CHAPTER I

INTRODUCTION

Chronic kidney disease (CKD) is a complex disease which affects approximately

13% of the world’s population. Over time, CKD can cause renal dysfunction and

progression to end-stage kidney disease and cardiovascular disease. Complications

associated with CKD may contribute to the acceleration of disease progression and the

risk of cardiovascular-related morbidities. Early CKD is asymptomatic, and symptoms

only present at later stages when complications of the disease arise, such as a decline in

kidney function and the presence of other comorbidities associated with the disease. In

advanced stages of the disease, when kidney function is significantly impaired, patients

can only be treated with dialysis or a transplant. With limited treatment options available,

an increasing prevalence of both the elderly population and comorbidities associated with

the disease, the prevalence of CKD is set to rise (Evans, et. al, 2021).

More than 500,000 people in the United States live with end-stage renal disease

(ESRD). The development of chronic kidney disease (CKD) and its progression to this

terminal disease remains a significant cause of reduced quality of life and premature

mortality. Chronic kidney disease (CKD) is a debilitating disease, and standards of

medical care involve aggressive monitoring for signs of disease progression and early

referral to specialists for dialysis or possible renal transplant. The Kidney Disease

Improving Global Outcomes (KDIGO) foundation guidelines define CKD using kidney

damage markers, specifically markers that determine proteinuria and glomerular filtration

rate. By definition, the presence of both factors (glomerular filtration rate [GFR] less than

60 mL/min and albumin greater than 30 mg per gram of creatinine) along with

1
abnormalities of kidney structure or function for greater than three months signifies

chronic kidney disease. End-stage renal disease is defined as a GFR of less than 15

mL/min (Hashmi, 2023).

In the Philippines, its prevalence is 35.94%, which is much higher than estimated

global rates. Aside from its contribution to mortality, the growing burden of CKD is also

illustrated by its associated financial costs. Locally, 94% of end stage renal disease

(ESRD) patients are undergoing center-based hemodialysis (HD), 4% are on peritoneal

dialysis (PD) and only 2% had kidney transplantation (KT). Despite KT being the gold

standard treatment for ESRD, HD is still preferred by most Filipino patients due to

transplant costs, low organ donations, lack of capable infrastructures, and long-term

immunosuppression therapy (Pajimna, 2023).

In Davao Region, the cases of end-stage renal disease (ESRD) leading to chronic

kidney disease (CKD) and requiring dialysis have increased each year. Dr. Alrick

Escudero, a nephrologist and member of the Philippine Society of Nephrology Mindanao

Chapter, said CKD is a global public health concern with a prevalence of 9.1 to 13.4

percent of the population worldwide. In the Davao region, there are around 2,400

patients, with an approximate increase of 12-15 percent per year. Locally, 94 percent of

end-stage renal disease (ESRD) patients undergo hemodialysis, four percent undergo

peritoneal dialysis, and only two percent have received kidney transplants (Palicte, 2024).

We, the BSN 4A Group 1 chose this study to understand the growing cases of

end-stage renal disease (ESRD) secondary to hypertension nephrosclerosis. This study

aims to raise awareness & explore ways to improve care for patients with chronic kidney

diseases.

2
 CHAPTER II

OBJECTIVES

General Objectives

The BSN 4A Group 1 conducts a comprehensive case study on End-Stage Renal

Disease (ESRD) to deepen understanding of the disease’s pathophysiology, progression

and impact on patient’s quality of life. The group aims to identify key contributing factors

and evaluate the effectiveness of various treatment modalities in managing symptoms of

ESRD and improving long-term outcomes.

Specific Objectives

Specifically, the group aims to:

1. define the specific disease (End-stage renal disease) with global, national and

local statistics to highlight its significance;

2. gather the patient’s profile, medical history and current functional abilities;

3. briefly explain the structure and function primarily of the Urinary System to

understand how it relates to the disease and underlying conditions;

4. explain how End-stage renal disease progress;

5. organize and present the relevant data gathered from the case study;

6. identify nursing diagnoses based on the patient’s condition and develop

individualized care plans to address them;

7. apply appropriate nursing interventions informed by disease knowledge and

relevant theories;

8. understand the role of medications in managing the patient’s specific diagnosis;

3
9. briefly discuss the actual outcome of the treatment based on observations of the

patient’s progress;

10. provide suggestions for the patient, family and nurse, and;

11. list all sources (academic journals and online resources) used in the case study.

4
 CHAPTER III

ASSESSMENT

A. PATIENT’S PROFILE

Name : Patient E

Address: : Almendras District, Padada Davao del Sur

Date of Birth : December 01, 1973

Age : 50 years old

Gender : Male

Height : 159cm

Weight : 52.5 kls

Citizenship : Filipino

Religion : Roman Catholic

Diagnosis : End-Stage Renal Disease Secondary To

Hypertension Nephrosclerosis

Occupation : N/A

Physician: : Dr. Emmie Joy G. Llanos

5
 COMPREHENSIVE ASSESSMENT

A. Personal Data

Name : Patient E

Age : 50 years old

Religion : Roman Catholic

Address : Almendras District, Padada Davao del Sur

Occupation : N/A

Physician : Dr. Emmie Joy G. Llanos

Diagnosis : End-Stage Renal Disease Secondary to Hypertension

Nephrosclerosis

B. Family Background

Patient E lives in a half-concrete housing in Almendras District, Padada, Davao

del Sur with his wife and 2 children. His wife is a micro-finance collector with a monthly

income of 20,000 pesos and has a health history of high blood pressure, she also

developed myoma and underwent surgery twice in 2014 and 2015. His two children are

both college graduates and are currently applying for jobs, and both of them are healthy.

His parents, along with the patient’s youngest brother, are healthy and currently living in

Hawaii. Patient E is the second of six siblings, with five brothers and one sister. His

younger sister died last 2018 due to dialysis complications, which caused her dialysis

access site to rupture. His youngest brother in Hawaii financially supported the client by

giving 20,000 pesos per month for the dialysis treatment and medical expenses.

6
C. Effects/expectation of illness towards family and self

The client’s initiation of dialysis started on August 27, 2015. His family

experienced stress and exhaustion due to responsibilities and concerns about the patient’s

treatment that may need to help with medication management, dialysis appointment, and

medical expenses. The client also states that he feels self-conscious sometimes because

his skin is getting darker and he gets sick more easily.

D. History of Past Illness

As per the client’s insight, his condition was developed due to his unhealthy

lifestyle, in which he prefers to eat salty foods and not eating nutritious foods, he likes to

drink liquor 4-7 bottles in a week and approximately half a pack of cigarettes daily. The

client also has hypertension since he was 35 years old and has a maintenance medication

of Losartan but the client doesn’t take the medication seriously.

E. History of Present Condition

According to the client, in 2014 he sought medical attention and was taken to the

Intensive Care Unit because he experienced nausea, vomiting, decreased urination, and

fatigue. The physician diagnosed the client with kidney failure and advised the client to

return in the Philippines because he could no longer work and needed to take care of his

illness since he was a factory worker at a company that manufactures ambulance in

Dubai. Upon returning to the Philippines, the client-initiated dialysis treatment in

Southern Philippines Medical Center. After several dialysis sessions, his right arm

dialysis access notably enlarged, which led to a surgical operation at Davao Doctor's

Hospital in 2015. In August 2024, the client shifted from the left femoral site to an

7
Internal Jugular (IJ) catheter on right side because the left femoral is not patent and it

only takes 5 dialysis sessions.

The patient was referred from SPMC to Gonzales Hospital to change their access

site to an intrajugular site because other sites were no longer usable for dialysis. At

Gonzales Hospital, a new access site was inserted, allowing the patient to continue

dialysis sessions. The transfer was also made because Gonzales Hospital is closer to the

patient’s home, making it easier and less tiring to travel and having a nearby facility is

more convenient and comfortable for their ongoing treatment.

8
 FUNCTIONAL PATTERN

Table I. Functional Pattern

DAY 1
GUIDELINES PATIENT’S NORMAL PATTERN
(September 3, 2024)
I. Mental Status

a. A. State of mental consciousness Alert, awake, and responsive Patient is alert, awake and responsive

b. B. Orientation Oriented to time, date, and place Patient is oriented to time, date, and place.

Can understand and answer questions

c. C. Intellectual capacity Patient can answer questions correctly.
properly

d. D. Vocabulary level Able to speak local dialect. Patient can speak local dialect.
Patient can focus and is attentive to the
e. E. Attention span Focus and attentive student nurse, and attention span lasts for
minutes.
Can understand basic medical information,
Patient can understand basic medical
f. F. Ability to understand follow instructions, and ask relevant
information, and follow instructions.
questions to clarify information.
II. Status of Spatial Senses

g. A. Audio Perception Can hear audibly and clearly Patient can hear audibly and clearly.

Pupils are equal, round, reactive to light and Pupils are equal, round, reactive to light and
h. B. Visual Perception
accommodation. accommodation.

9
 Patient can speak clearly, no slurred speech,
i. C. Speech Perception Can speak clearly
and unclear words.
Patient can sense pain, light touches and
j. D. Tactile Perception Can feel pressure, light touches and vibration
vibration.
Patient can differentiate bad odor and
k. E. Olfactory Perception Can smell properly
fragrance
III. Motor Ability
Patient can stand, and sit with assistance and
l. A. Current Mobility Can walk and sit without assistance
went home per wheelchair
Patient have a habit of slouching while
m. B. Posture Good posture and spinal curvature
sitting, kyphosis present.
Patient can extend arms and legs and move
n. C. Range of joint movement Normal upper and lower extremities with limitations. Normal active range of
motion
o. D. Muscle and nerve status Can move facial and eye muscles. Patient can move facial and eye muscles.

p. E. Loss of Extremities None None

IV. Body Temperature

q. A. Ranges 36.8℃ - 36.9 ℃ 8 am: 35.3℃

V. Respiratory Status

Crackles noted when the patient inhales with

r. A. Character No abnormalities or any adventitious sounds respiratory rate of 23 cycles per minute and
an O2 saturation of 99% with O2 inhalation.

10
s. B. Use of Respiratory Aid None With O2 inhalation @2LPM

t. C. Interfaces w/ Respiration's None None

u. D. Abnormal Respiratory Opening None None

VI. Circulatory Status

v. A. Characteristic of Arterial Pulse Strong and palpable Strong and palpable

w. B. Blood Pressure 120/80 mmHg 180/90 mmHg

x. C. Apical Radial Pulse 60-100bpm 83bpm

y. D. Intravenous Fluids PNSS Regulated @ prescribed rate N/A

VII. Nutritional Status

z. A. Condition of Buccal Activity Intact able to chew, swallow and drink Patient can swallow effectively

Patient is able to digest food properly with

aa. B. Digestion foods Normal, With proper digestion
normal bowel movement.
VIII. Elimination Status

bb. A. Bowel Normal Bowel Normal stool Consistency

Patient can produce only a small amount of

cc. B. Bladder Able to urinate
urine due to renal disease.

11
dd. C. Abnormalities None None

IX. Female Reproductive Status

ee. A. Age of Menarche N/A N/A

ff. B. Pregnancy N/A N/A

gg. C. Vagina N/A N/A

hh. D. Cervix N/A N/A

ii. E. Vaginal Discharge N/A N/A

jj. F. Last Menstrual Period N/A N/A

X. Male Reproductive Status

Can produce fluid for semen, supports
kk. A. Prostate Gland ejaculation, and helps control urine flow, all N/A
regulated by hormones.
XI. States of Skin and Appendages
Presence of necrosis at the old site of
No presence of lesion, rashes and
hemodialysis at the right arm and skin is
A. Skin discoloration such as redness, with good skin
darker than the previous years due to
turgor.
hemodialysis, with good skin turgor
Hair color is black, scalp intact, shiny no sign With minimal amount of grayish to whitish
B. Hair
of dandruff. hair due to age, scalp is intact.

12
 Normal curvature and color with good Intact nails with good capillary refill of 2
C. Nails
capillary refill. seconds.
XII. State of Physical arrest and Comfort

A. Sleep/ Rest Pattern 8 hours of undisturbed sleep Patient states that he is getting enough sleep.

B. Presence of Pain/ Discomfort None None

C. Use of Supportive Aids None None

XIII. Emotional Status

Patient feels anxious about his current health

A. Emotional status condition because he has expressed concerns
about being more susceptible to illnesses.

He has a negative self-image and

dissatisfaction with his body due to his skin
B. Body Image Good/Normal being darker than in previous years and the
prominent veins in his arms from
hemodialysis.
Patient have a good communication and
C. Ability to Relate others
relationship with his family.

13
 CHAPTER IV

ANATOMY AND PHYSIOLOGY

(Figure 1. Anatomy of the urinary system)

The urinary system, also known as the renal system, is essential for filtering

blood, removing waste products, and regulating the body's fluid and electrolyte balance.

Comprising the kidneys, ureters, bladder, and urethra, it begins with the kidneys, which

filter blood to produce urine by eliminating excess substances and toxins. This urine then

travels down the ureters to be stored in the bladder until it is expelled through the urethra.

In addition to waste elimination, the urinary system plays a vital role in maintaining

homeostasis by regulating blood pressure, electrolyte levels, and acid-base balance,

highlighting its importance in overall health.

Kidney

The kidney is a bean shaped organ. The outer surface of the kidney is covered by

renal capsule. The depression on medial side is hilum is the passage of nerves, blood

vessels, lymphatic vessels enter and exits. The kidney sectioned in a coronal plane to

study internal anatomy. The outer part of kidney known as renal cortex. The renal

14
medulla is deep to the cortex and is divided into renal columns and renal pyramid. Each

pyramid ends in the papilla and drips urine into small funnel shaped structure called

minor calyces. The minor calyces join to form major calyces takes urine to the renal

pelvis. The renal pelvis occupies most of the renal sinus, a space in the kidney. It takes

urine to the ureter.

Functions of kidney

The kidney is the major excretory and osmoregulatory organ in the human body

and has following functions:

• Removal of metabolic waste products

• Regulation of water contents in body fluids

• Regulation of pH of body fluids

• Regulation of chemical composition and substances

• It coverts vitamin D from supplements of the sun to the active form of

vitamin D that is needed by the body

• Kidney also secretes a hormone erythropoietin which stimulates

production of red blood cells from bone marrow.

(Figure 2. Anatomy of the kidney)

15
 MICROSCOPIC STRUCTURE OF KIDNEY:

Nephron

Contains about 1-2 million functional units, the nephron. The nephron is

essentially a tubule closed at one end and that joins a collecting duct at the other end. The

close or blind end is indented to form the cup - shaped glomerulus (Bowmen's capsule)

which almost completely encloses a network of tiny arterial capillaries. The glomerulus

resembles a coiled tuft and are shown in figure. It is about 3cm long. It has three parts:

• The proximal convoluted tubule

• The medullary loop

• The distal convoluted tubule

Function of nephron:

• Filtration of blood

• Reabsorption of necessary components

• Tubular secretions of ions

• Formation of urine

(Figure 3. Anatomy of the nephron)

16
 CHAPTER V

PATHOPHYSIOLOGY OF END STAGE RENAL DISEASE SECONDARY TO

HYPERTENSIVE NEPHROSCLEROSIS

This chapter will discuss the etiology of the disease as well as the factors that

contribute to the development of the disease. It will also explain the potential

management and the complications of the disease if not treated accordingly.

ETIOLOGY

PREDISPOSING PRESENT (/)

RATIONALE
FACTORS ABSENT (X)

According to (Hashmi et al., 2023)

Individuals aged 40 and older are
generally considered at higher risk for
developing End-Stage Renal Disease. This
Age (50 years old) ✔ age group experiences a more pronounced
decline in kidney function and is more
likely to have underlying health
conditions which increase the risk of
ESRD. Patient E is 50 years old.

According to (Hashmi et al., 2023) Men

are generally more affected by End-Stage
Renal Diseases than women. Biologically,
Sex (Male) ✔ hormonal differences may also play a role;
estrogen has protective effects on kidneys,
which can mitigate some risks associated
with kidney damage.

According to (Hugh et al, 2020) a family

history of conditions like diabetes or
hypertension, which are major causes of
ESRD, may also elevate individual risk
Family History ✔
due to shared genetic and environmental
factors. One of the patient’s sibling was
diagnosed with kidney illness and
underwent dialysis treatment.

17
PRECIPITATING PRESENT (/)
RATIONALE
FACTORS ABSENT (X)
According to (Choi et al., 2019) Tobacco
smoke contains harmful chemicals that
can contribute to endothelial dysfunction,
which impairs blood vessel function and
reduces blood flow to kidneys. This
Smoking vascular damage can lead to hypertension
✔ and nephrosclerosis, both of which are
major contributions to ESRD. The patient
started smoking during his teenage years
and can smoke half a pack of cigarette a
day.

According to (Pugh et al., 2019) Chronic

hypertension increases the pressure within
the glomeruli causing damage and
thickening of the blood vessels in the
Hypertension ✔ kidney which reduces blood flow and
oxygen delivery to renal tissues, impairing
kidney function and ultimately leading to
ESRD. Patient E was diagnosed with
Hypertension when he was 35 years old.

According to (Lin, 2018) Obesity

significantly increases the risk of ESRD
by directly affecting kidney function
Obesity X through increased filtration demands,
inflammation, and fatty infiltration. The
patient’s BMI is 20.9 which signifies a
normal weight.
According to (Habegger et al., 2024)
Diabetes Mellitus leads to ESRD by
causing chronic damage to the kidney’s
Diabetes Mellitus X
blood vessels, resulting in scarring,
reduced filtration, and progressive kidney
failure.

18
PATHOPHYSIOLOGY

PREDISPOSING FACTORS PRECIPITATING FACTORS

 Age (50 years old)  Sedentary Lifestyle
 Sex (Male)  Smoking (half pack per day)
 Genetics  Chronic Hypertension
 Family History  Non-Compliance to medication

Excess force on the

walls of the blood
vessels in the kidneys.

Narrowing and
thickening the small
arteries.

Afferent arterioles
become affected.

Reduced Blood Supply

(Ischemia)

Lack of oxygen causes death

to the kidney’s functional
cells

 Proteinuria
 Edema Glomerulosclerosis or  ↓ GFR
 Hypertension Nephrosclerosis  Oliguria
 Fatigue  Anemia

Glomerular filtration is
compromised, the tubular
structures are also damaged.

19
 Tubular Interstitial Fibrosis
& Tubular Atrophy

Progressive Nephrons Loss

Chronic Kidney Disease (CKD)

END-STAGE RENAL DISEASE

If NOT TREATED If TREATED

The condition can progressively Medical and nursing interventions;

worse, leading to serious  Blood Pressure Control
complications, primarily involving  Lifestyle Modifications
kidney failure and cardiovascular  Management of underlying
issues such as heart failure, condition
pericarditis, uremia, electrolyte  Anemia Management
imbalances, metabolic acidosis, and  Dialysis
bone disorders.  Kidney Transplant

Death Recovery &

Good Health Status

End-Stage Renal Disease (ESRD) caused by hypertensive nephrosclerosis

happens when long-term high blood pressure gradually damages the kidneys. The

kidneys have tiny blood vessels that filter the blood and maintain fluid balance, making

them sensitive to high blood pressure. Over time, high blood pressure causes the small

arteries in the kidneys to become thick and narrow, reducing blood flow (ischemia). This

20
lack of blood supply damages the glomeruli, leading to scarring and loss of function

called glomerulosclerosis or nephrosclerosis.

As more filtering units are damaged, the kidney's ability to filter blood decreases,

causing a drop in the glomerular filtration rate (GFR). Additionally, the tubules and

surrounding tissue become damaged and scarred (tubulointerstitial fibrosis), worsening

kidney function. The remaining functional kidney units try to compensate, but this

overwork leads to more damage. Eventually, the kidneys can no longer control blood

pressure, remove waste, or balance electrolytes, leading to chronic kidney disease (CKD)

and eventually ESRD. By this stage, the kidneys are significantly shrunken, scarred, and

unable to meet the body's needs.

At this point, patients require either dialysis or a kidney transplant to survive.

Diagnosis begins by identifying high blood pressure and signs of poor kidney function

through blood tests, urinalysis, imaging scans, and sometimes a kidney biopsy to confirm

nephrosclerosis. As the disease progresses, complications such as fluid overload, high

potassium, uremia, anemia, bone disease, and heart problems may arise. Treatment

involves controlling blood pressure with medications like ACE inhibitors or ARBs,

managing complications with specific drugs for anemia, hyperkalemia, and bone disease,

and initiating dialysis when the kidneys fail. A kidney transplant is the most effective

long-term solution but depends on donor availability and the patient's overall health.

Nurses play a critical role in monitoring the patient’s condition, educating them

on dietary restrictions, administering medications, and providing emotional support.

While dialysis is life-saving, it greatly affects the patient’s lifestyle, and transplantation

offers the best chance for recovery. Early intervention and aggressive blood pressure

21
management are crucial to slowing the progression of nephrosclerosis and improving

outcomes for patients with ESRD.

22
 CHAPTER VI

MEDICAL MANAGEMENT

A. Diagnosis: End – Stage Renal Disease Secondary to Hypertension Nephrosclerosis

B. Diagnostic / Laboratory Confirmatory Test

Table 5: Laboratory Examination

LABORATORY EXAM RESULTS RATIONALE
Clinical Chemistry
Gonzales Maranan Medical Center, Inc October 4, 2024
RBC 3.46
Hemoglobin 10.5 Essential to assess overall blood
health, detect anemia, and monitor
Hematocrit 31.4
immune response and clotting
WBC 6.94 function.
Platelet Count 201
November 1, 2023
RBC 3.51
Hemoglobin 9.8 Essential to assess overall blood
health, detect anemia, and monitor
Hematocrit 30.5
immune response and clotting
WBC 6.61 function.
Platelet Count 287
January 1, 2024
RBC 4.04
Hemoglobin 12.1 Essential to assess overall blood
health, detect anemia, and monitor
Hematocrit 35.9
immune response and clotting
WBC 6.40 function.
Platelet Count 212
February 3, 2024
RBC 3.52 Essential to assess overall blood
Hemoglobin 10.2 health, detect anemia, and monitor

23
 Hematocrit 31.3 immune response and clotting
WBC 4.18 function.

Platelet Count -
April 3, 2024
RBC 3.67
Hemoglobin 10.8 Essential to assess overall blood
health, detect anemia, and monitor
Hematocrit 32
immune response and clotting
WBC 6.34 function.
Platelet Count 188
June 6, 2024
RBC 3.48
Hemoglobin 9.8 Essential to assess overall blood
health, detect anemia, and monitor
Hematocrit 29.9
immune response and clotting
WBC 5.11 function.
Platelet Count 137
July 2, 2024
RBC 3.55
Hemoglobin 10.1 Essential to assess overall blood
health, detect anemia, and monitor
Hematocrit 30.2
immune response and clotting
WBC 8.39 function.
Platelet Count 139
August 1, 2024
RBC 3.03
Hemoglobin 8.7 Essential to assess overall blood
health, detect anemia, and monitor
Hematocrit 26.9
immune response and clotting
WBC 5.98 function.
Platelet Count 199

24
 Laboratory Exam Result Range Rationale
Renal Function Test
Davao Doctor’s Hospital August 13,
2015
Estimated Glomerular 12 ml/min 90 ml/min eGFR measures kidney
Filtration Rate function the estimates
how efficiently the
kidneys filter waste and
excess fluid from blood.
Blood Urea Nitrogen 20.4 mmol/L 2.5 – 7.1 BUN reflects nitrogen
mmol/L waste in the blood.
Elevated levels suggest
reduced kidney function.
Serum Creatinine 4.6 mg/dl 0.7 – 1.3 mg/dl Elevated creatinine levels
suggest impaired
filtration, helping
diagnose and monitor the
progression of CKD and
ESRD.
Serum Potassium 7.1 mEq/L 3.5 – 5.0 mEq/L Essential electrolyte
regulated by the kidneys,
crucial for maintaining
proper nerve, muscle, and
cardiac funcytion.

25
Table 6: Diagnostic Examination

TEST RESULT RATIONALE/DEFINITION

Chest X-Ray
Gonzales Maranan Medical Center, Inc. December 28, 2023

A chest X-ray in the posterior- anterior

(PA) view involves the X- ray beam
Cardiomegaly, passing from the back (posterior) to the
suggestive pulmonary front (anterior) of the chest. This
Posterior –
congestion. Extensive positioning provides a clearer and more
Anterior X-Ray
atherosclerosis of the accurate image of the heart, lungs, and
aorta. chest structures because the heart is
closer to the film, reducing magnification
and distortion.

C. Doctor’s Order
Table 7: Doctors Order
Progress Note Doctor’s Order Clinical Significance
7/10/24
New access femoral (L)
Attempted insertion in
intrajugular (N)
7/ 12/2024
 Elevate affected arm  To promote proper blood
Recently discharge from with 1 pillow during circulation.
admission for AVF hours of sleep.
condemn
 For compliance of co-  To prevent infection
amoxiclav as prescribed
by Dr. Crisostomo.
8/3/2024
 Helps stimulate red
 Erythropoietin 3x a week
blood cell production.

26
 DRUG STUDY NO. 1

Date/ Generic Route/ Drug Adverse Precautions/ Nursing

Action Indication
Time Name Dosage Interaction Effects Contraindications Responsibility
8/27/15 Sodium Sodium Prescribed for 2 Tabs Some products Metabolic Should not be used Monitor vital signs
carbonate Carbonate is people that may alkalosis, to patients with and notify the
the disodium with kidney TID interact with hypersensitivity, physician of
Fluids and salt of disease who this drug Headache, metabolic or abnormalities.
Electrolytes PO
carbonic acid develop are: aspirin and Muscle pain respiratory
with metabolic other salicylates alkalosis, Obtain patient
and twitching, history (drug history
alkalinizing acidosis, or a (such as hypocalcemia,
property. As a buildup of too salsalate), Nausea or excessive chloride and any
strong base, much acid in corticosteroids vomiting. (Cl-) loss from hypersensitivity).
sodium the body. Help (such as Bradypnea., vomiting or GI Monitor fluid
hydroxide reduce acid prednisone), Nervousness suctioning and balance (input-
neutralizes levels in the memantine, Unpleasant patients at risk of output ratio, weight,
gastric acid body, restore medications taste and developing edema).
thereby acting pH balance, with a special diuretic-induced
as an antacid. and potentially coating to Increased hypochloremic Monitor
slow the protect the frequency of alkalosis. manifestations of
progression of stomach urination hypokalemia and
CKD (enteric hyponatremia
coating). Report any
symptoms such as
nausea, vomiting
and anorexia.

27
 DRUG STUDY NO. 2

Date/ Generic Action Indication Route/ Drug Adverse effects Precautions/ Nursing
Time Name Dosage interaction Contraindications Responsibility
8/27/1 Ferrous Iron is Used for the 1 Tab This product Stomach upset Should not be used Obtain a thorough
5 Sulfate required to prevention and can decrease or cramps, who have a known patient history to
maintain treatment of TID the absorption Constipation, allergy or determine if the
optimal iron deficiency of other drugs Diarrhea, hypersensitivity to patient has any
health, anemia PO such as Nausea or iron supplements allergies or
Brand
particularly bisphosphonate vomiting contraindications to
Name:
for helping to s (for example, Individuals with ferrous sulfate
Feosol
form red alendronate), thalassemia, a
blood cells levodopa, genetic blood Assess the
(RBC) that penicillamine, disorder that patient's current
carry oxygen quinolone affects the iron status and
Classificati around the antibiotics (for production of laboratory results
on: body. A example, hemoglobin
Anti- deficiency in ciprofloxacin, Check the patient's
anemic iron indicates levofloxacin), May cause or blood pressure,
that the body thyroid worsen pulse, and other
cannot medications gastrointestinal vital signs
produce (for example, disorders such as
enough levothyroxine), inflammatory Explain to the
normal red and bowel disease patient the purpose
blood cells tetracycline of the medication,
antibiotics (for the dosage, and
example, potential side
doxycycline, effects
minocycline).

28
 DRUG STUDY NO. 3

Date/ Generic Route/ Drug Precautions/ Nursing

Action Indication Adverse effects
Time Name Dosage interaction Contraindications Responsibility
8/27/1 Essential for Nutritional 500 mg Some products Constipation, Allergy to Assess B/P, ECG
5 Calcium function, supplement or that may headache, dry calcium; renal and cardiac rhythm,
Bicarbonate integrity of to treat 1 tab interact with mouth, calculi, renal function,
nervous, hypocalcemia. this drug increased thirst, hypercalcemia, serum magnesium,
muscular, TID include: irritability, ventricular phosphate, calcium,
skeletal digoxin, decreased fibrillation during ionized calcium
systems. Plays PO certain appetite, cardiac
Generic an important phosphate metallic taste, resuscitation and Monitor serum
Name: role in normal binders (such fatigue, patients with the BMP, calcium,
Caltrate cardiac/renal as calcium weakness, risk of digitalis ionized calcium,
Plus function, acetate), depression toxicity. magnesium,
respiration, phosphate phosphate; B/P,
blood supplements cardiac rhythm,
coagulation, (such as renal function
Classificatio cell sulfonate.
n: membrane Calcium Do not take within
and capillary carbonate can 1–2 hours of other
Antacid permeability. decrease the oral medications,
Assists in absorption of fiber-containing
regulating other drugs. food
release
neurotransmitt
ers.
Neutralizes/re
d es gastric
acid
(increases
pH).

29
 DRUG STUDY NO. 4
Date/ Generic Action Indication Route/ Drug Adverse effects Precautions/ Nursing
Time Name Dosage interaction Contraindications Responsibility
8/27/15 Clonidine Stimulates Hypertension 150 mg Catapres may Feeling sleepy, Should not be used Monitor blood
alpha-adreno interact with tired and weak, in patients with pressure and pulse
receptors in 1 Tab other drugs Feeling dizzy or known rate frequently.
the brain that make you faint when you hypersensitivity to Dosage is usually
stem. This BID sleepy or slow stand up, Dry the active adjusted to the
action results your mouth, ingredient or other patient’s blood
Brand in reduced PO breathing Constipation, components of the pressure and can
Name: sympathetic (sleeping Erection product, and in cause hypotension,
Catapres outflow from pills, or problems patients with bradycardia, and
the central seizures), (erectile severe sedation.
nervous clonidine dysfunction or bradyarrhythmia Patients should be
system and in transdermal impotence) resulting from taught the
decreases in skin patches, Headaches. either sick sinus importance of
Classificat peripheral digoxin, syndrome or AV adhering to the
ion: resistance, digitalis, blocks of 2nd or same dosing
Central renal vascular antidepressant 3rd degree. schedule each day.
alpha resistance, s, beta-
agonists heart rate, and blockers, Patients may
blood heart or blood experience
pressure. pressure orthostatic blood
medicines pressure changes
and should be
cautioned against
the use of alcohol
while taking this
medication.

30
 DRUG STUDY NO. 5
Date/ Generic Name Action Indication Route/ Drug Adverse Precautions/ Nursing
Time Dosage interaction effects Contraindications Responsibility
8/27/15 Epoetin Alfa Stimulates the To treat 4000 Vitamin C Hypertension, Uncontrolled Assess for signs
differentiation anemia in increases iron arthralgia, hypertension. of adverse effects
and proliferation patients SA utilization and injection site Pure red cell
of erythroid with may lead to a pain, headache, aplasia. Monitor blood
precursors, chronic 2x a more nausea, Severe allergic pressure daily
release of kidney significant vomiting, reactions to epoetin
Generic Name: reticulocytes disease week increase in cough, and alfa. Monitor
Eposino into the (CKD) hemoglobin fever. hematology
circulation and who may levels when weekly
synthesis of be on combined Rare but more
cellular Hb thus dialysis. with epoetin serious adverse Observe for
regulating alfa. effects include localized
erythropoiesis. severe allergic cellulitis
Classification: reactions,
Erythropoiesis- anaphylaxis, Document
stimulating and severe injection site on
agents (ESAs). cutaneous drug chart and
reactions such rotate injection
as Stevens- sites
Johnson
Syndrome.

31
 NURSING CARE PLAN NO. 1
DATE/ CUES/ NURSING SCIENTIFC GOALS/ NURSING RATIONALE EVALUATION
TIME DATA DIAGNOSIS BASIS OBJECTIVE/ INTERVENTION
CRITERIA
9/3/202 Subjective: Impaired Gas Pulmonary After 2 hours of Independent: Goal met.
4 “Naga- exchange congestion nursing 1.Assess respiratory rate, -Early detection After 2 hours of
oxygen ko related to in patients intervention, depth, rhythm, and effort prevents nursing
sir kay pulmonary with end- patient will frequently. complications. intervention,
maglisud congestion as stage renal demonstrate patient
ko’g evidenced by disease is improved gas 2. Ensure the patient receives -Improves gas demonstrated
ginhawa Chest X-ray often due to exchange as adequate oxygen therapy. exchange and improved gas
pareha showing fluid evidenced by: alleviates exchange as
karon” as pulmonary overload, hypoxia. evidenced by:
verbalized congestion which can a. Normal 3. Encourage the patient to sit -Reduces a. respirato
by the lead to respiratory upright or lean forward to congestion and ry rate
patient. increased rate within facilitate optimal lung improves gas 23 cycles
Objective: hydrostatic 12-20 expansion. exchange. per
(+) pressure in cycles per minute.
pulmonary the minute. 4. Teach the patient deep -Open lungs and b. Oxygen
congestion pulmonary b. Oxygen breathing exercises. improve gas saturatio
(+) capillaries, saturation exchange. n ≥99%
cardiomegal causing fluid ≥95% in 5. Monitor for changes in -Affected by in room
y to leak into room respiratory status. various factors temperat
(+) dyspnea the temperature and may change ure.
RR: 22 interstitial . over time. c. Absence
-With spaces of the c. Absence of of
oxygen lungs. This dyspnea. 6.Carefully monitor the -Prevents dyspnea.
therapy in can impair patient's fluid intake and congestion and
use 2lmp gas exchange output. worsens gas
by reducing exchange.
the surface
area 7. Assess for signs of fluid -Prevents
available for overload, such as edema, complications
oxygen and weight gain, and jugular and guides
carbon venous distension. interventions.

32
 dioxide 8. Monitor the patient's -Affect
diffusion. electrolyte levels regularly, respiratory
especially potassium and function and
Levin, N. W., sodium as ordered. well-being.
& Weiner, D.
E. (2009). 9. Assess for signs of -It exacerbates
Pulmonary infection, such as fever, respiratory
complication chills, or changes in mental symptoms and
s of chronic status. worsen gas
kidney exchange.
disease.
Nephrology Dependent:
Dialysis 1. Give pain medication for -Affects
Transplantati pain management. respiratory
on, 24(1), 7- effort and well-
11. being

33
 NURSING CARE PLAN NO. 2
DATE/ CUES/ NURSING SCIENTIFIC GOALS/ NURSING RATIONALE EVALUATION
TIME DATA DIAGNOSIS BASIS OBJECTIVE/ INTERVENTION
CRITERIA
9/3/202 Subjective: Fluid Volume The human After 2 hours of 1. Monitor vital - This will help identify Goal partially met.
4 “Hilig ko Excess related body maintains nursing signs frequently. early signs of fluid After 2 hours of
magkaon- to fluid a delicate intervention, the overload, such as nursing
kaon ug accumulation balance of patient will reduce increased blood intervention, the
parat na of the body fluids, the risk of fluid pressure or heart rate. patient partially
pagkaon sir electrolytes, and volume excess as reduce the risk of
uy” as hormones to evidenced by: 2. Elevate the head -This can help alleviate fluid volume
verbalized regulate fluid a. The patient of the bed. pulmonary congestion excess as
by the volume. This will and improve breathing. evidenced by:
patient. balance is demonstrat a. Vital signs
essential for e stable 3. Assess for signs - To examine for are still
Objective: proper organ vital signs, of fluid overload. jugular vein distention, unstable
-Blood function and including edema, and crackles in especially
pressure of overall health. blood the lungs. the blood
180/90 When this pressure pressure.
(+) balance is and heart 4. Measure daily - Consistent weight b. Patient
pulmonary disrupted, fluid rate, within weights. monitoring can help reported
congestion can accumulate normal assess fluid balance. decreased
-Diagnosis in tissues, limits. dyspnea.
of ESRD leading to fluid b. Patient will 5. Restrict fluid - Adhere to the c. The patient
-Dialysis volume excess. report intake as ordered. prescribed fluid intake accurately
patient (National decreased limits to prevent fluid measured
-Fond of Institute of dyspnea. overload. and
eating salty Diabetes and c. The patient consumed
foods Digestive and will 6. Encourage low- - A low-sodium diet can fluids
-Potential Kidney accurately sodium diet. help reduce fluid within
fluid Diseases measure retention. prescribed
overload (NIDDK), and limits.
from 2018) consume 7. Monitor intake -Accurate measurement
dialysis fluids and output. of intake and output can
within help assess fluid
prescribed balance.

34
limits.
8. Address -Constipation can
constipation. contribute to fluid
retention.
9. Monitor for
signs of heart -Fluid overload can
failure. contribute to heart
failure.

35
 NURSING CARE PLAN NO. 3
DATE CUES/DATA NURSING SCIENTIFIC GOALS/ NURSING RATIONALE EVALUATION
TIME DIAGNOSIS BASIS OBJECTIVE/ INTERVENTION
CRITERIA
9/3/20 Subjective: Imbalanced Inadequate After 2 hours of 1. Determine the - Understand Goal partially
24 Nutrition: nutrient nursing intervention, patient's usual food current habits to met.
“Dili kayo ko intake, the patient will reduce intake, frequency, identify needs. After 2 hours of
hingaon ug lahi- Less Than
Body particularly imbalanced nutrition as and portion sizes. nursing
lahi na food sir” iron, can lead evidenced by: intervention, the
as verbalized by Requirements
related to to a a. Improved 2. Educate on iron- - Address iron patient partially
the patient. deficiency nutritional rich foods deficiency and reduced the
dietary
Objective: restrictions as that status as improve nutrition. imbalanced
(+) iron evidenced by compromises evidenced by nutrition as
deficiency iron the body's increase intake 3. Promote - Enhance iron evidenced by:
-fond of eating deficiency, ability to of iron-rich consumption of absorption. a. Not able
salty foods fond of eating produce red foods, decrease vitamin C. to improve
-limited variety salty foods, blood cells. intake of salty nutritional
of foods in diet and limited This, in turn, food and 4.Monitor - Detect anemia status.
variety of can result in increase variety hemoglobin and early for timely b. Adherence
foods in diet anemia, which of foods in diet. hematocrit levels. intervention. to dietary
can cause b. Adherence to restriction
fatigue, dietary 5.Track the - Evaluate s.
weakness, and restrictions. patient’s weight to intervention c. Increased
other c. Increased assess progress effectiveness and knowledg
symptoms. knowledge of towards nutritional overall nutrition. e of
Excessive salt healthy eating goals. healthy
intake can habits. eating
contribute to 6. Involve family - Reinforce habits.
fluid retention members or changes and
and caregivers. provide support.
hypertension,
which can 7.Address - Improve nutrient
also affect constipation. absorption and
overall health well-being.
and nutrient
absorption. A 8. Monitor for - Early detection

36
 limited signs of anemia. prevents
variety of complications.
foods can 9.Encourage - Enhance nutrient
deprive the regular exercise. absorption, energy,
body of and overall well-
essential being.
nutrients and
vitamins, 10. Explore any - Improve
increasing the emotional or motivation for
risk of psychological healthier eating.
nutritional factors that may
imbalances. affect the patient’s
eating habit.
(Journal of
Nutrition or
The American
Journal of
Clinical
Nutrition,
2018)

37
 NURSING CARE PLAN NO. 4
DATE CUES/DATA NURSING SCIENTIFIC GOALS/ NURSING RATIONALE EVALUATION
TIME DIAGNOSIS BASIS OBJECTIVE/ INTERVENTION
CRITERIA
9/3/20 Subjective: Activity After 2 hours of 1. Assess the - To determine the Goal met.
24 “Kanunay kong Activity nursing intervention, patient's perception patient's After 2 hours of
Intolerance
Intolerance the patient will identify of fatigue and understanding of nursing
gikapoy bisan related to iron
related to methods and activity tolerance. their limitations intervention, the
gamay ra ang deficiency as
sedentary techniques to reduce and identify patient:
akong gibuhat” evidenced by
lifestyle as activity intolerance as specific concerns.
fatigue
evidenced by evidenced by: 2. Teach the patient -To reduce anxiety, a. Demonstrate
Objective: decreased a. demonstrate deep breathing and promote relaxation, d deep
-Pallor muscle methods of relaxation and conserve breathing
strength, techniques. energy. and
-Decreased controlled
fatigue during relaxation
activity breathing
simple tasks, 3. Demonstrate - To provide techniques.
tolerance and reliance techniques to energy-conserving practical strategies b. Described
-decrease on assistance conserve techniques for for performing adaptive
hemoglobin for energy. ADLs. daily tasks techniques
level ambulation. b. describe efficiently. for ADLs,
Iron adaptive 4. Encourage - To prevent fatigue such as
deficiency pacing of activities and promote rest sitting while
techniques to
anemia can and taking iron periods. dressing or
lead to perform supplements. showering.
decreased activities of c. Identified
oxygen- daily living. 5. Assist the patient - To help the factors that
carrying c. identify the in prioritizing patient focus on aggravate
capacity of factors that activities. essential tasks and fatigue, such
the blood, aggravate avoid overexertion. as
resulting in decreased prolonged
tissue tolerance to 6. Educate the - To ensure optimal standing or
hypoxia. This activity. patient about the recovery and heavy
can manifest importance of energy restoration. lifting.
as fatigue, adequate rest and
weakness, and sleep.
decreased

38
 activity 7. Instruct the -To minimize
tolerance patient to avoid triggers and
activities that promote overall
exacerbate fatigue. well-being.

8. Encourage -To progressively

gradual increases build tolerance and
in activity level. prevent setbacks.

9. Collaborate with -To improve

the physical strength,
therapy team to endurance, and
develop an overall functional
individualized capacity.
exercise program.

10. Monitor the -To ensure the

patient's response effectiveness of the
to interventions care plan and
and adjust the plan achieve desired
as needed. outcomes..

39
 NURSING CARE PLAN NO. 5
DATE CUES/DATA NURSING SCIENTIFIC GOALS/ NURSING RATIONALE EVALUATION
TIME DIAGNOSIS BASIS OBJECTIVE/ INTERVENTION
CRITERIA
9/3/20 Subjective: Impaired skin Frequent After 4 hours of 1. Assess the -Baseline Goal partially met.
24 integrity needle nursing intervention, condition of the assessment ensures After 2 hours of
“Dugay naman related to insertion can the patient will be able skin around the proper nursing
frequent cause to: needle insertion identification of intervention, the
ni akong skin na
needle mechanical a. Lessen presence sites and note any skin integrity issues patient was able to:
medyo ga crack insertion as trauma to the of dryness, signs of infection, and guides
maam’’ as evidenced by skin, leading cracking. dryness, or intervention a. Lessened
verbalized by dry and to impaired b. Maintain intact cracking. planning. presence of
the patient cracked skin. skin integrity. skin integrity dryness,
This can without signs of 2. Clean the needle -Proper cleansing cracking.
result in skin infection at the insertion site reduces the risk of b. Not able to
breakdown, needle insertion before and after infection by Maintained
Objective: such as sites. dialysis with an eliminating intact skin
- Dry, cracked dryness, c. Verbalize appropriate microorganisms on integrity
skin on the cracking, and understanding antiseptic solution. the skin. without
insertion site potential of the signs of
-necrosis infection. importance of 3. Apply a gentle, -Moisturizers help infection at
-Poor wound proper skin care fragrance-free maintain hydration, the needle
healing Yoost, B. L., in preventing moisturizer to the reduce dryness, and insertion
& Crawford, further damage skin around the improve the skin’s sites.
L. R. (2019). insertion site as per barrier function. c. Verbalized
Fundamentals protocol. understandi
of nursing: ng of the
Active 4. Encourage the -Proper hydration importance
learning for patient to maintain improves skin of proper
collaborative adequate hydration health, making it skin care in
practice (2nd by consuming less prone to preventing
ed.). Elsevier. appropriate fluids dryness and further
within dialysis cracking. damage
restrictions.

40
 5. Protect skin -To avoid
from friction and damaging the skin.
shear.

6. Promote proper -Can support the

nutrition skin health and
wound healing.
7. Educate the -Empowering the
patient and patient and family
caregivers on with knowledge
maintaining good promotes
skin hygiene, consistent care and
including gentle prevention of skin
cleaning and issues.
moisturizing
techniques.

8. Apply protective -Dressings protect

dressings or the skin from
bandages to external irritants
vulnerable or and promote
healing areas after healing by
dialysis. maintaining a moist
wound
environment.

9. Monitor for -Early

signs of infection, identification and
such as warmth, treatment of
discharge, or fever, infection prevent
and report findings worsening
immediately. conditions like
cellulitis or sepsis

10. Collaborate -Targeted treatment

with the healthcare addresses specific

41
 team to provide complications, such
topical or systemic as infections or
medications if inflammation,
necessary enhancing recovery
and preventing
further skin
damage.

42
 CHAPTER VII
PROGNOSIS
Prognosis is an estimation of how likely a disease will progress based on the

patient’s health and the disease’s typical course as seen in comparable circumstances. To

determine the quality of the client’s recovery, the group of student nurses established a

prognosis checklist.

Table 8: Prognosis

Factor Poor Fair Good Justification

Patient E, a 50 years old male,
diagnosed with End-stage renal
disease secondary to Hypertension
Nephrosclerosis. As the risk rises
significantly after 40 years of age,
given that prognosis is poor. First,
the early onset of dialysis at 40
years old suggests a more
Age 
aggressive progression of the
disease, which may indicate a
higher risk of complications.
Additionally, the patient's age may
be a factor, as older individuals
may have other health conditions
that can complicate the
management of ESRD.
While ESRD secondary to
hypertension is not directly
hereditary, genetic factors can play
a role in increasing susceptibility
Family to both hypertension and kidney

History disease. Considering that Patient
E's 5th sister underwent dialysis
and subsequently died, his
prognosis could be considered fair.
While this family history suggests

43
 a potential genetic predisposition
or environmental factors that may
increase the risk of ESRD, it is
important to note that individual
outcomes can vary significantly.
Considering Patient E's history as
a smoker and alcohol drinker, his
prognosis would likely be poor.
Smoking and alcohol consumption
are both known to contribute to
Precipitating kidney damage and can accelerate

Factors the progression of the disease.
These lifestyle factors can increase
the risk of hypertension,
cardiovascular disease, and other
conditions that can further
compromise kidney function.
Financial The current financial status of
Status patient E and considering the
financial support provided by
Patient E's brother for dialysis or
treatment, is likely to have a
positive impact on his prognosis.
 Access to necessary medical care
is crucial for managing ESRD and
improving outcomes. With
adequate financial resources,
Patient E can more easily adhere
to treatment plans, including
regular dialysis, medication, and
dietary restrictions.
Environment Considering that Patient E's
environment is conducive to a
favorable prognosis, it could
positively influence his overall
outcome. An environment that

supports his well-being and
facilitates adherence to treatment
plans can significantly impact his
quality of life and management of
ESRD.

44
Willingness Patient E's willingness to take
to take the medication and compliance with
medicine or the treatment regimen is a strong
compliance indicator of a favorable prognosis.
of treatment Prompt compliance after diagnosis
regimen suggests a proactive approach to
managing his health, which is

crucial for individuals with ESRD.
Adherence to treatment plans,
including dialysis, medication, and
dietary restrictions, can
significantly improve outcomes
and reduce the risk of
complications.
Support Considering the emotional,
System mental, physical, and financial
support Patient E receives from
his family for treatment, his
prognosis could be considered

good. Strong family support can
significantly enhance a patient's
well-being, reduce stress, and
facilitate adherence to treatment
plans.

LEGEND:
Poor Lack, inadequate

Fair Balance

Good Adequate, appropriate, sufficient

SUMMARY
Poor 2x1=2/21=0.095x100 9.5%
Fair 2x2=4/21=0.190x100 19%
Good 3x3=9/21=0.429x100 42.9%
Total 71.4%

45
Overall prognosis: Fair

Patient E, diagnosed with ESRD secondary to hypertension nephrosclerosis, faces

a fair prognosis. While his financial status, willingness to take treatment, and strong

support system are positive factors, several other elements contribute to a less favorable

outlook. His age of 50 years old, combined with a family history of ESRD in a sibling,

indicates a higher risk of disease progression. Additionally, his history of smoking and

drinking are significant precipitating factors that can accelerate kidney damage.

Overall, while Patient E's positive attributes can help mitigate some of the

challenges associated with ESRD, the combination of his age, family history, and

lifestyle factors suggests a fair to poor prognosis. Effective management of his condition,

including adherence to treatment plans, regular medical check-ups, and addressing

lifestyle factors, will be crucial in optimizing his quality of life and delaying disease

progression.

46
 CHAPTER VIII

RECOMMENDATIONS

To the Patient

The group recommends that the patient follow the doctor's instructions and the

nurse's advice. Be sure to take all prescribed medications as directed to manage the

condition and prevent further complications. Make sure to understand the purpose and

dosage of each medication and discuss any concerns with the healthcare provider. Adhere

to scheduled follow-up appointments with nephrologists and other healthcare providers.

Regular monitoring is crucial to assess the condition, adjust medications as needed, and

address any emerging issues. Prioritize adequate rest to support overall health and

recovery. Engage in regular, low-intensity exercises, such as walking or light stretching.

These activities can improve cardiovascular health and manage stress. Maintain

good personal hygiene to reduce the risk of infections. This includes regular

handwashing, bathing, and proper care of any skin breaks. Attend dialysis sessions

regularly and on time. Follow the instructions provided by the dialysis care team. Report

any changes in the patient's condition or symptoms to a healthcare provider. Following

the dialysis schedule strictly is vital for managing fluid balance and removing waste

products from the body. Adopt a well-structured diet plan, such as the DASH diet, to

manage blood pressure and support kidney health. Emphasize the consumption of

nutrient-dense foods like fruits, vegetables, whole grains, and lean proteins while limiting

salt intake. Limit fluid intake as prescribed. Consider incorporating iron-rich foods to

combat potential anemia. Seek diet counselling to better understand and adhere to these

dietary changes.

47
To the family

Family members should educate themselves about the disease and dialysis process

to provide better care and encourage adherence to treatments and medications, as missing

these can lead to complications. Monitoring the patient’s diet, fluid intake, and helping

with transportation are also important roles. Emotional support is equally vital, as patients

may experience anxiety or depression, and providing reassurance and encouraging

activities can improve their well-being. It’s crucial to stay alert for symptoms like

shortness of breath and engage in discussions about future care, including advance

directives. Caregivers should also prioritize their own well-being to avoid burnout,

seeking support and balancing their responsibilities effectively.

To the Nurses

Nurses handling patients with end-stage renal disease (ESRD) secondary to

hypertensive nephrosclerosis and undergoing dialysis should focus on both

comprehensive clinical care and patient-centered support. It is essential to closely

monitor vital signs, especially blood pressure, as hypertension is a key factor in the

progression of renal damage. Nurses should ensure proper management of fluid balance,

track daily weights, and assess for signs of fluid overload, such as edema or shortness of

breath. Educating patients about the importance of adhering to their dialysis schedule,

medication regimen, and dietary restrictions is also crucial to their overall well-being.

Additionally, nurses should provide emotional support by addressing the psychosocial

impacts of living with chronic illness, helping patients cope with anxiety or depression,

and promoting open communication about their treatment preferences and future care

plans. In all care, maintaining open lines of communication with the interdisciplinary

48
team ensures that the patient receives holistic and individualized care that meets both

their physical and emotional needs.

49
 CHAPTER IX

GLOSSARY OF TERMS

Anemia - A condition where there is a deficiency of red blood cells or hemoglobin in the

blood, leading to fatigue and weakness.

Cardiomegaly - enlargement of the heart, often due to underlying heart or kidney

conditions.

Chronic Kidney Disease (CKD) - A progressive disease where kidney function

gradually declines over time.

Dialysis - A medical treatment that artificially removes waste and excess fluid from the

blood when kidneys fail.

Edema - Swelling caused by excess fluid trapped in the body's tissues.

End-Stage Renal Disease (ESRD) - The final stage of chronic kidney disease requiring

dialysis or kidney transplantation.

Erythropoietin - A hormone produced by the kidneys to stimulate red blood cell

production.

Glomerular Filtration Rate (GFR) - A test that measures the rate at which the kidneys

filter blood, indicating kidney health.

Nephrology - The medical specialty focused on kidney function and diseases.

Peritoneal Dialysis – a type of dialysis where waste is filtered through the lining of the

abdomen.

Proteinuria - The presence of excess protein in the urine, often a sign of kidney damage.

Renal Failure - A condition where kidneys lose the ability to filter waste effectively.

50
Uremia - A build-up of toxins in the blood due to kidney failure.

51
 CHAPTER X

BIBLIOGRAPHY

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Diagnosis-and-Classification-of-Diabetes.

Choi, H., Han, K., & Kim, C. (2019). Smoking and risk incident end-stage kidney disease

in general population: A nationwide population-based cohort study from Korea.

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Evans, M., Lewis, R. D., Morgan, A. R., Whyte, M. B., Hanif, W., Bain, S. C., Davies,

S., Dashora, U., Yousef, Z., Patel, D. C., & Strain, W. D. (2022). A narrative

review of chronic kidney disease in clinical practice: Current challenges and

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Hashmi, M., Benjamin, O., & Lappin, S. (2023). End-Stage Renal Disease.

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Lin, T. (2018). Obesity and risk of end-stage renal disease in patients with chronic kidney

disease: A cohort study. https://pubmed.ncbi.nlm.nih.gov/30321257/.

Pajimna, J. A. T., et al. (2023, July 15). The Lancet Regional Health – Western Pacific,

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Palicte, C. (2024, June 24). Renal disease cases in Region 11 rising: nephrologists.

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Pugh, D., Gallacher, P., & Dhaun, N. (2019). Management of hypertension in chronic

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53