End-stage renal disease, also

called end-stage kidney

disease, occurs when chronic
kidney disease — the gradual
loss of kidney function —
reaches an advanced state.
In end-stage renal disease,
the kidneys are no longer able
to work as they should to meet
body's needs.
The kidneys filter wastes and
excess fluids from your blood,
which are then excreted in
urine. When the kidneys lose
their filtering capabilities,
dangerous levels of fluid,
electrolytes and wastes can
build up in the body.
 Early in chronic kidney
disease, you may have no
signs or symptoms. As chronic
kidney disease progresses to
end-stage renal disease, signs
and symptoms might include:
•Vomiting
•Loss of appetite
•Fatigue and weakness
•Sleep problems
•Changes in how much you
urinate
•Decreased mental sharpness
•Muscle twitches and cramps
•Nausea
•Swelling of feet and ankles
•Persistent itching
•Chest pain, if fluid builds up
around the lining of the heart
•Shortness of breath, if fluid
builds up in the lungs
•High blood pressure
(hypertension) that's difficult to
control
Kidney disease occurs when a
disease or condition impairs
kidney function, causing
kidney damage to worsen
over several months or years.
Diseases and conditions that
can lead to kidney disease
include:
•Type 1 or type 2 diabetes
•High blood pressure
•Glomerulonephritis, an inflammation
of the kidney's filtering units (glomeruli)
•Interstitial nephritis, an inflammation of
the kidney's tubules and surrounding
structures
•Polycystic kidney disease
•Prolonged obstruction of the urinary
tract, from conditions such as enlarged
prostate, kidney stones and some
cancers
•Vesicoureteral reflux, a condition that
causes urine to back up into your
kidneys
•Recurrent kidney infection, also called
pyelonephritis
Glomerulonephritis is inflammation of the tiny filters in your
kidneys (glomeruli). Glomeruli remove excess fluid,
electrolytes and waste from your bloodstream and pass them
into your urine. Glomerulonephritis can come on suddenly
(acute) or gradually (chronic).
Glomerulonephritis occurs on its own or as part of another
disease, such as lupus or diabetes. Severe or prolonged
inflammation associated with glomerulonephritis can
damage your kidneys.

Conditions likely to cause scarring of the glomeruli

 High blood pressure. This can damage your kidneys and
impair their ability to function normally. Glomerulonephritis
can also lead to high blood pressure because it reduces
kidney function and can influence how your kidneys
handle sodium
Certain factors increase the risk that
chronic kidney disease will progress
more quickly to end-stage renal
disease, including:
 Diabetes with poor blood sugar
control
 Kidney disease that affects the
glomeruli, the structures in the
kidneys that filter wastes from the
blood
 Polycystic kidney disease
 Kidney disease after a kidney
transplant
 High blood pressure
 Tobacco use
 African-American descent
 Male sex
 Older age
 Lower level of kidney function when
your doctor first begins regular
measurements of kidney function
Kidney damage, once it occurs,
can't be reversed. Potential
complications can affect almost any
part of your body and can include:
Fluid retention, which could lead
to swelling in your arms and legs,
high blood pressure, or fluid in
your lungs (pulmonary edema)
A sudden rise in potassium levels
in your blood (hyperkalemia),
which could impair your heart's
ability to function and may be
life-threatening
 Heart and blood vessel
(cardiovascular) disease
 Weak bones and an increased risk
of bone fractures
 Anemia
 Decreased sex drive, erectile
dysfunction or reduced fertility
 Damage to your central nervous
system, which can cause difficulty
concentrating, personality changes
or seizures
 Decreased immune response, which
makes you more vulnerable to
infection
 Pericarditis, an inflammation of the
saclike membrane that envelops
your heart (pericardium)
 Pregnancy complications that carry
risks for the mother and the
developing fetus
•A discussion of your health
history, including your personal health
history and questions about your family's
health history.

•A physical exam, during which your doctor

measures your height, weight and blood
pressure and also looks for signs of
problems with your heart or blood vessels
and conducts a neurological exam.

•Blood tests, to measure the amount of

waste products, such as creatinine and
urea, in your blood.
•Urine tests, to check the level of the protein
albumin in your urine — a high albumin
level may indicate kidney disease.

•Imaging tests, such as ultrasound,

magnetic resonance imaging or a
computed tomography (CT) scan, to assess
your kidneys' structure and size and look for
abnormalities.

•Removing a sample of kidney tissue

(biopsy), to examine under a microscope to
learn what type of kidney disease you have
and how much damage there is.
End-stage renal disease treatment
may include:
1. Kidney transplant
2. Dialysis
3. Supportive care
 Kidney transplant
A kidney transplant is a surgical
procedure to place a healthy kidney
from a live or deceased donor into a
person whose kidneys no longer
function properly. Patient undergoes
a surgical procedure to place the
new kidney in your lower abdomen
and attach the blood vessels and
ureter — the tube that links the
kidney to the bladder — that will
allow the new kidney to function.
Dialysis
Dialysis does some of the work of your
kidneys when your kidneys can't do it
themselves. This includes removing extra
fluids and waste products from your
blood, restoring electrolyte levels, and
helping control your blood pressure.

Peritoneal dialysis
During peritoneal dialysis, blood vessels in
your abdominal lining (peritoneum) fill in
for your kidneys with the help of a fluid
that washes in and out of the peritoneal
space. Peritoneal dialysis is done in your
home.
Hemodialysis
During hemodialysis, a machine does
some of the work of the kidneys by
filtering harmful wastes, salts and fluid
from your blood.
For dialysis to be successful, patient may
need to make lifestyle changes, such as
following certain dietary
recommendations.
Hemodialysis Nursing Managements
Weigh daily before and after dialysis.
Monitor BP, pulse, and hemodynamic
pressures if available during dialysis.
Verify continuity of shunt and/or access
catheter:
Palpate for distal thrill.
Auscultate for bruit.
Avoid trauma to shunt. Handle tubing
gently, maintain cannula alignment. Limit
activity of extremity. Avoid taking BP or
drawing blood samples in shunt
extremity. Instruct patient not to sleep on
side with shunt or carry packages, books,
purse on affected extremity.
Attach two cannula clamps to shunt
dressing. Have tourniquet available. If
cannulas separate, clamp the arterial
cannula first, then the venous. If tubing
comes out of vessel, clamp cannula that
is still in place and apply direct pressure
to bleeding site. Place tourniquet above
site or inflate BP cuff to pressure just
above patient’s systolic BP.
Assess skin around vascular access,
noting redness, swelling, local warmth,
exudate, tenderness.
Avoid contamination of access site. Use
aseptic technique and masks when
giving shunt care, applying or changing
dressings, and when starting or
completing dialysis process.
Monitor temperature. Note presence of
fever, chills, hypotension.
Administer low-dose Heparin as
indicated
 Name: H.S.J.

Address: ATULAYAN,
TUGUEGARAO
Age: 10 years old

Gender: FEMALE

Significant other: MOTHER

Provider of history: PATIENT & SO

Birthdate: JANUARY 28, 2007

 Place of Birth:
TUGUEGARAO CITY

Race/ethnic background:
FILIPINO

Primary and secondary

languages:
ENGLISH AND TAGALOG

Status: SINGLE
Religious spiritual practices:
ROMAN CATHOLIC

Educational level:
GRADE 5

Occupation: STUDENT

Blood type: B
 Vital signs

BP: 140/90 mmHg

RR: 36 cpm

PR: 111 bpm

Temperature: 36.4 ºC
SO stated that Patient HSJ had
childhood illnesses like
measles and mumps. She
further added that Patient HSJ
had complete immunizations
then, but unrecalled
vaccines. She denied having
Patient HSJ undergone any
surgeries or accidents in the
past. Patient has no known
drug nor food allergies. When
Patient HSJ was 7 years old,
she was hospitalized for 4
days due to gastritis.
PHYSICAL ASSESSMENT
PHYSICAL ASSESSMENT
PHYSICAL ASSESSMENT
PHYSICAL ASSESSMENT
PHYSICAL ASSESSMENT
PHYSICAL ASSESSMENT
PHYSICAL ASSESSMENT
PHYSICAL ASSESSMENT
ANATOMY AND PHYSIOLOGY
ANATOMY AND PHYSIOLOGY
PATHOPHYSIOLOGY
PATHOPHYSIOLOGY
LABORATORY RESULTS (ANALYSIS AND
INTERPRETATION)
LABORATORY RESULTS (ANALYSIS AND
INTERPRETATION)
LABORATORY RESULTS (ANALYSIS AND
INTERPRETATION)
 DRUG STUDY
DRUG NAME DOSAGE ACTION CONTRINDICATION ADVERSE EFFECT NURSING
RESPONSIBILITIES
Cefuroxime 750 MCW - it interferes with • Contraindicated in • diarrhea • Determine history
(q 6 hours) the final step in patients • dizziness of hypersensitivity
the formation of hypersensitive to • headache reactions
the bacterial cell drug. • drowsiness tocephalosphorins
wall. • * Use cautiously in • itching/swelling , penicillin’s and
patients • rash history of allergies
hypersensitive to • nausea particularly to
• vomiting
penicillin because of drugs before
possibility of cross- therapy is
sensitivity with other initiated.
beta-lactam • Report onset of
antibiotics. loose stools
• * Use with caution • Absorption
in breast-feeding of cefuroxime is
women and enhanced by
inpatients with history food.
of colitis • Notify prescriber
• or renal sufficiency. about rashes or
superinfections
 DRUG STUDY
DRUG NAME DOSAGE ACTION CONTRINDICATION ADVERSE EFFECT NURSING
RESPONSIBILITIES
FELODIPINE 5g Treating high blood Contraindicated in Bloating or swelling Advise patient that
OB pressure, alone or patients with low blood of face, arms, dose of medication
with other pressure and hands, lower legs, may be adjusted to
medications. It may hypersensitivity or feet obtain max benefit
also be used to treat -rapid weight gain .>Advise patient to
other conditions as -tingling of hands take once daily
determined by your or feet regularly with food or
doctor, which may -unusual weight on an empty
not be listed in the gain or loss stomach. Caution
professional patient to swallow
package insert. Flushing tablets whole and not
>Headache to crush, chew, cut, or
Felodipine is a >Palpitations break
calcium channel >Dizziness
blocker. It works by >Fatigue
blocking the normal .>Peripheral
action of calcium on edema
blood vessels and >Nausea
the heart. This allows >Vomiting
the blood vessels to
relax, the heart to
beat with less force
and pump out less
blood, and the heart
to beat more slowly
and regularly.
 DRUG STUDY
DRUG NAME DOSAGE ACTION CONTRINDICATION ADVERSE NURSING
EFFECT RESPONSIBILITIES
CAPTOPRIL 25 g Captopril is used to Contraindicated in -a light- 1.Monitor blood
BID/TID treat high blood Pregnancy, headed pressure and pulse
pressure Hypertensitivity feeling, like you frequently during
(hypertension). ,Cross sensitivity among might pass out; initial dose adjustment
Lowering ACE inhibitors and -little or no and periodically
highblood Angieodema urination, or during therapy. (for
pressure (hereditary or idiophatic) urinating more patients treated with
helps prevent than usual; hypertension)
strokes, heart -shortness of 2.For patients treated
attacks, and breath (even with CHF, monitor
kidney problems. It with mild weight and assess
is also used to exertion), patient routinely for
treat heart failure, swelling, rapid resolution of fluid
protect the kidneys weight gain; overload. Signs of fluid
from harm due -chest pain or overload are:
to diabetes, and pressure, peripheral edema,
to improve survival pounding rales or crackles,
after a heart heartbeats or dyspnea, weight gain
attack. fluttering in and jugular vein
your chest; distention.
 DRUG STUDY
DRUG NAME DOSAGE ACTION CONTRINDICATION ADVERSE NURSING
EFFECT RESPONSIBILITIES
-high 3.The nurse should
potassium - keep in mind that
nausea, slow or Captopril may cause
unusual heart false-positive result for
rate, weakness, urine acetone.
loss of 4.The drug should be
movement; or administered 1 hour
sudden before or 2 hours after
weakness or ill meals. It may be
feeling, fever, crushed if the patient
chills, sore has difficulty
throat, painful swallowing.
mouth sores, 5.Keep this medication
pain when in the container it
swallowing, skin came in, tightly closed,
sores, cold or flu and out of reach of
symptoms. children.
cough; 6.Store it at room
flushing temperature and
(warmth, away from excess heat
redness, or and moisture (not in
tingly feeling); the bathroom).
 DRUG STUDY
DRUG NAME DOSAGE ACTION CONTRINDICATION ADVERSE NURSING
EFFECT RESPONSIBILITIES
fnumbness, 7.Throw away any
tingling, or medication that is
burning pain in outdated or no longer
your hands or needed.
feet; 8.Inform the patient
loss of taste that Captopril tablets
sensation; or may have a slight sulfur
mild skin itching odor (like rotten eggs).
or rash 9.Instruct the patient to
notify the physician
immediately when the
following
manifestations are
experienced:
chest pain
swelling of the face,
eyes, lips, tongue,
arms, or legs
difficulty breathing or
swallowing
fainting
rash
NURSING CARE PLAN 1
NURSING CARE PLAN 2
 NURSING CARE PLAN 3
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
OBJECTIVE= patient Risk for impaired skin SHORT TERM:  Establish  To gain the SHORT TERM:
manifested: integrity related to After 8 hours of rapport trust of the Patient was able to
-with history of edema nursing intervention  Monitor vital client demonstrate
hematuria patient will signs and note  To have a behaviors to prevent
-with history of demonstrate level of baseline data skin breakdown
frequent urination behaviors to prevent consciousness and to reveal LONG TERM:
but small amount of skin breakdown  Assess skin alteration Patient’s edema was
urine in yellow color LONG TERN: condition  To reveal able to
-appears weak After 8 days of  Monitor weight abnormality/ decreased/subside
-with good skin turgor nursing intervention daily skin disruption
decreased patient’s edema will  To provide  To monitor
-food intake decreased/subside meticulous skin presence of
-vital signs taken as care edema
follows  Keep bed linens  To prevent skin
 Temperature: dry breakdown
36.8 degree  Frequently  To prevent
celcius change moisture which
 PR: 72 patient’s may promote
 RR: 19 position skin breakdown
 BP: 80/72  To promote
The patient may paper
manifested circulation and
-dehydration prevent
-inappropriate urine excessive
output for intake pressure on
skin.
 NURSING CARE PLAN 4
ASSESSMENT DIAGNOSIS PLANNING INTERVENTIONS RATIONALE EVALUATION
OBJECTIVE Deficient fluid After 8 hours of  Monitored  To have a After 8 hours of
 Bipedal edema volume related to nursing intervention intake and baseline data nursing intervention
 Periorbital decreased the patient’s SO will output  To have a Patient’s SO was able
edema glomerular filtration able to verbalized of  Instructed to baseline data to verbalized
 (+) Protein in secondary to AGN understanding the limit intake of and to reveal understanding of
the urine condition. fluids and avoid alternation condition and
salty foods  To promote RBC therapy regimens
 Encouraged to production
eat foods rich in  To avoid
Vitamin C fatigue.
 Encouraged to  To promote
do diversional therapeutic
activities like communication
reading
 Assisted in
performing
activities of
daily living
 Encouraged
verbalization of
feelings and
concerns
 Watched out
for signs of
dehydration
 NURSING CARE PLAN 5
ASSESSMENT DIAGNOSIS PLANNING INTERVENTIONS RATIONALE EVALUATION
OBJECTIVE: Ineffective tissue After 8 hours of  Blood pressure  To detect early - No signs of
-pale skin perfusion related to nursing intervention monitor and symptoms of hypernatremia
-edema water retention and the client can record every 1-2 blood pressure
-irritability hypernatremia demonstrate normal hours per day changes and
Vital signs cerebral tissue during the acute determine
-BP: 80/73 perfusion is marked phase further
-HR:97 with blood pressure  Keep the airway intervention
-RR:18 within normal limits, hygiene,  Happen due to
decreased water prepare suction lack of oxygen
retention  Set of anti- to the brain
hypertension, perfusion
monitor client  Anti-
reaction hypertension
 Monitor the can be due to
status of the uncontrolled
volume of liquid hypertension
every 1-2 hours, can cause
monitor urine kidney damage
output
 NURSING CARE PLAN 5
ASSESSMENT DIAGNOSIS PLANNING INTERVENTIONS RATIONALE EVALUATION
 Assess  The monitor is
neurological very necessary
status (level of because the
consciousness, expansion of
reflexes, pupil the volume of
response) every fluid can cause
8 hours blood pressure
 Set of diuretics: to rise
esidricks, Lasix  To detect early
appropriate changes in
orders neurological
status, facilitate
subsequent
intervention
 Diuretic can
increase the
excretion of
fluids
Lopez, Heron Joshua
Saure, Ardon
Caluya Daryl
Latawan, Rosalyn
Ramiterre, Angel
Salva, Trixia Nicole
Suyu, Irishe Gold