5evere Azotem|a r/t CkI 5econdary

to Lnd 5tage kena| Ia||ure w|th

mu|t|p|e Nephro||th|as|s D/I
5tent|ng at the |eft k|dney b|f|d
r|ght ureter comp||cates to
Card|omega|y
by GkCU 4
Arro[adoLr|c Candadoau|yt C|a|re
CuaresmaMary Iane D|nga|Myra 8e||e
Mangaokona|yn Mo|||on khyza Ia|th
CagdanIunesten|y Louan erm|tes5weet kuve|ner
5|g|osIuster|ne Iade apIac|yn
2/14/2011
C8ILC1IVL5
W lor Lhe compleLlon of Lhls case presenLaLlon Lhe llsLeners wlll be able Lo
W undersLand and recoanlze Lhe conLrlbuLlna rlsk facLors and Lhe dlsease
process of Chronlc 8enal lallure
W know and undersLand Lhe dlfferenL assessmenL parameLers (ea Cordon's
AssessmenL and hvslcal AssessmenL) of Lhe paLlenL
W ueLermlne and undersLand Lhe consLanL beLween Lhe anaLomlcal and
phvsloloalcal sLrucLure lnvolved ln Lhe damaae and dlsease process
W uescrlbe and undersLand Lhe dlaanosLlc LesL used normal values lLs
resulLs and how lL ls performed
W know and ldenLlfv Lhe dlfferenL slans and svmpLoms LhaL manlfesLed bv
Lhe paLlenL
W Learn and applv Lhe baslc and effecLlve nurslna lnLervenLlon
W know and undersLand Lhe role of medlcal lnLervenLlons (ea drua Lherapv)
ln manaalna Lhe cllenL
W know Lhe proanosls of Lhe paLlenL wlLh Chronlc 8enal lallure
W know whaL are Lhe healLh Leachlnas LhaL can be Leach Lo Lhe paLlenL
W uurlna/AfLer Lhe presenLaLlon Lhe presenLers wlll be able Lo
W uellver a verv oraanlzed svsLemaLlc and loalcal presenLaLlon of Lhe case
W LxecuLe an oraanlzed lnLroducLlon of Lhe case
W use an audlovlsual alds LhaL wlll encouraae and enhance Lhe undersLandlna
of Lhe case Lo be presenLed
W resenL svsLemaLlcal and oraanlzed daLa perLlnenL Lo Lhe case LhaL belna
aaLhered
W LlaboraLe and explaln Lhe speclflc nurslna lnLervenLlons healLh Leachlna and
dlscharaed plan approprlaLe Lo paLlenL's condlLlon
W LxhlblL masLerv and confldence ln answerlna relevanL quesLlon wlLh poslLlve
aLLlLude Lowards crlLlclsm and suaaesLlons
W use en[ovable and effecLlve Leachlna sLraLeales LhaL wlll caLch and susLaln Lhe
audlence aLLenLlon all LhrouahouL Lhe presenLaLlon
W Lncouraae Lhe audlence Lo parLlclpaLe ln quesLlon and answer porLlon
W Learn abouL one's sLrenaLh and weaknesses reaardlna Lhe case presenLaLlon
measures Lo enhance one's skllls and ablllLles
W LxhlblL Leamwork and cooperaLlon ln answerlna Lhe quesLlon
IN1kCDUC1ICN
Chron|c k|dney d|sease (Cku) also known as chron|c
rena| d|sease ls a proaresslve loss ln renal funcLlon
over a perlod of monLhs or vears 1he svmpLoms of
worsenlna kldnev funcLlon are unspeclflc and mlahL
lnclude feellna aenerallv unwell and experlenclna a
reduced appeLlLe CfLen chronlc kldnev dlsease ls
dlaanosed as a resulL of screenlna of people known Lo
be aL rlsk of kldnev problems such as Lhose wlLh hlah
blood pressure or dlabeLes and Lhose wlLh a blood
relaLlve wlLh chronlc kldnev dlsease Chronlc kldnev
dlsease mav also be ldenLlfled when lL leads Lo one of
lLs recoanlzed compllcaLlons such as cardlovascular
dlsease anemla or perlcardlLls
Chronlc kldnev dlsease ls ldenLlfled bv a blood LesL for creaLlnlne
Plaher levels of creaLlnlne lndlcaLe a falllna alomerular fllLraLlon
raLe and as a resulL a decreased capablllLv of Lhe kldnevs Lo excreLe
wasLe producLs CreaLlnlne levels mav be normal ln Lhe earlv sLaaes
of Cku and Lhe condlLlon ls dlscovered lf urlnalvsls (LesLlna of a
urlne sample) shows LhaL Lhe kldnev ls allowlna Lhe loss of proLeln
or red blood cells lnLo Lhe urlne 1o fullv lnvesLlaaLe Lhe underlvlna
cause of kldnev damaae varlous forms of medlcal lmaalna blood
LesLs and ofLen renal blopsv (removlna a small sample of kldnev
Llssue) are emploved Lo flnd ouL lf Lhere ls a reverslble cause for Lhe
kldnev malfuncLlon 8ecenL professlonal auldellnes classlfv Lhe
severlLv of chronlc kldnev dlsease ln flve sLaaes wlLh sLaae 1 belna
Lhe mlldesL and usuallv causlna few svmpLoms and sLaae 3 belna a
severe lllness wlLh poor llfe expecLancv lf unLreaLed SLaae 3 Cku ls
also called estab||shed chron|c k|dney d|sease and ls svnonvmous
wlLh Lhe now ouLdaLed Lerms endstage rena| d|sease (L5kD)
chron|c k|dney fa||ure (CkI) or chron|c rena| fa||ure (C8l)
Azotem|a ls a medlcal condlLlon characLerlzed bv
abnormallv hlah levels of nlLroaenconLalnlna compounds
such as urea creaLlnlne varlous bodv wasLe compounds
and oLher nlLroaenrlch compounds ln Lhe blood lL ls
laraelv relaLed Lo lnsufflclenL fllLerlna of blood bv Lhe
kldnevs
AzoLemla has Lhree classlflcaLlons dependlna on lLs
causaLlve orlaln buL all Lhree Lvpes share a few common
feaLures All forms of azoLemla are characLerlzed bv a
decrease ln Lhe alomerular fllLraLlon raLe (Cl8) of Lhe
kldnevs and lncreases ln blood urea nlLroaen (8un) and
serum creaLlnlne concenLraLlons 1he 8unLocreaLlnlne
raLlo (8unCr) ls a useful measure ln deLermlnlna Lhe Lvpe
of azoLemla A normal 8unCr ls less Lhan
1vpes of AzoLemla
W rerenal azoLemla ls caused bv a decrease ln blood flow Lo Lhe kldnevs
whlch can be caused bv shock decreased cardlac ouLpuL volume
depleLlon narrowlna of Lhe renal arLerv eLc resulLlna ln lnadequaLe
blood supplv Lo Lhe kldnevs 1here ls no lnherenL kldnev dlsease lL can
occur from hemorrhaae shock volume depleLlon and conaesLlve hearL
fallure amona oLher Lhlnas
W 8enal azoLemla (acuLe renal fallure) Lvplcallv leads Lo uremla lL ls an
lnLrlnslc dlsease of Lhe kldnev aenerallv Lhe resulL of renal parenchvmal
damaae Causes lnclude renal fallure alomerulonephrlLls acuLe Lubular
necrosls or anv oLher klnd of renal dlsease
W 8lockaae of urlne flow ln an area below Lhe kldnevs resulLs ln posLrenal
azoLemla lL can be caused bv conaenlLal abnormallLles such as
veslcoureLeral reflux blockaae of Lhe ureLers bv kldnev sLones preanancv
compresslon of Lhe ureLers bv cancer prosLaLlc hvperplasla or blockaae of
Lhe ureLhra bv kldnev or bladder sLones Llke ln prerenal azoLemla Lhere ls
no lnherenL renal dlsease 1he lncreased reslsLance Lo urlne flow can
cause back up lnLo Lhe kldnevs leadlna Lo hvdronephrosls
Def|n|t|ons of 1erms
W Azotem|a ls a medlcal condlLlon characLerlzed bv abnormallv hlah levels
of nlLroaenconLalnlna compounds such as urea creaLlnlne varlous bodv
wasLe compounds and oLher nlLroaenrlch compounds ln Lhe blood lL ls
laraelv relaLed Lo lnsufflclenL fllLerlna of blood bv Lhe kldnevs
W 8|f|d spllL or clefL lnLo Lwo parLs
W Card|omega|y ls a medlcal condlLlon whereln Lhe hearL ls enlaraed
W Chron|c rena| d|sease ls a proaresslve loss ln renal funcLlon over a perlod
of monLhs or vears
W Nephro||th|as|s (oepbtos kldnev) refers Lo Lhe condlLlon of havlna
kldnev sLones
W 5tent ls an arLlflclal Lube lnserLed lnLo a naLural passaae/condulL ln Lhe
bodv Lo prevenL or counLeracL a dlseaselnduced locallzed flow
consLrlcLlon 1he Lerm mav also refer Lo a Lube used Lo Lemporarllv hold
such a naLural condulL open Lo allow access for suraerv
W Ureters are muscular Lubes LhaL propel urlne from Lhe kldnevs Lo Lhe
urlnarv bladder
VI1AL INICkMA1ICN
name Mrs valenLlne
8oom number 286
3
Aae 49 vears old
Cender female
Clvll SLaLus Marrled
uaLe of 8lrLh lebruarv 28 1961
8lrLhplace Mamba[ao Camlauln
CulLural Croup Cebuano
rlmarv Lanauaae 8lsava
8ellalon enLecosLal
PlahesL LducaLlonal ALLalnmenL
Colleae CraduaLe 8S
LducaLlon Ma[or ln Secondarv
LducaLlon
CccupaLlon Plahschool 1eacher
usual PealLh Care rovlder
hvslclan
8eason for PealLh ConLacL
ulfflculLv ln breaLhlna
uaLe of ConflnemenL !anuarv
292011
Source of PlsLorv
80 SC and aLlenL
20 CharL
ALLendlna hvslclan/s ur Abel
Comez and ur LaurlLo
lmpresslon/llnal ulaanosls Severe AzoLemla r/L
C8l 2
0
Lnd SLaae 8enal lallure wlLh mulLlple
nephrollLhlasls u! SLenLlna lefL klndev blfld
rlahL ureLer complemenLs Lo Cardlomeaalv
uescrlpLlon of aLlenL
lalrlv aroomed wearlna a whlLe hosplLal Cown
wlLh saved LefL Arm noLed wlLh folev caLheLer
Pas complalnLs of uC8 Consclous conversanL
coherenL and ls orlenLed Lo Llme person and
place
Nurs|ng n|story
A Ch|ef Comp|a|nts/keason for V|s|t
ulfflculLv of 8reaLhlna
8 n|story of resent I||ness
2 weeks 1A 1he paLlenL was admlLLed aL Lhe ClLv PosplLal for an
operaLlon She had a u! SLenLlna aL Lhe lefL kldnev AfLer Lhe operaLlon she
felL LhaL she cannoL breaLhe well her blood pressure ls aeLLlna hlaher Lhus
referrlna her aL Mlndanao SanlLarlum and PosplLal LasL !anuarv 292011
C n|story of ast I||ness
LasL 1992 she had her 8llaLeral 1ubal LlaaLlon Cn Lhe vear 2000 aL
Caaavan de Cro Medlcal CenLer she was dlaanose havlna renal fallure and
hvperLenslon
1here are no known allerales Lo food and druas Per lmmunlzaLlon ls
unrecalled She clalmed LhaL she experlenced chlcken pox ln her Leenaae
vears Per LasL hvslcal LxamlnaLlons Laken where LCC 2decho kldnev
ulLrasound chesL xrav urlnalvsls and 8lood LesLs
CbsLeLrlc PlsLorv C
3
1
2

1
A
0
L
2
She ls Laklna over Lhe counLer pllls and druas relaLed Lo her condlLlon
whlch are unrecalled
GCkDCN'5 A55L55MLN1
nea|th ercept|on/nea|th Management attern
1he paLlenL was admlLLed due Lo dlfflculLv of
breaLhlna she confessed LhaL she worrles
abouL her condlLlon buL sLlll accepLs lL slnce
lL's all her faulL and her loss of conLrol ln dleL
GCkDCN'5 A55L55MLN1
Nutr|t|ona|/Metabo||c attern
asL resenL
1he paLlenL had a aood
appeLlLe before she was
hosplLallzed She usuallv eaLs
veaeLables and flsh She can
consume 1 or Z cup of rlce per
meal Per dallv snacks conslsL
of banana cue or bread and
coke or anv [ulces She Lakes 3
alasses of waLer a dav
1he paLlenL has loss of
appeLlLe durlna Lhe
hosplLallzaLlon she
onlv consumes 33
spoonful of food She
has a low fluld lnLake
GCkDCN'5 A55L55MLN1
L||m|nat|on attern
asL resenL
1he paLlenL usuallv defecaLes once a dav
She sald LhaL She seldom experlence
consLlpaLlon And aL Llmes she has
dlfflculLv ln urlnaLlna
Cn Lhe flrsL dav of duLv she had her folev
caLheLer Cn Lhe second and Lhlrd dav lL
has been removed so she onlv wore
dlapers
Lxerc|se Act|v|ty attern
asL resenL
Per acLlvlLles for dav are qulLe sLressful
She Leaches aL lllaan clLv naLlonal
hlahschool durlna Lhe dav from 7am9pm
and usuallv walks from Lhe school Lo Lhelr
home ln baaona sllana she also spend
Llme ln dolna Lhe household chores llke
cooklna dolna Lhe laundrv and cleanlna
Lhe house She conslders Lhls as her
exerclse
1he paLlenL ls Loo weak Lo even Lransfer
from Lhe bed Lo Lhe chalr and mav need
asslsLance She sLopped Leachlna lasL
!anuarv
GCkDCN'5 A55L55MLN1
5|eep/kest attern
asL resenL
8efore PosplLallzaLlon Lhe paLlenL has a
shorL sleeplna Llme She usuallv sleeps aL
11pm and wakes up aL 430 or 3am Lo
prepare for school and Lo do some
household chores
1he paLlenL reporLed LhaL she has more
Llme Lo sleep now Lhan her sleeplna Llme
before she was hosplLallzed Lven Lhouah
she experlences dlfflculLv ln breaLhlna
LhaL alLers her sleeplna paLLern
Cogn|t|ve/erceptua| attern
asL resenL
1he paLlenL doesn'L wear an eve alasses
She clalms LhaL she doesn'L have anv
problems ln hearlna and ln seelna She
dldn'L have her eve check up elLher
She sLaLed LhaL she dldn'L experlence anv
paln aL Lhe momenL
GCkDCN'5 A55L55MLN1
5e|f ercept|on attern
She conflrmed LhaL she feels worrled abouL her slLuaLlon whenever she aeLs her
self dlalvzed she feels anxlous She never experlence lnsecurlLles and sLaLed LhaL
Cod made everv person unlquelv and dlfferenLlv
ko|e ke|at|onsh|p attern
Mrs valenLlne ls llvlna wlLh her famllv 1hev have a sLrona famllv bond and her
chlldren supporL and never leave her everv sLep of Lhe wav Per supporLlve
husband flnds a Wav Lo make monev for her dlalvsls She sald LhaL her famllv ls her
Lreasure and ls verv lmporLanL Lo her
Copp|ng 5tress Management attern
Per dauahLer sLaLed LhaL When she ls sLressed wlLh work and problems she
unwlnds Lhrouah waLchlna Lelevlslon and sleeplna afLer a lona davs work She ls
also open Lo her husband and shares her wlLh problems LhaL sLressed her ouL
Va|ue 8e||ef attern
Mrs valenLlne belleves LhaL evervLhlna happens for a reason She ls a verv
rellalous lndlvldual and she aoes Lo church wlLh her famllv Per falLh ln Cod ls so
sLrona LhaL no one could ever break her relaLlonshlp Lo her Cod As whaL she sald
Cod wlll make a wav when Lhere seems Lo be no wav
hvslcal AssessmenL
n5ICAL LkAMINA1ICN (DA 1)
lebruarv 9 2011
Ceneral PealLh SLaLus
aLlenL ls 49 vears old female falrlv aroomed
wearlna hosplLal aown wlLh save lefL arm
noLed She complalnLs of dlfflculLv of
breaLhlna wlLh folev caLheLer She consumes
1/4 of food served no eplsodes of vomlLlna
wlLhln Lhe shlfL She ls consclous conversanL
coherenL and ls orlenLed Lo daLe Llme
person and place
AkLA5/551LM 5U8ILC1IVL C8ILC1IVL kC8LLM5
IDLN1IIILD
(WI1nCU1
L1ICLCG)
Inc|ud|ng k|sk
rob|ems
Pead/Palr/lace no complalnLs
made
Pead svmmeLrlcal
ln slze shape and
faclal feaLures no
Lenderness noLed
no leslons Palr
evenlv dlsLrlbuLed
no problem
ldenLlfled
neuroloalc lnlL ako pamaLl LCC responds
approprlaLelv Lo
palnful sLlmull
orlenLed Lo
daLeLlmeperson
and place
Speech coherenL
ApproprlaLe affecL
(+)fever durlna pm
shlfL wlLh Lemp of
383
o
C
Lyes/Lars/Nose
and 5|nuses
No comp|a|nts
made
An|cter|c sc|era (+)
LkkLA 15 cm
p|nk|sh
con[unct|va no
nasa| d|scharge no
nasa| f|ar|ng no
s|gns of
|nf|ammat|on
No prob|em
|dent|f|ed
MouLh and harvnx no complalnLs
made
urv mouLh no slans
of lnflammaLlon no
Lenderness
lmpalred oral
mucous membrane
neck no complalnLs
made
resence of lvl of
u3nSS 1 llLer
rlahL [uaular veln
kvC ()
enaoraemenL ()
masses
no problem
ldenLlfled
1horax/Lungs No comp|a|nts
made
Lqua| chest
expans|on ()
cough no crack|es
and ra|es upon
auscu|tat|on ()
nasa| d|scharges
not |n resp|ratory
d|stress
No prob|em
|dent|f|ed
8ack saklL oa kaLol
akona llkod
() scollosls lordosls
and osLeoporosls
presence of rashes
and redness
lmpalred skln
lnLearlLv
8reasL/Axllla no complalnLs
made
nonLender ()
dlscharaes ()
leslons
no problem
ldenLlfled
Cardlovascular/erl
pheral vascular
no complalnLs
made
sLrona bounded
pulse () hearL
murmurs absence
of arrvLhmla
no problem
ldenLlfled
GI1 No comp|a|nts made s||ght|y d|stended
abdomen presence
of hypoact|ve bowe|
sounds |n a|| four
quadrants presence
of str|ae and some
stretch marks at LLC
and kLC
k|sk for
const|pat|on
Cu1 no complalnLs made presence of ollaurla
(below 180cc wlLhln
Lhe 8 hours of duLv
shlfL) urlne odorous
vellowlsh ln color no
blood presenL wlLh
folev caLheLer
aLLached
lmpalred urlnarv
ellmlnaLlon 8lsk for
lnfecLlon
MusculoskeleLal no complalnLs made
poor muscle Lone ln
lower exLremlLles
presence of muscle
weakness lmpalred
muscle
sLrenaLh(arade 3
falr) llmlLed 8CM
8lsk for fall 8lsk for
ln[urv AcLlvlLv
lnLolerance Selfcare
deflclL
Integumentary No comp|a|nts made
warm to touch
pa|e na|| beds pa|e
Ck1 4 sec presence
of bru|sess
Ineffect|ve t|ssue
perfus|on
LxLremlLles no complalnLs made edemaLous upper
and lower
exLremlLles save
lefL arm
ulsLurbed bodv
lmaae 8lsk for
ln[urv
Lndocrlne n/A
n/A
n/A
n5ICAL LkAMINA1ICN (DA 2)
lebruarv 10 2011
Ceneral PealLh SLaLus
aLlenL ls 49 vears old falrlv aroomed wearlna
blue hosplLal aown wlLh save lefL arm noLed She
complalnLs of dlfflculLv of breaLhlna wlLh oxvaen vla
nasal cannula 1 llLer per mln and has dlaper She has
occaslonal nonproducLlve couah and no eplsodes of
vomlLlna wlLhln Lhe shlfL needs asslsLanL when
chanalna poslLlon from suplne Lo semlfowlers
poslLlon unable Lo Lake LableL formed medlcaLlons and
needs Lo be crashed and mlxed wlLh fluld She ls
consclous conversanL coherenL and ls orlenLed Lo
daLe Llme person and place
AkLA5/551LM 5U8ILC1IVL C8ILC1IVL kC8LLM5
IDLN1IIILD
(WI1nCU1
L1ICLCG)
Inc|ud|ng k|sk
rob|ems
Pead/Palr/lace no complalnLs
made
1he cllenL's head ls
svmmeLrlcal and no
fracLure observed
wlLh a smooLh
shorL black and
whlLe evenlv
dlsLrlbuLed halr
wlLhouL flakes
leslons masses
Lenderness and
headllce noLed on
scalp lace ls
svmmeLrlcal
appeared confused
Self care deflclL
AnxleLv
Neuro|og|c
5C nay pag pa
ayo nah kay
mangu|| nah
dayon tah
LCC responds
appropr|ate|y to
pa|nfu| st|mu||
or|ented to date
t|me person and
p|ace resence of
|||us|on (+) fever
w|th temp of
381
o
C
nypertherm|a
D|sturbed
Lves/Lars/nose and Slnuses
no complalnLs made
Lves
svmmeLrlcal wlLh evenlv dlsLrlbuLed halr ln Lhe evebrows and evelashes Lvellds
can close properlv and no dlfflculLv no dlscharaes leslons redness swelllna noLed
on boLh eves Sclera appears whlLe and con[uncLlva appears plnk ln color uplls
are black and svmmeLrlcal (+) L88LA 13 cm
Lars
Aurlcles are svmmeLrlcal and Lhe same color as faclal skln has a clean exLernal
audlLorv canal wlLhouL leslons or dlscomforL noLed
nose
LxLernal nose color ls same as faclal skln svmmeLrlcal nares molsL plnk mucosal
wall wlLhouL dlscharaes and leslons wlLh oxvaen vla nasal cannula 1 llLer per mln
no problem ldenLlfled
Mouth and
harynx
No comp|a|nts
made
Dry mouth p|nk|sh
ora| mucosa no
s|gns of
|nf|ammat|on no
tenderness
Impa|red ora|
mucous membrane
neck no complalnLs
made
resence of lvl of
u3nSS 1 llLer
rlahL [uaular veln
kvC ()
enaoraemenL ()
masses
no problem
ldenLlfled
1horax/Lunas llsud kavo ko oa
alnhawa
Lqual chesL
expanslon (+) non
producLlve couah
(+) wheezes ()
nasal dlscharaes
Lachvpnelc 88 of
38
lneffecLlve
breaLhlna paLLern
8ack No comp|a|nts
made
() sco||os|s
|ordos|s and
osteoporos|s
presence of rashes
and redness (+)
bru|ses
Impa|red sk|n
|ntegr|ty
8reasL/Axllla no complalnLs
made
nonLender ()
dlscharaes ()
leslons
no problem
ldenLlfled
Cardlovascular/erl
pheral vascular
no complalnLs
made
sLrona bounded
pulse () hearL
murmurs absence
of arrvLhmla P8 of
96
uecrease cardlac
ouLpuL
GI1 No comp|a|nts
made
s||ght|y d|stended
abdomen (36 |nch)
() nausea and
vom|t|ng presence
bowe| sounds |n a||
four quadrants
presence of str|ae
and some stretch
marks at LLC and
kLC watery
ye||ow|sh green
stoo|
No prob|em
|dent|f|ed
Cu1 no complalnLs
made
presence of
ollaurla (below
130cc wlLhln Lhe 8
hours of duLv
shlfL) urlne
odorous vellowlsh
ln color no blood
presenL
lmpalred urlnarv
ellmlnaLlon
Muscu|oske|eta| No comp|a|nts
made
poor musc|e tone
|n |ower
extrem|t|es
presence of musc|e
weakness
|mpa|red musc|e
strength (grade 2
poor) ||m|ted kCM
k|sk for fa|| k|sk
for In[ury Act|v|ty
|nto|erance 5e|f
care def|c|t
|mpa|red transfer
ab|||ty
lnLeaumenLarv no complalnLs
made
warm Lo Louch
pale nall beds pale
C81 4 sec
presence of brulses
lneffecLlve Llssue
perfuslon
LxLremlLles no complalnLs
made
edemaLous upper
and lower
exLremlLles save
lefL arm
ulsLurbed bodv
lmaae 8lsk for
ln[urv
Lndocrlne n/A
n/A
n/A
n5ICAL LkAMINA1ICN (DA 3)
lebruarv 11 2011
Ceneral PealLh SLaLus
aLlenL ls 49 vears old falrlv aroomed wearlna
oranae hosplLal aown wlLh save lefL arm noLed
She sLlll has complalnLs of dlfflculLv of breaLhlna
and has dlaper no eplsodes of vomlLlna wlLhln
Lhe shlfL Able Lo perform slLLlna poslLlon wlLh
mlnlmal asslsLance She consumes 1/2 of food
served She ls consclous conversanL coherenL
and ls orlenLed Lo daLe Llme person and place
AkLA5/551LM 5U8ILC1IVL C8ILC1IVL
kC8LLM5
IDLN1IIILD
(WI1nCU1
L1ICLCG)
Inc|ud|ng k|sk
rob|ems
Pead/Palr/lace no complalnLs
made
1he cllenL's head ls
svmmeLrlcal wlLh a
smooLh shorL
black and whlLe
evenlv dlsLrlbuLed
halr () leslons ()
masses dandruff
noLed on scalp
lace ls svmmeLrlcal
Self care deflclL
Neuro|og|c No comp|a|nts
made
LCC responds
appropr|ate|y to
pa|nfu| st|mu||
or|ented to date
t|me person and
p|ace and
conversant dur|ng
|nteract|on
No prob|em
|dent|f|ed
Lves/Lars/nose and
Slnuses
no complalnLs
made
AnlcLerlc sclera (+)
L88LA 13 cm
plnklsh
con[uncLlva no
nasal dlscharae no
nasal flarlna no
slans of
lnflammaLlon
no problem
ldenLlfled
Mouth and
harynx
No comp|a|nts
made
Dry mouth p|nk|sh
ora| mucosa no
s|gns of
|nf|ammat|on no
tenderness
Impa|red ora|
mucous membrane
neck no complalnLs
made
resence of lvl of
u3nSS 1 llLer
rlahL [uaular veln
kvC ()
enaoraemenL ()
masses
no problem
ldenLlfled
1horax/Lunas no complalnLs
made
Lqual chesL
expanslon () non
producLlve couah
() wheezes ()
nasal dlscharaes
Lachvpnelc 88 of
32
lneffecLlve
breaLhlna paLLern
8ack No comp|a|nts
made
() sco||os|s
|ordos|s and
osteoporos|s
presence of rashes
and redness (+)
bru|ses
Impa|red sk|n
|ntegr|ty
8reasL/Axllla no complalnLs
made
nonLender ()
dlscharaes ()
leslons
no problem
ldenLlfled
Cardlovascular/erl
pheral vascular
no complalnLs
made
sLrona bounded
pulse () hearL
murmurs absence
of arrvLhmla
no problem
ldenLlfled
GI1 No comp|a|nts
made
s||ght|y d|stended
abdomen (36 |nch)
presence of
hypoact|ve bowe|
sounds |n a|| four
quadrants
presence of str|ae
and some stretch
marks at LLC and
kLC
No prob|em
|dent|f|ed
Cu1 no complalnLs
made
presence of
ollaurla (below
80cc wlLhln Lhe 8
hours of duLv
shlfL) urlne
odorous vellowlsh
ln color no blood
presenL
lmpalred urlnarv
ellmlnaLlon
Muscu|oske|eta| No comp|a|nts
made
poor musc|e tone
|n |ower
extrem|t|es
presence of musc|e
weakness
|mpa|red musc|e
strength ( grade 3
fa|r) ||m|ted kCM
k|sk for fa|| k|sk
for In[ury Act|v|ty
|nto|erance 5e|f
care def|c|t
|mpa|red transfer
ab|||ty
lnLeaumenLarv no complalnLs
made
warm Lo Louch
pale nall beds pale
C81 4 sec
presence of brulses
lneffecLlve Llssue
perfuslon
LxLremlLles no complalnLs
made
edemaLous upper
and lower
exLremlLles save
lefL arm
ulsLurbed bodv
lmaae 8lsk for
ln[urv
Lndocrlne n/A
n/A
n/A
D|agnost|c 1ests
2D Lcho f|nd|ngs
1he mlLral valve aorLlc valve Lrlcuspld valve pulmonarv
valve are sLrucLurallv normal
Cn LefL aLrlum LefL venLrlcle rlahL aLlum 8lahL veLrlcle are
normal ln lnLernal dlmenslon
1hee ls dvsklneLlc movemenL of Lhe lnLervenLrlcular sepLum
no lnLercardlae Lhombus seen
1he maln pulmonarv arLerv ls noL dllaLed
1he lnLervenLrlcular sepLum appears lnaLacL
1here ls an echo free space ln Lhe anLerlor and posLerlor
perlcardlal sac suaaesLlve of mlld perlcardlal effuslon
Dopp|er
Moanlc where dvsLrophv from Lhe aorLa Lo Lhe LefL
venLrlcle Lhe reauralLanL flow [eL/ lefL venLrlcle ouLflow
d|sconnect rat|o of 299 conslsLenL wlLh aorLlc
lnsufflclencv +2
ulmonarv arLerv pressure bv aucLuraLlon Llme 90 mmha
(mlld pressure) pulmonarv hvperLenslon
ooclosloo
LefL venLrlcle concenLrlc hvperLrophv
uvsklneLlc movemenL of Lhe lnLervenLrlcular sepLum
AorLl lnsufflclencv +2
ulmonarv P1n mlld
erlcardlal effuslon mlld
CnL51 A
lollow up chesL xrav showed Lhe enlaraed
and maanlfled C18 039
1he hllar vessels ae noL dllaLed 1he LefL luna
base was perslsLenLlv obsued 1he bonv Lhorax
ls normal
ptessloo
LefL venLrlcular cardlomeaalv
perslsLenL obscured
kIDNL UL1kA5CUND
1he rlahL measures 883 cm x 337 cm x 447 cm wlLh corLlcal
Lhlckness of 137c lncease ln parenchvmal echoaeneclLv wlLh mlnlmal
pelvocalelcLasls 1he renal ouLllne was poorlv deflned due Lo
parenchvmal hvperechoaeneclLv
1he lefL kldnev ls enlaaed measures 147 cm x 8 cm wlLh corLlcal
Lhlckness of 09 cm ModeraLe pelvocallecLasls was noLed wlLh
echoaenlc focl seen wlLhln Lhe dllaLed mlddle and lnferlor calvces 1he
laraesL echo measures 2cm 1he renal pelvls has obscured 8oLh
proxlmal echo appeared noL dllaLed
1he para renal spaces are normal
ptessloo
Mlnlmallv ConLracLed 8lahL kldnev wlLh ulffuse arechvmal
dlsease
Lnlaraed LefL kldnev wlLh ModeraLe elvocalelcLasls and
nephrollLhlasls
no AsclLes
ANA1CM AND n5ICLCG
1he k|dneys are oraans wlLh several funcLlons 1hev are seen ln
manv Lvpes of anlmals lncludlna verLebraLes and some
lnverLebraLes 1hev are an essenLlal parL of Lhe urlnarv svsLem and
also serve homeosLaLlc funcLlons such as Lhe reaulaLlon
of elecLrolvLes malnLenance of acldbase balance and reaulaLlon
of blood pressure 1hev serve Lhe bodv as a naLural fllLer of
Lhe blood and remove wasLes whlch are dlverLed Lo Lhe urlnarv
bladder ln produclna urlne Lhe kldnevs excreLe wasLes such
as urea and ammonlum Lhe kldnevs also are responslble for Lhe
reabsorpLlon of waLer alucose andamlno aclds 1he kldnevs also
produce hormones lncludlna calclLrlol renln and ervLhropoleLln
LocaLed aL Lhe rear of Lhe abdomlnal cavlLv ln Lhe reLroperlLoneum
Lhe kldnevs recelve blood from Lhe palred renal arLerles and draln
lnLo Lhe palred renal velns Lach kldnev excreLes urlne lnLo a ureLer
lLself a palred sLrucLure LhaL empLles lnLo Lhe urlnarv bladder
kIDNL DIAGkAM
Iunct|ons
1he kldnev parLlclpaLes ln wholebodv homeosLasls reaulaLlna acldbase
balance elecLrolvLe concenLraLlons exLracellular fluld volume and
reaulaLlon of blood pressure 1he kldnev accompllshes Lhese homeosLaLlc
funcLlons boLh lndependenLlv and ln concerL wlLh oLher oraans
parLlcularlv Lhose of Lhe endocrlne svsLem varlous endocrlne hormones
coordlnaLe Lhese endocrlne funcLlons Lhese lnclude renln analoLensln
ll aldosLerone anLldlureLlc hormone and aLrlal naLrlureLlc pepLlde
amona oLhers
Manv of Lhe kldnevs funcLlons are accompllshed bv relaLlvelv slmple
mechanlsms of fllLraLlon reabsorpLlon and secreLlon whlch Lake place ln
Lhe nephron lllLraLlon whlch Lakes place aL Lhe renal corpuscle ls Lhe
process bv whlch cells and larae proLelns are fllLered from Lhe blood Lo
make an ulLrafllLraLe LhaL wlll evenLuallv become urlne 1he kldnev
aeneraLes 180 llLers of fllLraLe a dav whlle reabsorblna a larae percenLaae
allowlna for onlv Lhe aeneraLlon of approxlmaLelv 2 llLers of urlne
8eabsorpLlon ls Lhe LransporL of molecules from Lhls ulLrafllLraLe and lnLo
Lhe blood SecreLlon ls Lhe reverse process ln whlch molecules are
LransporLed ln Lhe opposlLe dlrecLlon from Lhe blood lnLo Lhe urlne
Lxcret|on of wastes
1he kldnevs excreLe a varleLv of wasLe producLs
produced bv meLabollsm 1hese lnclude Lhe
nlLroaenous wasLes urea from proLeln caLabollsm
and urlc acld fromnuclelc acld meLabollsm
Ac|dbase homeostas|s
1wo oraan svsLems Lhe kldnevs and lunas malnLaln
acldbase homeosLasls whlch ls Lhe malnLenance
of pP around a relaLlvelv sLable value 1he kldnevs
conLrlbuLe Lo acldbase homeosLasls bv
reaulaLlna blcarbonaLe (PCC
3

) concenLraLlon 1he
kldnevs have Lwo lmporLanL roles ln Lhe malnLalnlna of
Lhe acldbase balance Lo reabsorb blcarbonaLe from
and Lo excreLe hvdroaen lons lnLo urlne
Csmo|a||ty regu|at|on
Anv slanlflcanL rlse ln plasma osmolallLv ls deLecLed bv
Lhe hvpoLhalamus whlch communlcaLes dlrecLlv wlLh
Lhe posLerlor plLulLarv aland An lncrease ln osmolallLv
causes Lhe aland Lo secreLe anLldlureLlc
hormone (AuP) resulLlna ln waLer reabsorpLlon bv Lhe
kldnev and an lncrease ln urlne concenLraLlon 1he Lwo
facLors work LoaeLher Lo reLurn Lhe plasma osmolallLv
Lo lLs normal levels
AuP blnds Lo prlnclpal cells ln Lhe collecLlna ducL LhaL
LranslocaLe aquaporlns Lo Lhe membrane allowlna
waLer Lo leave Lhe normallv lmpermeable membrane
and be reabsorbed lnLo Lhe bodv bv Lhe vasa recLa
Lhus lncreaslna Lhe plasma volume of Lhe bodv
8|ood pressure regu|at|on
LonaLerm reaulaLlon of blood pressure predomlnanLlv depends upon Lhe kldnev 1hls
prlmarllv occurs Lhrouah malnLenance of Lhe exLracellular fluld comparLmenL Lhe slze
of whlch depends on Lhe plasma sodlum concenLraLlon AlLhouah Lhe kldnev cannoL
dlrecLlv sense blood pressure chanaes ln Lhe dellverv of sodlum and chlorlde Lo Lhe
dlsLal parL of Lhe nephron alLer Lhe kldnevs secreLlon of Lhe enzvme renln When Lhe
exLracellular fluld comparLmenL ls expanded and blood pressure ls hlah Lhe dellverv of
Lhese lons ls lncreased and renln secreLlon ls decreased Slmllarlv when Lhe
exLracellular fluld comparLmenL ls conLracLed and blood pressure ls low sodlum and
chlorlde dellverv ls decreased and renln secreLlon ls lncreased ln response
8enln ls Lhe flrsL ln a serles of lmporLanL chemlcal messenaers LhaL comprlse Lhe renln
analoLensln svsLem Chanaes ln renln ulLlmaLelv alLer Lhe ouLpuL of Lhls svsLem
prlnclpallv Lhe hormones analoLensln ll and aldosLerone Lach hormone acLs vla
mulLlple mechanlsms buL boLh lncrease Lhe kldnevs absorpLlon of sodlum chlorlde
Lherebv expandlna Lhe exLracellular fluld comparLmenL and ralslna blood pressure
When renln levels are elevaLed Lhe concenLraLlons of analoLensln ll and aldosLerone
lncrease leadlna Lo lncreased sodlum chlorlde reabsorpLlon expanslon of Lhe
exLracellular fluld comparLmenL and an lncrease ln blood pressure Converselv when
renln levels are low analoLensln ll and aldosLerone levels decrease conLracLlna Lhe
exLracellular fluld comparLmenL and decreaslna blood pressure
normone secret|on
1he kldnevs secreLe a varleLv of hormones
lncludlna ervLhropoleLln and Lhe
enzvme renln LrvLhropoleLln ls released ln response
Lo hvpoxla (low levels of oxvaen aL Llssue level) ln Lhe
renal clrculaLlon lL sLlmulaLes ervLhropolesls
(producLlon of red blood cells) ln Lhe bone
marrow CalclLrlol Lhe acLlvaLed form of vlLamln u
promoLes lnLesLlnal absorpLlon of calclum and Lhe
renal reabsorpLlon of phosphaLe arL of Lhe renln
analoLenslnaldosLerone renln ls an enzvme lnvolved
ln Lhe reaulaLlon ofaldosLerone levels
nLAL1n LDUCA1ICN LAN
Cb[ecLlve
WlLhln 30 mlns Lo 1 hr of monlLorlna level of consclousness pL wlll
be able Lo perform Lasks approprlaLelv Lhrouah asslsLance and Lo
schedule Llme for resL as necessarv
WlLhln 30 mlns Lo 1 hr of provldlna wlLh Lhe necessarv lnformaLlon
abouL Lhe dlsease process dleLarv resLrlcLlons LreaLmenL
procedures medlclne deLalls nuLrlLlonal concerns pL wlll be able Lo
ease anxleLv
WlLhln 30 mlns Lo 1 hr of prlorlLlzlna essenLlal nurslna lnLervenLlons
such as aeneral and speclflc healLh Leachlnas pL wlll be able Lo
prevenL posslble compllcaLlons ensure comforL supporL
lndependenL selfcare and provlde needed lnformaLlon abouL Lhe
dlsease
uleL 8esLrlcLlon
LaL food low ln proLeln nlLroaen and
sodlum
8esLrlcL lnLake of oxalaLerlch foods
such aschocolaLe nuLs sovbeans and
splnach as Lhls wlll promoLe formaLlon of kldnev sLones plus
malnLenance of an
adequaLe lnLake of dleLarv calclum
1ake some frulL [ulces such as oranae
and cranberrv Cranae [ulce mav help
prevenL calclum oxalaLe sLone
formaLlon and cranberrv mav help wlLh
u1lcaused sLones
LlmlL lnLake of caffelnaLed beveraaes
such as coffee
Avold cola beveraaes
Avold larae lnLake doses of vlLamln c
romoLlna ComforL And SafeLv
Lncouraae Lhe paLlenL Lo chanae poslLlons
frequenLlv llke slde lvlna seml and hlah
fowlers everv 2 hours Lo prevenL bed sores
and promoLe adequaLe luna expanslon
8alse slde ralls Lo secure paLlenL ln case of
sudden movemenL
MalnLlnlna fluld volume
Lncouraae paLlenL Lo drlnk 68 alasses of waLer per
dav Lo decrease rlsk for dehvdraLlon
Medlclne ueLalls
Lncouraae paLlenL Lo Lake medlcaLlon aL Lhe rlahL
Llme and lnLervals as prescrlbed bv Lhe phvslclan
and ask phvslclan flrsL when paLlenL complalnLs of
abrupLlna Laklna of medlcaLlon
AcLlvlLv ManaaemenL
Lncouraae or use enerav savlna Lechnlques such as
slLLlna raLher Lhan alwavs sLandlna Lo conserve
enerav and reduce faLlaue
erform passlve exerclse and 8CM llke passlve
abducLlon adducLlon lnLernal and exLernal
roLaLlon exLenslon and flexlon Lo boLh upper and
lower exLremlLles excepL lefL arm Lo lmprove
clrculaLlon
SLress ManaaemenL
rovlde compleLe resL bv malnLalnlna quleL and peaceful
envlronmenL bv mlnlmlzlna sLlmull LhaL mav lnLerrupL
resL and sleep and promoLe adequaLe sleep of 68
hours aL nlahL Llme
Self Care ManaaemenL
AnLlclpaLe hvalenlc needs and calmlv asslsL as necessarv
wlLh care of nalls bv Lrlmmlna lona nalls skln bv
performlna 1S8 halr bv brushlna and baLhlna halr
dallv MouLh care bv LooLh brushlna once a dav
revenLlna lnfecLlon
MalnLaln sLerlle Lechnlque for all lnvaslve procedure such
as lv and urlnarv caLheLer
LmoLlonal SupporL
Advlse SC Lo be wlLh Lhe paLlenL all of Lhe Llme and
encouraae verballzaLlon of feellnas and anv slanlflcanL
chanae Lo Lhe condlLlon
AnxleLv and SplrlLual Care
Lncouraae pravlna and readlna of splrlLual messaaes Lo
reduce anxleLv and cofuslon
DI5CnAkGL LAN
Med|c|nes
keep a wrlLLen llsL of Lhe medlclnes vou Lake Lhe amounLs and when and
whv vou Lake Lhem 8rlna Lhe llsL of vour medlclnes or Lhe plll boLLles
when vou see vour carealvers Learn whv vou Lake each medlclne Ask
vour carealver for lnformaLlon abouL vour medlclne uo noL use anv
medlclnes overLhecounLer druas vlLamlns herbs or food supplemenLs
wlLhouL flrsL Lalklna Lo carealvers
Alwavs Lake vour medlclne as dlrecLed bv carealvers Call vour carealver lf
vou Lhlnk vour medlclnes are noL helplna or lf vou feel vou are havlna slde
effecLs uo noL qulL Laklna vour medlclnes unLll vou dlscuss lL wlLh vour
carealver lf vou are Laklna medlclne LhaL makes vou drowsv do noL drlve
or use heavv equlpmenL
Avold medlclnes LhaL mav cause more damaae Lo vour kldnevs 1hese
lnclude asplrln cerLaln anLlbloLlcs and some herbal supplemenLs Ask
vour carealver whlch medlclnes vou should noL use
lL ls verv lmporLanL LhaL vou Lake vour hlah blood pressure and dlabeLes
medlclne as dlrecLed bv vour carealver
Lxerc|se
ueep breaLhlna exerclse reaularlv
1herapy/1reatment
D|a|ys|s cleanses Lhe bodv of wasLe producLs ln Lhe bodv bv use of
fllLer svsLems 1here are Lwo Lvpes of dlalvsls 1) hemodlalvsls and
2) perlLoneal dlalvsls
k|dney 1ransp|ant ls replacemenL of nonworklna kldnevs wlLh a
healLhv kldnev from anoLher person (Lhe donor) 1he healLhv
kldnev (Lhe arafL) Lakes over Lhe funcLlons of vour nonworklna
kldnevs
nea|th 1each|ngs
Avo|d a|coho|conta|n|ng dr|nks 1hese lnclude beer wlne llquor
such as whlskev or aln or oLher adulL drlnks
5tress SLress mav slow heallna and cause lllness laLer Slnce lL ls
hard Lo avold sLress learn Lo conLrol lL Learn new wavs Lo relax
such as deep breaLhlna medlLaLlon relaxlna muscles muslc or
blofeedback 1alk Lo someone abouL Lhlnas LhaL upseL vou
CD VI5I15/kLILkkAL5
CCN1AC1 A CAkLGIVLk II
ou cannoL make lL Lo vour followup or dlalvsls vlslL
ou have a fever (lncreased bodv LemperaLure)
ou have chllls couah or feel weak and achv
our skln ls lLchv or has a rash
ou are passlna llLLle Lo no urlne
ou are vomlLlna (Lhrowlna up) evervLhlna LhaL vou eaL or drlnk
ou have quesLlons or concerns abouL vour care medlclne or LreaLmenL
5LLk CAkL IMMLDIA1LL II
ou hearL ls beaLlna fasL or vou are breaLhlna fasL
ou are confused and hard Lo awaken
ou have a selzure (convulslon)
ou have chesL paln or Lrouble breaLhlna all of a sudden
DIL1
Chanalna whaL vou eaL and drlnk mav be hard aL flrsL ou mav need Lo
make Lhese chanaes parL of vour dallv rouLlne A carealver called a
dleLlLlan or nuLrlLlonlsL mav work wlLh vou Lo flnd Lhe rlahL dleL for vou
ou mav need Lo eaL a hlahcalorle lowproLeln dleL ou mav also need Lo
eaL low sodlum (salL) and poLasslum foods such as cereals aralns
blueberrles or leLLuce
keep a llsL of lLems ln vour klLchen LhaL vou can eaL on vour dleL ou mav
use speclal cookbooks Lo help flnd new reclpes
lollow vour carealver's advlce abouL drlnklna llqulds WrlLe down how
much llquld vou drlnk and how much vou urlnaLe
Sucklna on hard candv or chewlna aum mav keep vour mouLh molsL
wlLhouL havlna Lo drlnk llqulds Lemon wedaes mav also help keep vour
mouLh molsL
5p|r|tua| Care
Lncouraae Lhe paLlenL Lo have falLh ln Cod
Lncouraae Lhe paLlenL Lo prav alwavs and ask for Lhe auldance of Cod
Lncouraae Lhe paLlenL Lo seek splrlLual supporL
5UkGICAL MANAGLMLN1
W DI 5tent|ng
W nemod|a|ys|s
Access
a Catheter
CaLheLers are usuallv found ln Lwo aeneral varleLles Lunnelled and nonLunnelled
Lwo aeneral varleLles
Nontunne||ed caLheLer access ls for shorLLerm access (up Lo abouL 10 davs buL
ofLen for one dlalvsls sesslon onlv) and Lhe caLheLer emeraes from Lhe skln aL Lhe
slLe of enLrv lnLo Lhe veln
1unne||ed caLheLer access lnvolves a lonaer caLheLer whlch ls Lunnelled under Lhe
skln from Lhe polnL of lnserLlon ln Lhe veln Lo an exlL slLe some dlsLance awav lL ls
usuallv placed ln Lhe lnLernal [uaular veln ln Lhe neck and Lhe exlL slLe ls usuallv on
Lhe chesL wall 1he Lunnel acLs as a barrler Lo lnvadlna mlcrobes and as such
Lunnelled caLheLers are deslaned for shorL Lo medlumLerm access (weeks Lo
monLhs onlv) because lnfecLlon ls sLlll a frequenL problem
b Av flsLula
c Av arafL
1ypes
1here are Lhree Lvpes of hemodlalvsls convenLlonal
hemodlalvsls dallv hemodlalvsls and nocLurnal
hemodlalvsls
aConvent|ona| hemod|a|ys|s
bDa||y hemod|a|ys|s
cNocturna| hemod|a|ys|s
4dvontooes ond uisodvontooes
AdvanLaaes
W Low morLallLv raLe
W 8eLLer conLrol of blood pressure
and abdomlnal cramps
W Less dleL resLrlcLlon
W 8eLLer soluLe clearance effecL for
Lhe dallv hemodlalvsls beLLer
Lolerance and fewer
compllcaLlons wlLh more frequenL
dlalvsls
ulsadvanLaaes
W 8esLrlcLs lndependence as
people underaolna Lhls procedure
cannoL Lravel around because of
supplles' avallablllLv
W 8equlres rellable Lechnoloav such
as hlah waLer quallLv and
elecLrlclLv
W 8equlres more supplles llke
dlalvsls machlnes
W 1he procedure ls compllcaLed and
requlres LhaL care alvers have
more knowledae
W 8equlres Llme Lo seL up and clean
dlalvsls machlnes and expense
wlLh machlnes and assoclaLed
sLaff
Nurs|ng Care
emodio/ysis voscu/or 4ccess Assess Lhe flsLula/arafL and arm before afLer each dlalvsls or
everv shlfL Lhe access flow compllcaLlons Assess Lhe compllcaLlon of cenLral venous
caLheLer Lhe Llp placemenL exlL slLe compllcaLlons documenL and noLlfv approprlaLe
healLh care provlder reaardlna anv concerns LducaLes Lhe paLlenL wlLh approprlaLe
cleanlna of flsLula/arafL and exlL slLe wlLh recoanlzlna and reporLlna slans and
svmpLoms of lnfecLlon and compllcaLlon
emodio/ysis odeouocy Assesses paLlenL consLanLlv for slans and svmpLoms of lnadequaLe
dlalvsls Assesses posslble causes of lnadequaLe dlalvslsLducaLlons paLlenLs Lhe
lmporLance of recelvlna adequaLe dlalvsls
emodio/ysis treotment ond comp/icotions erforms head Lo Loe phvslcal assessmenL
before durlna and afLer hemodlalvsls reaardlna compllcaLlons and access's securlLv
Conflrm and dellver dlalvsls prescrlpLlon afLer revlew mosL updaLe lab resulLs Address
anv concerns of Lhe paLlenL and educaLe paLlenL when recoanlzlna Lhe learnlna aap
Medicotion monooement ond infection contro/ proctice CollaboraLe wlLh Lhe paLlenL Lo
develop a medlcaLlon realmen lollow lnfecLlon conLrol auldellnes as per unlL proLocol
kCGNC5I5
Deaths and Morta||ty kates
Deaths from Lndstage rena| d|sease 76384 deaLhs ln paLlenLs
underaolna LreaLmenL ln Lhe uSA 2001 (unlLed SLaLes 8enal uaLa
SvsLem 2003 Annual uaLa 8eporL 2003)
Lst|mated morta||ty rate for Lndstage rena| d|sease from preva|ence
and deaths stat|st|cs
ueaLhs 76383 (uSA annual deaLhs calculaLed from Lhls daLa 76384
deaLhs ln paLlenLs underaolna LreaLmenL ln Lhe uSA 2001 (unlLed
SLaLes 8enal uaLa SvsLem 2003 Annual uaLa 8eporL 2003))
lncldence 392022 (uSA prevalence calculaLed from Lhls daLa 392023
people ln Lhe uSA 2001 (unlLed SLaLes 8enal uaLa SvsLem 2003
Annual uaLa 8eporL 2003)
193 (raLlo of deaLhs Lo prevalence)
See also ueaLhs and LndsLaae renal dlsease and Cvervlew of Lnd
sLaae renal dlsease
Lst|mated morta||ty rate for Lndstage rena| d|sease from |nc|dence
and deaths stat|st|cs
ueaLhs 76383 (uSA annual deaLhs calculaLed from Lhls daLa 76384
deaLhs ln paLlenLs underaolna LreaLmenL ln Lhe uSA 2001 (unlLed
SLaLes 8enal uaLa SvsLem 2003 Annual uaLa 8eporL 2003))
lncldence 89232 (uSA annual lncldence calculaLed from Lhls daLa
89232 new cases (nluuk)
838 (raLlo of deaLhs Lo lncldence)
k|dney D|sease reva|ence h|||pp|ne 5ett|ng
uo vou know LhaL Lnd SLaae 8enal ulsease ls alreadv Lhe 7Lh leadlna
cause of deaLh amona llllplnos? lL ls sald LhaL a llllplno ls havlna
Lhe dlsease hourlv or 120 llllplnos per mllllon populaLlon per vear
1hls shows LhaL abouL 10 000 llllplnos need Lo replace Lhelr kldnev
funcLlon unforLunaLelv Lhouah onlv 73 or abouL 7 267 paLlenLs
recleved LreaLmenL An esLlmaLe of abouL a quarLer of Lhe whole
populaLlon probablv [usL dled wlLhouL reclevlna anv LreaLmenL