I.

Nursing Care Management of a Client with “Chronic Kidney Disease, Stage V secondary
to Hypertension.”

II. Author

III. Introduction
a. Introduction paragraph
b. Overview/generalized description of the condition
c. Statistics and current trends
d. Reason for choosing

IV. Case presentation

a. Details of Nursing Assessment
b. ER notes
Upon admission of the client in the hospital, she underwent a series of laboratory
procedures such as Hematologic and Chemical tests. White Blood Cells, Basophils, Platelet,
Mean Corpuscular Volume, Mean Corpuscular Hemoglobin, Mean Corpuscular Hemoglobin
Concentration, Red cell distribution width standard deviation, Mean Platelet Volume, and
Potassium results were all normal. On the other hand, the following laboratory tests yield
abnormal values:
The client’s Hemoglobin (76 g/L) and Hematocrit levels (0.22 %) are decreased.
Decreased hematocrit and hemoglobin levels have been associated with blood loss of the client
leading to anemia and iron deficiency brought about by impaired production of erythropoietin.
Additional factors that can lead to anemia include inadequate sleep and stress.
The client’s Erythrocytes level (2.7 10^9/L) is below normal. This indicates that there is a
presence of anemia because of decreased production RBC brought about by Chronic Kidney
Disease as evidenced by pale palpebral conjunctiva.
Neutrophils level (68.3 %) is increased. This indicates that an elevated value occurs in
response to acute bacterial infection, inflammatory disease and some cancers and also
indicates neutrophilia may due to the condition and factor of smoking cigarettes.
Lymphocytes level (17.5 %) is decreased. Lymphocytes are the smallest of the white blood
cells. Their diverse activities involve the production of antibodies and other chemicals that
destroy microorganism therefore; a decrease in lymphocytes level indicates Lyphocytopenia
due to bacterial infection.
Monocytes level (6.2 %) is decreased. Monocytes are the largest of the white blood cell.
They are phagocytic cells that fight bacteria therefore; a decrease in monocytes indicates that
there is a presence of bacterial infection as evidenced by fever.
Eosinophils level (4.8%) is increased. Eosinophils contain antihistamines that kill foreign cells in
the blood. The eosinophils also participate in the inflammatory response by phagocytosis.
Increased in eosinophils indicates a possible exposed to certain types of bacteria and a
significant drug reaction.
Red Cell Distribution Width Coefficient Variation level (0.013 %) is decreased. This
indicates that there is possible presence of microcytic anemia and this also means that there is
abnormal variation in RBC size within blood sample and the population of red blood cell is also
abnormal.Serum Sodium Level (132.8 mmol/L) is decreased. This indicates hypovolemic
hyponatremia. Renal loss of sodium and water; caused by diuretic use, adrenal insufficiency,
renal tubular acidosis.
Serum Creatinine Level (960.4 umol/L) is increased. This indicates that patient cannot
eliminate properly the creatinine from the urine then it returns to the circulation that shows the
kidney is not functioning well and causes such conditions like anemia, and iron defiency as
evidenced by fatigue, weakness and pallor.

V. Hospital and Diagnosis

a. Medical Management
During the course of the client’s stay in the hospital, medical management consisted of
D5 Water 90cc as intravenous infusion administered at 10-11uggts/min to prevent further
dehydration, loss of electrolyte and edema formation. Dextrose 5% in water is also given for
nutritional support to patient and also indicated as a source of water, electrolytes and calories or
as an alkalinizing agent. Also, she was given 1 bags of PRBC prior to Blood Transfusion to
normalize the following abnormal blood content. Drugs given to the client includes Calcium
Carbonate to use therapeutically as a phosphate buffer in hemodialysis and as a calcium
supplement; Ferrous Sulfate + FA to prevent iron deficiency and to normalize Hgb and hct levels;
Amlodipine and Carvedilol to treat high blood pressure. Lowering high blood pressure helps
prevent strokes, heart attacks, and kidney problems.
 This is a case of Mr. J, 57 years old widowed and a natural born Filipino who resides in
San Joaquin Sta. Ana Pampanga. He was born on June 27, 1961 via normal spontaneous
delivery. He has a 23 year old daughter. He was admitted in a government hospital in
Pampanga with chief complaint of edema, chest pain and difficulty of breathing, weakness and
hypertension on July 11, 2018 at 10:00 am with a diagnosis of Chronic Kidney Disease Stage V
secondary to nephrosclerosis on maintenance hemodialysis secondary to hypertension. Mr. J
had coronary artery disease one year ago from his existing chronic kidney disease which was
started on 2015 at the age of 54. He was admitted at ONA, a secondary hospital in Pampanga
with chief complaint of chest pain, difficulty of breathing, hypertension and fatigue. He was
diagnosed of coronary artery disease and was given medications like losartan, amlodopine and
carvedilol then on July 11, 2018, the patient experience intermittent fever. According also to his
daughter, he doesn’t eat well during the day. In the morning he still have difficulty of breathing
accompanied by productive cough, difficulty of breathing and hypertension, this prompted him to
consult in a government tertiary hospital in Pampanga and was admitted. Mr. J comes from a
nuclear family. His wife died before his hospital confinement. He currently works as a driver of a
sand loader in Pampanga. He works everyday from 7:00am in the morning up to 5:00pm in the
afternoon. With his salary which is overall P5, 000 per month from his job, he pays for the
electric bill which is estimated at P1500 per month and water bill which is P400 per month and
food expenses which is P300 per day. His daughter helps him in providing money for his
medications and dialysis which is P3,000 per month as she works a part time as a house help.
Mr. J is a smoker and alcoholic. The patient’s usual diet includes eating fish like galunggong
and tilapia together with a soy sauce or patis. He eats an average of 3 cups of rice per day. He
also told that he likes soft drinks like coke, sarsi and royal. He also mentioned that he usually
eats junk foods especially when watching TV and while on a break after driving. Paternally, his
father died because of Chronic Kidney Disease at the age of 85. His mother died because of old
age at the age of 80. They have four children and Mr. J is the third among them. He was born
on June 27 1961 and is now 57 years old. His eldest, second and fourth are now 63 years old
and living with no known disease, 60 years old living with no known disease and 54 years old
living with no known disease. Propitiously, the rest have no reported diseases or illnesses.
Maternally, his father in law died because of liver disease at the age of 73. His mother in law
died because of heart attack at the age of 63. They have 3 children and his wife is the eldest
among them who died because of heart attack at the age of 54 one week before his hospital
confinement. The second and third are now 52 years old living with no known disease and 49
years old living with no known disease. Propitiously, the rest have no reported diseases or
illnesses. Mr. J and his deceased wife had one daughter who is now 23 years old living with no
known disease has no family yet and helping his father to provide for his medications and
dialysis.
b. Surgical Management
c. Nursing Management

VI. Discussion

a. Synthesis of the disease

Chronic kidney disease (CKD)—or chronic renal failure (CRF), as it was historically
termed—is a term that encompasses all degrees of decreased renal function, from damaged–at
risk through mild, moderate, and severe chronic kidney failure. CKD is a worldwide public health
problem. In the United States, there is a rising incidence and prevalence of kidney failure, with
poor outcomes and high cost (emedicine.com). The kidneys filter wastes and excess fluids
from blood, which are then excreted in the urine. When chronic kidney disease reaches an
advanced stage, dangerous levels of fluid, electrolytes and wastes can build up in the body.
(mayoclinic.com). Most people with CKD will be able to control their condition with medication
and regular check-ups. CKD only progresses to kidney failure in around 1 in 50 people with the
condition. But if you have CKD, even if it's mild, you're at an increased risk of developing other
serious problems, such as cardiovascular disease. This is a group of conditions affecting the
heart and blood vessels, which includes heart attacks and strokes.
Cardiovascular disease is one of the main causes of death in people with kidney
disease, although healthy lifestyle changes and medication can help reduce your risk of
developing it. In the early stages of chronic kidney disease, you may have few signs or
symptoms. Chronic kidney disease may not become apparent until your kidney function is
significantly impaired
Hypertension, or high blood pressure is when elevation in the arteries are present. The
American Heart Association has changed the basis of blood pressure as of 2017. Elevated
blood pressure is now at 120-129 systolic pressure and less than 80 diastolic pressure.
Whereas stage 1 hypertension is at 130-139 systolic pressure and 80-90 diastolic pressure, and
stage 2 hypertension 140 or higher systolic pressure, and 90 or higher pressure. Lastly,
hypertensive crisis, when you should immediately contact your physician is based at 130 higher
systolic pressure and higher than 120 diastolic pressure
VII. Nursing Implication
a. Based on finding and conclusion
The history is critical in making the diagnosis of CKD V and sometimes may provide the only
clues that lead to the diagnosis in the initial phases of the client presentation. Nurses should:
 Be knowledgeable on the different s/sx of CKD V such as edema, electrolyte
imbalances, severe anemia, uremia, acidosis, hyperkalemia, hypocalcemia and should
make necessary referral as early as possible for further management.
 Ensure that all the laboratory and diagnostic studies necessary for the maximum care of
the client are completed and any abnormal result to be monitored on a regular basis.
 Learn how to anticipate the recommended protocol in treating clients with CKD V, the
medications should at least be made available even in district hospital or private clinics.
 Be knowledgeable on the prescribed therapeutic regimen for clients with CKD V.

Dialysis program should be implemented upon admission and be continued even after
discharge from the hospital. Components of the program should include strict implementation
which is very important, thus must be advocated by the nurse. The program must be multi-
disciplinary.
Provisions of health teaching and counseling are of utmost importance to provide knowledge to
the client and his family, prevent non-compliance and correct any superfluous attitude that may
interfere with the client’s treatment. Awareness of the disease and certain risk factors the
increase the likelihood of life threatening is very important in the avoidance of these conditions.
Certain lifestyle changes can help to prevent or slow the progression of chronic kidney disease.

The problems that were identified by the student nurses took into consideration the holistic
effect of the disease to the client. Nursing interventions performed and implemented by the
student nurses such as monitoring vs regularly, implementing necessary dietary and activity
restrictions, assist in self care activities and provision of health teachings to the client and the
family facilitated relief and prevention of nursing diagnosis that were identified, specifically
decreased cardiac output, ineffective peripheral tissue perfusion, activity intolerance, ineffective
protection, excess fluid volume, noncompliance, Impaired urinary elimination.

The client’s initial management was multifaceted. Nursing management for the client with
CKD V aims at assisting in the treatment and administration of medications as ordered to assist
in client’s rehabilitation program and provision of health teachings that aims in identifying risk
factors. These interventions were all implemented and the client was regularly monitored as
ordered, medications and activities were implemented and health teachings were provided
appropriately.

VIII. Summary
IX. Referenece