General Objectives

By the successful completion of the course, BSN 4S-A nursing students will know more about the
Chronic Kidney Disease Secondary to Chronic Glomerulonephritis and be able to produce synthesis
based on real circumstances.
To help nursing students create a comprehensive and informative case presentation on renal care
that educates their audience about the complexities and nuances if this critical nursing specialty.
In this case study, we’ll examine techniques for managing patients with Chronic Kidney Disease
Secondary to Chronic Glomerulonephritis and enhancing any nursing interventions that might be
necessary for their care.
This case study also aims to cultivate well rounded nursing students who can deliver safe, effective
and compassionate care in a dialysis setting.
The nursing students in BSN 4S-A will be able to define the following after finishing this case study.

Specific Objectives in patient with CKD

• Assess the patient’s condition through building rapport, gathering all necessary information
and perform physical assessment on patient to attain baseline data.
• Determine the client’s previous and present health history, and how it might impact the
condition they now have.
• Recognize how the current illness is pathologically represented.
• Discuss the normal outcomes of a Chronic Kidney Disease Secondary to Chronic
Glomerulonephritis physical exam, diagnostic tests, patient signs and symptoms, and nursing
care for Chronic Kidney Disease Secondary to Chronic Glomerulonephritis.
• To conduct a drug study to comprehend the purpose, side effects, and contraindications of
the drug given to the patient.
• Evaluate patient’s condition after treatment and establish a home care and health
 Promotion plan.

Specific Objectives in Dialysis setting

 Clinical Competence: To develop proficiency in performing dialysis procedures,
understanding equipment, and ensuring patient safety during sessions.
 Patient Assessment: To enhance skills in assessing patient’s health status before, during
and after dialysis, recognizing any changes or complications.
 Communication Skills: To improve communication with patients, families and the
healthcare team to provide comprehensive care and ensure understanding of treatment
plans.
 Team Collaboration: To collaborate effectively with other healthcare professionals such as
nurse and technicians to optimize patient outcomes.
 Patient Education: To educate patient about kidney disease, dialysis procedures and self-
care to empower them in managing their health.
 Infection Control: To adhere strictly to infection protocols to minimize the risk of infections
associated with dialysis procedures.
 Ethical Practice: To uphold ethical standards in patient care, respecting autonomy,
confidentiality, and cultural diversity.
 Professional Growth: To seek opportunities for continuous learning about hemodialysis,
different kidney complications and dialysis technology.

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OVERVIEW OF THE DISEASE

Definition

- Chronic kidney disease is a long-term condition where the kidneys gradually lose their ability
to function properly. Chronic glomerulonephritis, often referred to as chronic glomerular
disease, is a specific type of kidney disorder where inflammation in the glomeruli (small
filtering units in the kidney) leads to kidney damage over time. CKD secondary to chronic
glomerulonephritis implies that the kidney disease is a consequence of prolonged
glomerulonephritis.

Causes

- Chronic glomerulonephritis can result from various factors, including infections, autoimmune
diseases, and genetic predisposition. Prolonged inflammation in the glomeruli can cause
scarring and eventually lead to CKD.

Signs and Symptoms

- Early stages may be asymptomatic.

- Common symptoms include blood in the urine (hematuria), foamy urine, high blood pressure,
swelling (edema), fatigue, and proteinuria (excess protein in urine).

Clinical Manifestation

- As CKD progresses, it can lead to complications like anemia, bone disease, and electrolyte
imbalances. Severe cases may result in end-stage kidney disease (ESKD), requiring dialysis
or a kidney transplant.

Risk Factors

- Risk factors for chronic glomerulonephritis and subsequent CKD include a family history of
kidney disease, certain infections (such as streptococcal infections), autoimmune disorders
(like lupus), and uncontrolled high blood pressure.

Diagnostic Procedure

The diagnosis of Chronic Kidney Disease (CKD) secondary to Chronic Glomerulonephritis (CGN)
typically involves several diagnostic procedures. Here's a breakdown with definitions:

 Medical History and Physical Examination

- A comprehensive review of the patient's medical history and a physical examination
conducted by a healthcare provider to assess symptoms, risk factors, and overall health.
In the context of CKD secondary to CGN: The medical history may reveal previous episodes
of kidney infections, autoimmune diseases, or family history of kidney problems. The physical

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 examination can identify signs such as hypertension, swelling (edema), or other kidney-
related symptoms.

 Blood Tests
- Blood tests, including serum creatinine and blood urea nitrogen (BUN), measure waste
products in the blood. Glomerular filtration rate (GFR) is also calculated to assess kidney
function.
In the context of CKD secondary to CGN: Elevated creatinine and BUN levels, along with a
reduced GFR, indicate impaired kidney function.
 Urine Tests
- Urinalysis examines a urine sample for the presence of blood, protein, and abnormal cells,
providing information about kidney health.
In the context of CKD secondary to CGN: Finding blood in the urine (hematuria) or significant
proteinuria suggests kidney damage due to glomerulonephritis.
 Kidney Biopsy

- A kidney biopsy is a procedure in which a small sample of kidney tissue is extracted and
examined under a microscope to determine the cause and extent of kidney damage.

In the context of CKD secondary to CGN: This procedure can confirm the presence of
glomerulonephritis and help identify the specific type and extent of damage to the glomeruli.

 Imaging Studies

- Imaging techniques like ultrasound, CT scans, or MRI may be used to visualize the kidneys
and assess their size, shape, and any structural abnormalities.

In the context of CKD secondary to CGN: Imaging can reveal information about the kidneys'
structure and potential complications.

These diagnostic procedures are crucial for establishing a precise diagnosis of CKD secondary to
CGN. The combination of these tests helps healthcare professionals understand the underlying
cause, stage, and severity of the kidney disease, which, in turn, guides treatment decisions.

Treatment

- Management aims to slow the progression of kidney damage and control symptoms.

- Medications like angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor

blockers (ARBs) can help control blood pressure and reduce proteinuria.

- Dietary and lifestyle changes, including salt and protein restriction, can be beneficial.

- In advanced stages, dialysis or kidney transplantation may be necessary.

Prevention

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- Prevention may involve managing underlying conditions like hypertension and diabetes.
- Timely treatment of infections and autoimmune diseases may reduce the risk of chronic
glomerulonephritis.
- Regular check-ups to monitor kidney function can aid in early detection and intervention.

It's essential to consult a healthcare professional for a personalized assessment and treatment
plan if you suspect or are at risk for chronic kidney disease secondary to chronic
glomerulonephritis.

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PATIENT’S PROFILE

o Name: Patient CL
o Age: 41 years Old
o Sex: Female
o Date of Birth: July 13, 1982
o Religion: Roman Catholic
o Civil Status: Married
o Educational Attainment: High School Graduate
o Occupation: N/A
o Date Diagnosed: October, 2020
o Date Started Hemodialysis: November, 2020
o Diagnosis: Chronic Kidneys Disease Secondary to Glomerulonephritis

PATIENT’S MEDICAL HISTORY

Past Medical History

The patient had asthma in her childhood. She also told us that she has allergies to dairy products,
especially milk, that cause skin itchiness. The patient has long-term hypertension and diabetes
mellitus type 2, which she was diagnosed with in Kuwait.
On September 17, 2021, she was admitted to Southern Isabela Medical Center because she tested
positive for COVID-19. She has been confined for almost 3 weeks. Due to her condition, she is not
allowed to go outside the premises of the hospital, so she didn’t have a choice but to comply with
her dialysis at SIMC. She completed her immunization during childhood and also had the COVID-19
vaccine.
Present Medical History
In November 2020, two weeks prior to admission at the hospital in Kuwait, the patient felt
dizziness, fatigue, a painful and small amount of urination, and generalized edema on her body. She
stated that if she needs to go to the bathroom or in the kitchen, she needs to crawl since she’s
unable to stand up due to severe fatigue and dizziness.
Her employer will buy a meal for them, along with the kids she needs to look after. They stayed
together in the house since her employer needed to go to work. Since she can’t endure anymore,
she called for rescue, but the rescuer told her she doesn’t have any problems, but she insisted on
going with them to be admitted to the hospital since if she stays, her employer won’t let her out.
The patient claimed that when she was admitted, she felt some relief; she could urinate well; her
fatigue was at a tolerable level; even her dizziness, but her edema didn’t subside. The doctor
explained that she needed dialysis, but the patient stated that she didn’t understand what the doctor
told her about her condition until she lost her consciousness. According to her, she gained
consciousness, and an intrajugular catheter was inserted at the right side of her neck, but she
clearly said that she never signed any consent for any insertion or procedure.

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November 20, 2020, when the patient had his temporary intrajugular catheter in Kuwait. She had
used it twice for her dialysis, and then they created a subclavian catheter that was used on
November 25, 2020. She used it nine times and continued it in the Philippines for almost three
years.
January 20, 2023, when her doctor created a new one on the left AV fistula in the wrist part, but it
failed, so they created a new one in the right femoral catheter on August 21, 2023.
On September 13, 2023, they created a new AV fistula in her left arm and removed the AV fistula in
the wrist part. The femoral catheter they created also failed due to clotting, so they removed it on
October 3, 2023. They created a new one in the left femoral catheter, and until now she is using it.
She also has cataracts in both of her eyes. According to the patient, she first noticed a redness in
her left eye and assumed it was just dust. She then noticed that on August 19, 2023, her right eye
had become slightly blurry, and on August 27, 2023, her left eye had followed suit, gradually blurring
until her vision was totally obstructed.
She can recognize colors, but not perfectly, and she can only catch a glimpse of shadows and
lights.
Timeline of Creation and Removal of Fistula.

Date of Creation Remarks

Creation of Temporary Intrajugular Catheter (L) November 20, 2020 Removed
Creation of Permanent Subclavian Catheter (L) November 25, 2020 Still in use
Creation of Arteriovenous Fistula (L) wrist part January 20, 2023 Failed
Creation of Femoral Catheter (R) August 21, 2023 Failed
Creation of Arteriovenous Fistula (L) Arm part September 13, 2023 Still in use
Removal of Femoral Catheter (R) October 3, 2023 Removed
Creation of Femoral Catheter (L) October 3, 2023 Still in use

OB History
The patient is 15 years old when she had his first menstrual period and duration of her period is 3-4
days. On her first day of menstruation, she only consumed 1 pad for the whole day but in her
second to last day she can use at least 3-4 pads per day and most of the time she used traditional
pad or cloth as an alternative pad if she’s in the house.
She has two kids and got pregnant in year 2000 and 2002. She gave birth with a normal
spontaneous delivery with a home birth.
Her first child was delivered by a midwife at 38 weeks, and the second child was delivered at 28
weeks with a “manghihilot”. According to her, she only had check-ups in the birthing center when
she got pregnant in her two children due to financial capabilities. She is now two years menopause.
The patient’s Gravida is 2, Term 1, Pre-term 1, Abortion 0 and Living 2 (G-2 T-1 P-1 A-0 L-2).

Gravida YEAR DELIVERY BIRTH PLACE

G1 2000 NSD HOME
G2 2002 NSD HOME

GYNECOLOGY HISTORY
The patient was 18 years old when she was married and had sexual intercourse. At the age of 19
she had her first baby. The patient used oral contraceptives named lady pills after she gave birth to
her two children

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Social/Psychological History
The patient is a domestic helper for 6 years, she works for 3 years in Egypt and another 3 years in
Kuwait. The patient stated that she never tried to smoke, but when she was in Kuwait, her employer
was a heavy smoker, and she admitted that she was a secondhand smoker at the time. She drank
alcohol occasionally, but when she had her children and start working in abroad she quit drinking
alcohol.
She loves to eat junk foods and fatty foods, her alternative water is a soft drink, which is way
cheaper than the water in Kuwait. She can consume 1 liter of pepsi in a day and 500 ml of water a
day.
The patient is parent of two children. In her 1 year of dialysis, the patient stays at home, and she
sometimes cleans the house, but she has more time to rest. Her past time is watching YouTube and
doing TikTok dance as her exercise when she still has a normal vision acquity, especially when
she's in Kuwait. Now the patient stays at their house with her in-laws to guide her in daily living
because her children are at school and her husband goes to the farm as his work and source of
daily living. She has dialysis scheduled every Monday, Wednesday, and Friday, and her husband is
the one who guides her in her appointments.

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 FAMILY HISTORY

FATHER SIDE MOTHER SIDE

GRANDFATHER GRANDMOTHER GRANDFATHER GRANDMOTHER

ASTHMA CKD
DM HTN HTN HTN

PARENTS

HTN HTN HTN CKD HTN

LEGEND:
MALE

HTN
CKD FEMALE
ASTHMA
PATIENT
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PHYSICAL ASSESMENT (HEAD TO TOE)

General survey : Patient CL, 41, is in a sitting position and is dressed in loose black shirts and
pajamas. Patient is receiving a blood transfusion of whole blood (O+) to run for one hour. She has a
newly created AVF with a weak thrill and bruit in her left arm and a temporary femoral catheter in
her right leg. Patient is conscious and coherent and is oriented to the place, time, and date.
Date of Assesment : September 29,2023
Time of Assessment: 9:00am
Start of Hemodialysis: December 2020

Vital Signs taken as follow;

Blood Pressure: 140/90 mm/hg
Temperature: 35.9 C
Pulse Rate: 99 bpm
Respiratory Rate: 15 cpm
SPO2: 96%
BMI: 18 kg/m^2 (underweight)
Height: 5.4 ft (161cm)
Weight: 47 kg (105 lbs)

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HEAD
Areas/Features Technique Normal Findings Actual Findings Interpretation
to assess

Facial features Inspection  (-) lesion  (-) lesion  Normal

 (-) areas deformity  (-) areas deformity  Normal

 (+) firm skin  Sagging of cheeks  Loss of weight

 Symmetric facial features  Symmetric facial  Normal

features, centered head
position

Palpation  Smooth, soft  (+) rough, dry skin  Insufficient nutrition, limited fluid
intake
 (-) tenderness  (-) tenderness  Normal

SCALP
Areas/Features Technique Normal Findings Actual Findings Interpretation
to assess

Palpation Absence of tenderness, masses no tenderness, lesions, masses  Normal

and scaliness and scaliness

SKULL

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 Areas/Features Technique Normal Findings Actual Findings Interpretation
to assess

SHAPE AND Inspection Rounded and symmetrical Rounded and symmetrical  Normal
SYMMETRY

Smooth, non-tender, free of masses Smooth and non-tender, and no  Normal

Contour, masses, Palpation and depressions masses and depressions
depressions and
tenderness

HAIR
Areas/Features Technique Normal Findings Actual Findings Interpretation
to assess

Inspection
Color  Even and varies in color  Black, evenly distributed  Normal
Hair distribution  Evenly distributed  Slight baldness at middle  Excessive Hair loss
hairline
Infestation  Free from any infestations  Absence of lice  Normal

Texture Palpation  Fine to coarse pliant  Dull, dry hair, brittle  Reduced oxygen delivered to
hair follicles due to anemia

EYES
Areas/Features Technique Normal Findings Actual Findings Interpretation

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 to assess

Eyes Inspection  Pink Conjunctivae  Pale Conjunctivae  Anemic

 (-) Periorbital Puffiness  (-) Periorbital Puffiness  Normal

 White Sclera  Paler Sclera  anemic

 Normal visual acuity  Blurry vision  Presence of cataract (nuclear

cataract) in both eyes.
 (+) PERRLA  (-) PERRLA  Complete nuclear cataract
 Eyelashes evenly  Eyelashes evenly  Normal
distributed distributed
 No drooping down of  No drooping down of
 Normal
eyelids eyelids
 Same eye color  Same eye color(brown)
 Normal
 Pupils converge and  Pupil do not converge or
Accommodation constrict as object moves in constrict  Complete Nuclear cataract is
toward the nose noted bilateral

Extraocular  Both eyes move in a  Both eyes move in a  Complete nuclear cataract
movement smooth coordinated smooth coordinated
manners in all directions manners in all directions
but in slow pace manner

NOSE
Areas/Features Technique Normal Findings Actual Findings Interpretation
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 to assess
Inspection
Symmetry  Located symmetrically,  Nose appeared  Normal
midline of the face with no symmetrical and no
lesions discharges and lesions
 (-) discoloration  (-) discoloration  Normal
Color
 (+) Nasal mucosa is pinkish  (+) Nasal mucosa is  Normal
red pinkish red
Patency  Each nostril is patent  Each nostril is patent  Normal

Palpation  (-) tenderness, masses  (-) tenderness, masses  Normal

EARS
Areas/Features Technique Normal Findings Actual Findings Interpretation
to assess

Inspection  Symmetrically aligned  Left ear is protruding  Genetic trait

 (-) discharge, redness  (-) discharge, redness  Normal

 Normal hearing acuity  Poor hearing  Due to hypertension and
diabetes
Palpation  Pinna immediately Recoil  Pinna immediately Recoil  Normal
after it is folded after it is folded

MOUTH
Areas/Features Technique Normal Findings Actual Findings Interpretation
to assess

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 Inspection
BREATH  Breath should smell  No bad breath  Normal
fresh

 (-) swelling  (-) swelling  Normal

 (-) lesions  (-) lesions

 Normal
 (-) bleeding  (-) bleeding  Normal

GUMS  Gums Pinkish in  Whitish gum  Patient is anemic and dry

color, lips due to limited fluid
intake.
LIPS  Lips are Pinkish in  Lips are pale and dry  Patient is anemic
color

TEETH  32 permanent teeth.  28 teeth (2nd premolar and first

 Teeth extraction
molar at upper teeth right side and
first molar and first premolar at
lower teeth at left side)
 Gapping of teeth due to
 Properly aligned  Properly aligned, gap teeth
extraction; neighboring
teeth may shift to vacant
 White and shiny  Yellow stained
space
TONGUE  Tongue is centrally  Tongue is pale, dry and cracking is  Coffee stained
positioned, pinkish noted (lingua plicata)  Limited fluid intake
and moist
 (-) oral thrush  (-) oral thrush  Normal

NECK
Areas/Features Technique Normal Findings Actual Findings Interpretation
to assess
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 Inspection
 (-) swelling and lesion  (-) swelling and lesion  Normal

Symmetry and  Muscles are Symmetrically  Symmetrical and moved

musculature with head in central smoothly side to side without  Normal
position. Movement though full discomfort or limitation
of range of motion without
compliant of discomfort or
limitation

 Lymph nodes should not be  Lymph nodes are not  Normal

LYMPH NODES Palpation palpable. Small movable nodes palpable
are insignificant
TRACHEA  Trachea is in midline  Placed in the midline of  Normal
position above the suprasternal the neck
notch
 Normal
(-) mass and lumps  (-) mass and lumps

BREAST
Areas/Features Technique Normal Findings Actual Findings Interpretation
to assess

Breast Inspection  (-) discoloration  (-) discoloration  Normal

 (-) wound  (-) wound  Normal

 (-) odor  (-) odor  Normal

 (-) discharge  (-) discharge  Normal

 Nipple is inverted  Nipple is inverted  Normal

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 Palpation  (-) palpable  (-) palpable masses or
masses or lesion, lesion  Normal
tenderness

THORAX AND LUNGS

Areas/Features Technique Normal Findings Actual Findings Interpretation
to assess

Thorax and Lungs Inspection  Respiratory are quite  Quiet, rhythmic and  Normal
effortless and regular with effortless respiration of 15
12-20 breaths per minute cpm

Palpation  Thumb should separate an  Thumb separates 3 cm  Normal

equal distance of 3-5 cm during inspiration and is
and in the same direction free from pain or lesion
during thoracic expansion
and meet in the midline on
expiration

Percussion  (+) tactile fremitus  (+) tactile fremitus  Normal

 (+) resonant sound  (+) resonant sound  Normal
Auscultation  (+) Normal vesicular  (+) Slight wheezing sound  Abnormal due to Asthma
breathing sounds

CARDIOVASCULAR
Areas/Features Technique Normal Findings Actual Findings Interpretation
to assess

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 Radial pulse Palpation  Regular pulse  Radial pulse of 99 bpm  Normal

Heart Auscultation  (+) regular rhythm  (+) regular rhythm  Normal

 (-) Murmur  (-) Murmur  Normal

UPPER EXTREMITIES
Areas/Features Technique Normal Findings Actual Findings Interpretation
to assess

Inspection  (-) redness, (-) swelling  (-) redness, (-) swelling  Normal

 (-) scars  (+) scars on her  Scars due to temporary

intrajugular vein ®, catheter and newly created
clavicle ®, arm and wrist AVF
Palpation  Moist skin (L)  Dehydrated skin due to excess
 Dry skin removal of fluid from body and
limited fluid intake

 (-) lesion, masses  (-) lesion, masses  Normal

ABDOMEN
Areas/Features Technique Normal Findings Actual Findings Interpretation
to assess

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 Generalized Inspection  Flat or rounded and  Patient has Abdominal  Edema
appearance of bilaterally symmetrical ascites
abdomen  (-) Scars  Stretch marks at  Skin stretching due to previous
hypogastric region pregnancy

Auscultation  5-30 bowel sounds per  13 bowel sounds of clicks  Normal

minute and gurgles and
occasional borborygmus
sounds

Percussion  tympanite  (+) dull sounds  Due to presence of fluids

sounds/resonant sounds
Palpation  (-) tenderness,  (-) tenderness,  Normal
masses, lesions, masses, lesions,
swelling swelling

LOWER EXTREMITIES
Areas/Features Technique Normal Findings Actual Findings Interpretation
to assess

Inspection  (-) lesions, redness  (-) lesions, redness  Normal

 (-) swelling  (+) pitting edema at legs  Fluid retention
bilaterally and ankles
 (-) scars  Scars on her left lower leg  Vehicular accident
 (+) scaliness on her right  Dehydration of skin due to
 (-) scaliness foot limited fluid in take

SKIN
Areas/Features Technique Normal Findings Actual Findings Interpretation
to assess

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 Color/lesion Inspection  Uniform complexion  Brown, Hyperpigmentation  Kidney disease
 (-) lesions  (-) lesions  Normal
 Firm  Sagging skin  Loss of weight
 Scars at her right  Scars related to removal
Scars Inspection intrajugular, subclavian, left catheter and creation of AVF
arm (wrist and biceps) right
femoral

 Stretchmarks in her  Due to previous pregnancy

hypogastric region
 Scars at her left lower leg  Vehicular accident

Masses Palpation  (-) masses  (-) masses  Normal

Inspection and  Warm, dry  Cool to touch  Poor circulation can affect
Moisture palpation temperature of the skin

Texture Palpation  Smooth, soft  Rough, dry skin, presence  Nutrient imbalance, dehydrated
of scaliness skin due to removal of excess
fluids from body
Edema Palpation  No swelling, pitting or  Pitting edema at legs  Fluid retention
edema bilaterally and ankle

NAILS
Areas/Features Technique Normal Findings Actual Findings Interpretation
to assess

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  Due to kidney disease the
Color Inspection  Pinkish fingernails and  Pale with splinter normal balance of blood
toenails hemorrhages (vertical line) clotting factors leading to
is seen mostly in her coagulation result to tiny blood
fingernails and some in her clots in the small vessel under
toenails the nails.

 Poor hygiene and Self-care

Appearance  Short and clean nails  Long and dirty nails deficit due to impaired vision

 (+) Convex  (+) Convex  Normal

 Nail is round, hard,  Thickened nails, immobile  Decreased circulation

immobile

 Normal
Texture Palpation  1-2 sec capillary refill time  2 sec capillary refill time

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GORDON’S 11 FUNCTIONAL HEALTH PATTERN

DATE OF INTERVIEW: September 29 ,2023

TIME OF INTERVIEW: 9:00 am

LOC: Conscious and Coherent

FUNCTIONAL HEALTH BEFORE HEMODIALYSIS DURING HEMODIALYSIS

PATTERN TREATMENT TREATMENT
HEALTH PERCEPTION According to the patient, when you Patient stated that she needs to
AND MANAGEMENT are sick, you are unable to perform pay more attention in her health
any activity. She also stated that she since as of now heaving her
has a history of hypertension but
dialysis gives her hard times. She
does not take any medication for it.
She is also allergic to dairy milk and takes all her medication for her
has asthma. The patient claimed hypertension and anemia that is
that she never takes food prescribed by her doctor as well as
supplements or vitamins but instead tried to take food supplements and
relies on over-the-counter vitamins to help boost her
medications such as paracetamol immunity.
when she is in pain or unwell. She
used to be an occasional drinker
before having her two children.

NUTRITIONAL/ According to the patient, she She has a poor appetite, her fluid
METABOLIC PATTERN consumes 2 cups of rice every intake is limited, and she indicated
meal. Before she started her
dialysis, she had a good appetite that she can only consume 250 ml
and had no problem swallowing
of water from the start of her
food. She drinks at least six glasses
of water a day. She stated, too, that dialysis to the end of her dialysis.
she and her family usually eat
The patient is stubborn; she still
vegetables and meat. She also
loves to eat fatty foods and junk drinks soft drinks, and she eats
food. She loves to drink soft drinks
bread, biscuits, and chicken fillets
and coffee; according to her, she
can drink 1 liter of pepsi per day and during her dialysis.
can consumed 2-3 cups of coffee
per day
ELIMINATION Before hospitalized, she regularly The patient mentioned that she
PATTERN defecates twice a day, usually defecates at least once a day, and
Morning and Afternoon sometimes she experiences painful
urination.
Feces
 Color: Not stated
 Texture: Not stated

She doesn’t have any difficulty in

defecating and urinating. She can
urinate at least 3x a day

Urine
 Color: Light Yellow
 Consistency: Clear
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  Odor: usually unnoticed by
the patient
EXERCISE AND According to the patient, since she The patient mentioned that she
ACTIVITY PATTERN is an OFW, her regular tasks at doesn’t have any exercise in her
work, such as household choirs, daily living because of her
have become her daily exercise. condition, she sleep and rest most
of the time.
SLEEP/REST The patient stated that she has at She goes to bed around 6 pm and
PATTERN least 9 hours of sleep every day, she wakes up at 8 am. She usually
goes to bed at 10 pm and wake up takes an afternoon nap because
at 7 am in the morning to prepare she is unable to do any household
herself for work choirs due to her condition.
COGNITIVE the patient speaks Ilocano she had The patient has a complete nuclear
PERCEPTION a good hearing and have a slight cataract in both eyes and also has
PATTERN
blurry vision, and that she wears a hearing impairment. You need to
reading glasses with an eye grade speak loudly or lean on her real
of .50 before she had her cataract. side so she can hear you properly.
She cooperates and communicates patient cooperates well and can
efficiently. understand Tagalog and Ilocano
SELF PERCEPTION The patient stated that she is the The patient takes a bath 2-3 times
AND SELF CONCEPT family breadwinner. The patient bath a week; most of the time, she uses
PATTERN
twice a day, in the morning and a tepid sponge bath to clean
before going to bed, especially herself with the assistance of her
when in Kuwait. According to the daughter. The patient stated that
patient, there is no history of plastic she seems like a burden to her
surgery or semi-permanent make- family since she can’t do anything,
up. even the simple household chores.
She also feels pity for herself since
she cannot take care of herself.
ROLE RELATIONSHIP The patient claimed that she gets The patient was accompanied by
PATTERN along well with her neighbors and her husband in complying with her
family members, especially her dialysis treatment or even going to
children. She’s a kind and loving her check-ups and appointments.
wife to her husband; she also She mentioned that she doesn’t
mentioned that she doesn’t have the have enough time with her children
time to participate in different kinds since she needs to comply with her
of community activities because her treatment, and when at home, she
focus is on providing for the needs needs to have adequate rest and
of her family. sleep.
SEXUALITY AND The patient claimed that she had Ever since her dialysis started,
22 | P a g e
 REPRODUCTIVE her menarche when she was 15 they never had a sexual
PATTERN years old and had her menopause intercourse. Patient has no
at the age of 39. The patient stated problem with her reproductive
that they are not sexually active system
because she’s an OFW
COPING AND STRESS When she feels anxious or stressed, Her stress reliever most of the time
TOLERANCE she always watches YouTube or was to rest and sleep
PATTERN
does a TikTok dance. The patient
also stated that she tells everything,
especially her worries, to her
husband, and they will seek the
guidance of the almighty father.
VALUE-BELIEF The patient is a Roman Catholic, The patient mentioned that she
PATTERN and she stated that she always doesn’t attend church anymore
attends Sunday masses with her because she prefers to stay at
family. She doesn’t believe in myths home. Sometimes she listens only
or any superstitious beliefs. to the Sunday masses through
radio broadcasting.

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ANATOMY AND PHYSIOLOGY
A comprehensive understanding of the anatomy and physiology of the kidney involves a
more detailed look. Here's a more extensive overview:

ANATOMY
The kidneys are retroperitoneal organs situated on either side of the vertebral column, just
below the ribcage. Each kidney is composed of several regions:
Renal Cortex- The outer layer containing the glomeruli and the proximal and distal convoluted
tubules.
Renal Medulla- The inner region, consisting of renal pyramids that contain collecting ducts.
Renal Pelvis- A funnel-shaped structure that collects urine from the nephrons and funnels it into the
ureter.
Nephrons are the functional units of the kidney and consist of:
Renal Corpuscle- Comprising the glomerulus (a capillary network) and Bowman's capsule (a
tubular structure).
Renal Tubules- Proximal convoluted tubule, loop of Henle, distal convoluted tubule, and connecting
tubule.
The renal artery brings oxygenated blood into the kidney, and the renal vein carries
deoxygenated blood away. The afferent arteriole delivers blood to the glomerulus, and the efferent
arteriole carries blood away. Each kidney is connected to a ureter, which transports urine from the
renal pelvis to the bladder.

PHYSIOLOGY
Filtration occurs at the renal corpuscle, where blood pressure forces water, electrolytes, and
waste products from the glomerular capillaries into the Bowman's capsule, forming filtrate.
Reabsorption- Useful substances like glucose, amino acids, and the majority of water are
reabsorbed in various sections of the renal tubules back into the bloodstream.
Secretion- Waste products, drugs, and excess ions are actively secreted from the blood into
the renal tubules for elimination in the urine.
Renal Blood Flow Regulation- The kidneys can regulate their own blood flow through
mechanisms like autoregulation, which ensures a stable filtration rate despite changes in blood
pressure.
Renin-Angiotensin-Aldosterone System (RAAS)-The kidneys play a critical role in blood
pressure regulation. When blood pressure drops, they release renin, initiating a series of events that
ultimately raise blood pressure.
Urine Concentration- The loop of Henle allows the kidneys to concentrate or dilute urine by
reabsorbing water and solutes.

24 | P a g e
 Acid-Base Balance- The kidneys help maintain the body's pH by excreting hydrogen ions
and reabsorbing bicarbonate ions.
Erythropoiesis Regulation- The kidneys produce erythropoietin, a hormone that stimulates
red blood cell production in response to low oxygen levels in the blood.
Detoxification- The kidneys contribute to the detoxification of drugs and metabolic waste
products.
Electrolyte Regulation- They regulate the levels of various electrolytes (sodium, potassium,
calcium) to maintain homeostasis.
This intricate system of filtration, reabsorption, and secretion, along with various regulatory
functions, allows the kidneys to maintain fluid balance, electrolyte balance, and waste elimination in
the body while supporting overall health and homeostasis.

ANATOMICAL CHANGES OF KIDNEY IN CHRONIC KIDNEY DISEASE

In Chronic Kidney Disease (CKD), the kidneys undergo several anatomical changes as the
condition progresses. These changes often result from ongoing damage and scarring to the kidney
tissues. The extent of these changes can vary depending on the stage of CKD and the underlying
causes. Here are some of the common anatomical changes in CKD:
Nephron Damage- CKD typically involves damage to the nephrons, which are the functional units
of the kidneys. This damage can lead to a reduction in the number of functioning nephrons.
Glomerulosclerosis- Glomerulosclerosis refers to scarring or hardening of the glomeruli, which are
tiny blood vessels in the nephrons responsible for filtering blood. This scarring reduces their ability
to filter effectively.
Tubular Atrophy- The tubules in the nephrons can undergo atrophy, meaning they shrink or
become damaged. This impairs the reabsorption and secretion functions of the tubules.
Interstitial Fibrosis- Interstitial fibrosis involves the development of fibrous tissue in the spaces
between nephrons and blood vessels. This fibrosis can disrupt the normal architecture of the kidney.
Renal Cortex and Medulla Changes- The renal cortex and medulla can show signs of scarring
and fibrosis as CKD progresses. The scarring can affect the overall structure and function of the
kidneys.
Cortical Thinning- With advanced CKD, the renal cortex may thin, indicating a significant loss of
functional kidney tissue.
Blood Vessel Damage- The blood vessels in the kidneys can also be affected, leading to impaired
blood flow and decreased oxygen supply to the kidney tissue.

25 | P a g e
Cyst Formation- In some cases, such as in polycystic kidney disease, cysts can develop in the
kidneys. These cysts can disrupt the normal kidney structure and function.
These anatomical changes in CKD are associated with the loss of kidney function and can
lead to impaired filtration, reabsorption, and secretion processes. As a result, waste products,
electrolytes, and excess fluid may accumulate in the body, leading to a range of systemic
complications. Early detection and management of CKD are essential to slow the progression of
these anatomical changes and preserve kidney function.

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PATHOPHYSIOLOGY

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COURSE IN THE WARD
DATE/TIME DOCTORS ORDER RATIONALE NURSING
RESPONSIBILITIES
9-29-23  Low Salt  To manage  Educate patient
10:13 AM blood pressure about the
(-) cough and fluid importance of a
(-) DOB balance. low-sodium diet in
CBS  Limit Fluid  To help prevent managing CKD.
(+) ascites excessive  Educate patient
(+) edema accumulation on identifying
of fluids which high-sodium
can lead to foods and
high blood alternatives to
pressure and maintain a
edema. flavorful, low

10-03-23  Dry Weight to 47 sodium diet.

kg  Educate patient

10-06-23  Continue  For continuous about the

9:20 AM Hemodialysis and improvement of importance of

(-) cough # of medications health status of adhering to fluid

(-) DOB the patient. and sodium

CBS restrictions.

(+) ascites  Advocate for the

(-) edema patient’s needs,

Swelling on ® Leg ensuring that fluid

and sodium

10-09-23  Limit Fluids and  To manage restrictions are

1:43 PM Salt blood pressure effectively

(-) cough and fluid communicated.

(-) fever balance.  Provide guidance

(-) DOB  To help prevent on reading food

(+) ascites excessive labels for sodium

(-) edema accumulation content and

of fluids which managing dietary

can lead to choices.

high blood
pressure and
 Continue edema.

28 | P a g e
 Hemodialysis  For continuous
improvement of
health status of
the patient.
10/13/23  Limit fluids and  To manage
9:25 pm salt intake blood pressure
(-) cough and fluid
(-) fever balance.
(-) difficulty of  To help prevent
breathing excessive
CBS accumulation
(+) ascites of fluids which
can lead to
high blood
pressure and
 Continue edema.
hemodialysis  For continuous
improvement of
health status of
the patient.

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LABORATORIES AND DIAGNOSTICS
Patient Name: Patient CL
Age: 41 Sex: Female
Date: September 29, 2023
Hematology Result Form
Laboratory Result Normal Values Interpretation Nursing Responsibilities
Unit
Hgb 8.0 11.0 – 16.0 g/dL Low hemoglobin Remind patient to gently
level is connected stand because when their
to low production Hemoglobin count is low
of erythropoietin they are vulnerable to
which results to orthostatic hypotension. In
anemia. The kidney addition, fatigue is also
is not making prevalent that is why she is
enough recommended not to strain
erythropoietin her body too much. Which
which is necessary may lead to injury.
to make red blood
cells.
Hct 27 37-54 % A low percentage of Remind patient to take iron
Hematocrit is supplement if prescribed.
directly related to Further more patient is
having an anemia. taught to eat green leafy
Due to the bone vegetables such as
marrow that is not spinach (kalunay in Iloco),
making enough malunggay, alukba
erythropoietin.
RBC 3.39 3.50 – 5.50 x 10^12/L Having a low RED Instruct patient to include in
BLOOD CELLS is her diet lean meat, and
directly related to green leafy vegetables,
having a kidney Milk (nephrocan hp).
disease. Because,
when
Erythropoietin is
not enough it then
results to having
lower RED BLOOD
CELLS. Other
factors include Iron
deficiency because
dialysis patients
have limited food
choices.
WBC 4.9 4.0 – 10.0 X 10^9/L NORMAL
Neu % 62.62 50.00 – 70.00 % NORMAL
Lym % 12.41 20.00 – 60.00 % Low percentage of Teach patient to always
lymphocytes makes keep her avg or avf safe at
the body more all times and refrain from
vulnerable to
30 | P a g e
 infection because any straining activities and
of the correlation of teach the patient to wash
it to the lowered and sanitize her hands
hemoglobin levels
before touching the site of
and hematocrit.
When the avg and avf. Also include
hemoglobin levels that picking any scabs in
decrease the levels the site is not a great idea
of lymphocytes as it might cause bleeding
also decreases. and further infection.

Mon % 11.82 3.00 – 10.00 % A slightly deviated Teach patient to always

level of monocyte is keep her avg or avf safe at
connected to the all times and refrain from
lowered any straining activities and
hemoglobin levels teach the patient to wash
and sanitize her hands
before touching the site of
avg and avf. Also include
that picking any scabs in
the site is not a great idea
as it might cause bleeding
and further infection.
Eos % 13.11 0.50 – 8.00 % High levels of Teach patient to always
eosinophils is keep her avg or avf safe at
connected to the all times and refrain from
lowered any straining activities and
hemoglobin levels. teach the patient to wash
When eosinophils and sanitize her hands
are low, patient is before touching the site of
more vulnerable to avg and avf. Also include
infection that picking any scabs in
the site is not a great idea
as it might cause bleeding
and further infection.
Bas % 0.04 0.00 – 1.00 % Having a high level Teach patient to keep her
of basophil is avg/avf healthy as
connected to possible, also hand
lowered sanitation and washing is
hemoglobin levels important. Removing scabs
with that said the may cause bleeding and
body is more also infection.
vulnerable to
infections.
MCV 80.3 80.0 – 100. 0 fL NORMAL
MCH 23.5 27.0 – 34.0 pg NORMAL
MCHC 29.4 32.0 – 36.0 g/dL Low level of mean instruct patient to include in
corpuscular her diet green leafy
hemoglobin vegetables such as
concentration malunggay,pechay,alukbati,
indicates lowered spinach and take
function of the nephrocan hp if possible.
RBC.

31 | P a g e
 RDW 16.6 11.0 – 16.0 % A slightly deviated Instruct patient to take iron
higher levels of Red rich foods such as green
blood cell leafy vegetables, and iron
distribution width is supplements if there is a
connected to prescription.
anemia within CKD
patients
PLT 99 100- 300 X 10^g/L A slightly lowered Instruct patient to be
platelet is a result careful when performing
of lowered daily activities because she
hemoglobin levels. is at risk for bleeding.
Lifting heavy weights is not
advisable

Date: October 2, 2023

Laboratory Result Normal Values Interpretation Nursing

Unit Responsibilities
Hgb 91 11.0 – 16.0 g/dL Low hemoglobin Remind patient to
level is connected gently stand because
to low production when their Hemoglobin
of erythropoietin count is low they are
which results to vulnerable to
anemia. The kidney orthostatic
is not making hypotension. In
enough addition, fatigue is also
erythropoietin prevalent that is why
which is necessary she is recommended
to make red blood not to strain her body
cells. too much. Which may
lead to injury.
Hct 29.6 37-54 % A low percentage Remind patient to take
of Hematocrit is iron supplement if
directly related to prescribed. Further
having an anemia. more patient is taught
Due to the bone to eat green leafy
marrow that is not vegetables such as
making enough spinach (kalunay in
erythropoietin Iloco), malunggay,
alukbati.
WBC 6.6 4.0 – 10.0 X 10^9/L NORMAL
Lym % 0.10 20.00 – 60.00 % Low percentage of Teach patient to
lymphocytes always keep her avg or
makes the body avf safe at all times
more vulnerable to and refrain from any
infection because straining activities and
of the correlation teach the patient to
with the lowered wash and sanitize her
hemoglobin levels hands before touching
and hematocrit. the site of avg and avf.
When the Also include that

32 | P a g e
 hemoglobin levels picking any scabs in
decrease the levels the site is not a great
of lymphocytes idea as it might cause
also decrease. bleeding and further
infection.
Mon % 0.12 3.00 – 10.00 % High level of Teach patient to
monocyte is due to always keep her avg or
the lowered avf safe at all times
hemoglobin levels and refrain from any
straining activities and
teach the patient to
wash and sanitize her
hands before touching
the site of avg and avf.
Also include that
picking any scabs in
the site is not a great
idea as it might cause
bleeding and further
infection.
Eos % 0.04 0.50 – 8.00 % NORMAL
Platelet 122 150-450 A slightly lowered Instruct patient to be
platelet is a result careful when
of lowered performing daily
hemoglobin levels activities because she
is at risk for bleeding.
Lifting heavy weights is
not advisable.
Segmenters 0.74 47 – 55 % When Segmenters Teach patient to
are low it means always keep her avg or
that there’s a avf safe at all times
lowered level of and refrain from any
Rbc. straining activities and
teach the patient to
wash and sanitize her
hands before touching
the site of avg and avf.
Also include that
picking any scabs in
the site is not a great
idea as it might cause
bleeding and further
infection

33 | P a g e
 NURSING CARE PLAN

NURSING CARE PLAN: PRIORITY 1

NAME: PATIENT CL
ATE AND TIME OF ASSESMENT: September 29, 2023 (9:00 am)
ASSESSMENT NURSING PLANNING NURSING RATIONALE EVALUATION
DIAGNOSIS INTERVENTION
Objectives: Fluid volume excess Short term: Independent: 1. Dialysis patients with Short term:
Pitting edema at related to impaired Within 4 hours of 1. Assessed lung fluid volume excess After 4 hours of nursing
lower extremities fluid balance nursing intervention sounds to identify are at risk for intervention the patient was
Depth:2cm the patient will be signs of pulmonary developing pulmonary able to verbalized 2
secondary to Chronic
able to verbalized at congestion edema, assessing strategies to limit fluid
kidney disease least 2 – 3 strategies helps identify early consumption like sip ice
Vital signs: to limit fluid signs of complications chips and limit consumption
BP: 140/90 consumption 2. Educated the 2. Adhering fluid limits of fruits rich in high water
mmHg patients on the help maintain a content
Long term: importance of balance between fluid
Within 4 weeks of adhering to intake and removal Long term:
nursing intervention prescribed fluid during dialysis session After 4 weeks of nursing
patient pitting edema intake limits intervention patient pitting
between dialysis edema on her lower
on her lower
session. extremities was gone and no
extremities will be 3. Instructed patients 3. Strategies for signs of pitting edema on the
reduced from 2 cm to to chew gum, sip ice managing thirst without other parts of the body
1 cm or completely chips or moisten lips excessive fluid
gone and no signs of and mouth consumption
pitting edema on the 4. Instructed patient to 4. Limiting consumption GOAL MET
other parts of the limit high water of fruits with high water
content food such content is a strategy to
body
as cucumber or control fluid intake and
watermelon maintain balance.

5. Instructed patient on 5. To facilitate fluid

proper positioning to reabsorption
34 | P a g e
 prevent dependent
edema.
6. Encouraged 6. To facilitate venous
elevation of the legs return and minimize
when sitting or lying dependent edema
down
7. Encouraged regular 7. Regular ambulation
ambulation at home breaks up prolonged
with guidance of SO periods of immobility
and helps counteracts
the effects of gravity on
fluid distribution

NURSING CARE PLAN: PRIORITY 2

35 | P a g e
NAME: PATIENT CL
DATE AND TIME OF ASSESMENT: September 29, 2023 (9:00 am)
ASSESSMENT NURSING PLANNING NURSING RATIONALE EVALUATION
DIAGNOSIS INTERVENTION
Subjectives: Imbalanced nutrition: Short term: Independent: Short term:
less than body Within 4 hours of After 4 hours of patient
“Wala akong requirements nursing patient 1. Instructed the 1. Protein is needed in teaching, patient was able to
gana kumain teaching, the client patient to eat a diet maintaining body understand and verbalize
secondary to dietary
minsan, tapos will be able to which is low in muscles, and providing four foods that help in
marami nang restriction and loss of understand and protein Such as fish, nutrient support. maintaining body
bawal sa akin na appetite related to verbalize at least 4 beans(limited), and However high levels of requirements like consuming
pagkain”as anemia as evidenced foods that will help lean meat (if protein is not advised fish, eating leafy vegetables
verbalized by the by weight less than maintain her body possible). because it will stress like malunggay, spinach and
patient. normal requirements within the patient’s kidney. alugbati
or close to normal
Objectives: body requirements. 2. Instructed patient to 2. Patient has lowered Goal met.
also include iron rich hemoglobin level so
WEIGHT: 47 Long term: vegetables on her iron rich foods will help
HEIGHT: 5’4 Within four weeks of diet such as in providing needed Long Term:
BMI: 18.5 nursing intervention, malunggay, spinach iron. Within four weeks of nursing
Underweight Patient will able to and alukbati. intervention, patient was able
follow the provided to followed the provided diet
diet meal plan. meal plan.
Dependent:
Goal is partially met.
1. Reminded the To prevent calcium deficiency.
patient to take
provided
supplements (cal
500) at the right
time.

36 | P a g e
NURSING CARE PLAN: PRIORITY 3
NAME: PATIENT CL
DATE AND TIME OF ASSESMENT: September 29, 2023 (9:00 am)
ASSESSMENT NURSING PLANNING NURSING RATIONALE EVALUATION
DIAGNOSIS INTERVENTION
Subjective: Impaired skin integrity Short term: Independent: Short term:
Patients related to dehydration Within 4 hours of After 4 hours of nursing
complain of secondary to nursing intervention 1. Encouraged patient 1. Long nails can intervention the patient was
generalized the patient will be: to maintain good accidentally scratch or able to
hemodialysis as
itching on her  Able to hygiene practices injure skin leading to  verbalized 2 effective
body evidenced by dry skin including keeping cuts, abrasions or
verbalize at strategies to reduce
and membranes least 2-3 clean and short nails irritations the itchiness or ability
Objective: itching and effective to tolerate itching
 Dry skin and pigmentation strategies to 2. Educated patient on 2. Constant scratching without scratching
membrane reduce the the harsh scratching due to itching can the skin like
 Patient is itchiness or and its potential to break the skin, leading massaging gently the
seen ability to worsen skin to open wounds and irritated area and
scratching tolerate itching integrity, instead increasing risk of applying moisturizer
her skin from without advised them to infection. to skin.
time to time scratching the massaged gently  Verbalized 2 skin
(pruritus) skin the area rather than care to help prevent
 Pigmentatio  Able to scratching it further skin problem
n on her verbalize at such as wearing loose
facial least 2 -3 skin 3. Recommended 3. Itching is a common shirts and applying
features, care to help some moisturizers symptom of individual moisturizer or lotion to
upper and prevent further to prevent dryness on dialysis. Moisturizer keep skin hydrated.
lower skin problem and flakiness help alleviate itching by
extremities like severe hydrating the skin and Long term:
 presence of dryness or providing relief After 6 days of nursing
flakiness on flakiness intervention patient was able
foot 4. Encouraged patient 4. Loose shirts prevent to maintain intact skin and no
to use loose-fitting friction between fabric signs of redness, irritation
cotton garments and the skin and help and open wound.
lessen exacerbation of
37 | P a g e
 Long term: irritation and
Within 4 weeks of discomfort GOAL MET
nursing intervention 5. Advised patient to 5. Hemodialysis involves
patient will be able to avoid prolonged the removal of excess
exposure to direct fluids and patients are
maintain intact skin
sunlight more prone
showing no signs of dehydration, prolonged
redness, irritation sun exposure can
and open wound. further contribute
dehydration making
more prone to dryness
and cracking
6. Advised patient to 6. Vitamin C is important
consumed foods for collagen synthesis
rich in vitamin c, which is crucial for skin
includes fruits like structure and wound
oranges and, healing.
strawberries, also
includes green leafy
vegetables like
alukbati, spinach,
malunggay

NURSING CARE PLAN: PRIORITY 4

38 | P a g e
NAME: PATIENT CL
DATE AND TIME OF ASSESMENT: September 29, 2023 (9:00 am)
ASSESSMENT NURSING PLANNING NURSING RATIONALE EVALUATION
DIAGNOSIS INTERVENTION
Subjective: Situational low self- Short term: INDEPENDENT:
“dati ako ang esteem related to Within 4 hours of 1. Establish a trustworthy 1. Strengthen the Short term:
nagproprovide changes in family role nursing intervention nurse-patient therapeutic After 4 hours of nursing
ng mga patient will: connection through relationship, intervention patient:
and function as
kailangan ng empathic and which enhances
bata ngayon evidenced by Verbalize at least 2-3 nonjudgmental effectiveness of Verbalized situational factors
pabigat na ako expression of situational factors communication. nursing interventions contributing to low self-
sa kanila “as uselessness contributing to low and promote better esteem like lack of support
verbalized by the self-esteem. patient outcomes and comparison to others.
patient 2. Encouraged patient to 2. Expressing anxieties
Identify and verbalize express feelings and patients can explore Identified and verbalize two
Objective: at least two anxieties about and develop coping entertaining and engaging
expression of entertaining and changes in family roles strategies hobbies to assist reduce
uselessness engaging hobbies to anxieties and stress like
assist reduce 3. Provided some 3. Help patient boost her listening to radio dramas and
anxieties and stress. information on coping self-esteem and help music and walking at least 5
mechanisms and stress patients to focus on minutes per day.
Long term: management and positive aspects of
Within 4 weeks of techniques like: their life Long term:
nursing intervention  Deep breathing After 4 weeks of nursing
patient will: exercises to intervention patient:
promote relaxation
 Demonstrate  Encouraged patient  Demonstrated
improved self- to meditate to improved self-esteem
esteem by promote sense of by verbalizing positive
verbalizing calm self-affirmations
positive self-  Encouraged
affirmations  Patient engaged in
patients to connect
 Patient will with supportive enjoyable activities
engage in at friends and family like listening to

39 | P a g e
 least 2-3 to boost self- favorite music and
enjoyable esteem and provide enjoying deep
activities daily emotional support breathing exercises
as evidenced  Emphasized the as evidenced by self-
by self- importance of self-
reported reported feelings of
care activities, such
feelings of as adequate sleep increased self-worth
increased self- and rest, healthy and satisfaction
worth and nutrition and
satisfaction engage in non-
extraneous
activities that bring
joy and relaxation

NURSING CARE PLAN: PRIORITY 5

40 | P a g e
NAME: PATIENT CL
DATE AND TIME OF ASSESMENT: September 29, 2023 (9:00 am)
ASSESSMENT NURSING PLANNING NURSING RATIONALE EVALUATION
DIAGNOSIS INTERVENTION
 Risk for injury Short term: 1. To prevent higher risk GOAL MET
Objectives: and falls Within the shift INDEPENDENT for injury and falls Short term:
related to patient will be free 1. Ensured that all floors After the shift patient was
Complete impaired visual from any injuries or are clear of tripping free from any injuries during
nuclear cataract acuity fall during stay at hazards stay at the dialysis center
on both eye secondary to dialysis center
complete 2. Encouraged patients 2. Cane provides
nuclear Long term: to use assistive additional supports and Long term:
cataract Within 4 weeks of device such as cane. enhances stability. It After four weeks of nursing
 Risk for injury nursing intervention also provides tactile intervention patient was able
and falls patient will be able connection with the to:
related to body to: surroundings and  Demonstrated
weaknesses  demonstrate serve as third leg to increased safety
secondary to increased maintain balance and awareness
anemia safety prevent stumbles  Demonstrated
awareness 3. Instructed SO to 3. Bathroom is a slippery behaviors, lifestyle
 Demonstrate assist patient when area and higher risk for changes to reduce
behaviors, going to bathroom to stumbling and slipping, risk factors and
lifestyle urinate or taking a assisting patients helps protect self from injury
changes to bath them navigate the or falls
reduce risk space safely, reducing  Reports of no
factors and risk of injuries. incidents or injuries
protect self during stay at dialysis
from injury or 4. Provided education on 4. Moving slowly reduces center and at home.
falls the importance of the chances of
 Reports of no moving slowly encountering
incidents or unforeseen obstacles
injuries during and allows better
stay at dialysis weight distribution and
center and at minimizes risk of loss
of balance
41 | P a g e
 home. 5. Asked the SO to keep 5. Lower bed makes it
bed of the patient in easier for the patient to
the lowest position at go in and out of the
their home or let the bed independently and
patient sleep on floor reduces risk of injury in
with adequate case the patient
beddings accidentally falls out of
bed
6. Encourage patient to 6. Calling for assistance
call for assistance helps conserve energy
before attempting to and prevents the
move independently patient from
overexerting
themselves which
leads to fall.

NURSING CARE PLAN: PRIORITY 6

NAME: PATIENT CL
42 | P a g e
DATE AND TIME OF ASSESMENT: September 29, 2023 (9:00 am)
ASSESSMENT NURSING PLANNING NURSING RATIONALE EVALUATION
DIAGNOSIS INTERVENTION
Objective: Risk for infection Short term: Independent:
related to vascular Within the shift Short term:
Temporay access for patient will be free 1. Practiced strict 1. To prevent introducing After the shift patient is free
femoral catheter from any signs of aseptic technique of pathogens during from any infections as
hemodialysis
(left leg) is seen infection such as during all hemodialysis process evidenced by no signs of
swelling, redness, procedures involving infections and temperature is
LAB VALUES Warmth, discharges vascular access 35.8C
Hemoglobin: and temperature is site, cannulation,
8.0 g/Dl within normal range connection during Long term:
hematocrit 27% hemodialysis and After 6 days of nursing
lymphocytes: Long term: termination process intervention the patient was
12.41% Within 4 weeks of 2. Performed proper 2. Proper hand hygiene able to:
RBC: 3.39 nursing intervention hand hygiene before helps prevent the
BASOPHIL: 4% the patient will: and after patient transmission of  Reported no incidents
EOS: 13. contact microorganism, of any signs of infection
 Report no reducing risk of such as swelling,
incidents of any bloodstream infections
redness, warmth at the
signs of
infection such 3. Educated the patient 3. For promptly address site, discharges and
as swelling, on signs of infection of interventions fever
redness, such as redness,  patient was able to
warmth at the swelling, warmth, verbalized management
site, discharges discharge or to prevent or reduced
and fever systemic symptoms
risk of infection at the
like fever and chills
4. Regularly monitored 4. Elevated body vascular site such as
 Patient will be patients body temperature often early keeping site dry and
able to verbalize temperature signs of infection clean and keep it free
management to from trauma
prevent or 5. Encouraged 5. Early detection
reduced risk of patient’s SO to facilitates timely
infection at the visually inspect the intervention and

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vascular site like vascular access site treatment which is GOAL MET
keeping the site regularly for any crucial for preventing
dry and clean changes in progression of
and keeping the appearance infections.
site free from
trauma 6. Instructed patient to 6. Moist or unclean
keep the site dry environments provide
and clean a breeding ground of
bacteria and helps
maintain catheter
functional

DRUG STUDY

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 DRUG NAME MECHANISM OF INDICATION AND SIDE EFFECT AND ADVERSE NURSING RESPONSIBILITIES
ACTION CONTAINDICATION REACTION

Generic Name: Elevates the serum Indication: Side effect: Before:

Ferrous sulfate iron concentration Prevention and treatment of  Nausea and Vomiting  Verify patient’s identity
and converted to hgb iron deficiency anemia  Constipation  Assess for ay history of allergy with this
Brand Name: or trapped in the  Diarrhea drug.
Fer-iron reticuloendothelial  Stomach cramps
cells for storage and Contraindication: During:
eventual conversion Contraindicated in patient’s Adverse Effect:  Administer right drug in the right dose and
Classification: to a usable form of hypertensive to drug or its  Acidosis route at the right time
Iron suppplement iron. components Anorexia  Administer the drug with regards to meal
 Instruct the patient to swallow the whole
Actual Dosage: tablet; do not to crush or chew.
1 tab  Educate the patient about the effects of the
drug.
Route:
PO After:
 Instruct patient to immediately report
Frequency: hypersensitivity reaction.
OD  Monitor the patient’s response to
medication.

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 DRUG NAME MECHANISM OF INDICATION AND SIDE EFFECT AND ADVERSE NURSING RESPONSIBILITIES
ACTION CONTAINDICATION REACTION

Generic Name: Increases plasma Indication: Side effect: Before:

Sodium bicarbonate, which Treatment of metabolic  Mood changes  Assess for ay history of allergy with this
bicarbonate excess buffer H ion acidosis; promotion of gastric,  Shortness of breath drug.
concentrations; systemic and urine  Irregular heartbeat During:
Brand Name: metabolic acidosis; alkalinization  Administer right drug in the right dose and
Bicitra neutralizes gastric Adverse Effect: route at the right time.
acid, which form  Edema  Instruct the patient to swallow the whole
Classification: water. Contraindications:  Gastric distention tablet; do not to crush or chew.
Alkalinizing agent Contraindicated in patient’s  Hypokalemia  Monitor patient for signs and symptoms of
hypertensive to drug or its adverse reactions during and immediately
Actual Dosage: components. after administration.
65 mg
After:
Route:  Instruct patient to immediately report
ORAL hypersensitivity reaction.
 Monitor the patient’s response to
Frequency: medication.
BID

DRUG NAME MECHANISM OF INDICATION AND SIDE EFFECT AND ADVERSE NURSING RESPONSIBILITIES
ACTION CONTAINDICATION REACTION

Generic Name: Blocks binding of Indication: Side effect: Before:

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Valsartan angiotensin ll to To lower high blood pressure  Dizziness  Assess for ay history of allergy with this
receptors sites in  Headache drug.
Brand Name: vascular smooth Contraindication:  Diarrhea  Monitor the patient blood pressure before
Diovan muscle and adrenal Contraindicated in patient’s  Nausea and after administration.
gland, which inhibits hypertensive to drug or its  Hypotension
Classification: the pressor effects of components During:
Angiotensin II the RAAS. Adverse Effect:  Administer right drug in the right dose and
receptor blocker  Renal impairment route at the right time.
 Blurred vision  Instruct the patient to swallow the whole
 Hypotension tablet; do not to crush or chew.
Actual Dosage:  edema  Instruct the patient about the effects of the
100 mg drug.
After:
Route:  Instruct patient to immediately report
oral hypersensitivity reaction.
 Monitor the patient’s response to
Frequency: medication.
OD

DRUG NAME MECHANISM OF INDICATION AND SIDE EFFECT AND ADVERSE NURSING RESPONSIBILITIES
ACTION CONTAINDICATION REACTION

Generic Name: Vasodilators that Indications: Side effect: Before:

Isosorbide relaxes and dilates To lower high blood pressure  Headache  Verify patient’s identity
47 | P a g e
mononitrate blood vessels. It  Dizziness  Assess for ay history of allergy with this
primarily acts on the Contraindication:  Weakness drug.
Brand Name: venous side, Contraindicated in patient’s  Nausea  Monitor the patient blood pressure before
Imdur reducing the hypertensive to drug or its  vomiting and after administration.
workload of the heart components During:
Classification: and decreasing the Adverse Effect:  Administer right drug in the right dose and
Vasodilator heart’s oxygen  Ankle edema route at the right time.
demand.  Orthostatic Hypotension  Instruct patients to take drug exactly as
 Palpitation prescribe
Actual Dosage: tachycardia  Advise patient that drug shouldn’t be taken
30 mg with food
After:
Route:  Instruct the patient to rest after taking
oral medicine
 Advise the patient to take an empty
Frequency: stomach, 30 minutes before meals or 1
OD hour after meal.
 Instruct patient to immediately report
hypersensitivity reaction.
DRUG NAME MECHANISM OF INDICATION AND SIDE EFFECT AND ADVERSE NURSING RESPONSIBILITIES
ACTION CONTAINDICATION REACTION

Generic Name: Inhibits platelet Indications: Side effect: Before:

Clopidogrel aggregation. It does Used to prevent blood clots  Headache  Verify patient’s identity
bisulfate this by blocking  Hypotension  Assess for ay history of allergy with this

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 adenosine Contraindication:  Constipation drug.
Brand Name: diphosphate (ADP) Contraindicated in patients  Diarrhea
Plavix receptors on hypersensitive to drug or its  ulcers During:
platelets, which components  Administer right drug in the right dose and
Classification: reduces the risk of Adverse Effect: route at the right time.
Antiplatelet drugs blood clot formation.  UTI  Administer once daily without regard of
 Gastritis food.
 Taste disorder  Instruct patient to take medication exactly
Actual Dosage: as directed.
75 mg
After:
Route:  Advise patient to notify the physician if
oral fever, chills, sore throat, or unusual
bleeding or bruising occurs. Monitor the
Frequency: patient’s response to medication
OD

DRUG NAME MECHANISM OF INDICATION AND SIDE EFFECT AND ADVERSE NURSING RESPONSIBILITIES
ACTION CONTAINDICATION REACTION

Generic Name: Improves myocardial Indication: Side effect: Before:

trimetazidine glucose utilization To lower high blood pressure  Dizziness  Verify patient’s identity
through stopping of  Hypotension  Assess for ay history of allergy with this
fatty acid metabolism
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Brand Name: by limitation of Contraindication:  Nausea drug.
vastarel intracellular acidosis. Contraindicated in patients  Vomiting  Monitor blood pressure and pulse rate
hypersensitive to drug or its before and after giving meds.
Classification: components Adverse Effect:  Monitor intake and output
Partial fatty acid  Rashes During:
oxidation inhibitors  Tachycardia  Administer right drug in the right dose and
 Orthostatic hypotension route at the right time
Actual Dosage: Flushing After:
35 mg  Instruct patient to immediately report
hypersensitivity reaction.
Route:  Monitor the patient’s response to
medication.

Frequency:
BID

DRUG NAME MECHANISM OF INDICATION AND SIDE EFFECT AND ADVERSE NURSING RESPONSIBILITIES
ACTION CONTAINDICATION REACTION

Generic Name: Beta-blocker that Indication: Side effect: Before:

nebivolol primarily acts on To lower high blood pressure  Dizziness  Verify patient’s identity
beta-1 adrenergic  Headache  Assess for ay history of allergy with this

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Brand Name: receptors. It reduces  Nausea drug.
Nebilet heart and cardiac Contraindication:  Bradycardia  Monitored vital signs especially the blood
output, thereby Contraindicated in patients  Low blood pressure pressure and heart rate.
Classification: reducing the hypersensitive to drug or its  Shortness of breath During:
betablocker workload on the components  Administer right drug in the right dose and
heart and lowering Adverse Effect: route at the right time.
blood pressure.  Asthma  Instruct the patient to swallow the whole
Actual Dosage:  Weight gain tablet; do not to crush or chew.
5mg  Skin reaction  Instruct the patient about the effects of the
 Allergy drug.
Route: After:
 Instruct patient to immediately report
hypersensitivity reaction.
Frequency:  Monitor the patient’s response to
OD medication.

DRUG NAME MECHANISM OF INDICATION AND SIDE EFFECT AND ADVERSE NURSING RESPONSIBILITIES
ACTION CONTAINDICATION REACTION

Name: Beta-blocker that Indication: Side effect: Before:

Carvedilol works by blocking To lower high blood  Dizziness  Assess for ay history of allergy with this drug.
beta receptors in the pressure  Fatigue  Monitored vital signs especially the blood

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Brand Name: heart and blood  Low blood pressure pressure and heart rate.
Coreg vessels, leading to  Diarrhea During:
reduced heart and Contraindication:  Bradycardia  Administer right drug in the right dose and
Classification: blood pressure. Contraindicated in patients  Weight gain route at the right time
Anti-hypertensive hypersensitive to drug or its  Preparation the medication according to the
components Adverse Effect: prescription ensuring the correct dosage,
Actual Dosage:  Bradycardia form, and route
25 mg  Changes in blood sugar  Educate the patient about the effects of the
level gastrointestinal drug.
Route:
- After:
 Instruct patient to immediately report
Frequency: hypersensitivity reaction.
OD  Monitor the patient’s response to medication.

DRUG NAME MECHANISM OF INDICATION AND SIDE EFFECT AND ADVERSE NURSING RESPONSIBILITIES
ACTION CONTAINDICATION REACTION

Generic name: Calcium is a mineral Indication:  Nausea Before:

CALCIUM that is found naturally To prevent or treat calcium  Vomiting  Assess for ay history of allergy with this
CARBONATE in foods. Calcium is deficiencies  Constipation drug.
necessary for many  Dry Mouth
Brand Name: malfunctions of your Contraindication:  Thirst During:
Calci-Acid body, especially bone Contraindicated in patients
 Administer right drug in the right dose and
52 | P a g e
 formation and hypersensitive to drug or its route at the right time.
Classification: maintenance
components  Tell patient that Tablets should be
Antacid, calcium
supplement swallowed while drinking water.
 Educate the patient about the effects of the
Dosage
500 mg drug.

Route
After:
oral
 Instruct patient to immediately report
Frequency hypersensitivity reaction.
BID
 Monitor the patient’s response to
medication.

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 DISHARGE PLANNING

MEDICINE  Educate the patient about the name of medication, why it is

important, what it treats and needs doses.
 Advised patient to put medication in a container, and label
them on how and when to take it to avoid medication errors
 When it comes to the medication safety, advise the patient to
keep it from direct sunlight and heat.
Complications
 Ensure the patient has a reliable supply of necessary
medications and understands how to manage them at home.
ENVIRONMENT AND  Assess the patient's home environment for suitability in terms
EXERCISE of space, cleanliness, and safety for dialysis equipment and
procedures.
 Instruct patient to do exercise as tolerated.
 Encourage the patient to perform some passive range of
motion to promote circulation.
TREATMENT  Develop a clear treatment plan that outlines the frequency
and type of dialysis, medications, and dietary restrictions, and
share this with the patient and their caregivers.
 Ensure that the patient can access the necessary medical
and support services, including transportation to and from
dialysis centers, and provide them with contact information
for emergency assistance.
HYGIENE  Arrange for the patient and their caregivers to receive proper
training on dialysis techniques, including catheter care,
infection control, and emergency procedures.
 Arrange for home health care services, if needed, to provide
additional support to the patient, including wound care or
assistance with activities of daily living
OUTPATIENT- FOLLOW  Assess the patient's home environment for suitability in terms
UP of space, cleanliness, and safety for dialysis equipment and
procedures.
 Develop a clear treatment plan that outlines the frequency
and type of dialysis, medications, and dietary restrictions, and
share this with the patient and their caregivers.
 Arrange for the patient and their caregivers to receive proper
training on dialysis techniques, including catheter care,
infection control, and emergency procedures.
DIET  Develop a dietary plan with a renal dietitian, taking into

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 account the patient's dietary restrictions and preferences.
 Advised patient to eat vegetables like broccoli, cauliflower,
kale, and cabbage, these are antioxidants that may help
offset the toxins and carcinogens.
 Also advised to have more protein-rich foods like lean cuts of
meat, fish, eggs, nuts, seeds, and beans, also include
healthy fats such as avocado or unsalted peanut butter.
 Eat whole, nutrient-dense foods like fruits and vegetables, whole
grains (chicken, salmon, and plant-based proteins sources like
lentils)
 Foods high in healthy fats and protein (nuts and seeds, avocados,
olive oil, eggs, fish)
 Eat high fiber foods (flax seeds, legumes, vegetables and fruits)
 Consume fewer process food and other high sodium items.
SPIRITUAL AND SEXUAL Spiritual
TEACHING  Assess the patient's spiritual beliefs and practices
 Encourage regular meditation, prayer, or mindfulness
practices that can provide emotional and spiritual comfort.
 Ensure access to any religious texts, symbols, or rituals that
the patient may need during their stay or at home.
Sexual
 Provide education on how dialysis and related medications
may impact sexual function and libido.
 Encourage open communication with healthcare providers
regarding sexual health concerns.

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