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GENERAL OBJECTIVES:The general objective of the case study is to gain the comprehensive knowledge about the disease to
gain the practical exercise about the Adult Health Problem and also to gain Practical experience working
with a patient having chronic kidney disease and to give holistic patient care according to their need.
SPECIFIC OBJECTIVES:The specific objectives of the case study are given below: To assess the patient and find out need of patient according to nursing process.
establish a nurse-client relationship to the client, as well as to the family by rendering a
therapeutic nurse-patient relationship;
gather adequate information to be used in the development of the study
present the clients personal data;
illustrate the patients family tree and trace significant diseases which may be of relevance to the
study
trace the health history of the client and the family by collecting information both of the past and
present illnesses;
To provide holistic nursing care to the client to all ages using nursing process.
To manage promptly as necessary to built up comfort.
To provide psychological support to the patient
To apply knowledge from the science, nursing theory and other related courses to plan and
implement nursing care.
To provide continuous care till discharge and follow-up care.
Counsel and make aware the patient party about importance of continuity of medicine and
psychological support to prevent from worsens.
To provide the discharge teaching to the patient and family member.
BIOGRAPHIC DATA
1) HEALTH HISTORY
A)
DEMOGRAPHIC DATA
NAME:
AGE:
SEX:
ADDRESS:
RELIGION:
EDUCATION
DATE OF ADMISSION:
DATE OF DISCHARGE:
IP NO. :
OCCUPATION:
MARITAL STATUS:
ATTENDING DOCTOR:
INFORMATION SOURCE:
DIAGNOSIS:
BLOOD GROUP:
BED NO:
WARD:
C) HISTORY OF PRESENT ILLNESS: According to the patients, he come for haemodialysis, due
to increased shortness of breath during dialysis he was admitted in the nephrology ward. His general
condition is ill looking and oriented with time place and person.
ALLERGIES
According to the patient, he doesnt have any allergic reaction to any factors.
.
PREVIOUS HOSPITALIZATION: Nepal medical college teaching hospital for the diagnosis of
CKD
E) FAMILY HISTORY:
Type of family: joint
No. of Family Members: 8
FATHERS RELATION
MOTHERS RELATION
Tuberculosis
Cancer
Heart disease
Jaundice
Epilepsy
Psychological
Absent
Absent
Absent
Absent
Absent
Absent
Absent
Absent
Absent
Absent
Absent
Absent
4
Hypertension
Present
Present
HEALTH SEEKING PRACTICE: He belongs to literate family, According to laxman kumar pandit,
they were not dependent in superstitious beliefs. If someone becomes ill in their family they take
homemade medicine then some times go to hospital.
PERSONAL HISTORY:
Health Habits:
Smoker but has left 1-2 months ago, Non alcoholic,
Non vegetarian.
No food allergy.
Maintain personal hygiene
Religion belief and worship kuldeuta.
Dietry history:
Non vegetarian.
Foods like egg-curry, rice, daal etc.
SOCIO-ECONOMIC STATUS:
He belongs to middleclass family. The major source of income is
farming and business. They are the permanent residence of jorpati.
They are well satisfied with their economic status. They have very
good inter relationship in the community.
ENVIRONMENTAL FACTOR:
Housing Pattern: Well facilitated
Waste disposal: They are practicing collective approach to manage the waste
product. Such as temporary container, burning and making compost manure. The
people from nagarpalika also come to take waste from there home.
Pollution and noise: his house is near the road , so he is very much affected by the
noise of the vehicle and the air pollution caused by the vehicle.
Description
Passed or
Failed
1. Adjusting to
decreasing physical
strength and health
Passed
2. Adjusting to
retirement and
reduced income
A central
developmental task
that characterized the
transition into old age
is adjustment to
retirement. The period
after retirement has to
be filled with new
projects, but is
characterized by few
valid cultural
guidelines. The
achievement of this
task may be
obstructed by the
management of
another task, living in
a reduced income after
retirement.
Passed
Failed
6
Passed
Passed
6. Establishing
satisfactory physical
living arrangements
Passed
Physical Assessment
8
Civil
Vital Signs
Axillary T=97 degree F, PR= 90/ min, RR= 22/ min, BP= 150/80 mmHg.
General survey
Height= 5 ft and 8 inches, weight= 56 kilos,. No signs of distress noted upon assessment, able to
smile, cooperate well, responsive to questions, conscious and alert, conversant. Well oriented. Show
calmness during the examination. He has no IVF infused, and was asleep at initial assessment.
Skin
Skin is brown in color, rough, dry and warm. He has good skin turgor. Brownish discolorations
that resemble wrinkles are observed on face.
Head
Skull is round in shape, symmetrical. No masses noted. Facial movement is symmetrical,
alopecia. Scalp is clear from dandruff and lice. No scars and wounds noted.
Eyes
Has symmetrical eyebrows movement, shape and hair distribution. Eyebrows have same color
with hair. Eyelashes are evenly distributed and curled outward. Eyelids have no discharges and
bilaterally blink. Upper lid covers the small portion of the iris and cornea. Lacrimal duct openings
(puncta) are evident at nasal ends of upper and lower lid with no tenderness noted. Palpebral conjunctiva
are pinkish in color while the pupils constricted to light, round in shape. He is able to rotate eyes and has
coordinated eye movements.
Ears
Auricle has same color with the skin, has symmetrical shape and located a little bit higher than
the eye. Pinnas are symmetrical with no lesions noted. He has wet cerumen noted on both ears when
pulled down and back for better visualization. he is able to hear on both ears.
Nose
Nose has uniform color and symmetrical in shape. Nasal hairs are very evident when light is
flashed through the nasal passageways; its color is black. No nasal flaring observed upon respiration.
9
Both nares are patent, air moves freely as client breathes through the nares. Nasal septum is straight and
in midline. Nasal mucosa is pinkish in color, has no discharges and no lesions. No tenderness of sinuses
noted.
Mouth
Lips are a little brownish in color, dry and has cracks. Tongue is in midline, pinkish in color with
thin whitish coating on top. Able to move tongue freely (up & down, side to side). Soft palate is light
pink in color while hard palate is lighter in color. Gums are pinkish in color. Plagues are present on his
teeth
Pharynx
Uvula is found well placed in midline of soft palate. Mucosa is pinkish in color. Tonsils are not
inflamed.
Neck
Trachea is in midline. No tenderness of thyroid noted. No enlargement of the neck noted. he is
able to flex and extend neck and move it laterally (L and R).
Chest and Lungs
Breathing pattern is regular. Anteroposterior diameter to transverse diameter is in 1:2. Respiratory
excursion is symmetrical (thumb separates to 2-3cm). No tenderness, lump, Presence of breath sound in
all area of lungs
Heart and Central Vessels
Heart sounds are regular. Pulsation of heart is heard in 4 anatomical areas but more audible in
apical area upon auscultation.
Back and Extremities
Peripheral pulses are symmetrical and regular. Nails are long and untrimmed, pinkish in color, and have
a capillary refill time of 2 sec. after blanching; and no clubbing of fingernails were noted.. His hands are
a little rough. Muscle strength is equal on both sides of the upper and lower extremities. He is able to
stand and walk on both feet independently, and his movements are well coordinated. Toes point straight
ahead. And he is able to sit up straight.
Abdomen
His abdomens color is same with the rest of the part of the body. His umbilicus is coated with
blackish dirt.
Neurologic Assessment
10
Cranial Nerves: able to identify aromas by smelling with eyes closed; able to see objects; pupil
constricted to light sensation; able to move eyeball downward and laterally; able to blink eyes; able to
smile, raise eyebrows, puff cheeks and close eyes; able to respond to questions being heard;) has rough
and vibrating sound; able to shrug shoulders, elevate and flex arms and legs against resistance; able to
protrude tongue and move it side to side.
FINDINGS:
Chronic kidney disease (CKD), also known as chronic renal disease, is a progressive loss of renal
function over a period of months or years in which the bodys ability to maintain metabolic and fluid
and electrolyte balance fails, resulting in uremia or azotemia. In this condition, the GFR falls below 10%
of the normal rate.
Causes:
Heredity
Glomerular dysfunction
Diabetic nephropathy
Hypertension
Glomerulonephritis
Polycystic kidney disease
Urinary tract obstruction
Bladder tumour
Urethral obstruction
Hypertensive nephrosclerosis (hardening of the kidney)
Other causes:
Hiv infection
Kidney stones
Chronic kidney infections and certain cancers
Regular use of anti inflammatory drugs
Vesicoureteral reflux ( a urinary tract problem in which urine travels the wrong way back
towards kidney)
Stages of chronic kidney disease
STAGE
1.
2.
3.
4.
5.
DESCRIPTION
Slight kidney damage with
normal or increased
filtration
Mild decrease in kidney
function
Moderate decrease in
kidney function
Severe decrease in kidney
disease
Kidney failure
GFR ML/MIN
More than 90
60-89
30-59
15-29
Less than 15 or dialysis
Pathophysiology:
12
Predisposing Factors
Genetics
Age >40
Decrease insulin
production/sensitivity
Precipitating
Environment(intrapartal)
Toxin/Virus
Obesity
Decrease Serum Potasium
Elevated Serum
Glucose
Increased Osmolarity
due to Glucose
Polydipsia
Polyuria
Chronic elevation of
Serum Glucose
Polyphagia
Weight loss
Diabetic
neuropathy
Small vessel
disease
Accelerated
atherosclerosis
Diabetic
retinopathy
Hypertension
Symmetrical loss
of sensation
Diabetic
nephropathy
End-stage
renal failure
Infection
Coronary artery
disease
Numbness and
paresthesia
Wasting of
intrinsic muscles
Impaired immune
function
Loss of vision
Increase
LDL levels
Delayed wound
healing
Autonomic
neuropathy
Impotence
Diabetic foot
ulceration
Dry, cracked
skin
4) COMPARISON OF:
Gastroparesis
Neurogenic
bladder
13
ACCORDING TO PATIENT
present
present
absent
absent
present
present
present
integumetry
ACCORDING TO BOOK
Dry, flaky skin
Thin, brittle nails
Thinning hair
ACCORDING TO PATIENT
present
present
absent
cardiovascular
ACCORDING TO BOOK
Hypertension
Pitting edema
Periorbital edema
ACCORDING TO PATIENT
present
present
present
pulmonary
ACCORDING TO BOOK
Shortness of breath
tachypnea
Kussmaul- type respiration
ACCORDING TO PATIENT
present
present
present
G.I
ACCORDING TO BOOK
Metallic taste
Anorexia, nausea
Vomiting, constipation/ diarrhea
ACCORDING TO PATIENT
Absent
Absent
present
14
Hematologic
ACCORDING TO BOOK
Anemia
ACCORDING TO PATIENT
present
Reproductive
ACCORDING TO BOOK
amenorrhea
infertility
Testicular atrophy
ACCORDING TO PATIENT
Absent
Absent
absent
Musculoskeletal
ACCORDING TO BOOK
Muscle cramps
Loss of muscle strength
Bone pain
Bone fracture
ACCORDING TO PATIENT
Present
Present
Present
absent
15
B) INVESTIGATION
ACCORDING TO BOOK
Laboratory test:
USG
biopsy
KUB film
ACCORDING TO PATIENT
Blood urea: 119.0 mg/dl
Creatinine:9.1
Na+:139.o
K+:5.2 meq/r
Serum albumin:2.8gm/dl
Hb:9.6gm%
Glucose f:120 mg/dl
Glucose pp : 141mg/dl
Done but report was not available
Done but report was not available
Not done
16
total output
4/9: 530ml was total intake and 150
ml was total output
4/10: 450ml total input and 300ml
total output
4/11: 400 ml total input and 300 ml
total output
My patient is undergoing regular
dialysis, 2-3 times in a week
ACCORDING TO PATIENT
Kidney transplantation cannot be
performed in my patient because of
hypertension and slow wound healing due
to diabetes mellitus.
18
ACCORDING TO PATIENT
As a nurse I assessed the fluid status of my patient
by monitoring input and output record closely.
My patient was prescribed to have fluid less than
500ml/day and was on renal diet. As a nurse I
closely observe the dietary pattern of my patient
I encouraged my patient to perform his activity of
daily living by himself and promoted the positive
feelings.
As a nurse I provided explanation to the patient
and his family members about his treatment
options and potential complications.
As a nurse I provided information to my patient
regarding various drugs used in it.
I provided my patient and his family emotional
support so that anxiety and tension is relieved to
some extent.
19
2. Furosemide
Novosimide; PMS-Furosimide
Classification: Loop diuretics
Indications:
Edema
d/t
heart
failure,
hepatic
impairment
chloride from
renal
20
excretion of water, sodium, chloride, magnesium, potassium, and calcium. Effectiveness persists in
impaired renal function. Decreased blood pressure.
Dosage: 1 tablet, 200 mg
Contraindication: Hypersensitivity; Cross-sensitivity with thiazides and sulfonamides may occur;
Hepatic coma or anuria; Some liquid products may contain alcohol, avoid in patients with alcohol
intolerance.
Precautions: Severe liver disease; electrolyte depression
Side effects: CNS blurred vision, dizziness, head ache, vertigo
EENT hearing loss, tinnitus
CV hypotension
GI anorexia, constipation, diarrhea, dry mouth, nausea, vomiting
GU excessive urination
Derm photosensitivity, rash
F and E dehydration
Nursing Responsibilities:
1. Assess fluid status. Notify physician or other health care professional if thirst, dry mouth,
hypotension, or oliguria occurs.
2. Monitor blood pressure and pulse before and during administration.
3. Monitor blood glucose closely; may cause increased blood glucose level.
4. Caution patient to change positions slowly to minimize orthostatic hypotension.
5. Advise patient to contact health care professional immediately if muscle weakness, cramps,
nausea, dizziness and numbness occurs.
6. Caution older patients or their caregivers about increased risk for falls.
3. tab pantop
Generic name: pantoprazole
Functional class: proton pump inhibitor
Action: it inhibits the secretion of hcl in the stomach by specific action on the proton pumps of the
patietal cells.
Dose and routes:
Adult: 40 mg/day (PO)
21
4. diclofenac gel
therapeutic class: NSAID, antipyretic, non narcotic analgesic
action: NSAID that inhibits prostaglandin synthesis reducing the intensity of pain
therapeutic effect: produces analgesic and anti-inflammatory effects
indication: osteoarthritis, rheumatoid arthritis, pain, primary dysmennorrhea
contra indication: hypersensitivity to aspirin, diclofenac
side effects: headache, abdominal cramps, constipation, diarrhea, nausea
5. Domperidone
Anti-emetic
and
anti-vertigo
Mode of Action: Domperidone is a dopamine-receptor blocking agent. Its action on the dopaminereceptors in the chemo-emetic trigger zone produces an anti-emetic effect.
Interactions:
Anti-muscarinic agents and opioid analgesics may antagonize the effect of MOTILIUM
MOTILIUM suppresses the peripheral effects (digestive disorders, nausea and vomiting) of
dopaminergic agonists.
22
Since MOTILIUM has gastro-kinetic effects, it could influence the absorption of concomitant
orally administered medicines, particularly those with sustained release or enteric coated
formulations.
As MOTILIUM interferes with serum prolactin levels, it may interfere with other
hypoprolactinaemic agents and with some diagnostic tests.
Antacids and anti-secretory agents lower the oral bioavailability of domperidone. They should be
taken after meals and not before meals, i.e. they should not be taken simultaneously with
MOTILIUM.
Reduced
gastric
acidity
impairs
the
absorption
of
domperidone.
Reversible raised serum prolactin levels have been observed which may lead to gynaecomastia.
Where the blood brain barrier is not fully developed (mainly in young babies) or is impaired, the
possible occurrence of neurological side-effects cannot be totally excluded
Nursing Responsibilities:
1. Assess for extra-pyramidal effects such as jerking and tongue protrusion.
2. Check for hypotension.
6. Haloperidol
Therapeutic class: antipsychotic
Action: an antipsychotics agent that competitively block postsynaptic dopamine receptors
Therapeutic effect: produces tranquilizing effect
Indication: treatment of psychotic disorders
Contra indication: CNS depression, hepatic disease
Side effects: blured vision, constipation, dry mouth, peripheral edema, difficulty urinating,
decreased thirst, dizziness, drowsiness
Nursing consideration:
7.
8.
9.
Explain to the patient that this medication controls hyperglycemia but does not cure
diabetes.
24
DATE
TIME
04/O8/068
04/09/068
04/10/068
PULSE
2am
TEMPERATU
RE
98 degree F
80/m
RESPIR
ATION
20/m
BP
6pm
97.6 degree F
88/m
28/m
12:30p 98 degree F
m
82/m
24/m
1:20p
m
98 degree F
90/m
20/m
210/100
mm of hg
2pm
98 degree F
100/m
22/m
6pm
101.6 degree F
110/m
24/m
200/90
mm of hg
210/80
mm of hg
SUMMARY
diet.
04/11/068
10am
97 degree f
90/m
20/m
210/90
mm of hg
2pm
97 degree f
88/m
20/m
10 am
97 degree f
92/ min
20/min
2pm
98 degree f
88/min
20/min
04/13/068
10am
98 degree f
80/min
22/min
04/14/068
10 am
97 degree f
80/ min
20/min
210/90
Pts general condition is
mm of hg satisfactory. Vital signs
are taken with rise in
blood pressure. prescribed
medicine carried out.
Normal bowel and
bladder habit. Patient
complain is dry and
itching over skin of
hands and legs. So he is
in dermatology
consultation.
Dermatology department
prescribed him coconut
oilto apply in itching and
dry areas three times a
day.
180/80
pts g/c seems satisfactory.
mm of hg Vital signs are taken and
recorded with rise in blood
pressure. haemodialysis done
through left femoral vein. Put
the sand bag pressure at the
femoral site for 2 hours. Patient
in normal diet. Prescribed
medication carried out. No any
specific complain from patient
side.
180/70
mm of hg
150/90
Patient general condition
mm of hg seems satisfactory. Vital
signs taken with rise in
blood pressure. Prescribed
medicine carried out.
Normal bladder habit but
bowel habit is disturbed.no
any such complain from
patient side
140/80
Patient general condition seems
mm of hg satisfactory. Patient general
condition seems satisfactory.
04/12/068
26
98 degree f
76/min
20/min
04/15/068
10am
98 degree f
78/min
22/min
04/16/068
10 am
97 degree f
80/ min
20/min
2pm
98 degree f
88/min
20/min
10am
98 degree f
90/min
22/min
04/17/068
170/70
mm of hg
190/80
mm of hg
190/70
mm of hg
180/60
mm of hg
180/70
mm of hg
27
Group therapy: I gave many examples of other people having the same disease condition and
also introduced him with some of them so that he can realize that many others have and share
problems which are very similar to their own problems and that they are not alone in their
suffering.
Relaxation training: I encouraged my patient for performing yoga and meditation as relaxation
produces physiological effect that are opposite to those anxiety, that is slow heart rate, increased
peripheral blood flow.
Psychological therapy: I encourage my patient to express his feelings and attitude, and
communicate with the care takers as well as the family members. Because of this his
psychological depression can be reduced and he feels better.
Medicine therapy: I provided his medicine to relieve his pain and for his
better recovery.
28
29
30
31
ASSESSMENT
DIAGNOSIS
GOAL
PLANNING
IMPLEMENTATI
ON
RATIONAL
EVALUATI
ON
Subjective data:
patient says
that, my hands
and face are
swelling
Excess fluid
volume
related to
fluid
accumulatio
n between
dialysis
treatments.
Patient
will
maintai
n fluid
volume
status
within
establis
hed
paramet
ers.
-assess weight,
lung sounds and
extremities for
presence of
edema
-weight, lung
sounds and
extremities was
assessed for
presence of
edema.
-input and
output was
monitored.
My goal
was fully
met as
patient is
free of
peripheral
edema.
objective data:
patients face
and hand was
swelling
-monitor intake
and output.
Some patient
continue to
urinate small
amounts, but it
is inadequate to
clear all waste
products.
-monitor
-laboratory data
laboratory data: was monitored
blood
urea,nitrogen,ser
um
creatinine,sodiu
m,potassium,cal
cium,hb,etc
-teach pt the
need for
maintaining
fluid restrictions
between
treatment
-teach pt the
need for
restricting
sodium intake
-fluid
restrictions
between
treatment was
maintained.
-the need for
restricting
sodium intake
was teached.
-Intake is limited
and must be
monitored to
prevent fluid
volume overload.
-nitrogenous waste
and electrolytes
accumulate
between treatments.
Anemia and blood
losses associated
with hemodialysis
are complications
associated with
kidney failure.
-to prevent excess
intake, which can
lead to
hypervolemia
-sodium intake
stimulates thirst
which can lead to
excessive fluid
intake and
subsequent
hypervolemia.
32
ASSESSMENT
DIAGNOSIS
GOAL
PLANNING
IMPLEMENTATI
ON
Subjective data:
patient says
that, my hand
and face are
swelling
Risk for
skin
integrity
related to
alterations
in skin
turgor
(edema)
Patient
will
maintai
n an
intact
skin
-inspect skin
for changes in
colour,turgor,va
scularity,note
redness
-monitor fluid
intake and
hydration of
skin and
mucous
membranes
-inspect
dependent areas
for edema.
Elevate legs as
indicated.
-skin was
inspect for
changes in
colour, turgor,
vasclarity.
- fluid intake
and hydration of
skin and mucous
membranes was
monitored.
-indicates areas of
poor
circulation/breakdo
wn that may lead to
infection.
-detects presence of
dehydration or
overhydration that
affect circulation
and tissue integrity
at the cellular level.
-dependent areas -edematous tissues
for edema was
are prone to
inspected and
breakdown.
legs was
Elevation promotes
elevated as
venous return,
indicated.
limiting venous
stasis,edema
formation.
- provide
-soothing skin
-lotions and
soothing skin
care was
ointment may be
care. Restrict
provided and
desired to relieve
use of soaps.
creams,
dry,cracked skin.
Apply ointments ointments was
or creams.
applied.
-keep linens dry, -linens were
-reduces dermal
wrinkles free
kept dry and
irritation and risk of
wrinkles free.
skin breakdown.
-investigate
- reports of
-although dialysis
reports of
itching was
has largely
itching
investigated
eliminated skin
problems associated
with uremic
frost,itching can
occur because the
skin is an excretory
route for waste
products.
- suggest
- loose fitting
-prevents direct
wearing loose
cotton garments dermal irritation
fitting cotton
were suggested
and promotes
garments
to wear.
evaporation of
moisture on the
skin.
My goal
was fully
met as
patient
maintain
an intact
skin.
ASSESSMENT
DIAGNOSIS
GOAL
PLANNING
IMPLEMENTATI
ON
RATIONAL
EVALUATI
ON
Subjective data:
patient says
that, I have
itching in my
neck
Risk for
injury
related to
infection
Patient
will be
free of
infectio
n
-assess skin ,
nothing
redness,swelling
,local
warmth,tendern
ess
-avoid
contamination
of assess site.
-nothing
redness,local
warmth,tenderne
ss and skin was
assessed
-signs of local
infection, which
can progress to
sepsis if untreated
-Aseptic
technique and
masks were
-prevents
introduction of
organisms that can
My goal
was fully
met as
patient did
not
33
develop
any sign
of
infection
objective data:
patients hand
and face was
swelling
objective data:
patients neck
was red.
RATIONAL
EVALUATI
ON
34
ASSESSMENT
DIAGNOSIS
GOAL
PLANNING
IMPLEMENTATI
ON
RATIONAL
EVALUATI
ON
- monitor
patients
response to
illness and
treatments
-patients
response to
illness and
treatments were
monitored.
My goal
was fully
met as
patient
verbalizes
acceptance
of
treatment
regimen as
part of
lifestyle
-allow patient to
grieve over his
losses
-patient was
allowed to
grieve over his
losses
-acknowledge
-patient grief
patients grief
about being
about being
dependent on a
dependent on a
machine was
machine
acknowledged
-support
-strengths,self
strengths,self
confidence,
confidence,deter determination
mination and
and motivation
motivation to
to live was
live
supported.
-help pt to
develop or
continue
interests beyond
dialysis and
return to as near
normal life as
possible
-monitor for
excessive
concerns about
losses,depressio
n
-excessive
concerns about
losses,
depression was
monitored
-demonstrate
empathy and
validates the
patients feeling
-Patients
undergoing dialysis
are not disabled in
all aspects of life.
Many live nearly
normal lives while
maintaining
treatment schedule
-pt may tend to
withdraw from
social activities
because of their
new schedule and
feelings of
loss,focusing on
other interests will
help the pt place
less focus on his
dependency
-there may be
indications of
suicidal
ideation,which
needs to be
identified and
treated quickly
ASSESSMENT
DIAGNOSIS
GOAL
PLANNING
IMPLEMENTATI
ON
RATIONAL
EVALUATI
ON
Subjective data:
patient says
that, I cant do
anything, I am
useless
Disturbed
thought
processes
related to
accumulatio
n of toxins
Patient
will
mainati
n
optimal
level of
mentati
on
- assess extent
of impairment
in thinking
ability, memory
and orientation
-provide
quiet/calm
environment
- impairment in
thinking ability,
memory and
orientation was
assessed
-quiet/calm
environment
was provided
-uremic syndromes
effect can begin
with minor
confusion,
irritability
-minimizes
environmental
stimuli and reduces
confusion
My goal
was fully
met as
patient
35
objective data:
patient looks
depressed
Exercise
and
the muscles.
regular
exercise
like
walking
after
eating
before
performing
any
physical activities.
Treatment
therapeutic effect.
As
part
of long-time treatment,
36
case of accidents.
youre
medications effectiveness.
maintaining
stable
blood
pressure.
mellitus.
for
medical
help
if
level
is
abnormally high.
Instruct patient to practice foot care
gangrenous
tissues
to
the
lower
extremities.
- Check and carefully wash your feet
every day.
-Do not wear shoes that are too small or
socks that do not fit right inside your
shoes.
-Soak your feet in warm soapy water for
10 minutes before cutting your nails.
Trim your toenails straight across to
prevent ingrown toenails. You may also
file down your toenails. Do not cut your
nails into the corners or close to the skin.
You should not dig under or around the
nail.
Emphasize
the
importance
of
37
hygiene.
underwear.
Out-Patient
Referral
38
vegetables.
beans.
39
Case study is the comprehensive study of one selected patient and comparative study with books. During
my case study, I learned the following things.
i. About the disease:I got opportunity to read and gain comprehensive knowledge through various books, literatures,
teachers, doctors, ward staffs, colleagues and via. Secondary internet. I also obtained a comprehensive
knowledge on the disease its treatment and management.
ii. About the patient:My patient was a open book to learn for me, as I got an opportunity in learning through
involving patients care, treatment, diversional therapy and teaching not only from patient but also from
his family member. I learned personal quality of patient and use the information in treating her. I also
taught the families, socio cultural, economical, religious and traditional beliefs of the patient which
influence her health.
iii. About nursing care:I applied holistic approach while giving nursing care to the patient. I followed the theorie of
Henderson in providing nursing care and I gained more knowledge and skill.
iv. About documentation.
40
My patient name is mr. laxman pandit , 68yrs old, male with the diagnosis of Chronic kidney
disease.
Chronic kidney disease (CKD), also known as chronic renal disease, is a progressive loss of renal
function over a period of months or years
Heredity
Glomerular dysfunction
Diabetic nephropathy
Hypertension
Glomerulonephritis
Polycystic kidney disease
Urinary tract obstruction
Bladder tumour
Urethral obstruction
Hypertensive nephrosclerosis (hardening of the kidney) are some of the causes of chronic kidney
disease
The clinical features of ESRD are: weakness and fatigue, confusion, seizures, burning soles of
feet, thin, brittle nails, hypertension,periorbital oedema,etc
It can be investigate through laboratory test such as cbc, urinalysis, blood urea ,ultrasonography,
kub film etc.
During my case study, I provided health education, applied different diversional measures, treatment,
investigation, diet, personnel hygiene etc. I feel great pleasure whenever patient and his family get
treatment satisfaction and getting better. His general condition was improved so he was discharged.
41
13) REFERENCES
Nursing care plan, Marilynn E. Doengs, Mary. Francesmoorhoose, Alice C. Geissles. Murs 6th
edition
Rai lalita nursing concept theories and principles; 1st edition
Helth learning materials centre Tu, institute of medicine, maharajgunj, ktm, textbook of adult
helath nursing
Mosbys nursing drug reference,2007
Phipps Monahan and sands marek neighborsmedical surgical nursing health and illness
perspectives 7th edition, page 1260 to 1271
A Lippincott manual the Washington manual of medical therapeutics,33rd edition, page 430 to
433
http://www.emedicinehealth.com/chronic_kidney_disease/page2_em.htm
http://www.ehttp://www.emedicinehealth.com/chronic_kidney_disease/page4_em.htmmedicineh
ealth.com/chronic_kidney_disease/article_em.htm
http://en.wikipedia.org/wiki/Chronic_kidney_disease
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