results, its shows that he has pneumonia on both
sides and pulmonary congestion. He also experienced chickenpox and measles during his
childhood.
Allergies: He has no known allergies to food or drugs.
Previous Hospitalization: Previous hospitalization was May 2003 due to difficulty of
breathing with a diagnosis of Pneumonia and had undergone appendectomy.
HPN
HP
HPN,
N
BA BA,
CKDCCC
CCCCC
Legend:
Deceased male
Deceased female
BA
Indicates patient
Living male
Living female
VI. BRIEF SOCIAL, CULTURAL AND RELIGIOUS BACKGROUND
A. Educational Background
Mr. R.E.B is a college graduate.
B. Occupational Background
He is working as a Government Employee.
C. Religious Background
He is a Roman Catholic and attends mass on Sundays and prays thee rosary at
night together with his family.
D. Economic Status
They belong to a middle class type of family and most of his children are schooling.
HEENT
Color of the eyes is dark brown, anicteric sclera
with pale conjunctiva. He has blurred vision and
wears glasses most of the time. His right & left ear
canal are not clean, (-) discharges, brown in color,
symmetrical in shape. Hearing is good with no pain
and infections. Have frequent colds. No discharges
or secretions and nosebleeds. Lips are dry. No
bleeding of gums or dentures noted. No inflamed
pharynx and able to swallow food without difficulty.
Musculoskeletal System (+) flank pain, (+) weakness, (+) limitation of motion
or activity, (+) bipedal pitting edema at the lower
extremities.
D. General Appraisal
B. Blood Chemistry
The serum chemistry profile is one of the most important initial tests that are commonly
performed on sick or aging patient. A blood sample is collected from the patient. The blood is then
separated into a cell layer and serum layer by spinning the sample at high speeds in a machine
called centrifuge. The serum layer is drawn off and a variety of compounds are then measured.
These measurements aid the veterinarian in assessing the function of various organs and body
systems.
Test Result Normal Values Significance
Date: 09/13/09
Glucose 6.78 mmol/L 4.10 – 5.90 ↑ Hyperglycemia
Sodium 125.3 mmol/L 137.0 – 145.0 ↓ Renal
insufficiency,
uremia
Magnesium 1.10 mmol/L .70 – 1.00 ↑ Renal disorder,
dehydration
Creatinine 298.3 mmol/L 71.0 – 133.0 ↑ Impaired renal
function, shock
Cholesterol 8.34 mmol/L 0.00 – 5.20 ↑ Elevation
indicates increase
risk in CAD
Direct HDLC .45 mmol/L 1.00 – 1.60 ↓ Indicates risks in
CAD
LDL 6.41 1.71 – 4.60 ↑ Elevation
indicates risk in
CAD
VLDL 1.49 0.00 – 1.03 ↑ Elevation
indicates increase
risk in CAD
Potassium 5.49 3.5 – 5.10 ↑ Acute renal failure
C. ABG Analysis
It is also called arterial blood gas (ABG) analysis, is a test which measures the amounts
of oxygen and carbon dioxide in the blood, as well as the acidity (pH) of the blood. It indicates
how well the lungs and kidneys are interacting to maintain normal blood pH (acid-base balance).
It evaluates how effectively the lungs are delivering oxygen to the blood and how efficiently they
are eliminating carbon dioxide from it.
D. Radiology
It provides a radiographic image of the organs or tissues, to detect abnormality such as
tumor, perforation, abscess, infection, foreign body or fracture.
E. Urinalysis
A urinalysis is a test performed on a patient's urine sample to diagnose conditions and
diseases such as urinary tract infection, kidney infection, kidney stones, inflammation of the
kidneys, or screen for progression of conditions such as diabetes and high blood pressure.
F. Sputum test
Sputum test is a test of secretions from the lungs and bronchi (tubes that carry air to the
lung) to look for bacteria that cause infection.
H. Bacteriology
The science and study of bacteria, and hence a specialized branch of microbiology. It
deals with the nature and properties of the bacteria as living entities, their morphology and
developmental history, ecology, physiology and biochemistry, genetics, and classification.
Test Result/s
Date: 09/07/09
Nature of specimen: Sputum Organism identified: Very light growth of
Candida but not albicans.
IX. PATHOPHYSIOLOGY
• Tell patient to
avoid alcohol
while taking drug.
• Notify patients
that smoking
may decrease
drug’s
effectiveness.
B. Other Treatments
Hemodialysis
Hemodialysis (also haemodialysis) is a method for removing waste products such
as potassium and urea, as well as free water from the blood when the kidneys are inrenal
failure. Hemodialysis is one of three renal replacement therapies (the other two beingrenal
transplant; peritoneal dialysis).
Hemodialysis can be an outpatient or inpatient therapy. It involves diffusion of solutes
across a semipermeable membrane. Hemodialysis utilizes counter current flow, where the
dialysate is flowing in the opposite direction to blood flow in the extracorporeal circuit.
Side effects:
• Fatigue
• Chest Pain
• Nausea
• Headache
• Leg Cramps
The severity of these symptoms is usually proportionate to the amount and speed of fluid
removal. These side effects can be avoided and/or their severity lessened by limiting fluid
intake between treatments or increasing the dose of dialysis
Complications of Hemodialysis
• Sepsis
• Hypotension
• Cramps
• Febrile Reaction
• Arrythmia
• Hemolysis
• Hypoxia
In hemodialysis, three primary methods are used to gain access to the blood: an intravenous
catheter, an arteriovenous (AV) fistula and a synthetic graft. The type of access is influenced by
factors such as the expected time course of a patient's renal failure and the condition of his or
her vasculature. Patients may have multiple accesses, usually because an AV fistula or graft is
maturing and a catheter is still being used.
PREPARING FOR HEMODIALYSIS
Preparations for hemodialysis should be made at least several months before it will be
needed. In particular, you will need to have a procedure to create an "access" (described below)
several weeks to months before hemodialysis begins.
Vascular access — An access creates a way for blood to be removed from the body,
circulate through the dialysis machine, and then return to the body at a rate that is higher than
can be achieved through a normal vein. There are three major types of access: primary AV
fistula, synthetic AV bridge graft, and central venous catheter. Other names for an access
include a fistula or shunt.
The access should be created before hemodialysis begins because it needs time to heal
before it can be used. Discussions about the access should begin even earlier, since you will
need to avoid injuring blood vessels that will eventually be used for access. Having an
intravenous line (IV) or frequent blood draws in the arm that will be used for access can damage
the veins, which could prevent them from being used for a hemodialysis access. The access is
usually created in the non-dominant arm; for a right-handed person this would be their left arm.
Primary AV fistula — A primary AV fistula is the preferred type of vascular access. It
requires a surgical procedure that creates a direct connection between an artery and a vein.
This is often done in the lower arm, but can be done in the upper arm as well. Sometimes a vein
that would not normally be useful for creating an AV fistula can be moved so that it is more
accessible; this is often done in the upper arm.
Regardless of its location or how it is created, the access is located under the skin.
During dialysis, two needles are inserted into the access. Blood flows out of the body through
one needle, circulates through the dialysis machine, and flows back into the access through the
other needle.
A primary AV fistula is usually created two to four months before it will be used for
dialysis. During this time, the area can heal and fully develop or "mature".
Synthetic bridge graft — Sometimes, a patient's arm veins are not suitable for creating a fistula.
In these cases, a surgeon can use a flexible rubber tube to create a path between an artery and
vein. This is called a synthetic bridge graft. The graft sits under the skin and is used in much the
same way as the fistula except that the needles used for hemodialysis are placed into the graft
material rather than the patient's own vein.
Grafts heal more quickly than fistulas and can often be used about two weeks after they
are created. However, complications such as narrowing of the blood vessels and infection are
more common with grafts than with AV fistulas.
Central venous catheter — A central venous catheter uses a thin flexible tube that is
placed into a large vein (usually in the neck). It may be recommended if dialysis must be started
immediately and the patient does not have a functioning AV fistula or graft. This type of access
is usually used only on a temporary basis. In some cases, however, there can be problems
maintaining an AV fistula or graft, and the central venous route is used for long-term access.
Catheters have the highest risk of infection and the poorest function compared to other
access types; they should be used only if a primary fistula or synthetic bridge graft cannot be
maintained.
Dietary changes — some patients, especially those who receive dialysis in a center, will
need to make changes in their diet before and during hemodialysis treatment. These changes
ensure that you do not become overloaded with fluid and that you consume the right balance of
protein, calories, vitamins, and minerals.
A diet that is low in sodium, potassium, and phosphorus may be recommended, and the
amount of fluids (in drinks and foods) may be limited. A dietitian can help you to choose foods
that are compatible with hemodialysis treatment.
Nutritionist
Hemodialysis Nurse
Social worker
The principle of hemodialysis is the same as other
It is a profession for those with a
Nephrologists
methods of dialysis; it involves diffusion of solutes
strong desire to help improve
A physician who has been trained in the diagnosis and
across a semipermeable membrane. Hemodialysis
people’s lives. Social workers assist
management of kidney disease, by regulating blood pressure,
utilizes counter current flow, where the dialysate is
people by helping them cope with
regulating electrolytes, balancing fluids in the body, and
flowing in the opposite direction to blood flow in the
issues in their everyday lives, deal
administering dialysis. Nephrologists treat many different
extracorporeal circuit. Counter-current flow
with their relationships, and solve
kidney disorders including acid-base disorders, electrolyte
maintains the concentration gradient across the
personal and family problems.
disorders, nephrolithiasis (kidney stones), hypertension (high
membrane at a maximum and increases the
blood pressure), acute kidney disease and end-stage renal
efficiency of the dialysis.
disease.
2. Ineffective airway clearance related to
presence of secretions in the
tracheobronchial tree.
XI. NURSING MANAGEMENT
Objective/s:
A. Concept Map of Nursing Problems (+) Crackles, (+) Whitish productive cough,
10. Low self-esteem Impaired gas exchange r/ t presence (+) Chest pain, (+) DOB, (+) Tachycardia, (+)
r/t loss of kidney function of secretions on both lung base Cyanotic Nails, (+) Weakness, (+) Confusion,
RR= 36 bpm, Hgb= 100 g/L, Hct= 0.27 Vol.fr
Objective/s: Objective/s: X-ray Results: Bilateral pleural effusion,
(+) indecisive nonassertive behavior, (+) (+) Restlessness, (+) DOB, (+) Crackles, (+) pulmonary congestion pneumonia in both
Weakness, Lack of eye contact, Refusal Pallor, (+) Irritability, (+) Decreased bases
to participate in hospital procedures, hemoglobin – 133 g/L (N.V. 120 – 160), RR-
increasingly dependent on her wife 36 bpm, (+) History of bronchial asthma,
X-ray Results: Pleural effusion, Pneumonia, 3. Acute Pain r/t decrease renal
both bases. function
9. Risk for impaired skin integrity
r/t altered fluid status
Objective/s:
`
Objective/s: (+) Flank pain, Pain scale of 6 out
(+) Pitting edema, (+) PD catheter, 0f 10, (+) Loss of appetite, (+)
(+) IV cut down, (+) Hematoma at Guarding at the flank area, (+)
right arm; warm to touch. CC: Difficulty of Inadequate rest, (+) Irritability, (+)
Facial grimace
Breathing
8. Activity Intolerance r/t
Medical 4. Altered thermoregulation related to
generalized body weakness Diagnosis: invasion of pathogens
• (+) Crackles 2. Encourage 2. To promote lung Faye Abdellah’s secretions are still
Dorothy Johnson’s
2. Administer 2. To loosen theory of Human
flumucil and Behavioral System
600mg ½ glass OD x liquefy secretions (Medicine focus: Cure)
5 daily
• (+) guarding at 10
Dependent:
1. Administer 1. To relieve pain Dorothy Johnson’s
Mobic 7.5 mg as theory of Human
ordered Behavioral System
(Medicine focus:
Cure)
of possible conditions
• Bloated
2. Encouraged 2. Maintains Ernestine
abdomen upon
increase fluids and hydration and good Weidenback (Nurse
palpation
maintain accurate urine flow meets through
• Pale in
intake identification of
appearance
needs)
• Weak looking
• Creatinine:
298.3 mmol/L
Dependent:
1. Administer PNSS 1.Assist in Dorothy Johnson’s
1L at 40 cc/hour maintaining theory of Human
as indicated hydration and Behavioral System
good urine flow (Medicine focus:
Cure)
Collaborative 1.Creatinine Lydia Hall’s theory
1. Monitor measures kidney of Components of
electrolytes level damage (>0.5 – 1 Nursing Caring (Core
particularly creatinine mg/dl) which and Cure -shared
indicates renal with other health
failure. care providers.)
ASSESSMENT NURSING PLANNING INTERVENTION/S RATIONALE NURSING EVALUATION
DIAGNOSIS THEORIST/S
with assistance meals and ambulation activities provides Nursing) of breath, weakness,
Weakness positive self- anger, withdrawal, and financial status system; interpersonal participate in all the
M – edications
Medications prescribed by the physician should be taken properly, to help the patient lessen
unusual condition.
The following are take home medications prescribed by the physician:
• Angistad 40mg/tab OD
• Coralan 5mg/tab I tablet OD
• Catapres 75mg/tab TID
• Clopidogrel 75mg/tab OD
• Carcinor 1 tablet OD
• Exforge 5/160 mg OD
T – reatment
Continue monitoring blood pressure, hemodialysis thrice a week and comply with the
medications given prescribed by the attending physician to prevent further complications that
may occur and to have a faster recovery.
H – ome Teaching/s
1. Instruct the client/folks on how to monitor fluid status, as well as, the signs and
symptoms in order to determine existing problems and to prevent further complications.
2. Teach/ educate the client and folks on infection prevention.
3. Explain the need for meticulous skin and oral care.
4. Instruct the client on how to delay weights and how to interpret the relationship of weight
loss/gain to need for sodium and water.
5. Instruct the client and folks about the medication metabolism.
6. Teach the client and folks about the dietary regimens such as low salt, low fat and high
fiber.
7. Importance of follow-up and physician appointment.
O – ut patient follow up
After discharge, Mr. R.E.B will have a regular follow-up check up with the physician to check
and monitor the patient’s medical condition and have a dialysis thrice a week to remove waste
products from the body and to prevent future complications.
D – iet
Maintain a low salt, low fat, and high fiber diet as prescribed by the attending physician. Advice
the patient not to eat foods that is high in cholesterol such as the fatty portion of the pork that
may increase the level of his blood pressure but to eat more green and leafy vegetables.
We, the group 1 of BSN – 3A would like to express our genuine gratitude to the
following persons who have helped and supported us in making this case study very successful.
Without them, the success of this study would be impossible.
Above everybody else, to our good Lord, our energy source, our Almighty king and
Father, for the strength, knowledge, guidance and the values that He provided us while doing
this case study. Without Him, everything that we’ve done is not possible.
To Sr. Editha A. Bagayaua DC, RN, MAN, Dean of the College of Nursing, for her full
support and willingness to help the students for without her this activity will not be
accomplished.
To Mrs. Katherine Conlu – Bengan, RN, our Level III Clinical Coordinator/Instructor for
her support, teachings and knowledge she shared to us. She has been a good educator,
facilitator, and cool clinical instructor. Pathophysiology would not be the same without her.
To Ms. Maureen Patricio, RN, our skillful clinical instructor for taking part in educating
us in the different nursing techniques and procedures we learn in the ward and for the
knowledge you’ve shared to the group. We learned a lot!
To Mrs. Pearl Joy Degoma, RN, our ever patient and understanding clinical instructor
for she has taught us some alternative techniques that would be helpful in the ward and some
significant and important facts/contributions that she impart to us in what she knows.
To Mrs. Rubilyn Sumaylo, RN, our humorous and witty clinical instructor for you had
made us laugh during the exposure, without you, life in the ward would be boring. Thank you for
the knowledge you’ve shared to the group although it’s only for a while.
And to all our teachers and mentors, who influenced, inspired, and shared their
knowledge and expertise to us to this activity. Thank you very much.
To St. Anthony Hospital staff nurses at the St. Joseph ward and to the other wards
as well, thank you for helping, guiding and teaching us during our exposure on your area.
To our patient with the initials of R.E.B and family, thank you for your warm acceptance,
trust and for allowing us to get some information’s and a one-on-one interview in just a speck of
time for the success of our case study.
To our beloved parents, for their never-ending moral support all throughout the study.
We love you so much!
To the Family of Mr. Jose Ian Kit Macato, for their warm accommodation in letting us,
use their house in making our case study from the beginning until now. Thank you so much!
To the BSN 3A students, for the support and the never-ending bond we’ve shared from
st
1 year until up to now.
To the Group 1 of BSN 3A, for the tireless effort, knowledge, wisdom, patience,
support, cooperation and teamwork for the success of this case study.
And lastly, to those whom we failed to mention who in one way or another helped us in
this undertaking, Thank You Very Much.
This study is limited due to lack of time spent with the patient because we are only
scheduled for duty twice a week, within eight hours. Sometimes, duty hours are spent with other
school activities. This is why the attention, time and communication that are supposed to be
spent by the student nurse gathering data and working with interventions to the patient are
affected.
This study is limited to one person/patient only so that we can give enough attention and
proper nursing interventions to the problems being manifested, and for us to give our optimum
level of quality care for the patient.
TABLE OF CONTENTS
PAGE
I. Introduction
Brief Description of the Disease------------------------------------------
Statistics (International)----------------------------------------------------
II. Objectives
General and Specific Objectives----------------------------------------------
III. Anatomy and Physiology of Chronic Kidney Disease-------------------
IV. Vital Information------------------------------------------------------------------
V. Clinical Assessment
Nursing History----------------------------------------------------------------
Past Health Problem/Status-----------------------------------------------
Family History of Illness----------------------------------------------------
Family Genogram------------------------------------------------------------
VI. Brief Social, Cultural and Religious Background
Educational Background----------------------------------------------------
Occupational Background--------------------------------------------------
Religious Practices-----------------------------------------------------------
Economic Status--------------------------------------------------------------
VII. Clinical Inspection
Vital Signs----------------------------------------------------------------------
Physical Assessment--------------------------------------------------------
General Appraisal------------------------------------------------------------
VIII. Laboratory and Diagnostic Data----------------------------------------------
IX. Pathophysiology------------------------------------------------------------------
X. Medical Management
Drug Tabulation--------------------------------------------------------------
Hemodialysis-----------------------------------------------------------------
Members of the Health Team (CKD)-----------------------------------
XI. Nursing Management
Concept Map of Nursing Problems-------------------------------------
Nursing Care Plan--------------------------------------------------------- -
XII. Discharge Planning-------------------------------------------------------------
XIII. Journey---------------------------------------------------------------------------
XIV. Bibliography/References-----------------------------------------------------