University of Saint Anthony (Dr. Santiago G.

Ortega Memorial) City of Iriga

ESRD
(END STAGE RENAL DISEASE)
Prepared by: Serdan,Princess C.

Patients profile:
Name :Ms X Age: 21 Address: Sta Cruz Bato Cam.sur Date of birth: October 22 1989 Sex: female Status: single Religion: Roman Catholic Date of admission: July 2, 2011 Time of admission: 7:45 pm Admitting physician : Dra . Elgar

Patient history:
Ms.X fond of eating is a 2nd year education student who is Junk foods about 3 packs per day, eating noodles, drinking sodas, and occasionally drinks alcoholic beverages but do not drink enough water .pt. has a family history of renal disease in her mother side. Pt is a known case of ESRD since last month of the same year and previously confined to Bicol medical center with the same diagnosis. On admission pt. Complains stabbing pain at the lumbar area, presence of bipedal edema, body weakness and difficulty urinating.

Introduction:
Ms. X 21 y/o admitted last June 2 2011 with a diagnosis of ESRD. End stage renal disease(ESRD)or also known as chronic renal. failure is a progressive, irreversible deterioration in renal function in which the body's ability to maintain metabolic, fluid and electrolyte balance fails.

Causes:
Diabetes mellitus HPN hereditary lesions obstruction in the urinary tract infections pyelonephritis medication toxic agents

Anatomy and Physiology

Kidney

are pair of bean shaped, brownish-red structure located retroperitoneally on the posterior wall of the abdomen from the 12th thoracic vertebra. It weighs about 113 to 170g and 10 to 12 long 6 cm wide and 2.5 cm thick right kidney is slightly lower than the left.

Nephron
is the functional unit of the kidney there are 2 kind of nephrons the cortical nephrons and juxtamedullary nephrons

Ureter

are small tubes that carry urine from the renal pelvis of the kidney the posterior inferior portion of the urinary bladder.

Bladder

a hollow muscular container that lies in the pelvic cavity just posterior to the pubic symphysis.

Urethra

is a tube that exist the urinary bladder inferiorly and anteriorly.

Functions of kidney
Regulates

blood pressure Regulates water excretion Regulates electrolytes balance Regulates rd blood cells production

Stages of chronic kidney disease

Stage

1: Kidney damage with normal or increased

reduction in GFR (60-89

GFR ( 90 mL/min/1.73 m2)

Stage2:
Stage3:

Mild mL/min/1.73 m2)

Moderate reduction in GFR (30-59 mL/min/1.73 m2) Severe mL/min/1.73 m2) m2) reduction in GFR (15-29

Stage4:

Stage

5: Kidney failure (GFR < 15 mL /min/1.73

Manifestations
Neurologic

Hematologic *weakness and fatigue *anemia Cardiovascular Respiratory *HPN *crackles *pitting edema *hyperkalemia

Complications
Hyperkalemia

Anemia
HPN

Diagnostic tests
urinalysis

Medical management
PHARMACOLOGIC THERAPHY *furosemide 40mg TIVT STAT *fluimucil 200mg/sachet 1 sachet +1/4 glass H2O q8 *paracetamol 300mg IV for temp 38.5 and above *norfloxacin 200mg 1tab BID *felodipine(versant)5mg 1 tab BID DIET *low salt low fat diet DIALYSIS *hemodialysis 3x/wk through intrajugular vein

Nursing management
strict monitoring of I and O encouraged to comply on take home medications
*norfloxacin 200mg/tab BID *felodipine (versant) 5mg/tab BID *FeSO4 1 tab OD *omeprazole2 0mg 1 cap OD advised to attend on dialysis sessions as ordered instructed to maintain on low salt low fat diet advised to limit intake of fluid IVF regulated at KVO