COLEGIO de KIDAPAWAN

Paramedical Department
Bachelor of Science in Nursing
First Semester SY: 2022-2023

“Chronic Kidney Disease Secondary

to Diabetes Mellitus Nephropathy”

GROUP 6
Name of the Students:

Palalisan, Yamerah
Palomo, Princess Hope
Panga, Bainor
Pangalong, Normaida
Pecson, Dina
Pore, Lovely Grace

Submitted To:
Ana C. Lagdameo, RN., MN
 TABLE OF
CONTENTS:

Title Page…………………………………………………………………………………………i

Table of Contents………………………………………………………………………………..ii

Acknowledgment………………………………………………………………………………..iii

Contents:

I. Introduction………………………………………………………………………...………..1-2

II. Objectives…………………………………………………………………………………..2-3

III. Patient’s Data………………………………………………………..……………….……3-4

IV. Family Background/Health History………………………………...………………….…3-

V. Developmental Data…………………………………….…………………………..……8-

11

VI. Definition of Complete Diagnosis……………………………………………………..12-

14

VII. Physical Assessment…………………………………………………………….……14-

15

VIII. Anatomy and Physiology……………………………………………………….……16-18

IX. Etiology Symptomatology…………………………………………………………………18

X. Pathophysiology………………………………………………………………………19-24

XI. Doctor’s Order…………………………………………………………………………25-28

XII. Diagnostic Exam………………………………………………………………………28-43

XIII. Drug Study…………………………………………………………………………….44-59

XIV. Surgical Procedure……………………………………………………………………

XV. Nursing Theories………………………………………………………………………59-

61

XVI. Nursing Care Plan…………………………………………………………………..62-68

XVII. Discharge Plan (M.E.T.H.O.D.S.) ………………………………………………..69-70

XVIII. Prognosis……………………………………………………………………………70-71

XIX. Recommendation………………………………………………………………………72

XX. References……………………………………………………………………………73-74
 ACKNOWLEDGEMENT

With the boundless and deep appreciation, the group would like to extend their

heartfelt gratitude and gratefulness to the people who helped to bring this case study

into reality. The group would like to sincerely thank all those who helped with their

valuable support during the entire process of this case study and send their profound

gratitude to the following:

To our family, for the unconditional love and undying support throughout these

years, for the financial support they gave every time we needed it and the

encouragement, they provide this entire process.

To our clinical instructor, Ma’am Ana C. Lagdameo RN. MN, for the exemplary

guidance, assistance and insightful feedback that helped us students to have much

better results and for sharing her expertise generously that gave the case study a lot of

learnings.

Mostly specially, to our Father almighty, for giving her strength, ability, knowledge

and wisdom that took a huge part in completing this case study successfully. Also, for

the life and blessings he showed upon us, we could have never done this without the

faith we have in Him.

I. INTRODUCTION

Nephropathy is the deterioration of kidney function. The final stage of

nephropathy is called kidney failure, end-stage renal disease, or ESRD. According to

the CDC, diabetes is the most common cause of ESRD.

Globally, the incidence and prevalence of diabetes mellitus has risen

dramatically. Diabetic kidney disease (DKD) is a frequent long-term complication of

diabetes. DKD is the leading cause of Chronic kidney disease (CKD) and end-stage

kidney disease (ESKD), accounting for 50% of cases. Typically, DKD is defined by the

presence of chronic kidney disease (CKD) characterized by persistently (at least 3

months) elevated urinary albumin excretion (albumin-to-creatine ratio [ACR] ≥ 30 mg/g)

and/or low estimated glomerular filtration rate (eGFR < 60 mL/min/1.73 m2 ) in a person

with diabetes. One of the most frequent and severe long-term complications of diabetes

is diabetic kidney disease (DKD), defined as chronic kidney disease in a person with

diabetes. Approximately 20–50% of patients with T2DM will ultimately develop DKD.

Worldwide, DKD is the leading cause of chronic kidney disease and end-stage kidney

disease, accounting for 50% of cases. In addition, DKD results in high cardiovascular

morbidity and mortality, and decreases patients’ health-related quality of life. In this

review we provide an update of the diagnosis, epidemiology, and causes of DKD. In

2021, the estimated global prevalence of diabetes among people 20–79 years of age

was 11%, which is expected to increase to 12% by 2045 [4]. The prevalence of diabetes

in 2021 was similar in men and women, steadily increasing with age, higher in urban

(12%) than rural (8%) areas, and greater in high-income (11%) and middle-income

(11%) compared with low-income countries (6%). Of note, about 6% of people older

than 20 years of age live in a low-income country. The highest rates of T2DM are

reported in specific ethnic groups, particularly indigenous populations in the US,

Australia, and New Zealand. More than 80% of people with diabetes live in low- or

middle-income countries (Table 1). China now has more people with diabetes than any

other nation, with 92 million people affected, being almost 1 in 10 adults. The greatest

relative increase in prevalence from 2021 to 2045 is expected in middle-income

countries, especially in Africa. Finally, the global epidemiology of T2DM is changing

from a chronic disease in middle aged and older people, into one that is increasingly

common at younger ages, including in young adults, adolescents, and children.

Majority of the increase in total morbidity and mortality in the Philippines have

actually come from Non-Communicable Disease (NCDs), specifically chronic kidney

disease (CKD). If left untreated, CKD can progress to more severe complications such

as End-stage kidney disease (ESKD) that now requires more immediate and regular

interventions. The increasing numbers of CKDs have become an urgent National

concern due to the burden of the disease and high costs of care. Hence, this program

aims to reinforce strategies for the prevention and control of CKD such as lifestyle-

related disease prevention, facilitation of early detection and evaluation, and proper

disease management for people with CKDs. As of March 03, 2022 the Philippines has a
population of more than 12 million. In 2018, the World Health Organization reported that

3.5 percent of total deaths in the country are due to CKDs. The 10 th leading cause of

mortality in the Philippines in 2020, kidney failure is one of the leading causes of

Hospitalization

II. OBJECTIVES

General Objectives:

This case study aims that the students and the readers will gain knowledge and further

understanding about the Chronic Kidney Disease Secondary to Diabetic Mellitus

Nephropathy.

Specific Objectives:

In order to meet the general objective, the group aims to:

Affective:

1. Establish a good interpersonal relationship to the client SO and her family.

2. To be able to give the appropriate health teaching and better understanding of

the disease to the patient, family and significant others.

Cognitive:

3. To be able to define regarding the condition as well as its signs and symptoms.

4. State the past and present health history of the patient.

 5. Discuss the anatomy and physiology of the organ involve in patients’ disease.

6. Trace the pathophysiology of the patient’s disease.

7. Formulate nursing care plan related to the disease and determine the possible

nursing intervention that will be a great help in patients’ prognosis.

8. To know and identify the drugs which the patient receives.

9. Provide the patient SO or family with proper discharge planning.

10. Outline recommendations base on the case studies findings.

Psychomotor:

11. Gather the pertinent data from the patient and her significant others.

12. To apply skills learned in the classrooms to actual handling and caring of a

patient who suffered from regarding to this condition.

III. PATIENT’S DATA

Patent’s Code Name: Patient A.

Age: 79 years old

Nationality: Filipino

Civil Status: Widow

Occupation: Housewife

Sex: Female
Religion: Roman Catholic

Educational Attainment: High School Graduate

Ward or Unit: Private

Room: 103

Bed No.: Female A

Date of Admission: 01/30/23

Vital signs on Admission:

BP-140/80mmHg

PR- 67bpm

RR- 16cpm

TEMP: 36*c

02 SAT.- 98%

Date of Discharge: Not ready to Discharge

Chief Complaint/s: lumbar pain with pain scale of 8/10, increase creatinine

Admission/Final Diagnosis: Chronic Kidney Disease secondary to Diabetic Mellitus

Nephropathy

Surgical Procedure Performed if any (Date and Time Performed): N/A

Attending Physician: Dr. Noel Camique M.D., Dr. Anne Mrie Cubero M.D.

Source of Information/Informant/s: Patient and Watcher

IV. FAMILY BACKGROUND/ HEALTH HISTORY

Genogram

Grand Parents Grand Parents

Father Side Mother Side

Legend: Color:
Present Condition:
-Female Yellow- chronic kidney disease
-Male Green: diabetic mellitus nephropathy
-Deceased
Blue -Patient Past Condition:
Symbols: Orange: Hypertension
-Present Condition of the patient
-Past Illness of the patient
A. FAMILY SOCIO ECONOMIC BACKGROUND
The grandparents of patient A. in the father side has a past illness of diabetes

mellitus which also lead to renal failure later on and died because of this condition. In

the mother side of patient A., her grandfather also a CKD and died because of that

disease.

Client’s Health History

B. History of Past Illness:

Patient A. was known for being Diabetic for five (5) years. According to her

she had a Hypertension, or high blood pressure that is a complication of diabetes that is

believed to contribute most directly to diabetic nephropathy. Hypertension is believed to

be both a cause of diabetic nephropathy, as well because of the damage that is created

by the disease. And Over time, poorly controlled diabetes causes damage to blood

vessel clusters in her kidneys that filter waste from the blood.

C. History of Present Illness:

Patient A. is a 79-year-old, widow and a resident of Purok 4 Midsayap Cotabato.

being hospitalized for the second time due lumbar pain with pain scale of 8/10 and

increase creatinine. With a vital sign of BP: 140/80 mmHg, PR: 67bpm, RR: 16cpm,

Temp: 36^c, 02 sat. 98% upon admission. She was advised to go for dialysis because

of her CKD stage 5, and have Laboratory examination such as, Complete Blood Count

(CBC), Urinalysis. Which results to chronic kidney disease due to very high in

Creatinine.
V. DEVELOPMENTAL DATA

Erikson’s Stages of Psychosocial Development

Stage Psychosocial What happens in Rationale

Crisis/Task this Stage?

1 Trust vs. Mistrust If needs are According to her

(0-18 months) dependably met, she developed

infants develop a trust because

sense of basic trust. her mother is a

full-time and a

loving mother to

them.

2 Autonomy vs. Toddlers learn to According to

Shame/Doubt exercise will and do her, her mother

(18 months- 3 years) things for let her play and

themselves, or they explore new

doubt their abilities. things.

3 Initiative vs. guilt Preschoolers learn to According to

(3-5 years) initiate tasks and her, during her

carry out plans, or preschool, her

they feel guilty about mother sent her

efforts to be to the school

and listen to
 independent. their teacher so

that they can

learn new things

and explore.

4 Industry vs. inferiority Children learn According to

(5-13 years) pressure of applying her, her parents

themselves to tasks, taught them

or they feel inferior. some house

chores so that

they will know

some

responsibility

while they are

young.

5 Industry vs. confusion Teenagers work at According to her

5-13 years refining a sense of she has more

self by testing roles girl friends like

and then integrating her cousins and

them to form single started to have

identity, or they crushes to

become confused opposite sex.

about who they are.

6 Identity vs. role Teenagers work at According to

 confusion refining a sense of her, she married

13-21 years self by testing roles at the age of 16

and then integrating years old.

them to form single

identity, or they

become confused

about who they are.

6 Intimacy vs. isolation Young adults According to

21-39 years struggle to form close her, she has a

relationships and to lot of friends

gain the capacity fir especially her

intimate love, or they cousins.

feel socially isolated.

7 Generativity vs. The middle-aged She has 6

stagnation discover a sense of children,

40-65 years contributing to the according to her

world, usually she is contented

through family and seeing her

work, or they may children had a

feel a lack of stable job.

purpose.

8 Integrity vs. despair When reflecting on According to her

65 and older his or her life, the she is contented

 older adult may feel a of her life, and

sense or satisfaction thankful

or failure. because her

children is

having their

stable jobs.

Sigmund Freud’s Psychosexual Stages

Stage Age Range What happens at this

age?

Oral range 0–1-year-old Children derive pleasure

from oral activities,

including sucking, and

tasting. They like to put

things in their mouth.

Anal stage 2-3 years old Children begin potty

training.

Phallic stage 3-6 years old Boys are more attached to

their mother, while girls are

more attached to their

father.

Latency stage 6 years old to puberty Children spend more time

and interact mostly with

 same sex peers.

Genital stage Beyond puberty Individuals are attached to

opposite sex peers.

Piaget’s theory of cognitive development

Stage Age range Descriptions

Sensory motor 0-2 years Coordination of senses

with motor response,

sensory curiosity about the

world. Language used for

demands and cataloguing.

Object permanence

developed.

Preoperational 2-7 years. Symbolic thinking, use of

proper syntax and

grammar to express full

concepts, imaginations

and intuition are strong,

but complex abstract

thought still difficult.

 Conservation developed.

Concrete operational 7-11 years Concepts attached to

concrete situation. Time,

space, and quantity are

understood and can be

applied, but not as

independent concepts.

Formal operations 11+ Theoretical, hypothetical,

and counterfactual

thinking. Abstract logic and

reasoning, strategy, and

planning become possible.

Concepts learned in one

context can be applied to

another.
VI. DEFINITION OF COMPLETE DIAGNOSIS

Diabetic nephropathy is a common complication of type 1 and type 2 diabetes. Over

time, poorly controlled diabetes can cause damage to blood vessel clusters in your

kidneys that filter waste from your blood. This can lead to kidney damage and cause

high blood pressure.

It is a long-term kidney disease that can affect people with diabetes. It occurs

when high blood glucose levels damage how a person's kidneys function. Diabetic

nephropathy is a kind of chronic kidney disease (CKD). Diabetic nephropathy is defined

as persistent proteinuria. It can progress to overt nephropathy, which is characterized

by progressive decline in renal function resulting in end-stage renal disease.

Chronic kidney disease (CKD): Chronic Kidney Disease (CKD) is a long-term

condition where the kidneys don't work and should. It is usually caused by various

conditions such as high blood pressure, diabetes, high cholesterol, kidney infections,

kidney inflammation, kidney stones that keep coming back, or an enlarged prostate,

long-term, regular use of certain medicines such as lithium and non-steroidal anti-

inflammatory drugs (NSAIDs).

Doctors determine the stage of kidney disease using the glomerular filtration rate

(GFR), a math formula using a person's age, gender, and their serum creatinine level

(identified through a blood test), which are classified into five stages:

 Stage 1 with normal or high GFR (GFR > 90 mL/min)

  Stage 2 Mild CKD (GFR = 60-89 mL/min)
 Stage 3A Moderate CKD (GFR = 45-59 mL/min)
 Stage 3B Moderate CKD (GFR = 30-44 mL/min)
 Stage 4 Severe CKD (GFR = 15-29 mL/min)
 Stage 5 End Stage CKD (GFR <15 mL/min)

VII. PHYSICAL ASSESSMENT

Vital signs
Temperature:36C
PR: 64
RR: 16cpm
BP:140/80
02sat: 98%
WT: 56 kg

SKIN, HAIR, AND NAILS:

The client’s skin is uniform in color.
The hair of the client is thick, silky hair is evenly distributed. The nails are intact.

HEAD:
The head is round and no bumps nor lesion notifies.

EYES:
Dry, red, and sore eyes that feel gritty.
NOSE:
no nasal discharge

MOUTH:
No bleeding of gums and no presence of oral cavity

NECK AND THROAT:

there is no disparity in the size and configuration both thyroid lobes.

CHEST AND LUNGS:

shortness of breath
VIII. ANATOMY AND PHYSIOLOGY

The main functions of the kidney are filtration

and excretion of metabolic waste products from the
bloodstream, regulation of electrolytes, acidity and
blood volume, and contribution to blood cell
production. The nephron is the functional unit of the
kidney. Each nephron is formed by a glomerulus, a
proximal convoluted tubule, loop of Henle, and
distal convoluted tubule. The last part of the
nephron is the common collecting duct, and is
shared by many nephrons The blood is filtered in a
specialized capillary network through the
glomerular barrier, which yields the filtrated
substances into Bowman's capsule space, and then into the renal tubules. The
glomerular barrier is composed by five layers: the inner layer is the glycocalyx covering
the surface of the endothelial cells; the fenestrated endothelium, the glomerular
basement membrane, the slit diaphragm between the foot-processes of the podocytes;
and the sub-podocyte space between the slit diaphragm and the podocyte cell body.

Chronic kidney disease is a common complication

and concomitant condition of diabetes mellitus. The
treatment of patients with diabetes and chronic
kidney disease, including intensive control of blood
sugar and blood pressure, has been very similar for
type 1 and type 2 diabetes patients. New therapeutic
targets have shown promising results and may lead
to more specific treatment options for patients with
type 1 and type 2 diabetes. Over time, poorly
controlled diabetes can cause damage to blood
vessel clusters in your kidneys that filter waste from
your blood. This can lead to kidney damage and
cause high blood pressure. High blood pressure can
cause further kidney damage by increasing the
pressure in the delicate filtering system of the kidneys.
Kidney damage may begin 10 to 15 years after diabetes starts. As damage gets worse,
the kidneys become worse at cleansing the blood. If the damage gets bad enough, the
kidneys can stop working. Kidney damage can't be reversed.
IX. ETIOLOGY AND SYMPTOMATOLOGY
 X. PATHOPHYSIOLOGY

Predisposing Factors

Overweight/Obesity Sedentary Lifestyle Pre-diabetes Family History Age

Most people with Less physical activity A serious health If you have a The risk of
Extradiabetes
weightmellitus
forces the for a long period of condition having family health diabetes
nephropathy
kidney to work harderare time can result in high blood sugar history of nephropathy
andoverweight/obese.
filter waste above changes in the body’s level than diabetes you are increases as
Increased levellevel.
the normal of fatty metabolism, including normal, but not more likely to you get older
Increaseacids and
glomerular insulin resistance. enough yet for a have especially at
inflammation,
filtration rateleading
(GFR) diabetes prediabetes and the age of 45
to insulin resistance.
that leads to diagnosis. develop and above.
enlargement of the diabetes.
renal glomerulus.

Precipitating Factors They are less

Lack of exercise can Eating too much It is often related
physically
cause muscle cells to sugary food or to life style
active that may
loss their sensitivity sweetened foods choices, parents
risk for
to insulin which increases the may pass on poor
combined
controls level of sugar level of sugar in health habits to
Chronic Hyperglycemia Hypertension effect of
in the blood. the blood. their children in
increasing
The high levels of sugar in the blood addition to
High blood pressure cana cause filter
insulin
damage the million of tiny filtering kidney damage genetic
by increasing the
resistance.
units with in each kidney that pressurepredisposition.
in the delicate filtering
eventually leads to kidney failure. system of the kidney.

Uncontrolled high blood sugar level High blood pressure can constrict and
damages nerves and interferes with narrow the blood vessels in your
their ability to send signals, leading to kidneys, which reduces blood flow and
diabetic nephropathy. stops the kidney from working well.
 Loss of kidney function can cause a build up of fluid or body
waste or electrolytes problems. Depending on how severe it
is, it can cause: nausea, vomiting, loss of appetite, fatigue,
sleep problems, urinating more or less, decreased mental
sharpness, swelling of feet and ankles, high blood pressure
(hypertension) that’s difficult to control.

Diagnostic Test & Laboratory Test

CBC, Blood typing, Renal Panel 3, Hepatitis Profile,
ECG, Chest X-ray

DIABETES MELLITUS NEPHROPATHY

Poorly controlled diabetes can cause damage to blood vessel

clusters in your kidneys that filter waste from your blood. This can
lead to kidney damage and cause high blood pressure.

High blood pressure can cause further kidney damage by

increasing the pressure in the delicate filtering system of the
kidneys.
 Therefore, there is progression of kidney deterioration and
affecting its function.

Affected filtrations ............. Decreased need to urinate, feet edema,

shortness of breathing, facial edema,
hand edema, abdominal distention, high
blood pressure

Affected reabsorption/ Affected . . .Elevated blood pressure, pitting edema,

regulation of extracellular fluid ankle edema

Affected secretion of erythropoietin . Low oxygen saturation, shortness of

hormone . .breathing, body weakness or fatigue

Affected excretion of waste and . . . Cognitive dysfunction, fatigue, loss of

toxins appetite, muscle cramps, nausea and
vomiting, itching, unexplained weight
loss.

DIAGNOSTIC TEST & IMAGING TEST

Blood Test eGFR, Urine Analysis, Imaging Test,
Biopsy

CHRONIC KIDNEY DISEASE

If treated If not treated

 Medical Surgical Nursing Management Poor family support/
Management Management financial support
- Impaired urinary
elimination
- Amlodipine Hemodialysis - Excess fluid volume
- Clonidine Kidney transplant - Imbalance nutrition: Less ESRD
than body requirements
- Erythropoietin
- Activity Intolerance
- Ketoanalogues
- Risk for Impaired Skin
- Atorvastatin DEATH
Integrity

Poor Prognosis
XI. DOCTOR’S ORDER

Patient name: PATIENT A. Birthday: March 16, 1943 Room No: 103

Attending Physician : : Dr. Noel Camique M.D., Dr. Anne Mrie Cubero M.D.

Date & Progres Doctor’s order Rationale

Time s notes
01/31/2023 - Please admit - To be able to provide the patient
patient to room of with the specific care needed and
choice under my have ethical considerations and also
service. Secure to protect their freedom to make
consent for healthcare decision
admission and
management.

- Diet: Full Diet, low - To have less waste for removal

salt, low fat, low during dialysis
purine, Limit oral fluid
intake to < 1 liter/day

- Venoclysis: PNSS 1 - To reduce areas of stasis and risk

liter x KVO of coagulation

- V/S Monitoring: Q 2 - To regularly check the condition of

hours and record the patient
- I&O: Q shift and
record

- Diagnostics: - To check for chronic kidney

Complete Blood disease
Counts (CBC)
- To determine if your blood is
Blood typing compatible with the potential donor's
blood.

Renal Panel 3 - Evaluate for kidney dysfunction in

patients

Hepatitis profile - To recognized if there is HCV

infection that cause of progression
to kidney failure,
Electrocardiogram - To determine a kidney disease
(ECG) patient's risk of dying from heart
disease

Chest X-ray - To check if the patient’s heart looks

healthy and normal

- Therapeutics: - An anti-hypertensive agent for

Amlodipine 10 mg hypertension in chronic kidney
OD disease (CKD).

Clonidine 150 - Used for hypertension, renal blood

mcg/tab, BID flow and glomerular filtration rate will
be maintained, and renin secretion
will reduce.
Erythropoietin - Used routinely in hemodialysis
(Eposino) patients to increase hemoglobin
levels in patients with ESRD and
anemia.
Ketoanalogues 630
- To prevent unnecessary increase
mg TID
in urea levels in the blood due to the
intake of non-essential amino acids
in patients with kidney failure.
Atorvastatin 40 mg
OD - the statin of choice in patients with
CKD stages 4–5.
- For Hemodialysis
- To filter wastes and water from
your blood, as your kidneys did
- Secure consent when they were healthy.
- To have ethical considerations and
also to protect their freedom to make
healthcare decision
XII. DIAGNOSTIC EXAM
Diagnostic Exam
HEMATOLOGY SECTION (CBC)
Date Test Normal Patients Clinical Nursing
ordered value result significance responsibility
January HEMOGLOBIN 135- 84 A hemoglobin - explain to the
31, 2023 175g/L test is often patient the
used to check purpose of the
for anemia, a test.
condition in Rationale: to
which your inform the
body has fewer patient about
red blood cells the test.
than normal. If
you have - tell the patient
anemia, the the test
cells in your requires blood
body don’t get sample.
all then oxygen Rationale: to let
they need. the patient be
Hemoglobin aware of the
tests are test will be.
measured as
part of a - explain who
complete blood will perform the
count. (CBC). venipuncture
and when.
Rationale: to let
the patient
know who to
approach.

- Explain to the
patient that he
may
experience
slight
discomfort from
the tourniquet
and needle
puncture.
Rationale: to
help the patient
get ready
before the test.
HEMATOCRIT 36.00- 26.4 A hematocrit
42.00 test is part of a
complete blood
count (CBC).
Measuring the
proportion of
red blood cells
in your blood
can help your
doctor make a
diagnosis, or
monitor your
response to a
treatment. A
lower-than-
normal
hematocrit can
indicate: an
insufficient
supply of
healthy red
blood cells
(anemia).

RBC 4.50- 2.58 The results of

5.00 an RBC count
mmol/L can be used to
help diagnose
blood-related
conditions such
as iron
deficiency
anemia. A low
RBC count
could also
indicate a
vitamin B6,
B12 or folate
deficiency.

MCV 80.00- 102.5 An MCV test

100.00 may also be
fL used with o
their tests to
help diagnose
or monitor
 certain blood
disorders,
including
anemia. There
are many types
of anemia. An
MCU test can
help diagnose
which type of
anemia you
have.

MCH 27.00- 32.7 The purpose of

31.00 a mean
pg/cell corpuscular
hemoglobin
(MCH) test is to
calculate the
amount of
hemoglobin in
an individual
red blood cell.
The MCN tests
is one of
several tests
that are use to
diagnose and
classify
different types
of anemia.

MCHC 320.00- 319 The purpose of

360.00 a corpuscular
g/L hemoglobin
concentration
test is to
evaluate
weather red
blood cells are
carrying an
appropriate
amount of
hemoglobin.
MCHC, is one
of several
measurements
 that are use to
assess the
function and
health of red
blood cells in
order to check
for signs of
anemia and
other blood
disorder.

LEUCOCYTE 5.00- 5.19 A white blood

NO. CONC 10.00 x count is most
(WBC) 10^9/L often used to
help diagnose
disorders
related to
having a high
white blood cell
count or low
white blood cell
count.
Disorders
related to
having a white
blood count
include:
autoimmune
and
inflammatory
diseases,
conditions that
cause the
immune
system to
attack healthy
tissues.

NEUTROPHILS 55.00- 54.4 Neutrophils

65.00 help your
Immune
system fight
Infectious and
heal injuries.
Neutrophils are
most common
 type of white
blood cell in
your body. An
absolute
neutrophil
count identifies
weather your
body has
enough
neutrophils or
if your count is
above or below
a healthy
range.
LYMPHOCYTE 25.00- 32.9 This test
S 40.00 measures the
levels of the
main types of
white blood
cells in the
body.
Lymphocytes
count in one
part of a
complete count
(CBC), which is
larger white
blood test.
Doctors may
request a CBC
if they suspect
that the
disease or
infection is
present.

MONOCYTE 2.00- 7.3 Monocytes are

6.00 a critical
component of
the innate
immune
system. They
are the source
of many other
vital elements
of the
 immune
system, such
as
macrophages
and dendritic
cells, monocyte
may play a role
in both
inflammatory
and anti-
inflammatory
processes that
take place
during an
immune
response.

EOSINOPHILS 1.00- 5.3 The

5.00 eosinophils
count is used
to help confirm
a diagnosis.
The test cannot
tell if the higher
number of cells
is caused by
allergy or
parasite
infection.

BASOPHILS 0.00- 0.1 This test shows

1.00 the number
and condition
of your white
blood cells,
your red blood
cells, and your
platelets. Since
basophils are
a type of white
blood cells,
your provider
may opt for
CBC with
differential.
This test details
 how many
basophils and
other white
blood cells you
have.

PLATELET 140-440 159 A platelet

count s a quick,
common test
that counts a
number of
platelets in
your blood. A
platelet count is
most often
used to monitor
or diagnosed
conditions that
cause too
much bleeding
or too much
clotting. A test
that is often
done as part of
a regular
checkup.

HEMATOLOGY SECTION
(BLOOD TYPING)
Date ordered Test Patients Clinical Nursing
result significance responsibility
January 31, 2023 Blood typing “A” Blood typing is >inform the
done so you patient for
Rh can safely blood typing
POSITIVE receive a to have
blood baseline data
transfusion or
transplant.
Your blood
type must be
closely
matching the
blood type of
 the blood you
are receiving.
If the blood
types do not
match: your
immune
system will
see the
donated red
blood cells as
foreign

RENAL PANEL 3
Date Test Normal Patients Clinical Nursing
ordered value result significance responsibility
January RENAL PANEL A test in which - Monitor fluid
31, 2023 3 blood or urine and electrolyte
samples are balance.
* Sodium 135.00- 132.7 checked for the Rationale: To
(Ionized) 148.00 amounts of indicate
mmol/I certain potential
* Potassium 3.50- 4.96 substances complications
(Ionized) 5.30 released by the during all
mmol/l kidneys. A phases of the
* Calcium 1.00- 1.11
higher- or disorder.
(Ionized) 1.32 lower-than- - Reducing
mmol/l normal amount metabolic rate.
* BUN 22.9
2.06- of a substance Rationale: Bed
8.07 can be a sign rest is
mmol/l 566 that the encouraged.
* Creatinine 53.00- kidneys are not - Promoting
97.00 working the pulmonary
umol/l way they function.
should. Also Rationale: to
called kidney prevent
function test. atelectasis and
respiratory tract
infection.

DEPARTMENT OF RADIOLOGY
HISTORY BODY WEAKNESS

Examination Technique CHEST X-RAY PAL views

FINDINGS

No active parenchymal infiltrates

Heart is not enlarged
Diaphragm and sulci are intact
There is mild left-sided deviation of the lower thoracic spine

IMPRESSION

Mild levoscoliosis, lower thoracic spine

ELECTROCARDIOGRAM REPORT
ATRIAL AXIS
RATE:
VENTRICULAR PR INTERVAL
RMYTHM:

SEROLOGY/BLOOD BANKING/IMMUNOLOGY SECTION

TEST NAME RESULTS

HCV (ANTIBODY) NONREACTIVE

ANTI-HBS QUALITATIVE NONREACTIVE
HBSAG NONREACTIVE

XIII. DRUG STUDY

1.AMLODIPINE DRUG STUDY
DRUG ACTION INDICATI CONTRAIN ADVERSE NURSING
NAME ON DICATION EFFECT RESPONSIBILITY
 Amlodipi Indicated Contraindic CV: • Monitor patient
ne is a to patient ated with Palpitations, carefully (BP, cardiac
dihydrop with angina allergy to flushing, rhythm, and output)
yridine pectoris amlodipine, tachycardia, while adjusting drug to
calcium due to impaired chest pain, therapeutic dose.
antagoni coronary hepatic or and Rationale: to ensure if
st artery renal postural the medication is
Generic (calcium spasm function, hypotension effective.
name: ion (Prinzmetal sick sinus . • Monitor cardiac rhythm
amlodipine antagoni ’s variant syndrome, CNS: regularly during
st or angina); heart block fatigue, stabilization of dosage
Brand slow- chronic (second or headache. and periodically during
name: channel stable third GI: long-term therapy.
Norvasc blocker) angina, degree), abdominal Rationale: to avoid
that alone or in lactation. pain, complications
Classificat inhibits combinatio - Use anorexia, •Educate the patient
ion: the n with cautiously nausea, what are the possible
Calcium transme other with CHF, vomiting, side effects of the drugs.
channel- mbrane agents; pregnancy. constipation Rationale: to aware the
blocker influx of and , flatulence patient.
Antianginal calcium essential and • Instruct the patient to
drug ions into hypertensi diarrhea. report irregular
Antihypert vascular on, alone SKIN: heartbeat, shortness of
ensive smooth or in flushing, breath, swelling of the
muscle combinatio rash. hands or feet,
Dosage: and n with pronounced dizziness,
5mg cardiac other constipation. Rationale:
muscle. antihyperte to have immediate
Route: nsives intervention
Oral • Documents and record
the effectiveness of the
drug.
Rationale: to provide
evidence of the activity.
 2. Clonidine drug study

DRUG ACTION INDICATI CONTRAIN ADVERSE NURSING

NAME ON DICATION EFFECT RESPONSIBILITY
Stimulat Indicated Contraindic Vomiting •Monitor BP carefully
e alpha- for the ated in Loss of when discontinuing
adrenerg treatment patients appetite clonidine. Rationale:
ic of with a Malaise (a Because hypertension
receptor hypertensi history of general ill usually returns in 48 hrs.
Generic s in the on alone or sensitizatio feeling)
name: CNS; in n or allergic Elevated •Advice patient to take
clonidine which combinatio reactions to liver drug exactly as
result is n with clonidine. enzymes prescribed and not to
Brand decreas other Lactating (found stop abruptly. Rationale:
name: ed medication and using a because withdrawal
Catapres sympath s pregnant. blood test) symptoms and and
etic Epidural Weight gain severe hypertension may
Classificat outflow administrati Rashes occur.
ion: inhibiting on is
antihyperte cardio contraindica •Educate the patient what
nsive accelera ted in the are the possible side
tion presence of effects of the drugs.
Dosage: vasocon an injection Rationale: to aware the
0.1 mg striction site patient.
0.2 mg center infection, in
0.3mg patients on • Documents and record.
anticoagula Rationale: To provide
Route: oral nt therapy evidence of the activity.
and in those
with a
bleeding
diathesis.
 3. Erythropoietin drug study
DRUG ACTION INDICATI CONTRAI ADVERSE NURSING
NAME ON NDICATI EFFECT RESPONSIBILITY
ON
Erythropoieti Indicated Contraindi CNS: • Before starting therapy,
n (Epo) is a in cated in dizziness, evaluate patient iron
glycoprotein condition patient fatigue, status.
hormone s where with headache, Rationale: Patient may
produced in there is hypersens seizures. need vitamin B and folic
Generic the kidney impaired itivity to CV: edema, acid.
name: that acts on red blood product hypertension
erythropo erythroid cell derived , increased • Monitor BP before
ietin progenitor productio from clotting of therapy.
cells in the n. The mammal arteriovenou Rationale: Blood
Brand bone two cells or s grafts. pressure may increase
name: marrow. A primary albumin GI: specially when hematocrit
Eposino negative FDA- (human) abdominal increases in the early part
feedback approved and in pain, of therapy.
Dosage: system, in indication those with constipation,
400 IU which tissue s for uncontroll diarrhea, • Monitor blood counts.
oxygenation ESAs are ed nausea and Rationale: elevated
Route: controls Epo anemia hypertensi vomiting. hematocrit may cause
SQ production secondar on. RESPIRATO excessive clotting.
and Epo y to RY: cough,
Frequen controls red chronic shortness of • Educate the patient that
cy: TID: blood cell kidney breath. it may need additional
6xday (RBC) disease SKIN: heparin.
production, and infection site Rationale: to prevent
provides chemoth reactions, clotting during dialysis
homeostasis erapy- rash. treatment.
in oxygen induced
delivery to anemia in
body tissues. patients
with
cancer.
DRUG ACTION INDICA CONTRAIN ADVERSE NURSING
NAME TION DICATION EFFECT RESPONSIBILITY
Following Used in Contraindic Hypercalce • Check the doctor’s
ingestion, the ated to mia may order. Rationale: to
the treatmen patient with develop. avoid medical error.
ketoanalogu t of hypercalce Increased
es are chronic mia, calcium • Assess electrolyte
Drug transaminate kidney disturbed levels, levels. Rationale: To
name: d by taking disease. amino acid nausea, monitor effects of the
Ketoanalo nitrogen metabolism. vomiting, medication.
gues from non- diarrhoea,
essential and • Explain therapeutic
Brand amino acids, abdominal value of drug. Rationale:
name: thereby pain. To provide understanding
Ketosterile decreasing about the drug.
the formation
Classifica of urea by • Assess allergy to the
tion: re-using the drug. Rationale: To
suppleme amino group. avoid complications.
nts The levels of
Dosage: accumulatin • Monitor vital signs
1tab PO g uremic especially cardiac
TID toxins are changes. Rationale: to
decreased. avoid complications.
Keto- and/or
hydroxy- • Instruct the patient if
acids do not signs of hypercalcemia
elicit occur like muscle
hyperfiltratio weakness, constipation
n of residual Rationale: To have
nephrons. immediate actions.
4. Ketoanalogues drug study
5. Atrovastatin drug study
DRUG ACTION INDICA CONTRAIN ADVERSE NURSING
NAME TION DICATION EFFECT RESPONSIBILITY
Atorvastatin Reductio •Hypersensi headache • Tell patient to take drug
competitively n of risk tivity to flatulence, at the same time each
inhibits 3- for atorvastatin. diarrhea, day.
hydroxy-3- stroke •Active liver nausea, Rationale: to maintain its
methylglutar and disease or vomiting, effects.
Generic yl-coenzyme heart unexplained rash
name: A (HMG- attack in transaminas allergies, • Instruct patient to take a
Atorvastati CoA) type 2 e elevation. infections, missed dose as soon as
n reductase. diabetes •Your chest pain. possible.
[2] By patient doctor Rationale: if it’s almost
Brand preventing without should not Potentially time for his next dose, he
name: the evidenc prescribe Fatal: should skip the missed
lipitor conversion e heart this Thrombocy dose.
of HMG-CoA disease medication topenia.
Classificat to but with if you are a Rhabdomy • Advise patient notify
ion: mevalonate, other CV patient with olysis with prescriber if he develops
Dyslipidae statin Risk liver acute renal unexplained muscle pain,
mic agent medications factor problems. failure. tenderness, weakness,
decrease and •Women specially accompanied by
Dosage: cholesterol revascul who are fatigue and fever.
20mg production in arization pregnant or Rationale: To have an
the liver. procedur breastfeedi immediate nursing
Route: es in ng should intervention.
GB-tube patient not take
without atorvastatin. • Documents and record.
Coronar Rationale: to provide
y heart evidence of the activity.
disease
(CHD).
XIV. SURGICAL PROCEDURE
Procedure Description Rationale Nursing responsibility
Kidney A kidney transplant is a A kidney transplant is < Asses Knowledge
Transplant surgery to place a healthy often the treatment of about the Procedure
kidney from a living or choice for kidney
< Maintain urinary
deceased donor into a failure, compared with
catheter patency and
person whose kidneys no a lifetime on dialysis.
closed system
longer function properly. A kidney transplant
The kidneys are two bean- can treat chronic < Measure urine
shaped organs located on kidney disease or output every 30 to 60
each side of the spine just end-stage renal minutes initially to
below the rib cage. Each is disease to help you determine fluid
about the size of a fist. Their feel better and live balance and
main function is to filter and longer. Compared transfunction
remove waste, minerals and with dialysis, kidney
fluid from the blood by transplant is < Monitor for possible
producing urine. associated with: complications such
Better quality of life. as hemorrhage or
renal artery
thrombosis.
Hemodialysis Hemodialysis is a treatment A hemodialysis - Checking the
to filter wastes and water patient’s lifeline, patients' vital signs
from your blood, as your because it makes life- and talking with them
kidneys did when they were saving hemodialysis to assess their
healthy. Hemodialysis helps treatments possible. condition
control blood pressure and Hemodialysis can
- Teaching patients
balance important minerals, help your body control
about their disease
such as potassium, sodium, blood pressure and
and its treatment and
and calcium, in your blood. maintain the proper
answering any
balance of fluid and
Hemodialysis is a treatment questions
various minerals —
for kidney failure that uses a
such as potassium - Overseeing the
machine to send the
and sodium — in your dialysis treatment
patient’s blood through a
body. Normally, from start to finish
filter, called a dialyzer,
hemodialysis begins
outside the body. The - Making sure
well before your
access is a surgically patients are given the
kidneys have shut
created vein used to remove correct medications
down to the point of
and return blood during ordered by their
causing life-
hemodialysis. doctors
threatening
complications. - Evaluating patients'
reaction to the
 dialysis treatment and
medications
- Reviewing the
patients' lab work,
home medications
and activities and
letting the doctors
know about changes
in their patients'
conditions
- Helping patient’s
follow-up with their
transplant center

XV. NURSING THEORIES

Dorothea E. Orem

Her theory defined Nursing as “The act of assisting others in the provision and

management of self-care to maintain or improve human functioning at the home level of

effectiveness.” It focuses on each individual’s ability to perform self-care, defined as “the

practice of activities that individuals initiate and perform on their own behalf in

maintaining life, health, and well-being.”

Dorothea Orem’s Self-Care Deficit Theory defined Nursing as “The act of assisting

others in the provision and management of self-care to maintain or improve human

functioning at the home level of effectiveness.” It focuses on each individual’s ability to

perform self-care, defined as “the practice of activities that individuals initiate and

perform on their own behalf in maintaining life, health, and well-being.” “The condition

that validates the existence of a requirement for nursing in an adult is the absence of
the ability to maintain continuously that amount and quality of self-care which is

therapeutic in sustaining life and health, in recovering from disease or injury, or in

coping with their effects. With children, the condition is the parent’s inability (or

guardian) to maintain continuity for the child the amount and quality of care that is

therapeutic.” (Orem, 1991). This theory is applicable to our case, also to determine the

self-care need of patient Namie with CKD. Our patient is 65 years old; this teaching of

self-care is intended for the patient’s guardian. The guardian should be advised to give

care and support the patient in her journey.

Florence Nightingale

Environmental Theory

Florence Nightingale’s Environmental Theory defined Nursing as “the act of utilizing the

patient’s environment to assist him in his recovery.”

It involves the nurse’s initiative to configure environmental settings appropriate for the

gradual restoration of the patient’s health and that external factor associated with the

patient’s surroundings affect the life or biologic and physiologic processes and his

development.

She identified 5 environmental factors: fresh air, pure water, efficient drainage,

cleanliness or sanitation, and light or direct sunlight. This theory is applicable to our

patient with CKD, because many viruses that can trigger the onset condition of our

patient. As a nurse, we should advise the patient and also the guardian to open the
windows for clean and fresh air, cleaning the house, and proper hand washing, this will

help the patient to promote personal and environmental hygiene.

Lydia Hall

Care, cure, core Nursing Theory

Core (patient), Care (nurse), Cure (doctor)

Than by any other person and behaves according to their feelings and values. The cure

is the attention given to patients by medical professionals. Hall explains in the model

that the nurse shares the cure circle with other health professionals, such as physicians

or physical therapists. These are the interventions or actions geared toward treating the

patient for whatever illness or disease they are suffering from.

The care circle addresses the role of nurses and is focused on performing the task of

nurturing patients. This means the “motherly” care provided by nurses, which may

include comfort measures, patient instruction, and helping the patient meet his or her

needs when help is needed.

XVI. NURSING CARE PLAN (Impaired Urinary Elimination)
Assessment Diagnosis Planning Intervention Evaluation
February 01, Impaired Short term: Independent: After the
2023 @8:00 Urinary After 8 - Establish rapport. nursing
A.M Elimination hours of Rationale: To get the interventio
related to nursing cooperation of the patient and n,
Subjective: failing interventio SO. - the
“Sa isa ka glomerular n, the - Monitor and record vital patient had
adlaw kaisa filtration patient will signs. Rationale: To obtain understand
or kaduha AEB be able to baseline data. about the
lang ko Impaired understand - Assess patient’s general condition
makaihi”, as excretion the condition. Rationale: To
verbalized of condition know what problem and - The
the patient. nitrogenou interventions should be patient
s products prioritizes. participate
Objectives: Long term: - Review for laboratory test d in
- Oliguria Rationale: After 3 for changes in renal function. measuring
- Hesitancy Renal days of Rationale: To assess for correct/
- Urinary Failure is a nursing contributing or causative compensat
Retention problem interventio factors. e for
- VS taken which n, the - Determine client’s pattern of defects
as follows: results to patient will elimination. Rationale: To
BP- 140/80 loss of be able to assess degree of Goal met.
mmHg kidney participate interference.
RR- 16cpm functions in - Determine client’s usual
PR- 67bpm and as measures daily fluid intake. Rationale:
Temp- 36^C GFR to To help determine level of
O2 Sat: 97% decrease, correct/co hydration.
the kidney mpensate
cannot for defects
excrete Dependent:
nitrogenou - Educate the patient to have
s product realistic activity goal.
and fluid Rationale: Enhance
causing commitments to promoting
impaired in optimal outcomes.
Urinary - Emphasize the need to
elimination adhere with prescribe diet.
Rationale: To prevent
aggravation of disease
condition.
ASSESSME DIAGNOSI PLANNING INTERVENTIO RATIONAL EVALUATIO
NT S N E N
February 01, Excess After 8 hours INDEPENDEN After 8 hours
2023 @8:00 fluid of nursing T: >This of nursing
A.M volume intervention, >Compare provides a intervention,
related to the pt. will current rate comparativ the pt. was
excessive verbalize with admission e baseline able to
Subjective: sodium understandi and/or and verbalized
‘’Ma’am intake. ng of previously elevates understandin
perme ko individual stated weight. the g of
uhawon’’ as dietary and Or on regular effectivene individual
pt. verbalized. fluid schedule, as ss of dietary and
restriction. indicated. therapies. (I fluids
Objectives: and O). restriction.
>Monitor the
S/X: intake and
Polydipsia- output. >Help care
increase thirst givers
Polyuria- ensure that
increase the patient
urination has proper
Polyphagia- >Limit oral fluid intake of
increase intake. fluid.
appetite >To
prevent
Vs taken as >Educate fluid
follow: patient and retention.
family numbers
BP- 140/80 regarding fluid >Informatio
mmHg volume excess n is key to
RR- 16cpm fins its causes. managing
PR- 67bpm problems.
Temp- 36^C
O2 Sat: 97%
 NURSING CARE PLAN (Imbalance Nutrition: Less Than Body Requirements)
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
February 01, Imbalance After 8 INDEPENDENT: >Daily self- After 8 hours
2023 @8:00 nutrition: hours of >Weigh patient weighing may of nursing
A.M less than nursing daily allow for better interventions,
body intervention, self-regulation of the patient
Subjective: requirements patient will body weight as was able to
Ma’am wala koy related to demonstrat small changes in demonstrate
gana mukaon’’ insufficient e body weight can willingness in
as pt. dietary willingness be identified on a nutritional
verbalized. intake. As in nutritional daily basis on status and
evidenced status. changes in diet maintained
Objectives: by appetite. and exercise weight.
>Anorexia behaviors
>Weight loss initiated as a
from 60kg to result.
56kg COLLABORATIVE
>Refer to dietician >The dietician
Vs taken as can also
follow: determine the
patients’ daily
BP- 140/80 requirements of
mmHg specific nutrients
RR- 16cpm to promote
PR- 67bpm sufficient
Temp- 36^C nutritional intake.
O2 Sat: 97%
>Maintained
proper electrolytes >Restriction of
balance by strictly these
monitoring levels. electrolytes may
be needed to
prevent further
renal damage
especially if
dialysis is not
part of the
treatment.
>Assess and
documented >General
dietary intake. physical
condition, uremic
symptoms and
multiple dietary
DEPENDENT: restrictions food
intake.
>Sodium
 bicarbonate 650mg
1 tablet 3x a day. >Management of
metabolic
acidosis, gastric
hyperacidity.

NURSING CARE PLAN (Activity Intolerance)

Assessment Diagnosis Planning Intervention Evaluation
February 01, Activity Short term: Independent: Short term:
2023 @8:00 intolerance After 8 - Assess the extent of After 8
A.M related to hours of weakness, fatigue, hours of
generalize nursing ability to participate in active nursing
Subjective: d interventio and passive activities. interventio
“Luya akong weakness n, the Rationale: Provides n, the
lawas as patient will information about the impact patient had
Ma’am”, as evidenced have of activities on fatigue and understand
verbalized by reports understand energy reserves. ing about
the patient. of fatigue ing about - Monitor and record vital her
on exertion her signs. Rationale: To obtain condition
Objectives: and Lab condition baseline data. which
- weakness result of that makes - Assess patient’s general makes her
noted hemoglobi her feel condition. Rationale: To feel weak
- Pallor n (102). weak or know what problem and or tired.
noted tired. interventions should be
- Fatigue prioritizes.
- Lack of - Emphasize bedrest. Long term:
energy Long term: Rationale: To regain energy After 1
- VS taken After 1 - Determine client’s pattern of week of
as follows: week of elimination. Rationale: To nursing
BP- 140/80 nursing assess degree of interventio
mmHg interventio interference. n, the
RR- 16cpm n, the - Assess the patient’s patient had
PR- 67bpm patient will nutritional ingestion for attain
Temp- 36^C be able to adequate energy sources and increased
O2 Sat: 97% attain metabolic demands. tolerance
increase Rationale: Fatigue may be a for activity
tolerance symptom of protein-calorie and be
for activity malnutrition, vitamin able to
and be deficiencies, or iron perform
able to deficiencies. personal
 perform daily
personal Dependent: activity
daily - Educate the patient to have such as
activity realistic activity goal. toileting.
such as Rationale: Enhance
toileting. commitments to promoting
optimal outcomes.
- Severe 2 units of PRBC of
pt. blood type after properly
succussed and crossmatch
transposed once available.
Rationale: To treat anemia
by increased the number of
RBC in your body and
temporarily relieved the
symptoms of anemia.

NURSING CARE PLAN (Risk for Impaired Skin Integrity)

Assessment Diagnosis Planning Intervention Evaluation
February 01, Risk for Short term: Independent: Short term:
2023 @8:00 Impaired After 8 - Inspect skin for changes in After 8
A.M Skin hours of color, turgor, vascularity. Note hours of
Integrity nursing redness, excoriation. nursing
may be interventio Rationale: Indicates areas of interventio
Objectives: related to n, the poor circulation or breakdown n, the
- Alterations alterations patient will that may lead to decubitus patient was
in skin turgor in skin be able to formation and infection. able to
(edema/dehy turgor, maintain - Monitor and record vital maintain
dration) reduced intact skin. signs. Rationale: To obtain intact skin.
- Reduced activity/ baseline data.
activity/immo mobility or - Monitor fluid intake and
bility accumulati Long term: hydration of skin and mucous Long term:
- on of After 1 membranes. Rationale: After 1
Accumulatio toxins in week of Detects presence of week of
n of toxins in the skin nursing dehydration or overhydration nursing
the skin interventio that affect circulation and interventio
- VS taken n, the tissue integrity at the cellular n, the
as follows: patient will level. patient was
BP- 140/80 be able to - Inspect dependent areas for able to
mmHg demonstrat edema. Elevate legs as demonstrat
RR- 16cpm e indicated. Rationale: e
PR- 67bpm behaviors Edematous tissues are more behaviors
Temp- 36^C and prone to breakdown. and
O2 Sat: 97% techniques Elevation promotes venous techniques
to prevent return, limiting venous stasis to prevent
skin and edema formation. skin
breakdown - Keep linens dry, wrinkle- breakdown
/injury. free. Rationale: Reduces /injury.
dermal irritation and risk of
skin breakdown. Goal met.

Dependent:
- Instruct patient to use cool,
moist compresses to apply
pressure (rather than scratch)
pruritic areas. Keep
fingernails short; encourage
use of gloves during sleep if
needed. Rationale: Alleviates
discomfort and reduces risk of
dermal injury.
- Instruct wearing loose-fitting
cotton garments. Rationale:
Prevents direct dermal
irritation and promotes
evaporation of moisture on
the skin.
 XVII. DISCHARGE PLANS (M.E.T.H.O.D.S.)
Medication Exercise Treatment Health Out Diet Sexuality
Environment teaching patient
Home continuous to treat and educate Instruct Instructed Encourage
Medication activity such control your the patient patient the patient the patient to
as walking, diabetes and on the to attend to eat have
Advised the
(indoors or high blood importance follow up foods like environmental
patient to have
out), skiing, pressure of glucose check- Fruits: cleanliness
drug compliance
aerobic (hypertension). control, up with berries, Ang proper
as prescribed by
dancing or This includes exercise, doctor grapes, hygiene's and
the physician as
any other diet, lifestyle follow up, DRA. cherries, also it's
« amlodipine activities in changes, and a Anne apples, important to
which you exercise and healthy Marie plums. continuously
Time: need to move prescription diet, Cubero Veggies: exercise and
OD During large muscle medications. whereas M.D. cauliflower Diet, exercise
breakfast groups With good the and Dr. , onions, and self-
continuously. management pharmacist Noel eggplant, management
Route: Oral Low-level of your blood should Camique turnips. are essential
Dosage: strengthening sugar and educate M.D. this Proteins: for controlling
exercises hypertension, the patient is to lean meats blood sugar
may also be you may on monitor (poultry, levels and
TABLETS beneficial as prevent or medication the fish), eggs, high blood
part of your delay kidney complianc condition unsalted pressure
«antiphypertensi program. dysfunction e and on the seafood.
Time:1:00 Pm and other blood patient Carbs:
complications. pressure white
For hypertension control. bread,
bagels,
Route: Oral
sandwich
Dosage: buns,
unsalted
O.1 mg
crackers,
O.2 mg pasta.
0.3 mg
XVIII. PROGNOSIS

XIX. RECOMMENDATIONS

This case study has provided as with important information about the patient having
chronic kidney disease secondary to diabetic mellitus nephropathy and its proper
nursing care. In order to ensure that optimal health is restored and maintained, the
group would like to recommend the following:
To the patient
 Patient should have a follow up checkup as advised by doctor.
 Practiced healthy lifestyle and proper hygiene
 Adhere therapeutic plan by the doctor.

To the family and significant others
 Assist client and her activity.
 Should actively participate in providing, promoting, assisting the client to perform
health activities.
 Should be knowledgeable of the signs and symptoms of complications to be
reported.
 Should understand the importance of follow up checkup for the monitoring of
complications.
To the caregivers
 Explain or teach about the nature of the patient’s conditions.
 Always make ones self-available for the patient needs.
 Provide emphasis on strict compliance of medication.

References:

Fernando C. Fervenza, M.D., Ph.D.; October 19, 2021; Diabetic nephropathy (kidney
disease). Mayo Clinic, Book: The Essential Diabetes Book
Deborah Weatherspoon, Ph.D., MSN; January 19, 2022; Diabetic nephropathy or
kidney disease. Medical News Today

Robert C. Albright, Jr., D.O., September 03, 2021; Chronic kidney disease. Book: Mayo
Clinic Family Health Book, 5th Edition

Matt Vera BSN, R.N., March 18, 2022. Chronic Renal Failure. Nurseslabs, Nursing Care