Case Study
CHRONIC KIDNEY
DISEASE STAGE 5
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Introduction
Chronic kidney disease, also called chronic kidney failure. It
involves a gradual loss of kidney function means your kidneys are
damaged and can’t filter blood the way they should. The disease
is called “chronic” because the damage to your kidneys happens
slowly over a long period of time. This damage can cause wastes
to build up in your body.
The term “chronic kidney disease” means lasting damage to the
kidneys that can get worse over time. If the damage is very bad,
your kidneys may stop working. This is called kidney failure, or
end-stage renal disease (ESRD). If your kidneys fail, you will
need dialysis or a kidney transplant in order to live. In the early
stages of chronic kidney disease, you might have few signs or
symptoms. You might not realize that you have kidney disease
until the condition is advanced.
AT RISK
Risk factors for chronic kidney disease include
older age, low birth weight, obesity, smoking,
high blood pressure, diabetes, and a family
history of kidney disease. To keep healthy
kidneys, it is important to control those risk
factors for CKD that can be modified.
I. Personal Data
Name: R. A.
Address: Caloocan City
Age: 68 years old
Sex: Female
Civil Status: Married
Religion: Roman Catholic
Birthday: March 26,1954
Birthplace: Taguig City
Room & Bed No.:
Hospital:
Case No.:
Attending Physician: Revy Leano,M.D.
Chief Complaint: Pneumonia
Medical Diagnosis: Chronic kidney Disease stage 5
secondary to diabetic nephropathy
II. Medical History
A.History of Present Illness
Patient is a 68-year-old Filipino woman with a history of hypertension. On January 20, 2020, she was confined for
three weeks due to pneumonia, and her creatinine was found to be 900. On February 16, 2020, she was confined
again due to water in both lungs, and she had a thoracentesis procedure in which her right lung was drained of
400 mL of fluids, followed by the left lung being drained of 400 mL after two days and her creatinine was reported
to be 1000, and her hemodialysis was started on March 11, 2020 up to present twice a week every Wednesday
and Saturday. She was admitted to the hospital on March 13,2020,due to low albumin and edema.
B.Past Medical History
The patient had the usual childhood illnesses like measles, no history of rheumatic fever. She
was diagnosed with type 2 diabetes in 2011, had LASIK eye surgery in 2017, She has active
medical problems, including hypertension and cataract, and takes astorvastatin 20mg 1 tablet
once a day for hypertension and for cataract she use Trusopt thrice a day every morning,
afternoon and evening,Normopres twice a day every morning and evening, red Forte twice a day
every morning and evening,Isipto Atropine twice a day. She has no known drug allergies. No
known environmental, food, or seasonal allergies.
C. Family Medical History
Etiology
Predisposing Factors Type 1 or 2 Diabetes Precipitating Factors
Second hand smoke
P Diabetes Hypertension
Glomerulonephritis
Frequent Use of Medications
High blood pressure Eating High sugary foods
A Second hand smoke Interstitial nephritis and junk foods
T
H
O Nephron Number
P
H
Y Adaptive hyper filtration at
Glomerulus
S
I Glomerular
RAAS
O permeability
L
Filtration of proteins
O Proteinuria and macromolecules Hypertension
G Nephrotoxic
Y Dyslipidemia inflammation/remodelling
Kidney Failure
IV. LABORATORY AND DIAGNOSTIC EXAMINATION
October 16, 2021 (11:20 PM)
RENAL FUNCTION
DIALYSIS MONITORING
MINERAL AND VITAMIN STUDIES
LIVER FUNCTION
DIABETIC STUDIES
V. Drug Study
VI. NURSING CARE PLAN
Actual
Subjective Objective Assessment Planning Interventions Evaluation
Edema in the Excess fluid Patient will Independent: After weeks of nursing
abdomen volume RT understand how Monitor and record intervention patient will state
Nasal decreased to reduce patients vital signs that they know and
“Namamanas congestion glomerular reoccurence of understand now how to
ako sa area filtration rate excess fluids Monitor and record maintain their fluid levels
ng tiyan ko” Weight :55kg AEB by edema patients weight
eGFR:2.9ml/ in the abdomen
min/1.73 m region Observe and
measure patients
abdomen for any
changes in size
Encourage patient
to observe the
proper diet which
includes meals
that have less
sodium
POTENTIAL
Assessment Diagnosis Planning Intervention Evaluation
Objective: Risk for Decreased After 1-2 weeks of Assessment After 2 week of nursing
-High Phosphorus Cardiac Output intervention the patients -Assess potential for developing decreased cardiac output. intervention patient was
-Hypertension related to able to maintain her able to understand the
Hyperphos-phatemia cardiac output and Independent actions to reduce risk for
(-) Dizziness verbalize her knowledge -Assist patient into a semi fowler’s position. decreased cardiac output
(-) Weakness about the disease. -Inspect patients skin for patches. and have enough
(-) Shortness of Breath -Monitor vital signs. knowledge about the
(16-20bpm) -Auscultate apical pulse. disease.
(-)Chest pain -Monitor for symptoms of decreased cardiac output.
(-)Chest discomfort -Monitor Cardiac rhythm.
-Encourage patient to breath in/out during activities.
-Monitor laboratory tests such as complete blood count, sodium
level, and serum creatinine.
Dependent
-Administer medications prescribed by the doctor.
Collaborative
-Collaboration with Cardiologist
Health Teaching
-Educate patient home monitoring of Blood pressure and pulse.
-Promote a restful environment and encourage periods of rest and
sleep.
-Encourage patient to maintain a healthier weight.
-Encourage to do active and passive exercises.
VII. MEDICAL INTERVENTION
Management of Chronic Kidney Disease is accomplished primarily with medications and diet therapy. Dialysis is also needed to decrease
the level of uremic waste products in the blood and to control electrolyte balance. Ms. R.A takes Calcium bicarbonate in between eating
meals 3 times a day. Calcium bicarbonate may be used to correct mild acidosis. This is also used to treat hyperphosphatemia and
hypocalcemia since it binds dietary phosphorus in the GI tract. If calcium is high or the calcium–phosphorus product exceeds 55
mg/dL, a polymeric phosphate binder such as sevelamer hydrochloride may be prescribed. She takes Renvela as prescribed by
the AP in between eating meals. Ms. R.A also takes Febuxostat every breakfast to help lower her uric acid. Since the kidneys are not
functioning well, it cannot do it’s work properly. Thus, uric acid is retained. She takes the Amlodipine as well every evening to manage her
blood pressure. Water and sodium is retained when kidneys are not functioning well, so excess fluid can cause high blood pressure as
well as swelling in the ankles and legs. In addition, when your kidneys are not working well, your body which regulates blood pressure
has to work harder to increase blood supply to the kidneys, which makes the heart pump harder that can lead to a heart disease. In
relation to that, Ms. R.D.A is prescribed Atorvastatin every after breakfast to prevent cardiovascular diseases. She also takes Ferrous
sulfate plus Folic acid to combat anemia associated with chronic renal failure. Vitamin B complex is prescribed as well because anorexia,
nausea, and dietary restrictions may limit nutrient intake.
For diet therapy, patients with End-Stage Kidney Disease or Chronic Kidney Disease should have careful regulation of protein intake,
fluid intake to balance fluid losses, sodium intake to balance sodium losses and some restriction of potassium. At the same time,
adequate caloric intake and vitamin supplementation must be ensured. Ms. R.A stated that she does not have a particular diet
restriction. She just needs to haveCREDITS:
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hemodialysis twice every week. It is scheduled icons by Flaticon, and
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have kidney failure. Dialysis keeps the body in balance as it removes waste, salt and extra water to prevent them from building up in the
body. Since the kidneys do not work well with the patients who have kidney disease, Dialysis does it for them.
Reference:
https://www.mayoclinic.org/diseases-conditions/chronic-kidney-
disease/symptoms-causes/syc-20354521
https://www.medscape.com/answers/238798-105274/what-is-the-
global-prevalence-of-chronic-kidney-disease-ckd#:~:text=In
%202017%2C%20697.5%20million%20cases,died%20from
%20CKD%20in%202017.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4089662/
Thank you !!!
