Case Study
)اسم القسم
(Dialysis
( February&march 2021
) الشهر
Student Name: Abd Elmawla Helmy Selim Salman
Group: ……
1
Sociodemographic data
Special unit: Dialysis
Patient’s name: Ramzy mohmed ibrahim
Date of admission: 12/3/2021
Age: 57
Level of education: Illitrare
Marital status: married
Hospital No: ……………..
Stay period: 3 days per week
Sex: Male
Occupation: unemployed
Religious: muslim
Present History:
-Diagnosis/ Present illness: ESRD on dialysis
-Chief complaints on admission: decreased balance, loss of sensation, fear of
falling, and to do dailysis
-Associated signs and symptoms: weakness, impaired B LE sensation, decreased
balance, and decreased mobility secondary to dialysis treatment 3 days per week.
Onset / Duration / Frequency: 3 days per week.
-Predisposing factors: Smoking, diabetes and high blood pressure.
Reliving measures and its effect: Avoid products with added salt, Limit the amount of
protein you eat and Choose lower potassium foods
Past History:
Medical:
-Diagnosis / Duration: HTN for 25 years
-Diagnosis / Duration: type 2 diabeties
Surgical:
-Name of surgery / Duration: (AV) fistula
-Name of surgery / Duration:--------------Allergy history:-------Family history:
-Diagnosis / Relation: HTN - Father
-Diagnosis / Relation: type 2 diabties - Father
Life style habit: Bed rest- limit intake salt ( a low-sodium diet) – No Alcohol
Patient’s physical assessment:
Vital signs: HR - 82 bpm, BP - 124/80 mmHg, RR - 18 breaths/min
Skin: Poor skin turgor, Excoriations (scratching), Localized erythema, Blisters,
Bruises and Aneurysm.
Neck: Distended neck veins
General: Malaise and In distress.
2
Definition of disease: End-Stage Renal Disease (ESRD) is a medical condition in which
a person's kidneys cease functioning on a permanent basis leading to the need for a regular
course of long-term dialysis or a kidney transplant to maintain life.
Path physiology\ types: Chronic renal failure is caused by a progressive decline in all
kidney functions, ending with terminal kidney damage. During this time, there is modulation and
adaptation in the still-functional glomeruli, which keeps the kidneys functioning normally for as
long as possible. The remaining glomeruli, therefore, experience a rise in pressure through
hyperfiltration.
The release of various cytokines and growth factors leads to hypertrophy and hyperplasia. At the
same time, the function of the glomeruli suffers due to the excessive demands on them, leading
to increased permeability and proteinuria. Increased protein concentrations in the proximal tube
system are direct nephrotoxins and can further impair kidney function. Stages:
Stage 1: Kidney damage with normal or increased GFR (>90 mL/min/1.73 m 2)
Stage 2: Mild reduction in GFR (60-89 mL/min/1.73 m 2)
Stage 3a: Moderate reduction in GFR (45-59 mL/min/1.73 m 2)
Stage 3b: Moderate reduction in GFR (30-44 mL/min/1.73 m 2)
Stage 4: Severe reduction in GFR (15-29 mL/min/1.73 m 2)
Stage 5: Kidney failure (GFR < 15 mL/min/1.73 m 2 or dialysis)
Etiology
According to patient
Type 2 diabetes
High blood pressure
According to literature
Type 1 or type 2 diabetes
High blood pressure
Glomerulonephritis (gloe-mer-u-lownuh-FRY-tis), an inflammation of the
kidney's filtering units (glomeruli)
Interstitial nephritis (in-tur-STISH-ul
nuh-FRY-tis), an inflammation of the
kidney's tubules and surrounding
structures
3
Polycystic kidney disease
Prolonged obstruction of the urinary
tract, from conditions such as enlarged
prostate, kidney stones and some
cancers
Clinical manifestations
According to patient
According to literature
weaknessdecreased balance, and
decreased mobility secondary to dialysis
treatment 3 days per week.
Nausea
Vomiting
Loss of appetite
Fatigue and weakness
Sleep problems
Swelling of feet and ankles
Persistent itching
Chest pain, if fluid builds up around
the lining of the heart
Nausea
Vomiting
Loss of appetite
Fatigue and weakness
Sleep problems
Changes in how much you urinate
Decreased mental sharpness
Muscle twitches and cramps
Swelling of feet and ankles
Persistent itching
Chest pain, if fluid builds up around
the lining of the heart
Shortness of breath, if fluid builds up
in the lungs
High blood pressure (hypertension)
that's difficult to control
Complications
According to patient
Heart and blood vessel (cardiovascular)
According to literature
disease
your arms and legs, high blood pressure, or
fluid in your lungs (pulmonary edema)
Weak bones and an increased risk of bone
fractures
Anemia
Fluid retention, which could lead to swelling in
your arms and legs, high blood pressure, or
fluid in your lungs (pulmonary edema)
Fluid retention, which could lead to swelling in
A sudden rise in potassium levels in your
blood (hyperkalemia), which could impair your
heart's ability to function and may be lifethreatening
Heart and blood vessel (cardiovascular)
disease
Weak bones and an increased risk of bone
fractures
4
Diagnostic measures
Lab investigation:
According to literature
Lab Investigation
According to patient
Patient's Results
Normal Range
Nursing Considerations
3,500 to 10,500
cells/mcL
135-175 grams/L
normal
normal
40
150,000 to
450,000/mcL
38.8-50.0 percent
Na
170
135 -145
high
Cr
6 mg/dl
0.84 to 1.21
high
AST, ALT
508 IU/L, 232 IU/L
5 to 40
high
Albumin
1.5
3.4 to 5.4 g/dL
high
WBC
7.5 cells/mm3
HgB
150 g/dl
platelets
390/mm3
Hct
normal
normal
Radiological examination:
According to literature
Type of examination
According to patient
Check for
what done
Patient's Results
Nursing Considerations
------------- ----------
------------
---------------
------------------
-----------------------
……………
……………….
……………….
…………………….
…………….
…………………
………………….
5
Medical management according to patient
No.
1
Drug name Route Dose / Frequency Side effect Nursing Consideration
Every time doing dialysis----Erythrocyte SQ
Check cBC
MED.
2
Captopril
oral
once
-----
Monitor blood pressure
3
heparine
i.v
once
-------
Blood clotting
---
--------------------------- -----------
-------------
---------------------
Surgical management
According to patient
According to literature
AV Fistula
arteriovenous (AV) graft.
arteriovenous (AV) fistula
6
Nursing management
According to patient
According to literature
1)Auscultate heart and lung sounds. Evaluate
1)Auscultate heart and lung sounds.
presence of peripheral edema, vascular congestion
Evaluate presence of peripheral edema,
and reports of dyspnea.
vascular congestion and reports of dyspnea.
2)Assess presence and degree of hypertension:
2)Assess presence and degree
monitor BP; note postural changes (sitting, lying,
of hypertension: monitor BP; note postural standing).
changes (sitting, lying, standing).
3)Investigate reports of chest pain, noting location,
3)Investigate reports of chest pain, noting
radiation, severity (0–10 scale), and whether or not it
location, radiation, severity (0–10 scale),
is intensified by deep inspiration and supine position.
and whether or not it is intensified by
deep inspiration and supine position.
4)Evaluate heart sounds (note friction rub), BP,
peripheral pulses, capillary refill, vascular congestion,
4)Evaluate heart sounds (note friction rub), temperature, and sensorium or mentation.
BP, peripheral pulses, capillary refill,
vascular congestion, temperature, and
5)Monitor Electrolytes (potassium, sodium, calcium,
sensorium or mentation.
magnesium), BUN and Cr;
Administer antihypertensive drugs such
5)Monitor Electrolytes (potassium, sodium, as prazosin (Minipress), captopril (Capoten), clonidin
calcium, magnesium), BUN and Cr;
e (Catapres), hydralazine (Apresoline).
Administer antihypertensive drugs such
as prazosin (Minipress), captopril (Capoten 6)Prepare for dialysis.
), clonidine (Catapres), hydralazine
(Apresoline).
7)Monitor fluid intake and hydration of skin and
6)Prepare for dialysis.
mucous membranes.
7)Monitor fluid intake and hydration of
skin and mucous membranes.
8)Change position frequently; move patient
carefully; pad bony prominences with
sheepskin, elbow or heel protectors.
9)Provide soothing skin care. Restrict use
of soaps. Apply ointments or creams
(lanolin, Aquaphor).
Abd Elmawla Helmy Selim Salma
Dr.Fatma Ibrahim
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