CHRONIC KIDNEY

DISEASE
A Case Study
Presented to the College of Nursing, Public Health and Midwifery

Case presented by:

Secretario, Shaun M.

BSN-4D

Case presented to:

Marvin A. Galicia RN
Clinical Instructor
I. Case
Description

This is a case of an 81-year-old female residing in San Andres,

Cabatuan, Isabela who was admitted on the 20th of November
2024 at 5:50pm with an admitting diagnosis of Chronic Kidney
Disease Stage V.

Chronic kidney disease includes conditions that damage your kidneys

and decrease their ability to keep you healthy by filtering wastes from
your blood. If kidney disease worsens, wastes can build to high levels in
your blood and make you feel sick. You may develop complications like:

•high blood
pressure
•anemia (low blood
count)
•weak
bones
•poor nutritional
health
•nerve
damage

Kidney disease also increases your risk of having heart and blood
vessel disease. These problems may happen slowly over a long
time. Early detection and treatment can often keep chronic kidney
disease from getting worse. When kidney disease progresses, it may
eventually lead to kidney failure, which requires dialysis or a kidney
transplant to maintain life.

SYMPTOMS OF CHRONIC KIDNEY

DISEASE

Signs and symptoms of chronic kidney disease develop over time if

kidney damage progresses slowly. Loss of kidney function can cause a
buildup of fluid or body waste or electrolyte problems. Depending on
how severe it is, loss of kidney function can cause:

•Nause
a
•Vomitin
g
•Loss of
appetite
•Fatigue and
weakness
•Sleep
problems
•Urinating more or
less
•Decreased mental
sharpness
•Muscle
cramps
•Swelling of feet and
ankles
•Dry, itchy skin
•High blood pressure (hypertension) that's difficult to control
•Shortness of breath, if fluid builds up in the lungs
•Chest pain, if fluid builds up around the lining of the heart

Signs and symptoms of kidney disease are often nonspecific. This

means they can also be caused by other illnesses. Because your
kidneys are able to make up for lost function, you might not develop
signs and symptoms until irreversible damage has occurred.

WHAT CAUSES
CKD?
Chronic kidney disease occurs when a disease or condition impairs
kidney function, causing kidney damage to worsen over several months
or years.
Diseases and conditions that cause chronic kidney disease
include:

•Type 1 or type 2
diabetes
•High blood pressure

RISK
FACTORS

Factors that can increase your risk of chronic kidney disease

include:
•Diabet
es
•High blood
pressure
•Heart (cardiovascular)
disease
•Smokin
g
•Obesit
y
•Being Black, Native American or Asian
American
•Family history of kidney
disease
•Abnormal kidney
structure
•Older
age
•Frequent use of medications that can damage the
kidneys

HOW IS CKD
DIAGNOSED?
You may not notice symptoms until your chronic kidney disease (CKD)
is quite advanced. That is why kidney disease is sometimes
referred to as a “silent” condition. Symptoms are often nonspecific
and may vary from person to person. Because your kidneys are
capable of compensating for reduced function, symptoms of CKD
may not show until irreversible damage has occurred.
 If you have medical conditions (e.g. diabetes and high blood pressure)
that put you at risk for CKD, your doctor will most likely use urine and
blood tests to check your blood pressure and kidney function on a
regular basis.

II. Anatomy and Physiology

Your urinary system, also called the renal system or urinary tract, removes
waste from your blood, in the form of urine. It also helps regulate your blood
volume and pressure and controls the level of chemicals and salts
(electrolytes) in your body's cells and blood.

• Bladder- The urinary bladder is a hollow muscular organ which

serves as a reservoir for urine
• Urethra- The urethra is a membranous tube which conveys urine from
the urinary bladder to the exterior of the body.
• Ureter- These narrow tubes carry urine from the kidneys to the bladder
• Kidney- The kidneys are the primary organs of the urinary system. The
kidneys are the organs that filter the blood, remove the wastes, and
excrete the wastes in
the urine. They are the organs that perform the functions of the urinary
system. The other components are accessory structures to eliminate
the urine from the
body
.
The kidneys are behind the peritoneum, or retroperitoneal and are
located on each side of the vertebral column. They are bean-shaped
organs, each about the
size of a tightly clenched fist. Structures that are behind the
peritoneum are said
to be retroperitoneal . A layer of connective tissue called the renal
(derived from the Latin word for kidney) capsule surrounds each
kidney, Around the renal
capsule is a thick layer of adipose tissue, which protects the
kidney from
mechanical shock. On the medial side of each kidney is the hilum,
where the renal artery and nerves enter and where the renal vein,
ureter, and lymphatic vessels exit the kidney . The hilum opens
into a cavity called the renal sinus, which contains blood vessels,
part of the system for collecting urine, and adipose tissue.

PARTS OF THE
KIDNEY

Nephron- are tiny tubules that play a role in urine formation in the
kidney. There are two types of nephrons, namely cortical nephrons and
juxtamedullary nephron.

Renal medulla - consists of a series of renal pyramids, which appear

striated because they contain straight tubular structures and blood
vessels.

Renal pelvis- is a large cavity that collects the urine as it is

produced.

Renal cortex- granular due to the presence of nephrons—the

functional unit of the kidney.

Ureter- They are approximately 25cm long and are situated bilaterally,
with each ureter draining one kidney.
Glomerulus- The glomerulus is the main filtering unit of the
kidney.
Renal corpuscle- The renal corpuscle, located in the renal cortex, is
made up of a network of capillaries known as the glomerulus and the
capsule, a cup-shaped chamber.

Renal capsule- The entire kidney is surrounded by tough fibrous

tissue — called the renal capsule — which, in turn, is surrounded by
two layers of protective, cushioning fat.

Hilum- The artery enters the kidney at the hilus , the indentation in
middle of the kidney.

Loop of Henle- The second part is called the loop of Henle, or

nephritic loop, because it forms a loop (with descending and ascending
limbs) that goes through the renal.

Renal column-The renal columns also serve to divide the kidney into
6–8 lobes and provide a supportive framework for vessels that enter
and exit the cortex.

Bowman's capsule-called the renal

corpuscle.

Distal convoluted tubule- The third part of the renal tubule is called
the distal convoluted tubule (DCT) and this part is also restricted to the
renal cortex.

Juxtamedullary nephron-Juxtamedullary nephrons have a glomerulus

near the junction of the cortex and medulla and their loops of Henle
penetrate deep into the medulla.

Proximal convoluted tubule-The proximal convoluted tubule is

located within the renal cortex and is continuous with the capsular
space.

Afferent arteriole-The vessel which brings blood into the

glomerulus is the afferent arteriole.

Renal pyramid-Between the renal pyramids are projections of cortex

called renal columns.

Renal papilla- Each renal papilla is associated with a structure known

as the minor calyx, which collects urine from the pyramids.
III. NURSING
HISTORY

a. Demographic Data:
Name: Patient Y
Age: 81 y/o
Address: Purok 4, San Andres, Cabatuan, Isabela
Birthday: January 05, 1942
Gender:
Female
Height:
160cm
Weight:
61kilos
Status: Widow
Religion: Roman Catholic
Nationality: Filipino
Chief Complaint: Difficulty of breathing
Admitting Diagnosis: Chronic Kidney Disease -
Stage V Admission Date: 11-20-2024
Time: 5:50pm
Attending Physician: Dra. Rhea Cez Javier

Initial Vital
Signs: PR: 114
RR: 22
02SAT:
86% TEMP:
36.0
BP: 14 0/90

b. History of Present
Illness:
Patient was previously admitted last February in our institution as a
case of CKD V secondary to Hypertensive Arteriolar Nephrosclerosis,
secure consent, blood transfusion were done, for hemodialysis
referred, and start for follow up.
1 week prior to admission, advise patient hemodialysis then
referred.

c. Past Medical
History
The patient has a past medical history of hypertension. She took
Losartan and Amlodipine for her maintenance due to high blood
pressure. Also, patient was a smoker wherein 5 packs of cigarettes
were consumed in a day.

d. Familial
History

The patient has a family history of hypertension and

diabetes.
IV. Gordon’s Functional Pattern

GORDON’S FUNCTIONAL HEALTH PATTERN

BEFORE DURING
According to the 7:00pm and wakes up at
patient’s significant other, 5:00 to
HEALTH the patient’s general
PERCEPTION AND condition is not really
MANAGEMENT good and she
takes medications to
enhance her health status.

The significant other stated

NUTRITIONA that the Patient loves
L eating nutritious food,
METABOLIC rarely eats meat but usually
eats fish and eats 3 times a
day.
The significant other stated
ELIMINATION that the Patient defecates
1-2 times a day and voids
3–4 times a day

ACTIVITY- The Significant Other

EXERCISE stated that the patient
spends the day watching TV
and finds leisure in reading
the Bible.

COGNITIVE- according to the

PERCEPTUA patient significant other,
L the patient has trouble
with her vision, and
hearing due to her age.

SLEEP- Significant other stated that

REST the patient has a normal
sleeping pattern she
sleeps early at
According to the other the patient was not
patient’s significant able to sleep straight
other they need to for a long time. She
follows doctor's would take short naps
order. and they
are very supportive
in taking care of her
needs. She is aware
of her current health
situation that she can
recover from her
present condition as
long as she
complies with every
order, medication
and instruction
given by the doctor.
The patient is
currently In NGT
Feeding. 2,100kcal as
ordered by the
doctor.

Currently, the
patient is under I
and O monitoring
per hour, uses a
diaper for defacation
and is is
changed 1-2 times a
day , with IFC
connected to urine
drainage bag with
output of <10 cc of
urine/hour. The
significant other
stated that the
patient need
assistance in doing
ADLs and wasn't
able to reposition
herself without the
aid of others.
according to the
patient’s significant
other Patient is able
to read, write, and is
able to comprehend
and understand .
according to the
patient significant
 6:00am and 1-2 hours knows the importance in her
nap at afternoon well- being.

The significant other stated

SELF- that the patient describes
PERCEPTION/ herself as a kind and
SELF-CONCEPT loving person. She
expressed her concerns

According to the
patient’s significant other
the patient is a mother of 4
ROLE- She lives together with her
husband and 39-year old
Son, and 2 of her
grandchildren.
RELATIONSHIP
The Significant other stated
that the patient doesn’t
have any sexual
SEXUALITY-
problems. No use of
REPRODUCTIV contraceptives and did not
E have family planning when
the time that her husband
is still alive. Now she’s
already menopaused. The
significant other stated that
the patient Copes up
with problems by talking
COPING- about it with the family and
STRESS finds ways to resolve it
TOLERANCE together

significant other stated that

The patient is a Roman
VALUE- Catholic who usually goes
BELIEF to church every Sunday or
SYSTEM wherever possible to attend
mass or even just offer a
prayer.She believes in GOD
and his son Jesus Christ and
less than an hour and the activities of
was not able to their church
have a good sleep but still pray
episode. Sometimes for her fast
she is distracted recovery.
and interrupted due
to pain,
Administration
of medication and
visitors
the patient
significant others
stated that the
patient’s
movements are very
minimal and
expresses desire to
recover from her
illness as soon as
possible.
The patient is
well- supported by
her family. Aside
from that, they are
praying that she
can recover from his
present condition
According to the
patient’s significant
other, the patient
does not have sexual
life.

The significant other

stated that the
patient Able to
accept situation
by cooperating
with the medical
advices and
procedures.
According to the
patient’s significant
other Because of her
hospitalization they
cannot attend in
V. Nursing Assessment

a. Head-to-toe Assessment

The patient is lying on bed, fully awake, with a height of 160cm and weight of
61kilos, vital signs as follows: T: 36.°C, RR- 22 cpm, PR: 114 bpm, SPO2: 86%

AREAS METHODS FINDINGS INTERPRETATION

1. HEAD Head Inspection ➢ ➢ Normal

➢ Normal
Inspectio ➢ Black
Hair, n
scalp, and ➢ Normal
Palpatio
face n white
hair ➢ Normal

➢ Dry scalp

➢ Presence of
skin
pigmentati
on
in the face

Eyes and Inspectio constrict

n ➢ Blurry vision
Vision when diverted to light
➢ Eyes are and
symmetric
al and
slightly
yellowish
➢ Pupils
➢ Abnormal

➢ Normal

➢ Normal
 dilates
when she
gazes afar
Ears Inspection ➢ Ears are at ➢ Normal
and the same
hearing size and
shape

➢ Ears are ➢ Normal

clean.
Nose Inspection ➢ Presence ➢ Abnormal
of
mucus

Mouth Inspection ➢ Tongue is ➢ Normal

pale and is
free of
swelling
and
lesions
➢ Normal
➢ Lips are dry
and brown
in color
without
lesions or
➢ Normal
swelling.
2. NECK Muscles Inspection ➢ Patient is
able to
freely
move her
neck.
3. PPER
U EXTREMITIES
Skin and nails ➢ skin brown in color ➢ Normal
Inspection
Palpation

➢ Normal
 ➢ good
skin
➢ Normal
turgor
➢ Saggy skin ➢ Normal

➢ nails are
short and
clean

Chest ➢ Crackles ➢ Abnormal

Auscultation -Pneumonia

➢ chest ➢ Abnormal
Inspection -Pneumonia
retracts
during
inhalation
Joint ROM Inspection ➢ able to ➢ Normal
move arms
through
active ROM

Sensation Inspection ➢ ➢ Normal

sensory
system
is intact

➢ Normal
➢ Was able
to
distinguis
h touch,
pain.

4. LOWER Skin and Inspectio ➢ nails are nails

EXTREMITIE n
toe nails short and
➢ Capillary refill within 2
S Palpatio
clean
n seconds
➢ Pale color of
➢ Normal

➢ Normal

➢ Normal
 Joint ROM Inspection ➢ Can move ➢ Normal
his
legs

VI. Diagnostic and Lab Results

VII. Course In The Ward

DATE AND TIME DOCTOR’S ORDER INTERVENTION

DAY 1 (11/20/2024) ➢ Please admit patient - For further
in the room of monitoring,
5:50 PM management and
choice
evaluation of
Patient’s condition.

➢ Secure consent for - The patients or SO

admission must be competent
to make a voluntary
decision about
whether to undergo
the procedure or
intervention.

- For management of
dehydration and
➢ PNSS 1L x 40 cc/hr
replacement of fluid
and electrolytes

- Nasogastric tube is
➢ Insert NGT and a type of medical
secure consent catheter that’s
inserted through
nose into stomach
and considered
invasive.
THERAPEUTICS:
1. Piptaz 2.25g TID
q6hr, OD - It is used to treat
various hospital-
acquired and
ventilator-
associated
pneumonia.
2. Azithromycin
500mg, OD - It's used to treat
infections including:
chest infections
such as pneumonia.
ear, nose and throat
and nose infections
such as sinus
infection (sinusitis).

3. NaHC03 tab TID - Sodium bicarbonate

is a very quick-
acting antacid. It
should be used only
for temporary relief.

4. feSo4 + folic acid

tab TID - used for the
treatment of folate-
deficiency
megaloblastic
anemia and iron-
deficiency anemia.
5. Amlodipine 10 mg 1
- to treat high blood
tab, OD
pressure and certain
types of angina
(chest pain) and
coronary artery
disease.

6. Paracetamol 300
mg TID every 4hr,
 PRN for fever - help treat pain and
reduce a high
7. Start chlorhexidine temperature (fever).
gargle TID
- It helps to reduce
the inflammation
(redness) and
swelling of your
8. Start NAC 600 mg 1 gums and to reduce
tab gum bleeding.

- Acetylcysteine is
used in the
treatment of airway
diseases such as
bronchitis.

DATE AND TIME DOCTOR’S ORDER INTERVENTION

DAY 2 (11/21/2024) ➢ Repeat Na ● Facilitate WAB UTS,
1:50 PM

VS:
BP: 140/90
CR: 119
T: 36.0
02: 86%
➢ PNSS 1L x 40 cc/hr
RR: 22

➢ OF at 2,100 kcal

DIAGNOSTICS:
- Repeating Na
because
Hypertonic
saline
significantly
increased
serum sodium
and osmolality.

- For
management
and
treatment of
dehydration

- To provide
adequate
nourishment to
help and not to
hinder
restoration of
health.

- Whole
abdomen
ultrasound
to
 ETA GSCS assess the organs
and structures
within the abdomen,
Endotracheal
Aspirate C/S (ETA)
with Gram Stain is a
procedure to
eliminate secretions
in patients with an
artificial airway.

- Is a test used to
● Attached RT PCR
diagnose people
result
infected with SARS-
CoV-2, the virus that
causes COVID-19.

THERAPEUTICS:
- Sodium bicarbonate
● NaHco3 1 tab TID is a very quick-
acting antacid. It
should be used only
for temporary relief.

- used for the

treatment of folate-
● Feso4 + folic acid,
deficiency
1TAb TID
megaloblastic
anemia and iron-
deficiency anemia.

- piperacillin/tazobact
● Shift ceftriaxone to am is a beta-
pip tazo 2.2g every lactamase inhibitor
6hr which reduces
resistance and
enhances the
activity of
Ceftriaxone against
bacteria.
 - It's used to treat
● Azithromycin 500 infections including:
mg IV OD chest infections
such as pneumonia.
ear, nose and throat
and nose infections
such as sinus
infection (sinusitis).

- to make sure that

➢ Monitor Vital signs patients are healthy
every hour and enough for surgery
record. or other procedures
and to keep track of
recovery after
surgery or other
procedures.

- Ensure that the

➢ Monitor Intake and
patient has proper
Output every shift
intake of fluid and
and record.
other nutrients and
to determine
adequate output of
urine as well as
normal defecation.

- fraction of inspired
➢ Decrease FI02 by oxygen (FiO2) is the
10% every hourly to concentration of
reach FI02 40% oxygen in the gas
without desaturation mixture.

➢ Refer - For further

monitoring and
evaluation.

11/21/2024 ➢ Paracetamol 60 mg - used to treat mild to

IV now then 30 mg moderate pain.
IV PRN for fever Paracetamol can
 also be used to treat
fever.
- For further
➢ refer monitoring and
evaluation.

IMCU TRANSFER IN NOTES

11/21/2024
➢ Shift to heplock - an IV catheter
5:40 Pm placed in a vein to
administer
VS: medication or fluid
BP: 140/80 into the
CR: 116 bloodstream.
T: 36.5
02: 92% - To assist a patient
RR: 22 ➢ Oral feeding
to meet her
2,000kcal in GEDF
nutritional needs.
INTAKE- 1800 DIAGNOSTICS:
OUTPUT- 500
● Facilitate ETA - Endotracheal
GSCS Aspirate C/S (ETA)
with Gram Stain is a
procedure to
eliminate secretions
in patients with an
artificial airway.

● Attach RTPCR - For evaluation

result

● Still for WAB - Whole abdomen

ultrasound ultrasound to
assess the organs
and structures
within the abdomen.
THERAPEUTICS:

• Piptaz 2.25g TID - It is used to treat

various hospital-
 q6hr, OD acquired and
ventilator-
associated
pneumonia.

- It's used to treat

• Azithromycin infections including:
500mg, OD chest infections
such as pneumonia.
ear, nose and throat
and nose infections
such as sinus
infection (sinusitis).

- Sodium bicarbonate
• NaHC03 tab TID is a very quick-
acting antacid. It
should be used only
for temporary relief.

- used for the

• feSo4 + folic acid treatment of folate-
tab TID deficiency
megaloblastic
anemia and iron-
deficiency anemia.

- to treat high blood

• Amlodipine 10 mg 1 pressure and certain
tab, OD types of angina
(chest pain) and
coronary artery
disease.

- help treat pain and

reduce a high
• Paracetamol 300
temperature (fever).
mg TID every 4hr,
PRN for fever - It helps to reduce
the inflammation
• Start chlorhexidine
(redness) and
 gargle TID swelling of your
gums and to reduce
gum bleeding.

- Acetylcysteine is
used in the
• Start NAC 600 mg 1 treatment of airway
tab diseases such as
bronchitis.

- To help patients
keep airways open,
deliver oxygen and
➢ Maintain on remove carbon
mechanical dioxide.
ventilator
- to make sure that
patients are healthy
enough for surgery
➢ Monitor VS q hr and or other procedures
record and to keep track of
recovery after
surgery or other
procedures.

- Ensure that the

patient has proper
intake of fluid and
➢ Strict I&O other nutrients and
monitoring every to determine
shift adequate output of
urine as well as
normal defecation.

- For further
monitoring and
evaluation.
➢ Refer
 DATE AND TIME DOCTOR’S ORDER INTERVENTION
DAY 3 (11/22/2024) ➢ Give digoxin 0.25g - It strengthens the
IV now force of the heart
3:10 PM muscle's
contractions, helps
restore a normal,
steady heart rhythm,
and improves blood
circulation

11/22/2024 ➢ Heplock - an IV catheter

placed in a vein to
6:10 PM administer
medication or fluid
into the
VS:
bloodstream.
BP: 130/80
HR: 113 - To assist patient to
➢ Continue oral
RR: 20 meet her nutritional
feeding
T: 36.0 needs
02: 98%
- The Sliding Scale
➢ Continue insulin
method is more
sliding scale
precise than fixed
dose insulin in that it
takes account of the
fact that people's
blood glucose is not
always in the normal
range before meals.

- To assess patient’s
➢ Monitor VS q hr
wellbeing

- To ensure that the

➢ Monitor I&O q shift
patient has proper
 intake of fluid and
other nutrients
- helps keep blood
➢ Bedside turning flowing and to
q2hr prevent bedsores

- helps to minimize or
➢ Refer to Rehab slow down the
tomorrow for muscle disabling effect of
reconditioning chronic health
conditions

- For further monitoring

➢ Refer and evaluation

11/22/2024 ➢ For femoral catheter - provides a rapid and

insertion reliable route for the
administration of
drugs to the central
circulation of the
patient in cardiac
arrest

➢ WOF: bleeding, - Hematuria arising

hematuria from injury in the
glomerular filtration
barrier, results in
passage of red
blood cells into the
urinary space;
promoting oxidative
stress,
inflammation, and
structural damage to
the kidney

➢ Refer - For further

monitoring and
evaluation
 DATE AND TIME DOCTOR’S ORDER INTERVENTION
DAY 4 (11/23/2024) ➢ Heplock - an IV catheter
placed in a vein to
10:23 AM administer
medication or fluid
into the
VS:
bloodstream.
BP: 130/90
HR: 88 - To assist patient to
➢ Oral feeding
RR: 20 meet her nutritional
T: 63.6 needs
02: 98%
➢ For repeat CBC,Na, - To review changes
K+, Crea and For from previous
repeat CXR AP results.

- To review results
➢ Follow up culture
and changes from
results, blood - ETA
previous results

- To assess the
➢ Still for WAB UTS
structures within the
abdomen.

➢ Shift insulin sliding - The Sliding Scale

scale x insulin 70/30 method is more
20-0-10 units precise than fixed
dose insulin in that it
takes account of the
fact that people's
blood glucose is not
always in the normal
range before meals.

- Hemodialysis is a
➢ Please secure
treatment to filter
another HD
wastes and water
schedule tomorrow
 from your blood, as
your kidneys did
when they were
healthy.

- To assess and
➢ Repeat ABG
detect changes

- To assess patient’s
➢ Monitor VS every
wellbeing
hour and record
- To ensure that the
➢ Strict I&O
patient has proper
monitoring every intake of fluid and
shift
other nutrients

- to maintain a patent
➢ Suctions secretions
airway and improve
accordingly
oxygenation by
removing mucous
secretions and
foreign material
from the mouth and
throat.

- For further monitoring

➢ Refer and evaluation

11/23/2024 ➢ Note present status - To alleviate the

signs and symptoms
11:00 AM of the patient.

➢ Facilitate TID with - To confirm the

HD prescription results
order
 DATE AND TIME DOCTOR’S ORDER INTERVENTION
DAY 5 (11/24/2024) ➢ Heplock - an IV catheter
placed in a vein to
2:40 PM administer
medication or fluid
VS: into the
bloodstream.
BP: 120/80
HR: 90
RR: 20 - To assist a patient
➢ continue oral
T: 63.6 to meet her
feeding
02: 98% nutritional needs.

- To alleviate the
➢ Continue present
signs and symptoms
medication
of patient's condition
➢ Maintain on
- To help patients
mechanical
keep airways open,
ventilation
deliver oxygen and
remove carbon
dioxide.
➢ Monitor VS q1hr
- To assess patient’s
and record
wellbeing

➢ Monitor I&O and - Ensure that the

record patient has proper
intake of fluid and
other nutrients and
to determine
adequate output of
urine as well as
normal defecation.

- For further
➢ Refer monitoring and
evaluation.
11/24/2024 ➢ Heplock - an IV catheter
placed in a vein to
3:30 PM administer
medication or fluid
into the
bloodstream.
➢ Continue oral
- To assist a patient
feeding
to meet her
nutritional needs.

- To alleviate the
➢ Continue present
signs and symptoms
management
of patient's condition

- Synchronized
➢ Shift back to SIMV
intermittent
PS: 16
BUR: 16 mandatory
ventilation (SIMV) is
a type of volume
control mode of
ventilation.

➢ Monitor VS every - To assess patient’s

hour wellbeing

➢ Monitor intake and - Ensure that the

output every shift patient has proper
intake of fluid and
other nutrients and
to determine
adequate output of
urine as well as
normal defecation.

➢ Refer - For further

monitoring and
evaluation.
11/24/2024 ➢ Heplock - an IV catheter
placed in a vein to
9:47 PM administer
medication or fluid
into the
bloodstream.

- Preparation for
➢ Reduce pressure
weaning
support
- continuous positive
➢ Then shift to CPAP;
airway pressure is a
for ABG after 1 hour
machine that uses
of CPAP then relay
mild air pressure to
keep breathing
airways open while
you sleep.

➢ Monitor VS every - To assess patient’s

hour and record wellbeing

➢ Monitor I&O - Ensure that the

patient has proper
intake of fluid and
other nutrients and
to determine
adequate output of
urine as well as
normal defecation.

➢ WOF: untoward s/sx - To seek immediate

attention and
alleviate

➢ Refer - For further

monitoring and
evaluation.

DATE AND TIME DOCTOR’S ORDER INTERVENTION

DAY 6 (11/25/24) ➢ Heplock - an IV catheter
placed in a vein to
10:23 AM administer
medication or fluid
VS:
into the
BP: 130/80 bloodstream.
HR: 94
RR: 20 - To assist a patient
➢ Oral feeding 2,100
T: 63.1 to meet her
kcal
02: 98% nutritional needs.

- To review changes
➢ Awaiting ETA
from previous
BSCS, blood CS
results.
results
.
- To assess changes
➢ For repeat CXR AP,
from the previous
CBC, Na, k+, crea
result

THERAPEUTICS:
- It is used to treat
● Piptaz 2.25g TID
various hospital-
every 8 hrs
acquired and
ventilator-
associated
pneumonia.

● Furosemide - It's used to treat

high blood pressure
(hypertension),
heart failure and a
build up of fluid in
the body (oedema).

● CaCo3 tab TID - used as an antacid

or as a calcium
supplement

- Sodium bicarbonate
● NaHcO3 tab TID
is a very quick-
 acting antacid. It
should be used only
for temporary relief.

- to treat high blood

● Amlodipine 10 mg 1
pressure and certain
tab
types of angina
(chest pain) and
coronary artery
disease.

● NAC 600 mg 1 tab - Acetylcysteine is

used in the
treatment of airway
diseases such as
bronchitis.

● Chlorhexidine - It helps to reduce

gargle TID the inflammation
(redness) and
swelling of your
gums and to reduce
gum bleeding.

- help treat pain and

● Paracetamol 300 reduce a high
mg TID every 4hr, temperature (fever).
PRN for pain

➢ Maintain for - To help patients

mechanical keep airways open,
ventilation deliver oxygen and
remove carbon
dioxide.

➢ Monitor VS every hr - To assess patient’s

wellbeing

➢ Monitor I&O every - Ensure that the

shift patient has proper
intake of fluid and
other nutrients and
 to determine
adequate output of
urine as well as
normal defecation.
➢ Refer
- For further
monitoring and
evaluation.

11/25/24 ➢ Start IVF: PNSS 1L - For replacement of

40cc/hr fluid and electrolytes
10:45 AM
➢ May have repeat - To assess changes
CBC, Na, k+, crea
pm 10/23/2023
- For further
➢ Facilitate HD as
monitoring
ordered

➢ Refer

11/25/2024 ➢ PNSS 1L x 40 cc/hr - For fluid and

electrolytes
8:40 PM
➢ Continue oral - To provide adequate
VS: nourishment to help
feeding
and not to hinder
BP: 130/70
HR: 97 restoration of health.
RR: 23
T: 63.6 - To alleviate the
02: 97% ➢ Continue present signs and symptoms
medication of the patient's
condition

- To monitor well
being and status
➢ Monitor VS every hr
and record - Ensure that the
patient has proper
➢ Monitor I&O every intake of fluid and
shift
 other nutrients and
to determine
adequate output of
urine as well as
normal defecation.
- For further
➢ Refer monitoring and
evaluation.

DATE AND TIME DOCTOR’S ORDER INTERVENTION

DAY 7 (11/26/2024) ➢ PNSS 1L + 50 meqs - For management of
dehydration and
9:22 AM replacement of
fluids and
VS: electrolytes.
BP: 130/70
- Help patients from
HR: 98 ➢ NacL x 40ml/hr
RR: 19 becoming
T: 63.6 dehydrated
02: 97%
- To provide adequate
➢ Continue oral
nourishment to help
feeding
and not to hinder
restoration of health.

- For assessment
➢ To repeat serum Na
tomorrow
- For review and see
changes from
➢ Awaiting blood cs
previous result
result
- To alleviate signs
and symptoms of
➢ Continue present
the patient’s
medications
conditions

➢ Maintain on
 mechanical - To help patients
ventilation setting as keep airways open,
pre ordered deliver oxygen and
remove carbon
dioxide.
➢ Monitor VS every
hour and record - To monitor well
being and status
➢ Monitor I&O q shift
- Ensure that the
patient has proper
intake of fluid and
other nutrients and
to determine
adequate output of
urine as well as
normal defecation.
➢ Refer
- For further
monitoring and
evaluation.

4:00 PM ➢ For ABG - measures the

balance of oxygen
and carbon dioxide
in your blood to see
how well your lungs
are working.
➢ For CXR
- to evaluate the
lungs, heart and
chest wall and may
be used to help
diagnose shortness
of breath, persistent
cough, fever, chest
pain or injury.

5:03 PM ➢ Maintain mechanical - To help patients

ventilation settings keeps airway open,
deliver oxygen and
 remove carbon
dioxide.
➢ Suctions secretions - To maintain patent
as needed airway and improve
oxygenation by
removing mucous
secretions and
foreign materials
from the mouth and
throat.

➢ Monitor VS q hr and - To monitor well

record being and status

- Ensure that the

➢ Monitor I&O q shift
patient has proper
intake of fluid and
other nutrients and
also to determine
adequate output of
urine as well as
normal defecation

➢ WOF: untoward s/sx - To alleviate

➢ Refer - For further

monitoring and
evaluation.

7:20 PM ➢ Continue IVF - For management of

dehydration and
replacement of
fluids and
electrolytes.

➢ Reduce FI02 to 10% - to maintain o2 sat

every hour until it increase 94%
become 50%

- To alleviate the
➢ Continue present signs and symptoms
medications of patents
conditions
➢ Monitor VS q hr and - To monitor well
record being and status

- Ensure that the

➢ Monitor I&O q shift
patient has proper
intake of fluid and
other nutrients and
also to determine
adequate output of
urine as well as
normal defecation

- Helps keeps blood

➢ Bed turning every
flowing and to
q2hr prevents bedsores

- For further
➢ Refer monitoring and
evaluation.
VIII. Pathophysiology
Pre-Renal Cause Intra-Renal Cause Post-Renal Cause Other Causes
-Heart Failure -Glomerulonephritis -Benign Prostatic Hyperplasia -Smoking
-Hemorrhage -Tubular necrosis -Renal Stones -Obesity
-Hypertension -Tumor -Old age

Activation of RAAS Sodium Retention Tubular Injury

Tubular
Increased Oxygen Consumption
Fibrosis

Tissue Hypoxia
Hyperglycemia

Increased Renal Blood flow

Glomerular Hyperfiltration

Increased glomerular permeability

Proteinuria Progressive Glomerular and

tubulointerstitial Damage

Decreased GFR Increased BUN & CREA

Decreased Urine output

Systemic Complications
• Anemia
• Edema
IX. Drug Study

Drug Name Classification Indication Contraindication Nursing Responsibilities

Sodium Alkalinizing To slow progression contraindicated -Monitor vital signs and
Carbonate Agents of CKD, making in those with laboratory results.
blood or urine less signs/symptoms
-Be cautious on giving
acidic or laboratory
sodium carbonate. Rapid
values indicating
administration of sodium
underlying
bicarbonate may increase
metabolic or
intravascular fluid volume,
respiratory
leading to acute pulmonary
alkalosis due to
edema.
the potential for
exacerbation of
symptoms.

Drug Classification Indication Contraindication Nursing Responsibilities

Name

Ferrous oral iron increases contraindicated -Monitor for signs of

Sulfate bivalent circulating iron when you have a constipation. Make sure
preparations stores and different type of patient is well hydrated.
hemoglobin anemia that is not
-Administer before feeds to
caused by low
maximize absorption.
levels of iron or
have any other
conditions that
affect your iron
levels, such as
haemochromatosis
or haemosiderosis.

Drug Name Classification Indication Contraindication Nursing Responsibilities

Amlodipine calcium To reduce blood contraindicated -Assess your patient for signs
channel pressure in patients with of CHF and angina
blockers cardiogenic
-Monitor your patient's
shock, severe
blood pressure and pulse.
aortic stenosis,
unstable angina,
severe
hypotension,
and heart failure
 Drug Name Classification Indication Contraindication Nursing Responsibilities
Piptaz penicillins and for the treatment contraindicated -Watch for seizures; notify
(Piperacillin and beta- of nosocomial in patients with physician immediately if
tazobactam) lactamase pneumonia a history of patient develops or
inhibitors (moderate to allergic reactions increases seizure activity.
severe) caused by to any of the -Monitor signs of
beta-lactamase penicillins pseudomembranous
producing isolates and/or colitis, including diarrhea,
of Staphylococcus cephalosporins abdominal pain, fever, pus
aureus or β-lactamase or mucus in stools, and
inhibitors other severe or prolonged
GI problems (nausea,
vomiting, heartburn).
Notify physician or nursing
staff immediately of these
signs.
-Monitor signs of allergic
reactions and anaphylaxis,
including pulmonary
symptoms (tightness in
the throat and chest,
wheezing, cough dyspnea)
or skin reactions (rash,
pruritus). Notify physician
or nursing staff
immediately if these
reactions occur.
-Assess muscle aches and
joint pain (arthralgia) that
may be caused by serum
sickness. Notify physician f
this occurs.
 Drug Classification Indication Contraindication Nursing Responsibilities
Name

Diazepam benzodiazepines To treat episodes contraindicated - Assess blood pressure,

of increased in patients with pulse and respiration if IV
seizures alcohol administration.
intoxication and
- Provide frequent sips of
severe
water for dry mouth.
respiratory
depression -Provide fluids and fiber for
constipation.

Drug Name Classification Indication Contraindication Nursing Responsibilities

Ceftriaxone Cephalosporin For the treatment contraindicated – monitor patient for signs
antibiotic of anaerobic in patients with and symptoms of
organisms of known superinfection
susceptible strains hypersensitivity
– Do not mix ceftriaxone
causing pneumonia to ceftriaxone
with other antimicrobial
drug

– Discontinue if
hypersensitivity occurs

Drug Name Classification Indication Contraindication Nursing Responsibilities

Furosemide Loop Diuretics to treat high blood Contraindicated -Assess fluid status. Monitor
pressure to patients with daily weight, intake and
hypoalbuminemia output ratios, amount and
comorbid location of edema, lung
illnesses sounds, skin turgor, and
mucous membranes.

-Notify health care

professional if thirst, dry
mouth, lethargy, weakness,
hypotension, or oliguria
occurs.

-Monitor BP before and

during administration.
 Drug Name Classification Indication Contraindication Nursing Responsibilities
Azithromycin Macrolide to manage and contraindicated -Instruct patient not to take
antibiotics treat various in patients with azithromycin with food or
bacterial infections a history of antacids. May cause
like pneumonia severe drowsiness and dizziness.
hypersensitivity
-Caution patient to avoid
driving or other activities
requiring alertness until
response to medication is
known.

-Advise patient to use

sunscreen and protective
clothing to prevent
photosensitivity reactions.

Drug Classification Indication Contraindication Nursing Responsibilities

Name

Regular short-acting indicated to contraindicated -Gently rotate the vial

Insulin insulin improve glycemic in patients with containing the agent and
control a history of avoid vigorous shaking to
allergy to insulin ensure uniform suspension
and in patients of insulin.
with insulinoma.
-Rotate injection sites to
avoid damage to muscles
and to prevent subcutaneous
atrophy.
X. Nursing Care Plan

XI. DISCHARGE PLANNING

MEDICATION/
S
Instruct the client’s significant other to continue with follow-up medical care
and describe the importance of regularly taking prescribed medications. In
addition, give thorough instructions on the benefits of the medications, as
prescribed by the doctor.

SUPPORTIVE CARE AND SAFETY

PRECAUTIONS

➢ Assess the level of understanding of the patient’s significant other related to the
diagnosis of seizures, and seizure precautions.
➢ Continue Home Medications
➢ Follow-up check up
➢ Provide information about the illness, its treatment, and methods of
preventing its progression
➢ Ensure safety environment
➢ Monitor vital sign and neuro assessment
➢ Never leave the patient alone to prevent any fall injury due to seizure.
➢ Asepsis: Promote simple home infection control procedures.
➢ Encourage to maintain the personal hygiene of the patient.
➢ Encourage the client to have some vaccines to prevent some bacterial
and viral infections

DIET and
LIFESTYLE

➢ Avoid flashy lights

➢ Consume safe, clean, and healthy foods.
➢ Never skip any medications unless advised to do so.
➢ Advise the patient to get enough sleep.

SPIRITUAL

Encourage the sufferer to turn to God for spiritual, emotional, and physical strength.
Encourage them to be more devoted to God in order to establish a solid foundation
and provide them with the strength to deal with difficulties. And encourage them to
believe that God is all they need when tough times arise.