A CASE STUDY ON INTESTINAL
OBSTRUCTION
____________________
A Case Study presented to the Clinical Instructors of Saint Mary’s
College of Tagum Inc., Tagum City
_____________________
In Partial fulfillment of the requirements of Related Learning Experiences
(RLE 112) of Bachelor of Science in Nursing
Presented to the Nursing Faculty:
By:
Group A1
Relampagos, Ana Sophia
Marces, Bea Jasmine’
Bretana, Seph Bianca
Surigao, Trisha Ericka
Francisco, Rheyna
Manzanares, Mae
Concepcion, Levi
Solatorio, Henry
Rafael, Rheina
Fabros, Noelle
Te, Edmark
December 2022
ii
TABLE OF CONTENTS
PAGE
TITLE PAGE
i
TABLE OF CONTENTS
ii
LIST OF TABLES
iii
LIST OF FIGURES
iv
CHAPTERS
I
INTRODUCTION
Background of the Study
II
1
Purpose of the Study
2
Theoretical Lens
3
Definition of Terms
3
Limitations and Delimitations
4
REVIEW OF RELATED LITERATURE
5
Journal Reading
5
Description/Definition of the disease
6
List of symptoms (Narrative form)
7
List of Etiologies (Narrative form)
8
iii
Management of the Condition
III
III
METHODOLOGY
9
17
Study Design
17
Research Participants & Informants
18
Data Sources
20
Data Collection Procedure
21
Trustworthiness of the study
21
Data Gathering Procedure
23
Research Instrument: PNA
24
Checking, Collating & Processing of Data
24
List of drugs presently taken by the patient
25
POSSIBLE RESULTS AND FINDINGS
Pathophysiology (Written)
27
Possible Signs and Symptoms/Etiologies (Table form)
35
Laboratory Results
39
Etiologies
39
Management of the Condition
40
Nursing Care Plan (NCP)
iv
Discharge Plan
42
IV
IMPLICATION FOR NURSING PRACTICE 101
45
VI
CONCLUDING REMARKS
46
Recommendations
47
REFERENCES
49
v
LIST OF TABLES
TABLES
PAGE
1
Possible Signs and Symptoms
2
Nursing Care Plan
3
Drug Study
LIST OF FIGURES
DIAGRAM
1
Pathophysiology
1
Chapter 1
INTRODUCTION
This chapter contains the Introduction of the study in which it comprises the Background of
the Study, Purpose of the Study, Theoretical Lens, Limitation and Delimitation of the study, and
Definition of term used.
BACKGROUND OF THE STUDY
According to Children's Hospital of Pittsburgh (2019), the intestine is a muscular tube which
extends from the lower end of your stomach to your anus, the lower opening of the digestive tract. It
is also called the bowel or bowels. Food and the products of digestion pass through the intestine,
which is divided into two sections called the small intestine and the large intestine.
Intestinal obstruction is a blockage that keeps food or liquid from passing through your small intestine
or large intestine (colon). Food and stool may not be able to move freely. The causes of intestinal
obstruction may include fibrous bands of tissue (adhesions) in the abdomen that form after surgery;
hernias; colon cancer; certain medications; or strictures from an inflamed intestine caused by certain
conditions, such as Crohn's disease or diverticulitis (Mayo Clinic, 2018).
Mechanical obstruction is divided into obstruction of the small bowel (including the duodenum) and
obstruction of the large bowel. Obstruction may be partial or complete. About 85% of partial smallbowel obstructions resolve with nonoperative treatment, whereas about 85% of complete small-bowel
obstructions require surgery according to a study by Ansari (2021).
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Globally, according to Nundy et al., (2021), adhesive obstruction has been reported to be the most
common reason for intestinal obstruction in Western countries since the end of the last century while
obstructed hernias are continuing to be the most common cause in developing countries. Due to
advances in diagnostic and operative techniques along with postoperative intensive care, the
mortality has now decreased from 60% to less than 10% over the last century but there is
considerable variation in these with age and different aetiological diagnosis. Meanwhile Ethiopia, the
highest reported prevalence of intestinal obstruction was 50.7% among patients with acute abdomen
and 34.6% among surgical admissions. Small intestine volvulus and sigmoid volvulus were the
common causes of small and large bowel obstructions, respectively. Therefore, clinicians have to
consider the common causes during the diagnosis and management of intestinal obstruction (Fekadu
et al., 2022).
In the Philippine setting, Postoperative adhesions (POAs) causing mechanical bowel obstruction is a
challenging problem for children who underwent prior abdominal surgeries. Of the 172 pediatric
patients admitted with the diagnosis of intestinal obstruction from possible POA at the Philippine
General Hospital, 91 or 53% underwent surgery, which confirmed intraoperatively the diagnosis of
MBO from POA. The male:female ratio was 2.8:1. There were 14 neonates, 21 infants, 31 children
ages 1–12, and 20 adolescents (Deogracias and Almonte (2019).
Locally, in Tagum City, Davao Del Norte, a 65 year old patient was admitted to Tagum Medical City
and was diagnosed with Partial Intestinal Obstruction during the seven - three shift exposure, of
January 25,2023. However the subject of this study is only focused on one assigned patient having
the said condition.
PURPOSE OF THE STUDY
The purpose of this study is to enhance the researchers understanding towards Intestinal
Obstruction in aiming to get reliable information in relation to the study, in which it can provide as a
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tool for the researchers to enrich each capacity and attitudes in the application of nursing process
and management of nursing care in the concept oxygenation for the patients having Intestinal
Obstruction.
THEORETICAL LENS

Mishel's Uncertainty in Illness Theory
This case study is anchored on the theory of “Uncertainty in Illness Theory” by Merle Mishel
because the main concept of Merle Mishel’s uncertainty in illness is uncertainty. The theory provides
a conceptual framework to explain how uncertainty is generated and how it affects psychological
adjustment to the experience. Uncertainty is the lack of ability to determine the meaning of events
related to a disease. For instance, patients are unable to determine the outcomes correctly and assign
value. Another concept is cognitive schema. Cognitive schema is an individual’s subjective
interpretation of events related to the disease. There are three major themes related to the concepts.
They include antecedents of uncertainty, appraisal of uncertainty and coping with uncertainty.
Antecedents of uncertainty refers to things that happen before the disease experience that impact
the patient’s thinking. They include pain, perception and earlier experiences. Appraisal of uncertainty
entails placing value on the uncertain circumstance. Coping with uncertainty refers to activities the
patient uses to deal with the uncertainty (Bora, 2019).
DEFINITION OF TERMS
COLON - According to Cleveland Clinic (2021) The colon is also referred to as the large
intestine or large gut. It is an organ that is a part of the human body's digestive system, which is also
known as the digestive tract. The set of organs that make it possible for us to consume and for our
bodies to utilize the food we eat as fuel is known as the digestive system.
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INTESTINAL OBSTRUCTION - According to Winchester Hospital (2020) A partial or total obstruction
of the gut is referred to as a mechanical intestinal obstruction. It can occur anywhere along the
intestines, but the small bowel is where it most frequently occurs. The large bowel is located lower in
the intestines, whereas the small bowel is located higher up.
BORBORYGMI - According to Health Jade Team (2019) The term borborygmi describes the
distinctive growling or rumbling sounds that come from the stomach and intestines as food, liquids,
and gas move through them. Normally, when anything is swallowed, it passes via the esophagus,
goes to the stomach, and then goes into the small and large intestines
LIMITATION AND DELIMITATION OF THE STUDY
This case study is delimited to the case of Intestinal Obstruction Acute Myeloid Leukemia and
this focuses on the disease process, signs and symptoms, risk factors, and how it can be treated and
managed by the patient and health care providers. The data is collected through research. Therefore,
this would help to nourish the knowledge of the researcher to expand the understanding on behalf of
the selected study topic with the case of Intestinal Obstruction.
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Chapter 2
REVIEW OF RELATED LITERATURE AND STUDIES
This chapter provides an overview of the review of the related literature and studies of
previous research on Intestinal Obstruction. The literatures revolve on the underlying symptoms,
etiology, disease process and management of the condition.
DESCRIPTION/DEFINITION OF THE CONDITION
Chronic Kidney Disease, according to the Centers for Disease Control and Prevention (2019),
is a disorder in which the kidneys are impaired and cannot filter blood as efficiently as they should.
This is because the kidneys contain millions of microscopic blood artery clusters (glomeruli) that filter
waste and surplus water out of the blood to generate urine. As a result of significant damage to these
blood arteries, diabetic nephropathy, reduced kidney function, and renal failure can occur. (Mayo
Clinic, 2021) The condition is called "chronic" because the damage to your kidneys occurs gradually
over time. As a result, extra fluid and waste from blood remain in the body and may cause various
health problems such as heart disease and stroke (National Institute of Diabetes and Digestive and
Kidney Diseases, 2017).
Moreover, Vaidya & Aeddula (2022) highlighted that Chronic kidney disease (CKD) is defined
as the presence of kidney impairment or an estimated glomerular filtration rate (eGFR) of less than
60 ml/min per 1.73 square meters that lasts for three months or longer. It is a gradual decline of
kidney function that eventually necessitates renal replacement treatment (dialysis or transplantation).
Classifications of Chronic Kidney Disease
Kidney disease is classified into five phases by the National Kidney Foundation (NKF).
According to the American Kidney Fund (2022), the kidneys may still filter waste from your blood in
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the early stages (Stages 1-3). In the latter stages (Stages 4-5), the kidneys must work harder to filter
the blood and may cease functioning entirely. The stages of chronic kidney disease are as follows:
Stage 1 with normal or high GFR (GFR > 90 mL/min). In Stage 1 CKD, the damage to your
kidneys is mild. Your kidneys are still working well, but you may have signs of kidney damage or
physical damage to your kidneys. Stage 1 CKD means you have a normal estimated glomerular
filtration rate (eGFR) of 90 or greater, but there is protein in your urine (i.e., your pee). The presence
of protein alone means you are in Stage 1 CKD.
Stage 2 Mild CKD (GFR = 60-89 mL/min). In Stage 2 CKD, your eGFR has gone down to
between 60 and 89. However, your kidneys are mostly still able to work as they should to filter your
blood, which is why you may not notice any effects on your health. While the damage to your kidneys
may not be reversible, there is a lot you can do to slow down the damage to your kidneys. You may
or may not also have protein in your urine.
Stage 3A Moderate CKD (GFR = 45-59 mL/min) and Stage 3B Moderate CKD (GFR = 3044 mL/min). In Stage 3 CKD, your kidneys have mild to moderate damage, and they are less able to
filter waste and fluid out of your blood. This waste can build up in your body and begin to harm other
areas, such as to cause high blood pressure, anemia and problems with your bones. This buildup of
waste is called uremia.
Stage 4 Severe CKD (GFR = 15-29 mL/min). our kidneys do not work as well as they should
to filter waste out of your blood. This waste can build up in your body and cause other health problems,
such as high blood pressure, bone disease and heart disease. You will likely have symptoms such
as swelling of your hands and feet and pain in your lower back. This is the last stage before kidney
failure.
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Stage 5 End Stage CKD (GFR <15 mL/min). Your kidneys are getting very close to failure
or have already failed (stopped working). Because your kidneys have stopped working to filter waste
out of your blood, waste products build up in your body, which can make you very sick and cause
other health problems. When your kidneys fail, treatment options to survive include dialysis or a
kidney transplant.
Complications of Chronic Kidney Disease
A study by Webster et al. (2017) has revealed the complications of CKD include Anemia. This
is because when kidneys are injured, they generate less erythropoietin (EPO), a hormone that
stimulates the bone marrow—the spongy tissue within most of the bones—to manufacture red blood
cells. With less EPO, the body produces fewer red blood cells and delivers less oxygen to the organs
and tissues. In addition to the body producing fewer red blood cells, persons with anemia and CKD
have red blood cells that exist in the bloodstream for a shorter period of time than usual, leading blood
cells to perish quicker than they can be replaced. People with anemia and CKD may have inadequate
amounts of nutrients needed to create healthy red blood cells, such as iron, vitamin B12 NIH external
link, and folate NIH external link. (National Diabetes and Digestive and Kidney Diseases Institute,
2020)
Further, Cardiovascular illnesses are the major cause of death in CKD patients, and the
incidence and impact of this consequence rises as kidney function declines. For example, a patient
with CKD stage G5 A3 (eGFR 15 ml/min per 1.73 m2 and urine albumin-creatinine ratio > 300 mg/g)
had an 8.1-fold higher risk of CVD mortality than a reference group without kidney disease. While
CKD raises the risk of traditional atherosclerotic cardiovascular events, the bulk of the increased risk
is due to non-atherosclerotic diseases such as left ventricular hypertrophy with diastolic and systolic
dysfunction, valve disease, and arterial calcification. These diseases can cause atrial and ventricular
dysrhythmias, heart failure, and sudden death. (Bello et al.,, 2017)
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Martin (2022) has enumerated that gout, an inflammatory arthritis in which urate crystals build
up in the body, most often in the joints, causing pain and immobility, is one complication of as well.
Another effect of CKD is that it can alter the pH balance (acid/base balance) of the blood, causing it
to become more acidic, affecting the body's systems and causing muscle wasting, heart failure (the
heart cannot pump enough blood to meet the body's needs), and insulin resistance (impaired sugar
metabolism), among other conditions. There is a possible complication on erectile dysfunction (ED)
due to a lack of blood flow. Chronic diarrhea, ulcers in the esophagus (food tube), and inflammation
in the small intestine are all frequent complications of CKD caused by waste buildup in the body.
Finally, the mineral imbalances that can develop with CKD can weaken bones, making them more
prone to fractures and osteoporosis.
LIST OF SYMPTOMS
As mentioned by the Health Wise (2020), detecting chronic kidney disease (CKD) can be
difficult since kidney disease symptoms appear late, after the ailment has advanced and kidney
damage has occurred. Indeed, CKD is commonly referred to as a "silent" disease since it is difficult
to detect—and most persons with early stage CKD are entirely unaware of it.
One sign that can be noticed in the later stages of CKD is the changes in urination. When the
kidneys are not functioning properly, you will need to pee more frequently or detect blood in your
urine. Urine that is frothy or bubbly may also be a symptom that protein is getting into the urine as a
result of damaged kidneys. Furthermore, you may suffer localized discomfort near your kidneys that
does not alter or worsens when you move or stretch. The kidneys are placed in your lower back on
each side of your spine, and kidney issues can cause discomfort in this location. Back discomfort can
also be caused by a kidney infection or obstruction, which can lead to kidney damage. (Fresenius
Kidney Care, 2022)
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Another indicator is dry and itchy skin, which indicates a mineral and nutritional imbalance in
your blood caused by renal illness. Swelling (also known as edema) develops in your hands, legs, or
feet when your kidneys fail to remove extra fluid and salt from your body. Reduced kidney function
can produce an accumulation of toxins in the blood, resulting in a loss of energy, feeling overly
exhausted, and dizziness. Symptoms such as shortness of breath is caused by excess fluid building
up in your lungs when your kidneys aren't draining enough fluid. Breathlessness may be caused by
CKD-induced anemia, which is a lack of oxygen-carrying red blood cells. (National Health Service,
2019)
Moreover, a systematic review reported by Murtagh et al (2007) which was cited by a recent
literature Schick-Makaroff et al (2018) has found out that fatigue, constipation, pain, sleep
disturbance, anxiety, dyspnea, nausea and restless legs are some of the most common symptoms
of patients suffering from end stage renal failure. Finally, toxin accumulation caused by decreased
kidney function may lead you to lose your appetite, whether because you are full or because you are
too unwell or sleepy to eat. Protein seeping into your urine as a result of kidney disease might cause
recurrent puffiness around your eyes. Excess fluid and salt buildup caused by renal illness might raise
your blood pressure. High blood pressure can also damage the blood vessels in the kidneys and lead
to a worsening of kidney disease over time. (Cleveland Clinic, 2020)
LIST OF ETIOLOGIES
Diabetes is the number one cause of kidney failure in the US which is responsible for 44% of
kidney disease cases. Second to this is Hypertension where about 29% of kidney failure cases are
caused by this. (Jennifer et al., 2019) This is because people with diabetes often have elevated levels
of sugar (glucose) in the blood. Thus, when sugar is high in the blood, the sugars can bind to different
proteins in the nephrons and change the structure of those proteins. This can make the nephrons
less effective at filtering and lead to protein in your urine. (Phillips, 2021) Hypertension, on the other
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hand, is an increase in the force of blood as it flows through your blood vessels and since the vessels
in the kidneys are delicate, that force can damage the tiny vessels in the nephrons, thus lose their
ability to remove waste and extra fluid from the body. Extra fluid raises blood pressure even more—
creating a cycle that can lead to kidney failure. (Fresenius Kidney Care, 2022)
Meanwhile, Sui et al. (2020) has discovered that in some developing countries, such as China,
diabetic nephropathy (DN) chronic glomerulonephritis (CGN) has been reported as the leading cause,
followed by diabetes and hypertension. It was revealed the leading etiology of CKD for patients with
stage 5 CKD was DN 22.8%, whereas CGN was the most common etiology for those with stage 1
CKD. According to Fresenius Kidney Care (2022), the glomeruli are tiny filters within each kidney
where blood is cleaned. Glomerular diseases damage these important filters so that the kidneys aren’t
able to filter waste and fluid properly.
Additionally, inherited diseases such as Polycystic kidney disease, or PKD, is a common
inherited disease that causes large cysts to form in the kidneys and damage the surrounding tissue.
Malformations that occur in the kidney and urinary tract as a baby develops in its mother's womb can
cause infections and damage to kidneys as well, for example, a narrowing may occur that prevents
normal outflow of urine and causes urine to flow back up to the kidney. Lupus nephritis is one such
autoimmune disease that results in inflammation (swelling or scarring) of the small blood vessels that
filter wastes in your kidney. Finally, obstructions caused by kidney stones or tumors can cause kidney
damage. An enlarged prostate gland in men or repeated urinary infections can also cause kidney
damage.
MANAGEMENT OF THE CONDITION
MEDICAL MANAGEMENT
An evaluation of the patient's airway, breathing, and circulation should always be a part of the first
care. If resuscitation is necessary, isotonic saline should be used along with electrolyte
11
replenishment. If the patient is septic or unstable, a Foley catheter should be placed to monitor the
patient's urine output. Inserting a nasogastric tube will enable bowel decompression to lessen
proximal distention. The installation of a nasogastric tube will also aid in reducing aspiration risk,
accurately measuring intake and output, and controlling emesis (Smith et.al., 2022).
With volume resuscitation, the therapeutic strategy aims to rectify electrolyte and hypovolemia
depletion. The development of fluid-electrolyte replacement and the appropriateness of resuscitation
should be directed by the degree of systemic impairment and the reaction of the patient to therapy.
Therefore, after renal function has been restored, vigorous fluid and electrolyte replacement might be
used. For the treatment of severe intestinal distension, the use of a nasogastric tube may be beneficial
(Neri, 2016).
SURGICAL MANAGEMENT
If nothing can flow through the gut, surgery is typically required to remove the obstruction.
What's causing the obstruction and which area of the intestine is damaged will determine the
procedure. Surgery often entails the removal of the obstruction as well as any dead or damaged
intestinal tissue. As an alternative, doctors may advise using a self-expanding metal stent to clear the
clog. An endoscope is put into intestine through the mouth or colon before the wire mesh tube is
placed inside. In order for the obstruction to be cleared, it forces the intestines to open. Stents are
typically used to treat colon cancer or to temporarily relieve symptoms in patients for whom immediate
surgery would be too dangerous. Once health is stable, patients might still require surgery (Mayo
Clinic, 2021).
Small bowel obstruction caused by small bowel tumors (adenocarcinoma, neuroendocrine tumors,
gastrointestinal stromal tumors, and lymphomas) is treated with resection and anastomosis.
Oncologic management of these tumors must be obviously considered following the same schemes
of tumors that arise outside the small bowel. After a successful course of conservative treatment
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during the same stay, resection and primary anastomosis are the preferred method for diverticular
large bowel obstruction, and they should be tried independently of bowel preparation. For high-risk
patients, only conservative therapy or the Hartmann operation might be more suitable. In the absence
of severe risk factors or perforations, resection and primary anastomosis also are the best treatments
for malignant large intestinal obstruction. (Catena et.al., 2019)..
PHARMACOLOGIC MANAGEMENT
For pharmacologic treatment, it is recommended to restore lost fluid with intensive intravenous
(IV) resuscitation using lactated Ringer solution or isotonic saline. Oxygen is also necessary, as is
the proper monitoring. Gram-negative bacteria and anaerobic microorganisms are treated with
antibiotics. Additionally, analgesics and antiemetics are given as clinically necessary (Ramnarine,
2021).
NURSING MANAGEMENT
Assessment
During the assessment phase, the nurse should get a thorough history of the patient's onset
of symptoms, eating habits, food tolerance, vomiting episodes, output and appearance of stools per
day, and abdominal distention. The following should be noted during a physical examination:
abdominal distention, the nature of bowel sounds, the presence and degree of dehydration, and
muscle guarding or indications of abdominal pain (Parekh, 2019).
Acute Pain
Patients with bowel obstruction can experience pain due to inflammation and blockage within
the intestine. Assessment of the patient's level and type of pain is important. Keep track of the
location, intensity, and type of pain (such as intense, dull, or constant). Check frequently for any
13
changes in the nature or location of pain. Keep an eye out for nonverbal indications that a patient
may be displaying even if they claim not to be in pain. Nonverbal indicators include guarded
abdominal muscles, restlessness, perspiration, and grimacing of the face. Assess changes in vital
signs as such changes can signify pain (Wagner, 2022).
As per doctor’s order, administer medications. Regular administration of medication improves
pain management. Given that the patient has an SBO and will likely be put on NPO state for bowel
rest, pain medication will probably be given intravenously (IV). Reduce patient’s discomfort by comfort
techniques like massage, deep breathing, and guided visualisation. Additionally, they might divert
their attention from the pain by engaging in diversion activities like watching TV, playing video games,
or reading. Pair medications with nursing care when the medications’ therapeutic effect is at its
highest. Predictably, pain medication should be given before discomfort becomes severe, with the
patient being kept as comfortable and in the least amount of pain as possible before tasks like
showering, walking, or changing positions. As ordered, place the nasogastric tube. A nasogastric
tube is required in patients with minor intestinal obstruction in order to assist the stomach relax.
Decompression will assist the patient feel less discomfort and relieve abdominal distention (Wagner,
2022),
Deficient fluid volume related to nausea, vomiting, fever, and diaphoresis
As part of the assessment, note possible conditions or processes that may lead to deficits
such as fluid loss, limited intake, fluid shifts, environmental factors to assess causative and
precipitating factors. Also, monitor I&O. Note number, character, and amounts of stools; estimate
insensible fluid losses (diaphoresis). Measure urine specific gravity and observe for oliguria. Maintain
oral restrictions, bedrest and avoid exertion to put the colon at rest for healing and to decrease
intestinal fluid losses. Observe for overt bleeding and test stool daily for occult blood as inadequate
diet and decreased absorption may lead to vitamin K deficiency and defects in coagulation,
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potentiating risk of hemorrhage. Note generalized muscle weakness or cardiac dysrhythmias
because excessive intestinal loss may lead to electrolyte imbalance, e.g., potassium, which is
necessary for proper skeletal and cardiac muscle function. Minor alterations in serum levels can result
in profound or life-threatening symptoms. Administer parenteral fluids and blood transfusions as
indicated to as Maintenance of bowel rest requires alternative fluid replacement to correct losses and
anemia. Monitor laboratory studies such as electrolytes (especially potassium, magnesium) and
ABGs (acid-base balance) to determine replacement needs and effectiveness of therapy (Vera, 2022)
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Chapter 3
METHODOLOGY
This chapter presents the research methodologies used in the study. This includes the study
design, research participants and informants, role of the researchers, data sources, data collection
procedure, trustworthiness of the study, and the data gathering procedures. Moreover, in this chapter
the Patient Need Assessment (PNA) and the List of drugs presently taken by the patient is also
included.
STUDY DESIGN
In making this study the researchers used Qualitative research design in which according to
the Lamar University (2017) that Qualitative research is a compilation of data. Nurses incorporate
several techniques to accumulate information. They may perform the following interviews, focus
groups, observations, and analysis of written materials. In healthcare, nurses tend to carry out semistructured interviews. The interview may include a topic and open-ended questions. The interview
discussion may be adapted to changes in the conversation so nurses can record a patient’s
experiences and attitudes about their healthcare. This kind of interview builds a rapport between
nurses and their patients, which can lead to insightful views and descriptions from patients that may
uncover issues and concerns that need to be addressed.
The data that the researchers collected in this qualitative study consist lot of ways such as
conducting an interview with the used of Patient Need Assessment (PNA), Inspected, Percussion,
Palpation, and Auscultation (IPPA), and the researchers also get data through the patient’s medical
record. The researchers also processed the data to involve and investigate a phenomenon or issue
that has occurred in the past. Such studies most often involve secondary data collection, based upon
data available from previous studies.
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RESEARCH PARTICIPANT AND INFORMANTS
In this case study, the selected participant is a 21-year-old female patient who was diagnosed
with Partial Intestinal Obstruction, the selected participant was confined in Tagum Medical City (TMC).
Moreover, the researchers use purposive sampling, also known as judgmental, selective, or
subjective sampling, in which it is a form of non-probability sampling which the researchers rely on
their own judgment when choosing members of the population to participate in their study (Foley,
2018). This sampling method requires researchers to have prior knowledge about the purpose of their
studies so that they can properly choose and approach eligible participants.
ROLE OF THE RESEARCHERS
In qualitative studies, the role of the researcher is quite different. The study is regarded as a
data collection tool (Denzin & Lincoln, 2003). The researcher's goal in developing a qualitative
research design is to aim to understand study participants' thoughts and feelings. This may be a
difficult undertaking for the researchers because it includes asking people to talk about topics that
are highly personal to them. Sometimes the experiences being studied are fresh in the participant's
consciousness, while other times it may be difficult to relive old experiences. However, while the data
is being collected, the researcher's first job is to protect the participants and their data. Mechanisms
for such safeguarding must be properly communicated to participants and authorized by a relevant
study ethics review. Before the investigation begins. Researchers and practitioners who are new to
qualitative research. Before beginning their project, researchers should seek help from an
experienced qualitative researcher.
DATA SOURCES
Interviews can be used to investigate specific experiences, points of view, ideas, or beliefs
(Bansig, 2007). In this study, the major source was an interview with the patient. The researchers
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used written responses from participants to ensure that their responses were either misunderstood
or manipulated. The written response was thoroughly examined.
Although the interview is the result of interaction between the researcher and the interviewee,
the setting and skills of the researcher (e.g., the ability to build a sense of trust (developing rapport),
the way of phrasing questions, giving the interviewee room to tell a story, body language) are
important. Green, J. N. Thorogood & Co. (2010).
Furthermore, in addition to having interviews as the key source of data for the study, the
Patients Chart and Laboratory Results make a significant contribution as a way of supporting sources
for making this study more legible and credible.
DATA COLLECTION PROCEDURE
n collecting the data, the researchers selected a participant through observation during the
said clinical exposure in Tagum Medical Center (TMC). The researchers approached the selected
participant through asking its permission to become part of the study. After receiving the response,
an in-depth interview was conducted. The researchers used interview as the research instrument to
capture the responses of the participant which helped explore data about its said condition.
Interviewing is either a set of planned questions or a set of interest areas to collect information
from people one-on-one. Interviews are frequently taped and written down. They can either follow a
closely written script that mimics a survey or be inspired by a loose series of questions that encourage
interviewees to express themselves more freely. They can be structured or unstructured (Paradis
et.al, 2017).
The participant was able to provide verbal consent through researchers asking permission to
the selected participant to be interviewed.
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First, the researchers informed their clinical instructor about the case that the researchers will
be going to use.
Second, the researchers inform the Nurse on Duty if they are allowed to conduct such
observations and interview the selected participant.
Third, the researchers asked the selected participant, informing them about the purpose of
the study.
Fourth, after the selected participant approved, the researchers gave a short information
about the main core of conducting this study. Along with this, the researchers also provided the scope
and limitation for the participant to be guided as to where this study evolved and for the participant to
share and give only what is necessary with the help of the prepared questionnaires.
Fifth, the researchers executed an in-depth interview to the watcher of the said selected
participant.
In addition, the responses of the watcher of the selected participant were recorded as it is
without alteration of words to obtain accurate responses as the basis for interpretation and analysis.
Lastly, findings were discussed.
TRUSTWORTHINESS OF THE STUDY
In qualitative studies, this concept is more obscure because it is put in different terms.
Trustworthiness has become an important concept because it allows researchers to describe the
virtues of qualitative terms outside of the parameters that are typically applied in quantitative research.
Since qualitative researchers do not use instruments with established metrics about validity and
reliability, it is pertinent to address how qualitative researchers establish that the research study’s
findings are credible, transferable, confirmable, and dependable. (Olivia, 2018)
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● Credibility – Is how confident the qualitative researchers is in the truth of the
research study’s findings. This boils down to the question of “How do you know that your
findings are true and accurate?” Qualitative researchers can use triangulation to show the
research study’s findings are credible (Statistic Solution, 2019). The researchers had thorough
persistent observations during the said interview.
● Transferability - Is how the qualitative researcher demonstrates that the research
study’s findings are applicable to other contexts. In this case, “other contexts” can mean
similar situations, similar populations, and similar phenomena. Qualitative researchers can
use thick description to show that the research study’s findings can be applicable to other
contexts, circumstances, and situations (Statistic Solution, 2019). The researchers made sure
that the findings of this study have the applicability in other context, circumstances and
situations by using thick description.
● Confirmability - Is the degree of neutrality in the research study’s findings. In other
words, this means that the findings are based on participants’ responses and not any potential
bias or personal motivations of the researcher. This involves making sure that researcher bias
does not skew the interpretation of what the research participants said to fit a certain narrative.
To establish confirmability, qualitative researchers can provide an audit trail, which highlights
every step of data analysis that was made in order to provide a rationale for the decisions
made. This helps establish that the research study’s findings accurately portray participants’
responses (Statistics Solution, 2019). The researchers used an audit trail and shall use every
method in therapeutic communication to bring forth the emotions in every participant including
their facial expression, gestures and will use voice recorder to catch all words uttered by the
participant.
20
● Dependability - Is the extent that the study could be repeated by other researchers
and that the findings would be consistent. In other words, if a person wanted to replicate your
study, they should have enough information from your research report to do so and obtain
similar findings as your study did. A qualitative researcher can use inquiry audit in order to
establish dependability, which requires an outside person to review and examine the
research process and the data analysis in order to ensure that the findings are consistent
and could be repeated (Statistic Solution, 2019).
In other words, the researchers presented the data and the result of the study to other experts to
validate its results of our analysis and end up in the same or similar conclusions of the data presented.
DATA GATHERING PROCEDURE
Data gathering, which enables the researcher to discover answers to research questions, is
one of the key phases in a research study. Data gathering is the process of gathering information
with the goal of learning more about the research issue (Taherdoost, 2022).
To conduct a case study based on the participant's condition, the student nurses in this study
requested permission from the Head Nurse and Nurse on Duty (NOD) in the OR/DR Department to
scan the patient's chart of the participant they had chosen for the study. They gave a thorough
explanation of why they needed this permission.
The patient's document's contents were copied onto another piece of paper with their consent
because it is illegal to photograph a patient's original chart that contains sensitive information like
their full name, age, or home address. The patient's chart for the aforementioned patient contains the
following documents: KARDEX, FDAR, Medication Sheet, Physician's Order Sheet, and List of
Laboratory Results. The student nurses are required to abide by the hospital's data privacy policy
21
because they are an apprentice. The patient's chart is returned to the NOD in the nurse's station once
the data necessary for the study has been gathered.
The NOD is asked more questions regarding the patient's health and care in order to complete
the data needed for a thorough analysis and case study findingsscan the patient's chart of the
participant they had chosen for the study. They gave a thorough explanation of why they needed this
permission.
The patient's document's contents were copied onto another piece of paper with their consent
because it is illegal to photograph a patient's original chart that contains sensitive information like
their full name, age, or home address. The patient's chart for the aforementioned patient contains the
following documents: KARDEX, FDAR, Medication Sheet, Physician's Order Sheet, and List of
Laboratory Results. The student nurses are required to abide by the hospital's data privacy policy
because they are an apprentice. The patient's chart is returned to the NOD in the nurse's station once
the data necessary for the study has been gathered.
The NOD is asked more questions regarding the patient's health and care in order to complete
the data needed for a thorough analysis and case study findings.
RESEARCH INSTRUMENT: PNA
Patient needs assessment tool is a very effective tool for making choices, allocating
resources, and ultimately achieving programme objectives. They can be used in various contexts
such as hospitals to shed light on a range of issues, such as what programming measures should be
implemented to enhance breastfeeding rates at a hospital. It's crucial to carry out a requirements
analysis at the project's outset so that programs can be properly tailored to the people and areas you
serve (NICHQ, 2022).
22
The aforementioned tool was crucial in carrying out this study since it allowed the researcher
to organize and examine the patient's medical records and gain more knowledge about their
symptoms and other concerns. Also, the researchers were able to determine the patient's
involvement with services and willingness for support.
CHECKING, COLLATING, AND PROCESSING OF DATA
The patient was interviewed face-to-face by the researchers, who were nursing students,
while they strictly followed safety protocols in the recovery area. As part of this procedure, both
subjective and objective data are gathered as part of the assessment. Assessment is the first step
and involves critical thinking skills and data collection; subjective and objective. Subjective data
involves verbal statements from the patient or caregiver. Objective data is measurable, tangible data
such as vital signs, intake and output, and height and weight.
The participant's replies were also gathered through the usage of a research tool. As a result,
the researchers compile the information gathered for data analysis.
The data analysis was performed with the use of interview, patient need assessment (PNA),
IPPA (inspection, percussion, palpation, and auscultation), and head to toe assessment. The nursing
process functions as a systematic guide to client- centered care with 5 sequential steps. These are
Assessment, Diagnosis, Planning, Implementation, and Evaluation.
Data may come from the patient directly or from primary caregivers who may or may not be
directly related family members.
Critical thinking is a major instrument for better decision-making, avoiding biases in judgment,
and improving thinking (Peppen et.al., 2021). Thus, critical thinking skills are essential in assessing
patients.
23
And the most important one is the formulation of a nursing diagnosis where it is the nurse’s
clinical judgment about the client’s response to actual or potential health conditions or needs..
LIST OF DRUGS TAKEN BY THE PATIENT
●
Omeprazole 40 mg Q12 IVTT
●
Gasmotin 1 tab TID
●
Pantoprazole 40 mg OD IVTT
●
Ondasentron 5 mg IV Q8
●
Kalium Durule 1 tab TID
24
Chapter 4
RESULTS AND FINDINGS
This includes the pathophysiology, actual signs and symptoms and result and findings from
the diagnostic and laboratory tests taken from the client, the interpretation of each result, the normal
values and justification of each laboratory results, etiologies in table form, management of the
condition, the nurse care of plan, and discharge plan.
WRITTEN PATHOPHYSIOLOGY
Intestinal obstruction is a blockage that keeps food or liquid from passing through your small
intestine or large intestine (colon). Causes of intestinal obstruction may include fibrous bands of tissue
(adhesions) in the abdomen that form after surgery; hernias; colon cancer; certain medications; or
strictures from an inflamed intestine caused by certain conditions, such as Crohn's disease or
diverticulitis. A mechanical bowel obstruction is a partial or complete blockage in the intestine. It can
happen at any point along the intestine tract but it is more common in the small bowel. The small
bowel is the upper part of the intestines and the large bowel is the lower part. Following obstruction,
fluids accumulate in the bowel wall and any excess fluid is secreted in the lumen. Because absorption
is retarded, dehydration and electrolytes disturbance are inevitable. This causes reduced oral intake,
vomiting, defective intestinal absorption and increased contractions of the proximal intestine.
Consequently, this increases the intraluminal pressure in which compresses the veins and results to
an increase in venous pressure. Furthermore, as the tension within the bowel loops become more
and more, venous congestion takes place resulting in edema of bowel wall. If the obstruction is not
relieved capillary rupture and hemorrhage takes place. This would cause a decrease in arterial blood
supply which causes gangrene of bowel walls which can be identified with decreased bowel sounds.
Moreover, further necrosis of the intestinal walls may lead to perforation of necrotic segments wherein
there is a possibility that the bacteria or toxins will leak into the Peritoneal cavity that results to
Peritonitis and if it leaks within the blood supply it can lead to septicemia. Complications of intestinal
25
obstruction includes dehydration as a result from loss of water, sodium and chloride, which can
eventually lead to shock due to loss of electrolytes and peritonitis. Untreated, intestinal obstruction
can cause serious, life-threatening complications, including: Tissue death. Intestinal obstruction can
cut off the blood supply to part of your intestine. Lack of blood causes the intestinal wall to die.
DIAGRAMMATIC PRESENTATION
PRECIPITATING FACTOR
a)
PREDISPOSING FACTOR
a.
Age – Increased age in general is a
known risk factor for morbidity and
mortality in malignant small bowel
obstruction
b)
Scarring – When your body heals small cuts
(wounds), scar tissue forms. This can happen
inside your intestine as well. These scars can build
up and create partial or total intestinal blockages.
Scarring can result from tears in your intestinal
wall, belly (abdominal) or pelvic surgery, or
infections
Tumor-benign – within the intestine, extends into
the intestinal lumen; outside the intestine and
places pressure on the wall of the intestine. This
makes the intestinal lumen partially or completely
obstructed
Mechanical Obstruction
Borborygmi Sounds
Gases and fluids accumulate
in the area
Increased contractions of proximal
intestine
Distension of intestine
Persistent Vomiting
Severe abdominal pain

Increase intraluminal pressure
Abdominal guarding
Loss of electrolytes
Increase secretions into the
intestine


Loss of appetite
Scaphoid Abdomen
Weight loss
(BMI:14.6)


Compression of veins


Increase venous pressure


Nutritional Anemia
Hgb: 10.5 g/dl (N.V. 1216.0 g/dl)
Hct: 33% (N.V. 37-40%)
Decrease absorption
Potassium: 3.31 (N.V. 3.55.0 mmol/L)
Sodium:131 (N.V. 135145mmol/L)
Calcium: 1.03 (N.V 1.121.32 mmol/L
Dry mucous membrane
and slightly sunken eyeball
Hypotension Shock
 BP: 90/60
26
Edema of the intestine
Compression of terminal
branches of mesenteric artery
Decreased arterial blood
supply
Ischemia and may lead to
anoxia
Necrosis
Perforation of necrotic
segments
Bacteria or toxins leak into:
Gangrenous intestinal
wall
Peritoneal cavity
Blood supply
Peritonitis
Septicemia
Cessation of peristalsis
Peritonea
Decreased bowel sounds
PROGNOSIS
Good Prognosis
Treatment for Intestinal obstruction
 Lifestyle changes
 Compliance with prescribed
diet
 Surgery
Bad Prognosis
Not treated:
 intestinal obstruction can
cut off the blood supply to
a part of your intestine thus
leading to tissue death.
 Sepsis
Death due to shock
SYMPTOMATOLOGY
The listed terms below, is the set of symptoms characterized by a medical condition called
Partial Intestinal Obstruction as exhibited by our patient.
27
SYMPTOMS
Loss of appetite
ACTUAL
OBSERVATION
JUSTIFICATION
Due to cramping of the abdomen, gas
and bloating, patients tend to lose
interest in consuming food or lose
one’s appetite. Early satiety is one of
its symptoms.
Source:
(https://www.msdmanuals.com/home
/digestive-disorders/gastrointestinalemergencies/intestinal-obstruction)
Weight loss
Consequently,
with
the
loss
of
appetite patients may lead to weight
loss since they are burning more
calories than they take in.
Source:
(https://www.msdmanuals.com/home
/digestive-disorders/gastrointestinalemergencies/intestinal-obstruction
Vomiting
An obstruction can cause the material
inside the bowel to back up into the
stomach. This causes nausea and
vomiting of dark green bile (bilious
vomiting)
Source:
(https://jamanetwork.com/journals/ja
ma/fullarticle/2681748#:~:text=An%2
0obstruction%20can%20cause%20th
e,that%20would%20otherwise%20m
ove%20forward.)
28
Nutritional Anemia
This is due to decreased intake of
food containing vitamin B-12 and
folate.
Nutritional
encompasses
conditions
all
in
anemia
pathological
which
the
blood
hemoglobin concentration drops to an
abnormally low level, due to a
deficiency in one or several nutrients
Source:
(https://www.ncbi.nlm.nih.gov/pmc/ar
ticles/PMC3104701/#:~:text=The%20
term%20'nutritional%20anemia'%20e
ncompasses,acid%2C%20and%20vit
amin%20B12.)
Abdominal Pain
Signs of an intestinal blockage will
depend on how severe the obstruction
is. But it almost always comes with
belly pain, usually around your belly
button, and cramping.
Source:
(https://www.webmd.com/digestivedisorders/what-is-bowel-obstruction)
Hypotension
Potassium
and
sodium
are
electrolytes that help your body
function normally by maintaining fluid
and blood volume. Abnormal levels of
your electrolytes can affect your blood
pressure
Source:
29
(https://www.cdc.gov/salt/potassium.
htm)
LABORATORY RESULTS
HEMATOLOGY RESULT
LABORATORY TEST
LABORATORY RESULTS
Hemoglobin
10.5 g/dL
Leukocytes
9.05 x 10 9/L
Erythrocytes
4.12 x 10 12/L
Lymphocytes
0.24
Segmenters
0.67
Hematocrit
0.33
BLOOD CHEMISTRY
LABORATORY TEST
LABORATORY RESULTS
Sodium
131 mmol/L
Potassium
3.31 mmol/L
Calcium
1.03 mmol/L
MISCELLANOUS RESULT
LABORATORY TEST
LABORATORY RESULTS
H.pylori
(-)
ETIOLOGY
The causation for the formation of Intestinal obstruction as a subject of investigation are as
shown in the table below with its implication for the development of such disease.
30
PREDISPOSING ETIOLOGIC FACTOR
The identified etiologies below are factors or conditions that render an individual vulnerable
to develop Intestinal obstruction.
ETIOLOGY
ACTUAL
OBSERVATION
Age
IMPLICATION
Increased age in general is a known
risk factor for morbidity and mortality
in malignant small bowel obstruction
X
Sex
A higher incidence rate of preoperative bowel obstruction and
larger tumor volume in male patients
was observed in a study. More male
patients suffered from IO than
females (Zhou et al., 2018)
PRECIPITATING ETIOLOGIC FACTOR
The following etiologies below are factors that cause or trigger the onset of Intestinal
Obstruction.
ETIOLOGY
ACTUAL OBSERVATION
IMPLICATION
31
Gallstones
X
Gallstones
large
enough
to
cause
intestinal
obstruction
almost
invariably
reach
the
intestinal tract through a fistula
between the gallbladder and the
duodenum. The symptoms of
gallstone
obstruction
are
principally those of mechanical
obstruction of the small bowel.
(Rogers & Carter, 1958)
Crohn's disease
X
Obstruction (the most common
complication of Crohn's disease)
may arise from swelling and the
formation of scar tissue. The
result is thickening of the bowel
wall and a narrowed intestinal
passage.
Scarring
When your body heals small cuts
(wounds), scar tissue forms. This
can happen inside your intestine
as well. These scars can build up
and
create
intestinal
partial
blockages.
or
total
Scarring
can result from tears in your
32
intestinal wall, belly (abdominal)
or pelvic surgery, or infections.
Abdominal adhesions
X
Loop
of
intestine
become
adherent to areas that heal
slowly or scar after abdominal
surgery: produce kinking of an
intestinal loop
Tumor
Within the intestine extends into
the intestinal lumen outside the
intestine pressure on the wall of
the intestine intestinal lumen
becomes partially or completely
obstructed
Hernia
X
Protusion of intestine through a
weakened area in the abdominal
muscle or wall intestinal flow may
be completely obstructed blood
flow
to
obstructed
the
area
may
be
33
Intussusception
Volvulus
Foreign objects
X
one part of the intestine slips into
X
X
Bowel twists and turns on itself
another part located below it and
the intestinal lumen becomes
narrowed
intestinal
obstructed
lumen
gas
becomes
and
fluid
accumulate in the trapped bowel
Nonfood
objects
swallow
on
that
purpose
you
or
accidentally may cause partial or
complete intestinal obstruction
(Understanding
an
Intestinal
Obstruction, 2019)
MANAGEMENT OF THE CONDITION
DISCHARGE PLAN
Chronic kidney disease is a condition in which the kidneys are damaged and cannot filter
blood as well as they should. Because of this, excess fluid and waste from blood remain in the body
and may cause other health problems, such as heart disease and stroke.
Healthy Lifestyle
34
According to Centers for Disease Control and Prevention(2021) that there are following
recommendations about diet, exercise and other habits can help alleviate heart failure symptoms,
slow your disease’s progression and improve your everyday life. In fact, people with chronic kidney
disease often can lead nearly normal lives as a result. Important lifestyle changes may includes:
●
Maintain a healthy weight. According to the Centers for Disease Control and Prevention(2021)
If you're at a healthy weight, maintain it by being physically active most days of the week. If
you need to lose weight, talk with your doctor about strategies for healthy weight loss.
●
Don't smoke. According to the Centers for Disease Control and Prevention (2021), Cigarette
smoking can damage your kidneys and make existing kidney damage worse. If you're a
smoker, talk to your doctor about strategies for quitting. Support groups, counseling and
medications can all help you to stop.
●
Avoiding or Limiting Alcohol. According to Centers for Disease Control and Prevention(2021).
If you drink alcohol, do so in moderation. This means no more than one to two drinks per day
for men and one drink per day for women. Talk to your doctor about whether it’s OK for you
to drink alcohol.
●
Manage your medical conditions with your doctor's help. According to Centers for Disease
Control and Prevention (2021). If you have diseases or conditions that increase your risk of
kidney disease, work with your doctor to control them. Ask your doctor about tests to look for
signs of kidney damage
●
Choose lower potassium foods. According to Mayo Clinic (2018), high-potassium foods
include bananas, oranges, potatoes, spinach and tomatoes. Examples of low-potassium
foods include apples, cauliflower, peppers, grapes and strawberries.
DISCHARGE INSTRUCTIONS:
When to call your healthcare provider:
35
Call your healthcare provider right away if you have any of the following:
●
Chest pain (call for nearest hospital)
●
Trouble eating or drinking
●
Weight loss of more than 2 pounds (0.9 kg) in 24 hours or more than 5 pounds (2.27
kg) in 7 days
●
Little or no urine output
●
Trouble breathing
●
Muscle aches
●
Fever of 100.4°F ( 38°C) or higher, or as advised by your healthcare provider
●
Blood in your urine or stool
●
Bloody discharge from your nose, mouth, or ears
●
Severe headache or a seizure
●
Vomiting
●
Swelling of legs or ankles
Diet changes
Always discuss your diet with your healthcare provider before making any changes. Some
people find the required dietary changes overwhelming and confusing. If it feels like that to you or
your family members, ask your provider to meet with a registered dietitian to get help managing the
changes to your diet.
Salt (sodium) in your diet
●
Based on your condition, you may be told to eat 1,500 mg or less of sodium daily Limit
processed foods such as:
-
Frozen dinners and packaged meals
-
Canned fish and meats
36
-
Pickled foods
-
Salted snacks
-
Lunch meats
-
Sauces
-
Most cheeses
-
Fast food
●
Don't add salt to your food while cooking or before eating at the table
●
Eat unprocessed foods to lower the sodium, such as:
-
Fresh turkey and chicken
-
Lean beef
-
Unsalted tuna
-
Fresh fish
-
Fresh vegetables and fruits
-
Season foods with fresh herbs, garlic, onions, citrus, flavored vinegar, and sodiumfree spice blends instead of salt when cooking.
●
Don't use salt substitutes that are high in potassium. Ask your healthcare provider or a
registered dietitian which salt substitutes to use.
●
Don't drink softened water, because of the sodium content. Make sure to read the label on
bottled water for sodium content.
●
Don't take over-the-counter (OTC) medicines that contain sodium bicarbonate or sodium
carbonate. Read labels carefully. If you aren't certain about an OTC medicine, talk with the
pharmacist before using it.
Potassium in your diet
●
Based on your condition, you may be told to eat less than 1,500 mg to 2,700 mg of potassium
daily.
37
●
Always drain canned foods such as vegetables, fruits, and meats before serving.
●
Don't eat whole-grain breads, wheat bran, and granolas
●
Don't eat milk, buttermilk, and yogurt
●
Don't eat nuts, seeds, peanut butter, dried beans, and peas
●
Don't eat fig cookies, chocolate, and molasses.
●
Don't use salt substitutes that are high in potassium. Ask your healthcare provider or a
registered dietitian which salt substitutes to use.
Protein in your diet
●
Based on your condition, your healthcare provider will talk with you about why you should limit
protein in your diet.
-
Cut back on protein. Eat less meat, milk products, yogurt, eggs, and cheese.
Phosphorus in your diet
●
Don't drink beer, cocoa, dark colas, ale, chocolate drinks, and canned ice teas
●
Don't eat cheese, milk, ice cream, pudding, and yogurt.
●
Don't eat liver (beef, chicken), organ meats, oysters, crayfish, and sardines.
●
Don't eat beans (soy, kidney, black, garbanzo, and northern), peas (chick and split), bran
cereals, nuts, and caramels.
Eat small meals often that are high in fiber and calories. You may be told to limit how much fluid you
drink.
Other home care
●
Try not to wear yourself out or get overly fatigued.
●
Get plenty of rest and get more sleep at night.
38
●
Move around, walk as you can, and bend your legs to prevent getting blood clots when you
rest for a long period of time.
●
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.
●
Take your medicines exactly as directed.
●
Keep all medical appointments.
●
Take steps to control high blood pressure or diabetes. Talk with your healthcare provider for
advice.
●
Talk with your healthcare provider about dialysis. This procedure may help if your chronic
kidney disease is progressing to end stage renal disease.
Follow-up care
Follow up with your healthcare provider, or as advised.
39
Chapter 5
IMPLICATION FOR NURSING PRACTICE
Upon conducting this study, there is a lot of information that is beneficial to us not just as
Student Nurses but also as future Registered Nurses in handling patients diagnosed with chronic
kidney disease. This would equip us in interpreting the signs and symptoms manifested by our
patients and would also give us the knowledge and guidance in giving necessary nursing
interventions to our patients. Moreover, through this study it will help us to diagnose a patient
experiencing chronic kidney disease since the information is focused on the signs and symptoms and
nursing management of the disease. Not only that, but we could also use the information we have
learned in this study in promoting health to those people around us, especially about those factors
that would contribute to this condition.
40
Chapter 6
CONCLUSION AND RECOMMENDATIONS
Chronic kidney disease is a condition in which the kidneys are damaged and cannot filter
blood as well as they should. This disease impairs kidney function, causing kidney damage to worsen
over several months or years.
Chronic kidney disease is one of major complications caused by Type 2 diabetes mellitus.
This is due to high blood sugar from diabetes can damage blood vessels in the kidneys .
The risk factors for chronic kidney disease are hyperglycemia (high blood sugar) ,hypertension
(high blood pressure), heart disease, obesity, a family history of CKD, genetic renal problems, prior
kidney injury, and advanced age. There are signs and symptoms so that we can detect the presence
of chronic kidney disease. These are worsening blood pressure control,protein in the urine, swelling
of the hand,increased need to urinate,and reduced need for insulin or diabetes medicine. Chronic
kidney disease can be treated by administering prescribed medications, procedures like dialysis and
kidney transplant.
To prevent the progression of kidney disease in diabetics their blood sugar levels must be
controlled, they should eat according to their diet and take medication particularly insulin as
prescribed by the doctor and other members of the health care team's recommendations.
Men, women, children, and older adults should all be aware of their own bodies in order to
see any anomalies or abnormalities that may be occurring. This will enable us to respond more quickly
and prevent the condition's deterioration.
41
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