UNIVERSITY OF THE CORDILLERAS

College of Nursing
Governor Pack Road, Baguio City, Philippines 2600
(+6374) 442-3316, 442-2564, 442-8219, 442-8256
E-mail: webmaster@bcf.edu.ph
Website: www.bcf.edu.ph

A CASE STUDY ON ACUTE KIDNEY INJURY ON TOP OF CHRONIC KIDNEY DISEASE

SECONDARY TO CHRONIC GLOMERULONEPHRITIS

A Case Presented to the

College of Nursing

In Partial Fulfillment of the requirements in the Course

Nursing Care Management 118

Submitted By:

CATALON, Ceithleen Jelly

CENDANA, John Kyle
CULATON, James Allen
DONONGAN, Joana Mae
FERNANDEZ, Ernelle Jhay
GAMBICAN, Limay Shaira Mae
LEYO, John Daven
MAYOS, Julianne Kaye
QUERIMIT, Herschel
SALANG-OY, Zaine

(1st of September, 2023)

Noted and Approved for Presentation:

Name of Case Presentation Adviser or Panel/s

________________________
Signature of Adviser / Date

________________________
Signature of Adviser / Date

ABSTRACT
TITLE: A Case Study on Acute Kidney Injury on top of Chronic Kidney Disease secondary to Chronic
Glomerulonephritis

AUTHOR INFORMATION: University of the Cordilleras College of Nursing 4 th Year, Section E, Group B;
Ceithleen Jelly Catalon, John Kyle Cendana, James Allen Culaton, Joana Mae Donongan, Ernelle Jhay
Fernandez, Limay Shaira Mae Gambican, John Daven Leyo, Julianne Kaye Mayos, Herschel Querimit, Zaine
Salang-Oy.
BACKGROUND:
According to LeMone 2018, chronic kidney disease (CKD) can lead to acute kidney injury (AKI)
secondary to chronic glomerulonephritis through a complex interplay of factors. In CKD, persistent damage to
the glomeruli, the kidney's filtration units, reduces their ability to filter waste products and regulate
electrolytes. Over time, this can result in progressive renal dysfunction. In chronic glomerulonephritis, ongoing
inflammation and immune response cause structural changes in the glomeruli. This can lead to scarring,
fibrosis, and impaired blood flow within the kidneys. As CKD progresses, the kidneys' ability to maintain a
stable internal environment becomes compromised. The decreased glomerular filtration rate (GFR) impairs
waste excretion and fluid balance, contributing to a buildup of toxins and electrolyte imbalances (Ignatavicius,
2021). This compromised kidney function sets the stage for AKI. The accumulation of waste products,
electrolyte imbalances, and compromised fluid regulation can lead to sudden declines in kidney function, as
seen in AKI. Additionally, the inflammatory response in chronic glomerulonephritis can exacerbate tissue
damage during episodes of AKI. Hence, the underlying CKD-related damage in chronic glomerulonephritis
weakens the kidneys' ability to adapt to stressors, making them more susceptible to acute insults that can
trigger AKI. This case presentation addresses a critical scenario frequently encountered in clinical nursing
practice. Thus, this case is noteworthy as it provides valuable insights into its pathophysiology, management
strategies, and patient-centered care.
CASE DESCRIPTION:
BSN 4E-B presents a case of a 22 Years old Male, admitted at Baguio General Hospital and Medical Center
(BGHMC), Semi Private Room, with an admitting diagnosis of ---
One day prior to consult, patient had a drowning incident where patient was able to recover and had episodes
of vomiting and dyspnea. Patient then sought consult at the nearest hospital (Ilocos Training and Regional
Medical Center) where he was advised for admission however he chose to be transferred at BGHMC. Further
evaluation and diagnostic tests then revealed patient as having acute kidney injury, chronic kidney disease, and
chronic glomerulonephritis. Patient was received with an intact heplock inserted at right metacarpal vein and
was closely monitored for intake and output. During the first day of clinical duty, the patient appeared fatigued
and has weakness of extremities with muscle strength of 3/5. Noted pitting edema on both lower extremities;
abnormal breath sounds and crackles were noted on both lung fields upon auscultation. He is not in respiratory
distress.
Further laboratory diagnostics were, done specifically: --- Treatment procedures done include emergency
arteriovenous fistula creation on left arm, right internal jugular catheter insertion, right closed tube
thoracostomy,
CONCLUSION:
In conclusion, the case study sheds light on the intricate interplay between acute kidney injury (AKI) and
chronic kidney disease (CKD) within the context of chronic glomerulonephritis. By delving into the diagnostic
challenges, treatment complexities, and the broader implications for patient management, this study
underscores the critical need for a comprehensive understanding of these intertwined conditions to provide
optimal care and improve patient outcomes. Additionally, it holds significant value for future research
contributing to tailored patient care, therapeutic management, and renal pathophysiology.

Table Of Contents
I. INTRODUCTION.........................................................................................................................................4
II. STATEMENT OF OBJECTIVES.....................................................................................................................5
A. GENERAL OBJECTIVES...................................................................................................................................5
B. SPECIFIC OBJECTIVES....................................................................................................................................5
III. PATIENT’S PROFILE..................................................................................................................................5
2
IV. CHIEF COMPLAINT...................................................................................................................................5
V. PRESENT HISTORY ILLNESS.......................................................................................................................5
VI. PAST HISTORY OF ILLNESS.......................................................................................................................6
VII. FAMILY HEALTH HISTORY.......................................................................................................................6
VIII. DEVELOPMENTAL HISTORY...................................................................................................................6
IX. SOCIAL AND ENVIRONMENTAL HISTORY.................................................................................................6
X. LIFESTYLE AND HEALTH PRACTICES...........................................................................................................6
XI. HEALTH ASSESSMENT..............................................................................................................................6
A. GENERAL SURVEY........................................................................................................................................ 6
B. HEAD TO TOE ASSESSMENT...........................................................................................................................7
C. 13 AREAS OF ASSESSMENT............................................................................................................................7
XII. DIAGNOSTICS.......................................................................................................................................10
XIII. COMPREHENSIVE PATHOPHYSIOLOGY.................................................................................................12
XIV. TREATMENT AND MANAGEMENT.......................................................................................................13
A. DRUGS.....................................................................................................................................................13
B. IV FLUIDS.................................................................................................................................................23
C. SURGERY..................................................................................................................................................25
XV. NURSING CARE PLANS..........................................................................................................................26
A. PRIORITIZATION OF PROBLEMS.....................................................................................................................23
B. NURSING CARE PLANS................................................................................................................................24
C. DISCHARGE PLAN.......................................................................................................................................29
XVI. LEARNING INSIGHTS............................................................................................................................30
XVII. LIST OF REFERENCES...........................................................................................................................31

I. Introduction

Acute kidney injury (AKI) is a broad clinical syndrome, which includes both direct injury to the kidney
and the acute impairment of function. A person is described as having chronic kidney disease (CKD) if they
have a glomerular filtration rate (GFR) < 60 mL/min/1.73 m2 for more than 3 months with or without evidence
of kidney damage. Chronic glomerulonephritis is characterized by long-term inflammation and scarring of the
glomeruli. Glomerulonephritis (GN) affects both the structure and function of the glomerulus, disrupting
glomerular filtration, and is the third leading cause of chronic kidney disease (CKD) world-wide and accounts

3
for about 10% of AKI in adults. Patients who survive AKI have a greater risk for CKD, end-stage kidney
disease, and other adverse outcomes compared with patients without AKI, after adjustment for confounding
variables. CKD is also recognized as a clear risk factor for acute kidney injury (AKI), as both decreased GFR
and increased proteinuria have each been shown to be strongly associated with AKI. A growing body of
literature also provides evidence that AKI accelerates the progression of CKD (Hsu, 2017). The major
manifestation of these intertwined kidney diseases is a decrease in GFR. According to LeMone 2018, common
manifestations of these diseases include, hematuria, proteinuria, edema, fatigue, and uremia.

According to the International Society of Nephrology, the incidence of AKI is increasing globally,
which occurs in about 13.3 million people and contributes to about 1.7 million deaths every year. The number
of people with CKD accounts to 10% of the general population worldwide, amounting to 800 million
individuals and millions die each year because they do not have access to affordable treatment. Chronic kidney
disease is a worldwide health crisis. For example, in the year 2005, there were approximately 58 million deaths
worldwide, with 35 million attributed to chronic disease, according to the World Health Organization. In terms
of glomerulonephritis, there were 48,375 point prevalent cases, 722,244 incident cases, and 10,522 deaths
attributed to chronic glomerulonephritis in 2019.

In the national context, the incidence of AKI in the Philippines is 49.4% in 2016. According to the
World Health Organization (WHO) together with the National Kidney and Transplant Institute of the
Philippines (NKTI) , in 2020, it was recorded that the Philippines had a total of 39,380 deaths caused by
kidney disease. Latest data in 2021 show that around 7 million Filipinos have CKD, and NKTI estimates that
one Filipino develops CKD every hour or about 120 Filipinos per million population every year. For
glomerulonephritis, there are 8,752 Filipinos diagnosed with it in 2020.

In Cordillera Administrative Region, according to the Department of Health-Cordillera Administrative

Region (DOH-CAR) based on their statistical data of patients undergoing hemodialysis from 2008-2014, a
total of 2,162 new cases have been monitored in the different hemodialysis units in the region. 2,162 new
cases, 80.2% are from CAR (1,735). The other 19.8% (427) are from other regions, particularly Region I.

To conclude, AKI, CKD, and glomerulonephritis diseases’ incidence and prevalence may have increased
in the last years and will continue to rise over the next 30 years, particularly in countries with a middle
socioeconomic index, making it one of the world's largest epidemics and public health challenges. Effective
nursing assessment, interventions, and health education are crucial in improving the prevalence of these kidney
diseases. Thus, this paper can create awareness, spread facts, and provide evidenced and research-based
information on the prevention, treatment, and management of AKI, CKD, and glomerulonephritis.

II. Statement Of Objectives

A. General Objectives
This case analysis aims to increase the understanding and knowledge of student
nurses on how to care for patients with acute kidney injury, chronic kidney disease, and
glomerulonephritis effectively and efficiently.

B. Specific Objectives
Specifically, this case analysis aims to :
1. define acute kidney injury, chronic kidney disease, and glomerulonephritis and its
effects to the body as a whole;
2. illustrate the pathophysiology of acute kidney injury, chronic kidney disease, and
glomerulonephritis and in relation to the signs and symptoms specifically observed
in the patient;
3. describe and identify the common signs and symptoms of acute kidney injury,
chronic kidney disease, and glomerulonephritis
4. discuss the medical and surgical interventions for the management of acute kidney
injury, chronic kidney disease, and glomerulonephritis
5. formulate appropriate nursing care plans suited for the patient based on the
assessment findings;
4
 6. identify care measures to be given to the patient and family to promote continuity of
care and independence after discharge.

III. Patient’s Profile

Name : Patient X
Age/Sex : 22 Male
Civil Status : Single
Religion : Muslim
Ethnic Background : Arabian
Occupation : N/A
Admitting Diagnosis : Acute Respiratory Distress secondary to Drowning
Final/Principal Diagnosis : Acute Kidney Injury on top of Chronic Kidney Disease
secondary to Chronic Glomerulonephritis
Date and time admitted : August 17,2023 1:05 AM

IV. Chief Complaint

Drowning

V. Present History Illness

The patient's condition began three weeks ago when the patient and his friends embarked on a trip to
Bolinao, Pangasinan, with plans for a snorkeling session. Suddenly, the patient decided to dive deep, unaware
that the snorkel was submerged. In doing so, he accidentally inhaled a significant amount of seawater, leading
to a near-drowning experience. Fortunately, his friends acted swiftly and managed to save him from this
perilous situation. Following the incident, the patient's friend graciously provided a place for him to stay.
However, during his stay, the patient suddenly began to experience episodes of vomiting. Concerned about his
well-being, they decided to seek medical assistance at the nearest hospital. Upon examination, the medical
staff advised the patient to be admitted for further evaluation and treatment. Despite this recommendation, the
patient opted to be transferred to Baguio General Medical Hospital, perhaps in search of specialized care or a
more comfortable environment. As the patient embarked on this transfer, he held onto the hope of a smooth
recovery, with gratitude for the quick thinking of his friends and the support of the medical professionals who
would guide him on his path to healing.

VI. Past History Of Illness

The patient had a history of PDA device insertion when he was young.

VII. Family Health History

The patient reported no known presence of comorbidities within his family medical history. However, he
did admit to certain lifestyle habits that may have an impact on his health. Firstly, he acknowledged a habit of
alcohol consumption, particularly beer. This raises concerns about the potential effects of excessive alcohol
intake on his overall health and well-being. In addition to his alcohol consumption, the patient disclosed a
penchant for indulging in fast food and sweets. Such dietary choices can contribute to various health issues,
including obesity, diabetes, and cardiovascular problems. It's important to consider how these dietary
preferences might be affecting his current condition and overall health.

VIII. Developmental History

The patient is the family’s second child. He is 22-Year-old age. According to Erik Erikson’s
developmental theory, the growth stage revolved around Intimacy versus isolation. The patient stated that he is
very social and always hangs out with his friends on his free time. The patient was able to express his interest
on how he can improve his overall condition and seeks for medical advices.

IX. Social and Environmental History

The patient has recently enrolled at the University of the Cordilleras and is an outgoing individual. He
resides in Camp 7, Baguio City, but originally hails from Saudi Arabia. He is single and currently lives in his
own house. Furthermore, he has a strong penchant for spending time with his friends. As a person belonging to
the middle class, access to healthcare facilities and interventions is not a significant concern for him.

5
X. Lifestyle and Health Practices
As the family's second child, the patient has entered the stage of adulthood at the age of 22. According to
Erik Erikson's developmental theory, this phase is characterized by the conflict of Intimacy versus Isolation,
where individuals must strike a balance between forming close relationships and avoiding feelings of social
isolation. Remarkably, the patient has embraced the social aspect of this developmental stage with enthusiasm.
He is inherently sociable and frequently dedicates his free time to the company of friends. This sociability can
significantly impact his life choices, affecting the depth of his relationships and his capacity to cultivate lasting
connections. What's truly commendable is the patient's proactive approach to his well-being. While many
individuals in their early twenties may not prioritize their health, he stands out by demonstrating a genuine
desire to enhance his overall condition. His willingness to seek medical advice and guidance underscores his
commitment to personal growth and self-care, which are vital components of navigating the complexities of
this developmental stage.

XI. Health Assessment

A. General Survey
Patient was received with an intact heplock inserted at right metacarpal vein and was closely monitored
for intake and output. During the first day of clinical duty, the patient appeared fatigued and has weakness of
extremities with muscle strength of 3/5. Noted pitting edema on both lower extremities; abnormal breath
sounds and crackles were noted on both lung fields upon auscultation. He is not in respiratory distress. Patient
appears weak, needs assistance when assuming activities of daily living like toileting and feeding or in
changing positions. He wears a neat gown, hygiene is fair. Patient is conversant speech is well formulated,
oriented to the self and others around him, able to determine the time and date and is aware that he stays in a
private room.

B. Head To Toe Assessment

Head Inspection No Abnormalities noticed.

Palpation
Eyes Inspection Conjunctivas are normal and full EOM. Isochoric pupils 2-
3mm eyes reactive to light. Brisk corneal bilaterally. Noted
subconjunctival hemorrhage in the right eye.
Ears Inspection No Abnormalities noticed.
Palpation
Nose and sinuses Inspection No Abnormalities noticed.
Mouth and pharynx Inspection Pale dry mucous membranes. Noted bruises on lip.
Neck Inspection No neck vein engorgement noted. With dressing intact on the
right side.
Chest/ pulmonary Inspection Noted presence of fine bilateral crackles upon auscultation.
(anterior and Palpation Increased respiratory rate and deep respiration was noted. Use
posterior wall) Auscultation of accessory muscles when breathing was also noted

Cardiac Inspection Regular heart rate and rhythm. No murmur sound upon
Auscultation auscultation.
Abdomen Inspection Soft, Flat, non-tender and with normal bowel sounds.
Auscultation
Percussion
Palpation
Musculoskeletal Inspection Decreased movements noted by measuring range of motion
Integumentary Inspection Noticed dry skin. Decreased skin turgor of >3 seconds
Palpation
Upper extremities Inspection No edema, weakness, and tingling sensation. Noticed fine
Palpation tremors. Prolonged capillary refill of >3 seconds. Impaired
sensation in fingers noted
Lower extremities Inspection Capillary refill >3 seconds, partial pulse rating (+1) faint but
Palpation detectable, noticeably deep pitting extremity. Noticed impaired
sensation of the lower extremities
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 C. 13 Areas of Assessment
1. Psychosocial and Psychological Status
The patient is the family's second child. He is a 22-year-old. According to Erik Erikson's developmental
theory, the growth in this stage revolves around Intimacy vs Isolation. He form a close bond to his friend and
comfortable with mutual dependency. He stated that he is having fun to do some activities and active with that
together with his friends. The patient did not think twice to go to the hospital after the incident happened to
him. During the interview with him he mentioned that he is not a smoker and he is not drinking alcoholic
beverages.

2. Mental and Emotional Status

The patient is oriented to time, place and person. He can identify things or names being asked. He can
recall recent and remote memories he experienced. He can read without reading glasses. He speaks English
and Arabic language. He is responsive to the questions being asked. He is cooperative to staff nurses and
doctor and even to the student nurses. He has a Glasgow Coma Scale (GCS) score of E4 V5 M6.

3. Environmental Status
The patient is originally from Saudi Arabia, but is currently residing in Camp 7, Baguio City. Patient x
and his brother live in a concrete apartment. At first he was rush to Western Pangasinan District Hospital but
referred immediately to Baguio General Hospital Medical Center to a semi-private room with a table, near the
window. During hospitalization, the patient was able to minimally sleep well despite the busy surroundings
especially when he was calm.

4. Sensory Status
a. Visual Status
The patient does not use glasses and sees all objects around him at a certain distance. He was able to
identify the correct color of objects. We assessed this by asking him to compare the color of the blanket and
the curtain. We also asked him to read the letters on a flashcard. Conjunctivas are normal and full EOM.
Isochoric pupils 2-3mm eyes reactive to light. Brisk corneal bilaterally. Noted subconjunctival hemorrhage in
the right eye.
b. Auditory Status
During the assessment, the patient can distinguish voices in distance. She is responsive to verbal stimuli
at times; was able to distinguish her student nurse voice through a whisper test and reacts when her name is
called. No auditory device noted being used by the patient. No swelling, pain, and tenderness on the patient’s
ear. No lumps and lesions, and no discharge.
c. Olfactory Status
The patient has no difficulty distinguishing different smells when asked to identify objects place in front
of nostrils such as coffee and sanitizer. No secretions noted in both nostrils. Use of accessory muscles when
breathing was also noted.
d. Gustatory Status
Upon assessment, the patient is not wearing any dentures. Noticed pale and dry mucous membrane.
Notice lip bruises. He was able to identify foods with eyes closed according to their taste. Thus, patient X has
no trouble in distinguishing flavors.
e. Tactile Status
The patient could distinguish between hot and cold sensations. We used sharp and dull pen ends for this
test as well. Her lower and upper extremities are unable to feel pain or sensation.

5. Motor Status
Minimal hand tremor was noted on assessment. Patient X does not have difficulty in coordinating
movements and but needs moderate assistance in performing activities of daily living. With a muscle strength
of 3/5 in lower extremities and 3/5 in upper extremities.

6. Thermoregulatory Status
DATE TIME TEMPERATURE
2 am 36.5
August 28, 2023
6am 36.7
2am 36.7
August 29, 2023
6am 36.9
2am 36.5
August 30, 2023
6am 36.8

7
Analysis: The patient was afebrile with normal temperature ranging from 36.5 to 36.9 the entire shift from
August 28-30, 2023

7. Respiratory Status
DATE TIME RESPIRATORY SPO2
RATE
2 am 19 cpm 95%
August 28, 2023
6am 23 cpm 95%
2am 24 cpm 95%
August 29, 2023
6am 26 cpm 95%
2am 19 cpm 95%
August 30, 2023
6am 20 cpm 95%
Analysis: Since the patient use accessory muscle when breathing it was evident in his respiratory rate values
that he is tachypneic ranging from 19-26cpm. Patient X’s O2 level is maintained into normal values.
8. Circulatory Status
DATE TIME CR Capillary
2 am 93 bpm
August 28, 2023 3-4 seconds
6am 93 bpm
99 bpm
2am
August 29, 2023 98 bpm 3-4 seconds
6am
2am 51 bpm
August 30, 2023 3-4 seconds
6am 88 bpm
Analysis: Normal cardiac rate for an adult is 60-100 beats per minute. Indicating that during the third shift at
2am, cardiac rate is dropped to the normal limit.

Blood Pressure Status

DATE TIME BP
2 am 120/80 mmHg
August 28, 2023
6am 110/80 mmHg
2am 120/80 mmHg
August 29, 2023
6am 120/80 mmHg
2am 120/80 mmHg
August 30, 2023
6am 110/70 mmHg
Analysis: Patient X blood pressure are within normal limits.

9. Nutritional Status
Prior to admission, the patient consumes halal foods such as vegetables, fish, and meat specifically
chicken and beef. He mentioned that he likes sweet foods. On admission, patient x is served a low-salt, low-fat
and no pork diet.

10. Elimination Status

During the hospital stay, the patient verbalized that he defecates at least once a day. There is a changed
input-output ratio with a total input of 450 mL and an output of 210 mL reports that he is having a difficulty in
urinating.

11. Sleep, Rest, and Comfort Status

Before hospitalization, the patient reported that he rested and slept about 6 to 7 hours a day. He stated
that his sleep is sometimes disrupted when nursing students obtain vital signs early in the morning. During the
examination, the patient has trouble sleeping and feels restless and tired due to the usual rounds and intensive
observation of the patient and due to the disease process. He also verbalized that he felt uncomfortable because
he was lying on the bed too long.

12. Fluid and Electrolyte Status

Before admission, the patient drinks about 4 glasses of water a day. He also stated that he consumed 1
can of soda daily. During the hospital stay, he has dry skin, decreased skin turgor.

13. Integumentary Status

8
 On examination he has poor skin turgor (> 3 seconds) and has dry skin, no history of skin allergy. He
has dark complexion. His hair is thick and curly. Noted subconjunctival hemorrhage in the right eye. His nails
are short, and the nail beds are pale in color.

9
XII. Diagnostics
Diagnostic Description of the Procedure Date of Procedure Findings/ Implications
Significance/ Purpose of the Procedure
Procedure

An abdominal ultrasound is a noninvasive An abdominal ultrasound is performed to August 18, 2023 Acalculous Cholecystitis with Biliary Sludge, Renal
Abdominal procedure used to assess the organs and provide pictures of the kidneys, gallbladder, Parenchymal Disease; Bilateral with signs of Chronicity,
Ultrasound structures within the abdomen. liver, pancreas, urinary bladder, and prostate Sonographically normal Liver, and Unenlarged Prostate
gland Gland.

Chest Ultrasound A chest ultrasound is a noninvasive diagnostic Chest ultrasound was performed to assess August 18, 2023 With Pulmonary Edema and no pleural effusion noted.
exam that produces images, which used to the organs and structures within the chest.
assess the organs and structures within the
chest

2- Dimensional 2D echocardiography is used to analyze the This technique is used to "see" the actual August 28, 2023 Echocardiographic Report:
Echocardiograp hic functioning and assess the sections of your motion of the heart structures. A 2-D echo  Eccentric left ventricular hypotrophy with
Report heart. This test gives images of the different view appears cone-shaped on the monitor, multisegmented wall motion abnormally and
parts of the heart with the help of sound and the real-time motion of the heart's depressed systolic function.
vibrations. It assists in checking damages, structures can be observed.  Normal right ventricular dimension with adequate
blockages, and blood flow rate. contractility and systolic function.
 Normal pulmonary artery pressure with pulmonic
regurgitation; EF 40%

Bronchoscopy Bronchoscopy is a procedure to look directly at Bronchoscopy is a test to view the airways. August 17, 2023 Notes frothy secretions on all bronchopulmonary
the airways in the lungs using a thin, lighted segments, foul smell.
tube (bronchoscope). No appreciated foreign body, mass, nor lesions.

External Eye Exam An ophthalmological examination in which the Examination of the external eye includes August 26, 2023 Oculus Dexter: Positive subconjunctival hemorrhage in
external eye structures (orbit, eyelid, inspection of the alignment and position of the temporal bulbar conjunctiva, clear cornea, deep
eyelashes, lacrimal system, conjunctiva) are the eyes, and evaluation of surrounding Anterior Chamber, and clear lens.
assessed. structures, conjunctiva, sclera, cornea, iris, Oculus Sinister: Non-infected conjunctiva, clear cornea,
pupils and extraocular movements. deep Anterior Chamber, and clear lens.

Dilated Fundus Dilated fundus examination (DFE) is a It allows the optometrist to obtain a better August 26, 2023 Oculus Uterque: Clear media, DDM, Cup-to-disc ratio
Examination diagnostic procedure that employs the use of view of the fundus of you eye and to look for 0.2, Retinal Arteriovenous Ratio 1:3, positive retinal
pupil dilating eye drops to dilate or enlarge signs of eye disease. arteriovenous nicking, positive arterial tortuosity and
your pupil. slight venous engorgement, good foveal reflex, negative
hemorrhages, and negative exudates.
 Diagnostic Description of the Procedure Significance/ Purpose of Significant Findings Nursing Implications
Procedure and Date the Procedure
Done

Complete Blood A Complete Blood Count (CBC) may be To determine the red blood Hemoglobin Normal A low hemoglobin count indicates that your cells are not receiving
Count ordered when a person has any number of cells, white blood cells, Range: 120-160g/L sufficient oxygen from your blood. Without enough oxygen, cells are
August 27, 2023 signs and symptoms that may be related to hemoglobin, hematocrit and Result: 104- Low unable to convert glucose (the body’s primary fuel source) into
disorders that affect blood cells. When an platelets level because a low energy, resulting in fatigue, weakness, and other symptoms of
individual has an infection, inflammation, CBC level indicates impaired anemia.
bruising, or bleeding, a doctor may order a kidney function or kidney
CBC to help diagnose the cause and/or disease. White Blood Cells A high white blood cell count usually indicates that more white blood
determine its severity. Count cells are being created to fight an illness or as a result of a drug that
Normal Range: increases white blood cell production. Leukocytosis is an
4.50-11.0 x 10 9/L inflammatory response characterized by an increase in white blood
Result: 11.04 - High cells.

Neutrophils Infection is a common factor in elevated neutrophil counts. Most

Normal Range: bacterial infections result in a high neutrophil count, but not all of
0.51- 0.67 them do. Viral infections rarely produce neutrophilia, however they
Result: can in the early stages of illness.
0.87% - High

Lymphocytes A low lymphocyte count indicates a higher risk of infection.

Normal Range: Lymphopenia symptoms range from mild to severe and are related to
0.25- 0.40 the severity and duration of the lymphopenia.
Result: Some people experience no symptoms.
0.07 - Low

11
 XIII. Comprehensive Pathophysiology

PREDISPOSING FACTOS
 Geographic Culture
Acute Kidney Injury on top of Chronic
C Family History of Hypertension
Kidney Disease secondary to Chronic PRECIPITATING FACTORS
 History of Heart Surgery
Glomerulonephritis  Unhealthy Lifestyle
 History of Near Drowning
 Lisinopril and Metformin
 History of CKD Stage 5 secondary to
Maintenance
Hypertensive Nephroscelrosis
 NSAID medication
 DM Type 2 non-obese and non-
insulin requiring and Hypertension
Controlled

Past medical illness of Anti- Hypertensive and Anti Diabetic medication

hypertension and diabetes NSAID Medication

Metformin enhancing conversion of

Hypertensive medication Vasodilates sugar into lactate in small intestine and
Non-Enzymatic Glycation and efferent arteriole and NSAID broken down by liver into lactic acid
production of pro inflammatory vasoconstricn afferent arteriole

Damaging of glomeruli and also lead to Metabolic Acidosis due to accumulation

Thickening of efferent arterioles of lactic acid lead to liver impairement
and increased pressure to inflammation and affect filtration
glomeruli and scarring occurs

Kidney becomes dysfunction

Hormonal Imbalance
Altered Renal Tissue Perfusion related to
Decrease glomerular filtration and glomerular malfunction as evidenced by
Inactivation of Vitamin D elimination elevated creatinine level of 849.47 umol/L

Electrolytes and Fluids

No secretion of Hormone RAAS Toxins and Waste retention
Retention

No secretion of Hormone Distribution of Toxins and Waste and

Increased Blood Volume and blood pressure
Erythropoeitin decrease oxygen to the other tissues

Decreased RBC in body Excessive Fluid Volume related to

decreased urine output and sodium and Activity Intolerance related to fatigue as
water retention evidenced by retention of waste product

Decreased appetite

Risk for Infection related to post op incision

Hemodialysis via Internal Jugular
as evidenced by presence of Right internal
Catheter
jugular catheter
Risk for imbalanced nutrition less
than body requiremente related to
as evidenced by refusal to take
peptamen and dietary restrictions
COLOR BANK
Risk Factors

Medical Diagnosis

Nursing Diagnosis
XIV. Treatment and Management
A. Drugs
ADVERSE
MECHANISM OF
DRUG #1 INDICATION/CONTRAINDICATION EFFECTS/SIDE NURSING RESPONSIBILITIES
ACTIONS
EFFECTS
GENERIC NAME Appears to inhibit INDICATIONS: ADVERSE EFFECTS: BEFORE
Paracetamol prostaglandin synthesis in the Fever reduction. Temporary relief of mild Dx:
CNS and, to a lesser extent, to moderate pain. Generally, as substitute CNS: Agitation (child) a. Check the patient’s allergies regarding medications.
CLASSIFICATION: block pain impulses through for aspirin when the latter is not tolerated (IV); headache, fatigue, b. Check for the medication’s expiration date.
PHARMACOLOGI peripheral action. Acts or is contraindicated. anxiety (IV) c. Monitor for S&S of hepatotoxicity, even with moderate
C: centrally on hypothalamic paracetamol doses.
Para-aminophenol heat-regulating center, CONTRAINDICATIONS: Resp: Dyspnea (IV), Tx:
Derivatives producing peripheral Hypersensitivity to this product, atelectasis (child) (IV) a. Check for the Doctor’s order, manufacturer’s label and follow
vasodilation (heat loss, skin phenacetin dosage guidelines precisely.
THERAPEUTIC: erythema, diaphoresis). aspartame, saccharin, tartrazine. CV: Hyper- and b. Ensure that the dosage is correct and appropriate.
Analgesics, hypotension (IV) Edx:
Anti-pyretic THERAPEUTIC EFFECTS: DRUG-DRUG INTERACTIONS: a. Advise SO to contact prescriber before taking other prescription
It provides temporary analgesia  Barbiturates, carbamazepine, GI: Nausea, vomiting, or Over-The-Counter products because they may contain
PATIENT’S ROUTE for mild to moderate pain. In hydantoins, rifampin: High doses or abdominal pain; acetaminophen.
AND DOSAGE: addition, acetaminophen long-term use of these drugs may hepatotoxicity, hepatic b. Inform the significant other about the drug’s adverse effects.
IV 900 mg lowers body temperature in reduce therapeutic effects and enhance seizure (overdose), GI c. Educate the patient about the medication’s intended use.
individuals with a fever. hepatotoxic effects of acetaminophen. bleeding DURING:
Avoid using together. Dx:
SOURCE:  Busulfan: May increase busulfan level. GU: Renal failure (high, a. Assess for pain or fever depending upon reason for administration.
Kizior, R. J., & Hodgson, K. Monitor patient closely. prolonged doses) b. Double-check the patient’s name.
(2020). Saunders Nursing  Cholestyramine resin: May decrease c. Re-check the drug.
Drug Handbook 2021 E-Book. acetaminophen absorption. Give at HEMA: Leukopenia, Tx:
Elsevier Gezondheidszorg. least 1 hour after acetaminophen or neutropenia, hemolytic a. Use proper techniques to administer the medicine, such as
consider therapy change. anemia (long-term use), utilizing toys, to lessen discomfort and the need for acetaminophen.
Skidmore-Roth, L. (2020).  Dasatinib: May enhance hepatotoxic thrombocytopenia, b. Administer the drug slowly through IV.
Mosby’s 2021 Nursing Drug effects of dasatinib and increase pancytopenia Edx:
Reference (Skidmore Nursing acetaminophen level. Avoid use a. Advice SO to inform physician/ clinicians if an allergic reaction
Drug Reference) (34th ed.). together. INTEG: Rash, urticaria, occurs.
Mosby.  Imatinib, mipomersen: May increase inj site pain AFTER
hepatotoxic effects of these drugs. Dx:
Wilkins, W. L. (2020). Monitor patient closely. SYST: Stevens-Johnson a. Assess onset, type, and location
Nursing2021 Drug Handbook  Isoniazid: May increase risk of syndrome, toxic b. Watch out for adverse effects.
(Nursing Drug Handbook) acetaminophen adverse effects. epidermal necrolysis c. Monitor V/S.
(Forty-First ed.). LWW. Monitor patient closely. d. Monitor patient for effectiveness of medication.
TOXICITY: Cyanosis, Tx:
 Lamotrigine: Prolonged
anemia, neutropenia, a. Observe IV Dressing to ensure that it is clean and intact.
acetaminophen use may decrease
jaundice, pancytopenia, b. Ensure that the medication is completely consumed.
lamotrigine level. Monitor patient for
 therapeutic effects; adjust lamotrigine CNS stimulation, c. Discontinue drug if hypersensitivity reactions occur
dosage as needed. delirium followed by Edx:
vascular collapse, a. Instruct SO to report severe or prolonged skin reactions such as
DRUG-FOOD INTERACTIONS: seizures, coma, death rash, itching, and hives.
Alcohol use: May increase risk of hepatic b. Report rash, unusual bleeding or bruising, yellowing of skin or
damage. Discourage use together. eyes, changes in voiding patterns.
c. Warn patient that high doses or unsupervised long-term use can
cause liver damage.

DRUG #2 MECHANISM OF ACTION INDICATION/CONTRAINDICATION ADVERSE EFFECT NURSING RESPONSIBILITIES

GENERIC: Antagonizes the inhibitory INDICATION: BEFORE:
Metoclopramide effect of dopamine on GI  Treatment of diabetic CNS: DX:
smooth muscle. This causes gastroparesis Agitation, confusion, a. Obtain medical history of contraindicated conditions
BRAND: gastric contraction, which  Prevent or treat nausea and hallucinations, b. List drugs taken for drug history
Gimoti promotes gastric emptying and vomiting neuroleptic malignant c. Check allergy
peristalsis, it also reduces syndrome, seizure, and d. Identify if the patient has depression
THERAPEUTIC: gastroesophageal reflux. CONTRAINDICATION: suicidal ideation TX:
Antiemetic; Upper GI Metoclopramide also blacks  Hypersensitivity to a. Prepare the appropriate dosage as ordered
stimulant dopaminergic receptors in the metoclopramide CV: b. Double check the medications before attending to the patient
chemoreceptor trigger zone,  Catecholamine releasing Brady cardia, fluid c. Verify that the patient is not taking any medications that may
PHARMACOLOGI preventing nausea and paragangliomas retention, hypertension, adversely affect the prescribed drug
C: vomiting after a surgery.  Epilepsy and hypotension d. Provide basin if vomiting
Dopamine-2 receptor  Pheochromocytoma EDx:
antagonist  Gastrointestinal hemorrhage GI: a. Explain use and administration of drug to patient and support
 Mechanical obstruction of the GI Constipation person.
DOSAGE: Source: b. Educate the client regarding the drug name, dosage, and schedule
10 mg Harris, M. (2021). DRUG TO DRUG INTERACTION: EENT: for administration; method of administration
Metoclopramide. Retrieved  Anticholinergics: decrease dry mouth, laryngeal c. Instruct the support person that that drug can cause change in
ROUTE: from https://www.medscape./ effectiveness of metoclopramide edema, visual mental status if currently taking antipsychotics
IV  Antipsychotics: potentiate effects disturbances DURING:
of antipsychotics such as DX:
neuroleptic malignant syndrome ENDO: a. Monitor vital signs, including pulse and blood pressure
and tardive dyskinesia Galactorrhea, b. Assess for dehydration
 CNS depressants: increase CNS gynecomastia c. assessfor any allergic reactions
depression d. Assess for change in mental status
 MAOI: increased risk for severe GU: TX:
hypertension urinary retention a. Administer the medication via slow IV push
b. Provide non-pharmacological nausea management such as
DRUG TO FOOD INTERACTION: HEME: consumption of ginger root tea and eliminating odor, and positioning
N/A Agranulocytosis, in high fowler.
leukopenia, neutropenia c. Provide comfort and safety measures to improve patient
compliance and to ensure patient safety

14
 EDx:
a. Instruct patient to eat in small but frequent manner
b. Teach patient to prevent constipation by increasing dietary fiber
and fluid intake and exercising regularly.
c. Instruct increase water intake in a small but frequent manner
d. Instruct to move slowly to prevent injury
AFTER:
DX:
a. Assess for possible adverse reactions such as changes in mental
status like agitation and confusion
b. Monitor blood pressure for hypertension or hypotension
c. Monitor renal function.
d. Access for decrease in nausea and vomiting or effectiveness of the
drug
TX:
a. Document drug administration
b. Provide ice chips for dry mouth
c. Assist in side-lying position while head of bed is raised in case of
vomiting occurs
EDx:
a. Instruct to avoid eating full meals in one sitting
b. Instruct support person to monitor for suicidal ideation
c. Urge Patient to avoid alcohol and other CNS depressants

ADVERSE
MECHANISM OF
DRUG #3 INDICATION/CONTRAINDICATION EFFECTS/ SIDE NURSING RESPONSIBILITIES
ACTIONS
EFFECTS
GENERIC NAME Inhibits reabsorption of INDICATIONS: ADVERSE BEFORE
Furosemide sodium and chloride at Pulmonary edema; edema with HF, hepatic EFFECTS: Dx:
proximal and distal disease, nephrotic syndrome, ascites, CNS: dizziness, a. Check the expiration date before administering.
CLASSIFICATION: tubule and in the loop hypertension headache, vertigo, b. Monitor patient’s temperature and review patient history of illness.
PHARMACOLOGICA of Henle. weakness, lethargy c. Check vital signs, esp. B/P, pulse, for hypotension before administration.
L CONTRAINDICATIONS: Tx:
Sulfonamide loop diuretic THERAPEUTIC Anuria, Hypersensitivity to sulfonamides CV: tachycardia a. Prepare the medication in right dosage PRN.
EFFECTS: Precautions: Pregnancy, breastfeeding, b. For I.V. infusion, dilute in dextrose 5% in water, normal saline solution,
THERAPEUTIC Increases excretion of diabetes mellitus, dehydration, severe renal or lactated Ringer’s solution.
Diuretic, water, sodium, chloride, disease, cirrhosis, ascites, hypersensitivity GI: nausea, vomiting, Edx:
Antihypertensive magnesium, calcium to sulfonamides/thiazides, infants, diarrhea, a. Tell the s/o of the patient to expect increased frequency, volume of
hypovolemia, electrolyte depletion, urination.
15
 PATIENT’S ROUTE SOURCE: hypersensitivity b. Tell the s/o of the patient to avoid OTC medications unless directed by
AND DOSAGE Kizior, R. J., & Hema: prescriber
INTRAVENOUS, 20 mg, Hodgson, K. (2020). DRUG-DRUG INTERACTIONS: thrombocytopenia During:
every 6 hours Saunders Nursing Drug Aminoglycosides, ethacrynic acid, other Dx:
Handbook 2021 E- ototoxic drugs: increased risk of a. Check the right patient and right route.
Book. Elsevier ototoxicity Amphotericin B, b. Watch for symptoms of electrolyte imbalance: Hypokalemia may result
Gezondheidszorg. corticosteroids, corticotropin, potassium- in changes in muscle strength, tremor, muscle cramps, altered mental
wasting diuretics, stimulant laxatives: status, cardiac arrhythmias;
Skidmore-Roth, L. additive hypokalemia Antihypertensives, Tx:
(2020). Mosby’s 2021 diuretics, nitrates: additive hypotension a. Note extent of diuresis.
Nursing Drug Cardiac glycosides: increased risk of b. Administer medication as ordered
Reference (Skidmore glycoside toxicity and fatal arrhythmias Edx:
Nursing Drug Clofibrate: exaggerated diuretic response, a. Report palpitations, signs of electrolyte imbalances (noted previously),
Reference) (34th ed.). muscle pain and stiffness hearing abnormalities (sense of fullness in ears, tinnitus)
Mosby. Hydantoins, nonsteroidal AFTER:
antiinflammatory drugs, probenecid: Dx:
Wilkins, W. L. (2020). diuresis inhibition Insulin, oral a. Monitor the patient's activity and vital signs.
Nursing2021 Drug hypoglycemics: decreased hypoglycemic b. Monitor for possible adverse effects of medication.
Handbook (Nursing effect Lithium: decreased lithium Tx:
Drug Handbook) excretion, possible toxicity a. Assess the patient and determine unusual changes.
(Forty-First ed.). LWW. Norepinephrine: decreased arterial b. Evaluate therapeutic response: improvement in edema of feet, legs,
response to norepinephrine sacral area (HF); increased urine output, decreased B/P; decreased calcium
levels (hypercalcemia)
DRUG-FOOD INTERACTIONS: Edx:
 none known - a. Immediately report to the physician, if unusual changes are noticed.
b. To use sunscreen or protective clothing to prevent photosensitivity

MECHANISM OF INDICATION/ ADVERSE EFFECTS/

DRUG #4 NURSING RESPONSIBILITIES
ACTIONS CONTRAINDICATION SIDE EFFECTS
GENERIC NAME Trimetazidine inhibits INDICATIONS: CV: Tachycardia, BEFORE
Trimetazidine βoxidation of fatty acids by For the symptomatic orthostatic hypotension Dx:
blocking long-chain 3- treatment of stable angina a. Check the expiration date before administering.
CLASSIFICATION: ketoacyl-CoA thiolase, with pectoris in patients GI: Nausea, vomiting, b. Obtain baseline and follow-up ECGs to evaluate drug effects on QT interval.
PHARMACOLOGI the effect of enhancing inadequately controlled or c. Receive full medication history and screen for contraindications.
C glucose oxidation, resulting intolerant to first line CNS: Headache d. Record onset, type (sharp, dull, squeezing), radiation, location, intensity, duration
Piperazine Derivative in more efficient production therapies. of anginal pain, precipitating factors (exertion, emotional stress).
of ATP with less oxygen Tx:
THERAPEUTIC demand. It prevents a CONTRAINDICATIONS a. Prepare the medication in right dosage PRN.
Anti-angina decrease in intracellular ATP : Edx:
levels by preserving energy Parkinson's disease, a. Inform the s/o of the patient that drug can be taken with or without food, but not
PATIENT’S ROUTE metabolism in cells exposed parkinsonian symptoms, with grapefruit juice or grapefruit containing products.
AND DOSAGE to ischemia or hypoxia, thus restless leg syndrome, b. Inform the s/o of the patient that drug isn’t intended for acute angina episodes

16
 PO 35 mg/1 tab BID ensuring the proper tremors, and other related DURING:
functioning of ionic pumps movement disorders. Severe Dx:
and transmembrane Na-K renal impairment (CrCl <30 a. Check the right patient and right route.
flow without changing mL/min). Lactation. b. Monitor ECG, pulse for irregularities.
hemodynamic parameters. Tx:
DRUG-DRUG a. Give with food if nausea occurs.
THERAPEUTIC INTERACTIONS: Edx:
EFFECTS: Metaclopramide: The risk a. Inform the s/o of the patient that the product must be continued for prescribed time
Relieves chest pain for or severity of adverse to be effective
angina. effects can be increased b. To notify all health care providers of product use
when Metoclopramide is AFTER:
SOURCE: combined with Dx:
Kizior, R. J., & Hodgson, K. Trimetazidine. a. Monitor the patient's activity and vital signs.
(2020). Saunders Nursing b. Monitor for possible adverse effects of medication.
Drug Handbook 2021 E- DRUG-FOOD Tx:
Book. Elsevier INTERACTIONS: a. Assess the patient and determine unusual changes.
Gezondheidszorg.  none known - b. Evaluate the therapeutic response: decreased anginal pain, attacks
Edx:
a. Immediately report to the physician, if unusual changes are noticed.
b. Notify prescriber of dizziness, edema, dyspnea
c. To comply with all areas of medical regimen

MECHANISM OF INDICATION/
DRUG #5 ADVERSE EFFECT NURSING RESPONSIBILITIES
ACTION CONTRAINDICATION
GENERIC: Depress the CNS by INDICATION: BEFORE:
Diazepam potentiating GABA, an  Muscle relaxant used CNS: fatigue, ataxia, DX:
inhibitory pre-operatively confusion, dizziness, vertigo, a. Assess blood pressure, pulse, and respirations
BRAND: neurotransmitter.  Induction of sedation vivid dreams, headache, b. Review history of drug consumption
Valium Produces skeletal pre-operatively slurred speech, tremor; EEG c. Assess for contraindications or cautions: history of allergy to diazepam
muscle relaxation by changes, tardive dyskinesia. TX:
THERAPEUTIC: inhibiting spinal CONTRAINDICATION: a. Prepare medication at the right dosage as ordered
Anticonvulsants; polysynaptic afferent  Hypersensitivity to CV: Hypotension, b. Provide a safe environment
skeletal muscle pathways. Has diazepam and other tachycardia, c. Verify that the patient is not taking any medications that may adversely affect the
relaxants anticonvulsant benzodiazepines edema, cardiovascular prescribed drug
properties due to  Acute angle-closure collapse. EDx:
PHARMACOLOGI enhanced presynaptic glaucoma a. Educate and inform the patient about the indications of diazepam
C inhibition. Relief of  Myasthenia gravis Special Senses: Blurred b. Instruct support person to report history of alcohol dependence before drug
Benzodiazepine anxiety and sedation  Severe hepatic vision, diplopia, nystagmus. administration
are also effects of CNS impairment c. Inform patient who receives diazepam that drowsiness is normal
DOSAGE: depression by GI: Xerostomia, nausea, DURING:
5 MG diazepam. DRUG TO DRUG constipation, hepatic DX:
INTERACTION: dysfunction. a. Assess IV site frequently for phlebitis

17
 ROUTE: Source:  Antacids: altered rate of b. Assess level of sedation periodically
IV Vallerand, A. H., diazepam absorption Urogenital: Incontinence, c. Monitor cardiac and respiratory function noting for hypotension and bradycardia
Sanoski, C. A., &  Cimetidine: decreased urinary retention, TX:
Quiring. C. (2015). diazepam metabolism gynecomastia (prolonged a. Administer 45 to 72 minutes before scheduled intraoperative transfer
Davis’s drug guide for  Opioids: increased risk use), menstrual irregularities, b. Administer the medication right dose at the right time
nurses. Fourteenth of severe respiratory ovulation failure. c. Observe for respiratory depression after bolus injection and during I.V. infusion of
edition. Philadelphia, depression diazepam
PA, F.A. Davis Respiratory: Hiccups, d. Raise bedside rails to ensure safety
Company. coughing, laryngospasm. EDx:
a. Instruct client to stay in bed and avoid ambulating
b. Advise patient to report any hypersensitivity reactions
c. Educate the client to move slowly

AFTER:
DX:
a. Continuously assess for blood pressure, pulse, and respirations
b. Assess level of sedation and adverse reactions
c. Obtain a baseline pulse rate to assess for any cardiovascular effects of the drug.
TX:
a. Document drug administration
b. Provide comfort measures and rest promoting environment
c. Assist for patient needs
d. Demonstrate relaxation techniques
EDx:
a. Urge client to avoid hazardous activities
b. Urge support person not to leave the client alone
c. Instruct support person to report adverse reactions immediately to the nurse on duty

DRUG #6 MECHANISM OF INDICATION / ADVERSE EFFECT NURSING RESPONSIBILITIES

ACTION CONTRAINDICATION

GENERIC: Reduces gastric acid INDICATIONs: CNS: BEFORE:

Omeprazole secretion and increases To treat symptomatic dizziness, headache, asthenia Dx:
BRAND: Prilosec gastric mucus and gastroesophageal reflux GI: a. Monitor older adults for fluid and sodium imbalances.
bicarbonate disease (GERD) nausea, vomiting, diarrhea, b. Assess baseline mental status
CLASS: production, creating a constipation, abdominal pain Tx:
THERAPEUTIC: protective coating on CONTRAINDICATION: Metabolic: hypomagnesemia a. Perform a thorough physical assessment to establish baseline data before drug
Antiulcer gastric mucosa and Hypersensitivity to Musculoskeletal: back pain; therapy begins, to determine the effectiveness of therapy,
PHARMACOLOGI easing discomfort omeprazole substituted fractures of hip, wrist, spine b. Restrict amount of drug available to patient.
C: Proton pump from excess gastric benzimidazoles or to any of (with long-term daily use) c. Periodically assess dose.
inhibitor acid the excipients. Omeprazole Respiratory: cough, upper EDx:
DOSAGE: like other proton pump respiratory tract infection a. Educate client on drug therapy to promote compliance.

18
 40-60mg References: inhibitors (PPIs) should not Skin: rash b.Insure the patient takes the medication as prescribed.
ROUTE: Jones & Bartlett be used concomitantly with DURING:
Intravenous Infusion Learning. (2020). nelfinavir. Dx:
2021 Nurse’s Drug a. Check for abdominal pain, emesis,
Handbook (20th ed.). diarrhea, or constipation.
Jones & Bartlett b. Evaluate fluid intake and output.
Learning. Tx:
a. Monitor neurologic status, particularly for signs of impending seizures.
EDx:
a. Advise patient to avoid St John’s wort while taking this drug.
AFTER:
Dx:
a.Assess knowledge/teach patient appropriate use, interventions to reduce side
effects,and adverse symptoms to report
b.Assess for serotonin syndrome
Tx:
a.Provide safety measures (e.g. adequate lighting, raised side rails, etc.) to prevent
injuries.
b. Provide comfort measures to help patients tolerate drug effects.
EDx:
a. Monitor patient compliance to drug therapy..
b. Advise pt. to avoid alcohol intake.
c. Instruct patient to verbalize feelings and concerns.

B. IV Fluids

NAME MECHANISM OF ACTION COMPONENT INDICATIONS AND ADVERSE EFFECTS NURSING RESPONSIBILITIES
S CONTRAINDICATIO
NS
Generic Name Hypertonic solutions are those that have Electrolytes, INDICATION GI: Belching, gastric BEFORE:
Dextrose 5% in Lactated an effective osmolarity greater than the Sodium,  Treatment for distention, flatulence. Dx:
Ringer’s Solution (D5LRS) body fluids. This pulls the fluid into the Potassium, persons needing Metabolic: Metabolic a. Obtained history of the patient’s fluid
vascular by osmosis resulting in an Calcium, extra calories who alkalosis; electrolyte and electrolyte status before therapy and
Brand Name increase vascular volume. It raises Chloride, cannot tolerate fluid imbalance: sodium reassess regularly.
Lactated Ringer’s in 5% intravascular osmotic pressure and Lactate, overload. overload b. Assessed vital signs
Dextrose provides fluid, electrolytes and calories Osmolality  Treatment of shock. (pulmonary edema), c. Assessed physical health status
for energy. hypocalcemia (tetany), Tx:
Classification CONTRAINDICATIO hypokalemia, milk-alkali a. Do not administer unless solution is
 Hypertonic Sources: N syndrome, dehydration. clear and container is undamaged
 Nonpyrogenic, Parenteral Lactated Ringer’s in 5% Dextrose  Hypersensitivity to Other: Rapid IV in b. Observed aseptic technique when before
Fluid, Electrolyte and (Lactated Ringer’s and 5% Dextrose any of the neonates (Hypernatremia, administering the IV fluid.
Nutrient Replenisher Injection): Uses, Dosage, Side Effects, components. reduction in CSF c. Provided comfort and rest

19
 Interactions, Warning. (2021, July 12). pressure, intracranial Edx:
Dosage/Frequency/Route RxList. https://www.rxlist.com/lactated- hemorrhage). a. Instructed the client to use only as a
500 mL @ 12 hours / 42 cc per ringers-in-5-dextrose- Skin: Severe tissue temporary measure to relieve
hour IV drug.htm#medguide damage following constipation. Do not take if abdominal
R. (2017, August 9). D5LRS (Lactated extravasation of IV pain, nausea or vomiting occurs.
Ringer’s Solution) IV Fluid. RNpedia. solution. b. Educated to report any signs of unusual
https://www.rnpedia.com/nursing-notes/f Urogenital: Renal calculi symptoms.
undamentals-in-nursing-notes/d5lrs- or crystals, impaired c. Educated the patient about the drug
lactated-ringers-solution-iv-fluid/ kidney function. taken
DURING:
Dx:
a. Do not give IVF with abdominal pain,
nausea, or vomiting.
b. Monitored vital signs
Tx:
a. Checked for patient’s comfort
b. Observed aseptic technique during
administering the IV fluid.
c. Provided comfort and rest
Edx:
a. Educated the client that they may
experience certain adverse effects such
as blurred vision, chills, convulsions
and irregular heartbeat. If this occurs,
discontinue drug and consult your
health care provider.
b. Caution must be exercised in the
administration of parenteral fluids,
especially those containing sodium ions
to patients receiving
c. Educated about the drug information
AFTER:
Dx:
a. Assessed for any redness or swelling of
the ongoing IVF
b. Assess for any signs of phlebitis/
infection
c. Check correct solution, medication and
volume
Tx:
a. Provided necessary comfort for the
patient

20
 b. Be alert of fluid overload.
c. Regulate the drop rate properly
d. Do not stop solutions abruptly
Edx:
a. Instructed the client to report sweating,
flushing, muscle tremors, or twitching,
inability to move extremities.
b. Evaluated patients’ knowledge on the
therapy
c. Instructed to report any unusual finding
to a health provider

C. Surgery

PROCUDURE DESCRIPTION AND INDICATION NURSING RESPONSIBILTIES

1. EMERGENCY INTRAJUGULAR Central venous access allows rapid high-volume • Vigorously and thoroughly wash your hands
CATHETER, INSERTION, RIGHT fluid administration, administration of multiple
• Wear sterile clothing
medications, and hemodynamic measurements. It is
often used for reliable venous access in ill patients. • Careful and full skin disinfection
There are numerous routes of central venous access • Widely cover the implant area, ensuring sterility
including internal jugular (IJ), subclavian and
femoral.

21
XV. Nursing Care Plans

A. Prioritization of Problems

a. 1. List of Problems

1. Altered Renal Tissue Perfusion related to glomerular malfunction as evidenced by

elevated creatine level of 849.47 umol/L and BUN level of
2. Excess fluid volume related to decreased urine output, and sodium and water retention.
3. Activity Intolerance related to fatigue and retention of waste products
4. Risk for Imbalanced Nutrition: Less Than Body Requirements related as evidenced by
dietary restrictions and refusal to take Peptamen.
5. Risk for infection related to post op incision as evidenced by presence of intrajugular
catheter.

a. 2. Basis for Prioritization

NURSING DIAGNOSIS JUSTIFICATION

1. Altered Renal Tissue When following our ABC in nursing, altered renal perfusion is the 1st
Perfusion related to glomerular priority. This is considered in the circulation; also, it is 2nd priority in the
malfunction as evidenced by MAAUAR, the impairment of the urinary elimination. The patient should
elevated creatine level of submit himself immediately to hemodialysis in order to correct alteration
849.47 umol/L evidenced by in renal perfusion.
elevated creatinine level of
622.3 and BUN level of .

2. Excess fluid volume related This nursing problem identified is our 2nd priority in rendering
to decreased urine output, and interventions to alleviate condition because fluid overload occurs when
sodium and water retention. the body can't get rid of fluid or holds onto it (retention), and a high
dietary salt intake is assumed to increase fluid intake.

3. Activity Intolerance related This is the 3rd prioritized problem, activity intolerance is a condition that
to body weakness and retention the patient manifested by weakness and easy fatigability. Insufficient
of waste products physiological or psychological energy to endure or complete required or
desired daily activities.

4. Risk for Imbalanced This is the 4th prioritized problem due to insufficient intake of nutrients to
Nutrition: Less Than Body meet metabolic needs. According to Maslow, Nutrition is part of the
Requirements related as physiologic needs that should be met to survive. This may affect the
evidenced by refusal to take nutritional sustainment of cell of the body causing now systematic
Peptamen and dietary imbalances.
restrictions

5. Risk for infection related to This is the 5th prioritized problem and risk diagnosis. Comfort is also a
post op incision as evidenced first priority in Maslow's hierarchy of needs, but it is less prioritized than
by presence of intrajugular all of the mentioned problems above. If not given immediate attention,
catheter. the client has a tendency to acquire infection and may trigger other
complication.
 B. Nursing Care Plans
NCP 1: Altered Renal Tissue Perfusion related to glomerular malfunction as evidenced by elevated creatine level of 849.47 umol/L and BUN level
ASSESSMENT EXPLANATION OF OBJECTIVES NURSING INTERVENTIONS RATIONALE EVALUATION
THE PROBLEM
Subjective: For optimal cell STO: Dx: Dx: STO:
functioning the kidney Within 8 hours of  Establish rapport  To get the cooperation of the patient and Goal met
excrete potentially effective nursing SO.  After 8 hours of
Objective: harmful nitrogenous interventions,  Monitor and record vital signs.  To obtain baseline data effective nursing
product-Urea, Creatinine,  The client will  Determine factors related to individual situation and  To assess causative and contributing factors interventions, the
 Increase in Uric Acid but because of urinate at least note situation that can affect all body system. patient urinated at
Lab results the loss of kidney 30cc per hour.  Note characteristic of urine: measure urine specific  To assess for hematuria and proteinuria and least 100cc within
specifically excretory functions there gravity. renal impairment. 8 hours
Creatinine. is impaired excretion of  Observe for dependent generalized edema.  To note degree of impairment of renal
 Oliguria nitrogenous waste product function. LTO:
LTO:
 Noticeable causing in increase in Goal met
Within 16 hours of
edema on Laboratory result of BUN, Tx: Tx: After 16 hours of
effective nursing
lower Creatinine, Uric Acid  Noted mentation status and review lab result such as  Increase BUN and creatinine levels may effective nursing
interventions,
extremities. Level. BUN and creatinine levels. alter mentation. intervention:
 Patient will
 Fatigue and  Measured urine output on a regular schedule and  To assess renal perfusion and function.  Patient verbalizes
verbalize a
Weakness SOURCE: weigh daily.  Calories to meet body’s need while decrease feelings
feeling of
https://nurseslabs.  Provide diet restriction as indicated, while providing restriction of protein helps limit BUN. of fatigue and
decrease
com/fatigue/ adequate calories.  To compensate for the reduction in O2
fatigue and weakness.
weakness.  Provide supplemental oxygen therapy as needed. saturation and promote oxygenation.
 The client’s edema
Nursing  The client’s particularly in
Diagnosis: edema EDx: EDx
lower extremities
Altered Renal particularly in  To decrease anxiety about condition and
slowly decreased.
Perfusion related to lower  Encourage discussion of feelings regarding prognosis correct his wrong ideas about condition.
glomerular extremities or long term effects of discussion.  To reduce fatigue.
malfunction as will slowly
evidenced by decrease.  Educate the client and the family regarding food rich  Diet is an important factor for optimum
elevated creatine in iron, folic acid, and vitamin B12. health especially to CKD clients.
level of 849.47  Educate patient on low salt and low fat diet as per
umol/L. doctor’s order

NCP 2: Excess fluid volume related to decreased urine output, and sodium and water retention.
ASSESSMENT EXPLANATION OF OBJECTIVES NURSING INTERVENTIONS RATIONALE EVALUATION
THE PROBLEM
Subjective: Fluid Volume Excess STO: Dx: Dx : STO:
>” I feel like my refers to an isotonic Within 8 hours of  Monitored vital signs.  To establish a baseline data. (Goal Met)
feet is swollen.” expansion of the ECF due effective nursing  Checked Intake and Output  Monitoring sources of intake via oral and Intravenous and Within 8 hours of
to a decrease in protein in interventions, effective nursing
 Objective: the blood vessels due to a) The client comparing to the patient’s output will prevent fluid overload. interventions,
 Noticeable the passing of protein in will  Determined laboratory Values.  With excess fluid volume, electrolytes may be diluted causing a) The client
Edema in the urine. A decreased understand low sodium and Serum osmolality will be decreased with understands the
Lower protein, specifically the importance of fluid
overhydration. Hematocrit will also decrease with an excess
Extremities reduction in the albumin importance of restrictions.
alters the oncotic pressure fluid of circulating blood volume. Creatinine measures kidney b) The client
 Urine Output
of 50cc within which pulls fluid from the restrictions.  Monitored lung sounds function and will decrease with too much fluid. urinated at least
8 hours interstitial spaces into the b) The client  Adventitious breath sounds can indicate increased pleural 15cc per hour
 Tachycardia vascular system. Due to will urinate at effusion or pulmonary congestion LTO:
with HR of the patient's CKD, the least 30cc per Tx : (Goal Met)
117 level of albumin decreases hour. Tx :  Dialysis performed to cleanse the toxins waste in the body Within 16 hours of
 Increased in causing a shift of fluid  Assisted for hemodialysis since the client has decreased glomerular filtration rate or her effective nursing
Lab result from the vascular system interventions, the
kidneys malfunction to secrete these toxins.
(BUN and into the interstitial spaces LTO: client:
which causes pitting Within 16 hours  Pitting edema to the body, such as in the arms, hands, legs, a) Stabilized
Creatinine)
edema, pleural effusion, of effective and feet is a sign of fluid in the tissues. fluid volume
 Reassessed for edema
DIAGNOSIS and pericardial effusion. nursing  Fluid restriction decreases extracellular fluid volume and b) The
Fluid volume Fluid volume excess is interventions, the reduces demands on the heart. client’s edema
excess related to also caused by a reduction client will:  Limit fluids and sodium as ordered.  To intervene any signs and symptoms of current disease. particularly in
decreased urine of I and O ratio which a) Stabilize fluid  Monitoring and recording accurate I&O is vital. All intake lower extremities
output, and sodium causes water retention. volume  Administered medications as ordered slowly decreases.
from IV fluids, water taken with medications.
and water Source: b) The client’s and noted side effects.
retention. edema  Recorded accurately client intake and
G. Wayne (March 2022) particularly in
output Edx :
Fluid Volume lower
Excess,Nurselabs : extremities  For better adherence. Fluid restrictions prevent the patient
https://nurseslabs.com will slowly Edx : from taking in too much extra fluid.
decrease.  Enforced fluid restrictions and  To stimulate exercises to prevent future complications.
educated on the importance.
 Encouraged ambulation such as
walking within individual limits.

NCP 3: Activity Intolerance related to fatigue and retention of waste products

ASSESSMENT EXPLANATION OF OBJECTIVES NURSING INTERVENTIONS RATIONALE EVALUATION
THE PROBLEM
Subjective: STO: Dx: Dx: STO: (Partially Met)
“I feel so weak.” as Activity intolerance is Within 8 hours of After 8 hours of effective nursing
verbalized. a condition in which effective nursing  Assess the patient’s present level of activity  This will allow the nurse to evaluate where the interventions, the patient slightly
an individual lacks the interventions, and tolerance to activity. patient is beginning and then develop a patient participated in physical activities
Objective: physical or mental  The patient will  Assess the underlying cause of activity specific activity plan. and verbalized the importance of
 Patient appears energy to perform or participate in intolerance.  This will allow the nurse to appropriately treat continued physical exercise.
weak and complete necessary physical activities.  Assess skin integrity frequently. any underlying causes of decreased activity. LTO: (Partially Met)
lethargic. activities. Nurses play  The patient will After 24 hours of effective
 Difficulty a vital role in verbalize the Tx: nursing interventions, the patient
24
 engaging in recognizing and caring importance of  Patients with decreased activity level or demonstrated energy
activity. for clients with general continued physical Tx: intolerance to activity are at an increased risk management techniques.
 Fatigue weakness or exercise.  If the patient is limited to bed-rest, begin with of developing pressure ulcers. Assess skin
intolerance to activity. LTO: range of motion (ROM) exercises. frequently to prevent skin breakdown.
Whether it’s due to a Within 24 hours of  Provide frequent position changes.  It is important to adapt activity exercises to the
Nursing Diagnosis client’s chronic effective nursing  Assist with ADLs as indicated, but not to the patient’s current tolerance level and build from
Activity Intolerance condition, decreased interventions, extent of promoting dependency. there.
related to fatigue and tolerance to activity  The patient will  Patients that may be on bed rest or chair-rest
retention of waste can greatly impact report an increased should be repositioned frequently to decrease
products. their ability to perform tolerance to risk of skin breakdown.
daily tasks and their perform activities.  Assisting the patient with ADLs allows for the
overall well-being.  The patient will conservation of energ
demonstrate Edx
energy  Rest between activities provides adequate time
management Edx for energy conservation.
techniques.  Encourage adequate rest periods, especially  Assistive devices help in easing fatigue and
before meals, other ADLs, and exercise. discomfort.
 Encourage or assist the patient in using  Encourage physical activity, especially
assistive devices if necessary. exercises that enhance endurance.
 Encourage to continuously do physical
activity, especially exercises that enhance
endurance.

NCP 4: Risk for Imbalanced Nutrition: Less Than Body Requirements related as evidenced by dietary restrictions and refusal to take Peptamen
Assessment Explanation of the Objective Nursing Intervention Rationale Evaluation
Problem
Subjective: This is the state STO: Dx Dx STO:
where an individual  Assess general appearance and monitor  To establish baseline data. (Goal Met)
experiences or suffers After 8 hours of nursing vital signs.
the risk of intervention, the patient  Identify patient at risk for malnutrition.  To assess contributing factors. After 8 hours of nursing
experiencing reduced will be able to:  Ascertain understanding of individual intervention, the patient was
weight due to Verbalize nutritional needs.  To determine what information to provide the patient. be able to: Verbalize
insufficient intake or understanding with  To provide comparative baseline. understanding with causative
metabolism of causative factors when  Assess age, body build, strength, rest factors when known and
nutrients necessary known and necessary level.  To establish a nutritional plan. necessary intervention
for the body’s intervention
Objective: metabolic needs.  Determine whether patient prefers more  The anthropomorphic assessments should form the basis
 Weakness Adequate nutrition is calories in a meal. for the requirements for nutrients and calories and
 Refusal to take necessary to meet the
 Accurately and procedurally take the should therefore be accurate.
feeding formula body’s demand.
actual weight of the patient
25
 Vital Signs as Nutritional status can
follows: be affected by disease Tx Tx LTO:
BP- or injury state.  Administer Medications as ordered.  To prompt treatment. (Goal Met)
RR-  Regulate Intravenous line as Ordered.
PR-  Assist in developing individualized  To maintain hydration status. After 24 hours of nursing
SPO2- regimen. intervention, the patient was
T- LTO:  Provide small frequent feeding with  To control underlying factors. able to: Demonstrate
After 24 hours of protein and carbohydrates, considering behavior, lifestyle change to
nursing intervention, dietary restriction.  To establish a nutritional plan. regain and maintain an
the patient will appropriate weight.
Nursing Diagnosis: demonstrate behavior, Edx
Risk for Imbalanced lifestyle change to  Tell patient to avoid high in sodium-rich
Nutrition: Less Than regain and maintain an food. Edx
Body Requirements appropriate weight.  To prevent further increase in sodium level.
 Advised to maintain bed rest.
related as evidenced
 Instructed to limit fluid intake as ordered.  To decrease metabolic demand.
by dietary restrictions
 To prevent water retention.
and refusal to take
Peptamen.

NCP 5: Risk for infection related to post op incision as evidenced by presence of intrajugular catheter.
ASSESSMENT EXPLANATION OBJECTIVES NURSING INTERVENTION RATIONALE EVALUATION
OF THE
PROBLEM
STO Dx Dx: STO (Goal Met)
Patients at risk for Within 8 hours of effective  Assess for the presence of local infectious processes  Signs and symptoms include localized swelling, After 8 hours of
Subjective infection are those nursing interventions, in the skin or mucous membranes. localized redness, pain or tenderness, loss of function in effective nursing
whose immune  Patient verbalizes the affected area, and palpable heat. interventions, the
Objective: system or natural understanding of  Observe and report if an older adult client has a low-  Temperature elevation that appears in clients must be patient verbalized
 Weak in defenses are behavioral and hygiene grade fever. reported as it could potentially be an infection. understanding of
appearance compromised. One measures to prevent behavioral and
Tx
 Clean and intact key risk factor is the infection.  Frequent cleansing of the skin, particularly the hands,
hygiene measures to
dressing breakdown of the prevent infection
 Patient verbalizes Tx provides a simple, inexpensive, widely used, and
body’s physical and recognition of
 T: 36.8 recognition of signs of  Assist clients in carrying out appropriate skin effective strategy for preventing self-inoculation.
defense signs of infection
mechanisms. This infection that need to be hygiene.  An aseptic technique is used when cleansing the skin; that need to be
type of breakdown reported to a healthcare dressings are changed as prescribed by the surgeon. reported to a
can be broken skin provider for treatment.  Avoid contact of soiled items with uniforms and avoid healthcare provider
due to injury,  Change dressing and bandages that are soiled or
shaking bed linens or clothes; instead, dust with a damp for treatment.
surgery, or other LTO wet.
Nursing Diagnosis: cloth as required.
invasive procedure. Within 24 hours of effective  Respiratory infections are quite virulent and easily
Risk for Infection nursing interventions,  Follow proper cleaning or disinfecting procedures of LTO (Goal Met)
related to post op transmitted throughout populations. These pathogens are
 The client will remain clients and their environment. After 24 hours of
26
incision as evidenced by free of infection, as easily aerosolized and are quite contagious. effective nursing
presence of intrajugular evidenced by normal  Avoid talking, coughing, or sneezing over open  Gloves provide an effective barrier for hands from the interventions, the
catheter. vital signs and the wounds or sterile fields. microflora associated with client care. patient remains free
absence of signs and Edx from infection, as
symptoms of infection.  The most frequent cause of bacterial transmission in evidenced by normal
 Alleviate or reduce the healthcare institutions is the spread of microorganisms vital signs and the
absence of signs and
problems related to the  Wear gloves when handling the client’s body fluids. by the hands of healthcare workers.
symptoms of
infection.  This helps reduce the stasis of secretions in the lungs and infection and
Edx bronchial tree. alleviated the
 Instruct clients to perform hand hygiene when  Rough edges or hangnails can harbor microorganisms problems related to
handling food or eating. infection.

 Encourage coughing and deep breathing exercises

and frequent position changes.
 Promote nail care by keeping the client’s and the
nurse’s fingernails short and clean.

27
 C. Discharge Plan
Health Teaching
Diet/Nutrition  Implement a dietary program to ensure proper nutritional intake within
the limits of the treatment regimen
 Eat small meals often that are high in fiber and calories.
 You may be told to limit how much fluid you drink. Season foods with
fresh herbs, garlic, onions, citrus, flavored vinegar, and sodium-free
spice blends instead of salt when cooking.
 Weigh yourself every day. Do this at the same time of day and in the
same kind of clothes. Keep a record of your daily weights.
 Monitor your I and O. Measure the amount of urine and stool you have
each day.
Activity  Encourage to perform passive ROM exercises as tolerated by the body
to promote circulation
 Encourage to have adequate rest periods and sleep to promote faster
recovery
 Encourage to do deep breathing exercises to promote relaxation and
promote circulation.
 Follow any activity restrictions such as driving, operating a machinery
as recommended by your healthcare provider
 Encourage the patient to maintain good hygiene to increase comfort,
promote blood circulation and build self esteem
 Avoid lifting heavy object. Do not wear yourself out or get overly
fatigued
Medication  Take the medication on time as prescribed
 Follow the dosage recommendations printed on the label to avoid
overdose
 Explain to the patient and family members the nature of drugs
prescribed and its side effects
 Encourage and provide assistance for client in creating schedules for
intake of medication.
 Present ways such as utilization of pill boxes, medication journals, and
alarms to prevent skipping or extra intake of medications
 Instruct not to take other medications without consulting the physician
to prevent any harmful drug to drug interactions.
 Emphasize the importance of compliance to the hemodialysis treatment
and other therapeutic regimen.
Others  Inform the patients that regular check-ups are important to ensure that
the patient condition is constantly monitored by the doctor.
 Advised client and family to maintain safe, clean, and calm
environment.
 Encourage and allow the client to ask questions and incorporate
lifestyle choices to the discussion of home based treatment
 Provides emotional support coming from family. Encouraged the
patient to participate in the community service

XVI. Learning Insights

A. CATALON, Ceithleen Jelly

My takeaway from this case study is that it is rich in information. It was extremely beneficial because we
thoroughly analyzed the case and practiced our critical thinking skills. This case study would benefit many
people because it would help them understand the problem or a patient's case. The drug study and NCP in this
case study would greatly assist people in providing treatment and care. It also emphasizes appropriate
intervention and diagnosis, as well as verifying all of the patient's data or information, such as medical history,
signs, symptoms, and so on.
B. CENDANA, John Kyle
A case study is an important tool for us, student nurses, as it prepares us for a bigger platform when we finally
work as registered nurses in the future where we are the ones who will be handling the life of our patients. A
case study is done with so much focus and understanding of a particular case, not just for compliance’s sake. It
is important to put all our efforts into analyzing the given case, not just thinking as a student nurse but also as a
registered nurse in the future wherein the life of our patients is in our hands. What I have learned in making
this case study is that cooperation and combined knowledge and understanding will make something easier and
more comfortable to do. "Teamwork divides the task and multiplies the success."
C. CULATON, James Allen M.
Chronic kidney disease (CKD) is still one of the leading causes of death and disability in the Philippines. It is
critical to educate patients about kidney problems, including disease progression prevention, the importance of
dialysis, and its complications. I've learned that if these patients do not receive dialysis, their condition will
deteriorate because it is a lifelong treatment. Doing this case study as a student made me realize the importance
of knowing key information about such a disease. Hearing from patients with this disease makes me realize
that they face many limitations in their daily lives, such as food and drink. I learned a lot while working on this
case study that will help me in the future.
D. DONONGAN, Joana Mae J.
In our case presentation, this case can help us in understanding chronic kidney disease more. This study
demands for careful monitoring and appropriate patient intervention. This would be a great opportunity for us
to gain experience handling cases like this while also considerably enhancing our skills and experience. This
case just serves to show how leading a healthy lifestyle and adhering to professional directives might help us
avoid the events we're trying to avoid.
E. FERNANDEZ, Ernelle Jhay
Based on my experience on the span of the three days duty in the Benguet General Hospital, I realized that a
single disease can cause a lot of nursing diagnosis within days. Whereas, choosing the priorities in the NCP
had me in awe. Throughout this case in the span of the clinical duty i have learned that noticing little ques can
help avoid further complications such as reporting the sudden drop of SPO2 and temperature. This case gave
me some insights in what to do in the future when encountering such case and made me slowly forge my way
through the medical field.
F. GAMBICAN, Limay Shaira Mae D.
This case study taught us that a particular patient requires a great deal of attention in order to provide quality
healthcare because each patient has a different disease but only one goal, which is to be disease-free. So, as a
nursing student, learning some step-by-step procedures helped me build a weapon to eliminate those diseases
from people who suffer from such diseases; it may not completely treat them, but it can prolong their life.
Personally, I know someone who has been on dialysis, and it is not only physically and emotionally
exhausting, but it is also financially constraining. This is the main reason why they don’t go to hemodialysis
service. Thus, it is important to have a checkup for the early detection of disease to prevent complications.
Deeply understanding the cause of patient’s disease help us to greatly to come up with this case study.
G. LEYO, John Daven S.
This case made me recognize the significance of accurately evaluating sets of information, especially in
coming up with the entirety of comprehensive pathophysiology. One major learning I gained is about how we
came up with the wholeness of our study, and that would be through our teamwork. The whole process of a
case study is a complicated step-by-step process wherein cooperation and teamwork are essential, which I
believe we all managed to achieve. Moreover, reading about the different factors affecting the case, including
the patient’s chart and diagnostic test results helped me better comprehend and analyze our case. Unlike our
very first case study where we weren’t able to actually collect data in a clinical setting, this time, we had the
opportunity to apply our learnings on how to conduct head-to-toe assessment, 13 areas, and other data that are
deemed essential for our case. With all things considered, this study taught me crucial information such as
nursing interventions that I can apply in case I encounter other patients with chronic kidney diseases.
H. MAYOS, Julianne Kaye
In this case study, in my own opinion, lots of people will benefit from it and at the same time this case study
will help us analyze the patient case it provides us with the data's that we need to know in order to give the
appropriate interventions, diagnosis and as well as the treatment the patient need in order to recover.
I. QUERIMIT, Herschel P.
This case study would be beneficial to many people since it would help them comprehend a patient’s condition
or circumstances. In this case study, the pharmacological study and nursing care plan would considerably assist
individuals in providing therapy and care. It is also concerned with giving appropriate intervention and
diagnosis as well as validating all the patient's data or information, such as medical history, signs and
symptoms. Overall, it gives us loads of information about the patient that we may use to decide on how to
intervene or treat a patient.
J. SALANG-OY, Zaine
In assessing our patient, it is important not only to give or administer their medicine; it is important to show
them your care to your patient by assisting them in everything that they need to do. As a nurse, we should
communicate to our patients and family members or the watcher not only for our rapport but also, it may help
us to know more about the patient that was not in his or her records. Also, before communicating with our
patients and watcher, we should review first the record of the patient so as to have a piece of knowledge about
the condition on our patient and for us to know the things that might happen and what are the things that we
can do to help them in any ways for our independent nursing care for us to have accurate information accurate
patient that we can explain to the watcher or family members in case they ask any thing.

XVII. List of References

29
Harris, M. (2021). Metoclopramide. Retrieved from https://www.medscape./

G. Wayne (March 2022) Altered Renal Tissue Perfusion ,Nurselabs : https://nurseslabs.com

G. Wayne (March 2022) Fluid Volume Excess,Nurselabs : https://nurseslabs.com

G.Wayne (March 2022) Activity Intolerance ,Nurselabs : https://nurseslabs.com

G. Wayne (March 2022) Risk for impaired balance nutrition : less than body requirements
H. ,Nurselabs : https://nurseslabs.com

G.Wayne (March 2022) Risk for Infection,Nurselabs : https://nurseslabs.com

Marymount University. (2022, September 30). The ABCs of Nursing Prioritization. Marymount
University Online. Retrieved from https://online.marymount.edu/blog/abcs-nursing-prioritization

Rn), O. R. for N. (Open. (n.d.). 2.3 Tools for Prioritizing. Wtcs.pressbooks.pub. Retrieved from
https://wtcs.pressbooks.pub/nursingmpc/chapter/2-3-tools-for-prioritizing/

Kizior, R. J., & Hodgson, K. (2020). Saunders Nursing Drug Handbook 2021 E-Book. Elsevier
Gezondheidszorg.

Skidmore-Roth, L. (2020). Mosby’s 2021 Nursing Drug Reference (Skidmore Nursing Drug
Reference) (34th ed.). Mosby.

Wilkins, W. L. (2020). Nursing2021 Drug Handbook (Nursing Drug Handbook) (Forty-First ed.).
LWW.

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