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Chronic Kidney Disease

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by

Charles Santiago

on 6 July 2014

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Transcript of Chronic Kidney Disease

Chronic Kidney Disease
Gordon's Functional Health Patterns
Clinical Summary
Health perception and health management
Nutritional and Metabolic Pattern
Elimination Pattern
Activity and Exercise Pattern
Sleep and Rest
Cognitive Perceptual Pattern
Self-Perception
Role and relationship
Coping and Stress Tolerance
Value and belief
The work of the renal system especially the kidneys are essential to life. The kidney’s primary function is to maintain homeostasis in the body. However, various kinds of pathologic insults impair this important function. Chronic kidney diseases arise from these conditions. Inadequacy with the treatment could hasten the development of end stage renal disease among these patients.
Introduction
One pathologic condition known to cause CKD is chronic glomerulonephritis. Chronic glomerulonephritis is uncommon and affects only 4 out of every 100,000 individuals. Twenty to fifty percent of individuals with acute glomerulonephritis will eventually develop chronic glomerulonephritis. Approximately 25% of individuals with chronic glomerulonephritis have no prior history of kidney disease, and in these cases, the disorder first appears as chronic renal failure.
Statistics
Recent research reported that 16.8% or the U.S population, aged as young as 20 years old and older adults have CKD (Centers for Disease Control and Prevention).
In the Philippines, In 2003, the Department of Health reported that the prevalence of chronic kidney disease (CKD) among adult Filipinos was 2.6 percent (or 2.6 out of 100 adult Filipinos). Recent research suggests that CKD prevalence has worsened, affecting one in 10 adult Filipinos.
In 2012, the National Kidney and Transplant Institute cited kidney failure as the ninth leading cause of death among Filipinos.
Personal Data
A. PATIENT DATA

NAME: Patient X
AGE: 40 years old
NATIONALITY: Filipino
ADDRESS: Rizal
SEX: Male
STATUS: Married
RELIGION: Roman Catholic
OCCUPATION: laborer (lifts glass windows)
DATE OF ADMISSION: October 18, 2013
Personal Data
B. CHIEF COMPLAINT
• Painful and enlarged mass at left forearm (site of Arteriovenous fistula)

C. DIAGNOSIS
• PseudoaneurysmLeft forearm, status post AVF creation, end stage renal disease due to CGN

D. FAMILY HISTORY
• (-) Hypertension
• (-) Diabetes Mellitus
• (-) Kidney Diseases
• (-) asthma or other pulmonary condition

F. PAST MEDICAL HISTORY
1. Childhood Illness
• Patient X remembers to have had cough and cold during his childhood
2. Immunization
• Cannot recall immunization
3. Allergies
• No known allergies
4. Accidents
• Have not been involved in any accident
Personal Data
5. Hospitalization
• Was not yet confined in a hospital
6. Medicine
• is on maintenance medication for hypertension
7. Foreign Travel
• Travelled to Saudi Arabia for work
8. Operation
• No surgical procedure performed to him other than the AVF
9. Educational Attainment
• High school Graduate
History of Present Illness
Physical Assessment
Laboratory and Diagnostics
Chest X-Ray
Impression:
Suspicious nodulohazed densities in both upper lobe; suggest CT scan for further evaluation.
Consider pulmonary interstitial edema.
Left ventricular cardiomegaly.
Tortuous aorta.

Electrocardiogram
Findings:
Rhythm: Regular P waves: Normal, upright
P-R interval: 0.16 sec QRS: 0.08 sec
VR: 94 bpm AR: 94 bpm
Interpretation:
Normal sinus rhythm

ARTERIAL BLOOD GAS
Findings
pH- 7.341
CO2-15.1
PCO2-27.1
HCO3-14.3
PO2- 108.8
BE- -10.3
O2 Saturation- 97.4%

Partially Compensated Metabolic Acidosis with more than adequate oxygenation
BLOOD TYPING
Blood Typing Result:

Type “AB “ Rh Positive

COMPLETE BLOOD COUNT
RBC - 3.14 = Decrease
Hemoglobin - 88L = Decrease
Hematocrit - 0.27L = Decrease
WBC - 12.80H = Increase
Platelet Count - 195L = Decrease
Neutrophil - 87H = Increase
Lymphocyte - 5L = Decrease
Eosinophil - 1L = Decrease
Electrolytes
Sodium:
133 mmol/L = Decrease
Potassium:
5.2 mmol/L = Increase
Chloride:
101 mmol/L = Normal
Ionized Calcium:
1.06 mmol/L = Hypocalcemia
Metabolites
Creatinine
1.38 H mmol/L = Increase

Blood Urea Nitrogen
82.11 H mmol/L = Increase
Albumin
Albumin
30.0 g/L = Decrease
Bleeding Factors
Prothrombin Time
13.1 seconds = Prolong
Drugs
Sultamicillin 750 mg/PO BID x 7 days
Amlodipine 10 mg/PO OD
Calcium Carbonate PO TID
Calcium Gluconate ampule
Sodium Bicarbonate/PO BID
Epoetin Alfa 4,000 “u”/ SQ 2x week
Oxacillin sodium 500mg/ IV q 6 hrs.
Nalbuphine 10mg IV q 6 hrs for 24 hrs
Piperacillin/ Tazobactam 4.5 grams/ IV q 12 hrs initially then reduced to 2.25 grams q 8 hrs
Tramadol HCl 37.5 mg /Pacetamol 375 mg /PO BID
Ferrous Sulfate+ Folate/ PO OD
Cefuroxime 1.5 g/ IV
Paracetamol 500mg/ PO
Course in the Ward
Day 3
12:00 am = 3rd Blood Transfusion 1 unit PRBC STARTED
5:00 am = 3rdBlood Transfusion 1 unit PRBC ENDED
9:00 am = Transferred to Adult Service Ward
6:00 pm = 4th Blood Transfusion 1 unit PRBC STARTED
10:00 pm = STAT hemodialysis performed
10:30 pm =
4th Blood Transfusion 1 unit PRBC ENDED
5th Blood Transfusion 1 unit PRBC STARTED
Day 2
5:57 am = Scheduled for repair of pseudoaneurysm
12:16 pm = 1st Blood transfusion 1 unit PRBC started to run for 4 hours
3:00 pm = Brought to OR
4:00 pm
Repair of Pseudoaneurysm started
Blood transfusion ended
6:00 pm = Operation Ended
7:15 pm =
Transferred to SICU
2nd Blood Transfusion 1 unit PRBC STARTED to run for 4 hours
Intra Jugular Catheter inserted
11:50 am = Admitted to the Emergency Room
8:15 pm = Admitted to ASW
Day 1
7:00 am = Pain Management
Day 4
Day 5
12:05 pm = Patient wish to be discharged
INTERDISCIPLINARY CARE
Hemodialysis
Blood Transfusion
Pharmacologic Management
Antibiotics
Antihypertensive
Anti - Ulcer
Anti - Anemic
Analgesic
Medical Management
Surgical Management
Arterio-Venous Fistula Repair
Vital Signs


Temperature - 38.5 degrees Celcius
Pulse Rate - 83 bpm
Respiratory Rate - 30 bpm
Blood Pressure - 150/100
BMI - 25.12 = Overweight

Motor Strength - 5/5 on all extremities except upper left extremities in which shows a 3/5 motor strength.

Peripheral Pulse - +4 Pulse

Breath Sounds - (+) Bibasal breath sounds located at both lungs

ABG Level - Partially Compensated Metabolic Acidosis with more than adequate oxygenation

Moderate Swelling (+2 Edema) at left forearm and with redness.
Nursing Care Plan
Acute pain related to surgical repair of left Arteriovenous fistula
Hyperthermia related to pulmonary infection
Excess fluid volume related to impaired renal regulatory mechanism
Impaired skin integrity related to surgical repair of AVF on left forearm, placement of new AVF on left arm and edema of the left hand
Deficient knowledge on the importance of hemodialysis treatment and care of AVF fistula related to lack of information resources
M
MEDICATION

Amlodipine
Calcium Carbonate
Sodium Bicarbonate
Epoetin Alfa
Tramadol HCL
Ferrous Sulfate + Folate
E
EXERCISE

Stretching or flexibility exercises
Strengthening or resistance exercises will increase strength of muscles
Cardiovascular or endurance exercise
T
TREATMENT

Proper Wound Care
Dialysis
H
HEALTH TEACHINGS

Daily Weighing
Arteriovenous Fistula Care
O
OUT-PATIENT (FOLLOW-UP)

Check ups assigned
Laboratory procedure
S
SPIRITUAL

Pray
D
DIET

Low Protein
Low Fat
Low Salt
Low Potassium
Discharge Planning
Statistics 2009 - 2013
Morbidity
Female - 54 patients
Male - 55 patients

Mortality
Female - 5 patients
Male - 4 patients
Full transcript