SURIGAO EDUCATION CENTER
College of Allied Medical Science
Nursing Department
Km 2 Brgy. Luna, Surigao City
CASE STUDY OF
CHRONIC KIDNEY DISEASE SECONDARY TO AUTOSOMAL DOMINANT
`POLYCYSTIC KIDNEY DISEASE
Presented to:
Maria Carla M. Balosca, RN
Marc Daniele L Bajade, RN
Shenna Mae S. Banez, RN
Presented by:
Ababon, Sherie Ann
Abansa, Angelo Justine
Aborro, Jene Mea
Adlawon, Daniel
Aclo, Glacy
Alcala, Queen Lyra
Almeda, Noel King
Andres, Jamela
Ariar, Ronn Lylle
Arreo, Geraldin
Buca, Diana Grace
Taypa, Mia Jean
December 2023
DEDICATION
We would like to dedicate this paper to our family, whose unwavering support and
encouragement have been instrumental in our academic journey. Their belief and their sacrifices
have allowed us to pursue our passions and reach our goals.
We would also like to acknowledge our clinical instructors, whose expertise and
guidance have shaped our academic development. Their dedication to teaching and commitment
to growth have made a significant impact on our educational journey.
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ACKNOWLEDGEMENT
"The world never moves in the direction you expect. You have often got to knowledge the
direction in which the world is moving. (N.S Chandra, 2019). We were having our gratitude for
the opportunity to gather data rendered to this kind of case study which reflects our studies here
in Surigao Education Center.
We would like to express our heartfelt gratitude for the effort and cooperation of each
individual members of the group who helped and contributed for the success of this output. To
our parents for sustaining the absence financially regards to this case study.
To our dear clinical instructors who supervised us during clinical exposures at Surigao
Medical Center and for the guidance throughout this case presentation.
Foremost, we acknowledge the Almighty Father the wisdom along the process that
guided us to open-up our minds for this activity. The protection and care with regard to the
activity to pursue on it.
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Table of Contents
Dedication……………………………………………………………………………………ii
Acknowledgment…………………………………………………………………………….iii
Table of Contents…………………………………………………………………………….iv
Introduction……………………………………………………………………………….…1
Review of Related Literature………………………………………………………………...3
Patient’s Health History
a. Biologic Data………………………………………………………………………1
b. Admission Data……………………………………………………………………1
Functional Health Pattern…………………………………………………………………….1
Physical Assessment………………………………………………………………………….1
Review of System…………………………………………………………………………….1
Laboratory Result…………………………………………………………………………….1
Drug Study……..…………………………………………………………………………….1
Human Anatomy and Physiology…………………………………………………………….1
Pathophysiology……………………………………………..……………………………….1
Nursing Care Plan…………………………………………………………………………….1
Discharge Plan………………………….…………………………………………………….1
Appendices………………………………………………………………...………………….1
Definition of Terms……………………………………………………………...……………1
References…………………………………………………………………………………….1
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INTRODUCTION
Autosomal Polycystic Kidney Disease is a genetic disorder characterized by the growth of cysts
on the kidneys. Over time, these cysts can lead to complications, such as high blood pressure and
decreased kidney function, eventually causing chronic kidney disease (CKD). The gradual expansion of
cysts in the kidneys can impair their function, leading to CKD. Regular monitoring and medical
management are crucial to manage the progression of the disease. APKD, or Autosomal dominant
polycystic kidney Disease, is caused by genetic mutations affecting proteins responsible for the
development and structure of kidneys. These mutations result in the formation of fluid-filled cysts in the
kidneys, gradually replacing normal tissue. As these cysts enlarge, they interfere with kidney function,
leading to complications such as hypertension, kidney stones, urinary tract infection, and eventually
CKD.
Autosomal dominant polycystic kidney disease is the most frequent genetic cause of chronic
kidney disease. Chronic kidney disease is a global public health concern, with prevalence of 9.1%–
13.4% of the population worldwide. In the Philippines, its prevalence is 35.94%, which is much higher
than estimated global rates. Aside from its contribution to mortality, the growing burden of CKD is also
illustrated by its associated financial costs. Locally, 94% of end stage renal disease (ESRD) patients are
undergoing center-based hemodialysis (HD), 4% are on peritoneal dialysis (PD) and only 2% had
kidney transplantation (KT). Despite KT being the gold standard treatment for ESRD, HD is still
preferred by most Filipino patients due to transplant costs, low organ donations, lack of capable
infrastructures, and long term immunosuppression therapy. (Bayani D. Almirol B. Uy G. et al. 2021).
CKD develops as the kidney function declines over time due to the progressive damage caused
by cysts. Initially, the kidneys can compensate for the loss of function, but as the potentially leading to
end stage kidney failure, where dialysis or a kidney transplant might be necessary. Early detection,
1
regular monitoring, and appropriate management are vital in slowing down the progression of APKD
and its impact on kidney function. Symptoms usually begin between the ages of 30 and 40, but they can
begin earlier, even in childhood. APKD is the most common form of PKD. In fact, about 90% of all
PKD cases are APKD.
This case presentation is about 49-year-old female Filipino citizen, born on July 23, 1974,
permanently residing at Km. 4 Luna, Surigao City, Surigao Del Norte. She currently lives with her
daughter after separating from her husband and has been employed at Surigao Medical Center as a
nurse in the ward station for an extended period. She was diagnosed with Chronic Kidney Disease
(CKD) and Autosomal Dominant Polycystic Kidney Disease (ADPKD) on November 13, 2023, at
Surigao Medical Center, following complaints of shortness of breath, fever, and flank pain.
Given these facts related to this case, we aim to explore the molecular intricacies of APKD,
understand the pathophysiological mechanisms driving cyst formation, and examine the progressive
renal deterioration that ensues. By examining the clinical course of CKD secondary to APKD, we seek
not only to comprehend the unique challenges faced by affected individuals but also to shed light on
potential therapeutic avenues and management strategies.
Through this case study, we embark on a journey through the intertwined realms of genetics,
nephrology, and personalized medicine, aiming to contribute to the growing body of knowledge that
informs the management and care of patients with CKD secondary to APKD. The insights gained from
this exploration have the potential not only to enhance our understanding of this specific genetic
nephropathy but also to pave the way for innovative approaches to the broader spectrum of chronic
kidney diseases.
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REVIEW OF RELATED LITERATURE
Autosomal dominant polycystic kidney disease is the most common inherited form of polycystic
kidney disease. A parent with autosomal dominant PKD has a 50 percent chance of passing the altered
gene (PKD1 or PKD2) and associated condition to each of their children. If a person doesn't inherit the
gene, there is no chance of their children inheriting the gene because it never 'skips' a generation.
Occasionally, a person develops the condition when there is no family history. It is thought that a
different inheritance pattern or perhaps a genetic change may be responsible. Like inherited PKD, the
affected person has a 50 percent chance of passing the altered gene and associated disease to each of
their children. Autosomal dominant PKD can lead to kidney failure. (Polycystic kidney disease, 2018,
Mayo Clinic).
Autosomal dominant polycystic kidney disease is the most common monogenic kidney disease, and the
leading inheritable cause of end-stage renal disease (ESRD) among adults. The disease arises from
genetic mutations in PKD1 (85% of cases) and PKD2 (15% of cases), which cause progressive bilateral
renal cyst formation, kidney enlargement, fibrosis, chronic kidney disease and renal failure. While
ADPKD may present in utero and during childhood, early-stage disease is often asymptomatic and
undiagnosed due to compensatory glomerular hyperfiltration. In later stages of ADPKD, the irreversible
loss of functional glomeruli exhausts compensatory mechanisms, leading to a detectable decline in
glomerular filtration rate (GFR) during the third and fourth decades of life.
Polycystic kidney disease is a genetic disorder that causes many fluid-filled cysts to grow in your
kidneys. Unlike the usually harmless simple kidney cysts that can form in the kidneys later in life, PKD
cysts can change the shape of your kidneys, including making them much larger. PKD is a form of
chronic kidney disease that reduces kidney function and may lead to kidney failure. PKD also can cause
3
other complications, or problems, such as high blood pressure, cysts in the liver, and problems with
blood vessels in your brain and heart. (Vicente E Torres MD, William M Bennett
MD, 2016).
Polycystic kidney disease is group of chronic kidney diseases where thousands
of cysts (fluid filled sacs) grow in the kidneys. PKD is the most common inherited kidney disease and is
a common cause of Chronic Kidney Disease. If you have PKD both of your kidneys will be affected but
one kidney may develop the cysts earlier than the other. The cysts gradually grow which makes your
kidneys larger and reduces the healthy kidney tissue. This makes it harder for your kidneys to work
properly. Some people develop high blood pressure and kidney failure as a result of PKD. PKD affects
males and females in equal numbers, and the cysts can appear at any age, depending on the type of PKD.
It is not uncommon for people to develop simple kidney cysts as they become older. Around 50% of
people over the age of 50 develop simple cysts. These cysts are not inherited and do not usually require
treatment. (Ong AC, Devuyst O, Knebelmann B, Walz G Lancet. 2015).
Autosomal dominant polycystic kidney disease is a genetic disorder characterized by the formation of
cysts within the kidneys. Symptoms caused by cyst formation in the kidneys include high blood
pressure (hypertension), pain on the sides of the body between the last rib and the hip (flank pain),
blood in the urine (hematuria) and progressively poor function of the kidneys (kidney insufficiency). In
most patients, ADPKD eventually progresses to cause end stage renal disease, requiring renal
replacement therapy, either dialysis or renal transplantation. ADPKD is not simply a kidney disorder
and other organ systems of the body can potentially be affected (multisystem disorder) by the
development of cysts.
Autosomal dominant polycystic kidney disease is the most frequent genetic cause of chronic kidney
disease. Chronic kidney disease is a global public health concern, with prevalence of 9.1%–13.4% of
4
the population worldwide. In the Philippines, its prevalence is 35.94%, which is much higher than
estimated global rates. Aside from its contribution to mortality, the growing burden of CKD is also
illustrated by its associated financial costs. Locally, 94% of end stage renal disease (ESRD) patients are
undergoing center-based hemodialysis (HD), 4% are on peritoneal dialysis (PD) and only 2% had
kidney transplantation (KT). Despite KT being the gold standard treatment for ESRD, HD is still
preferred by most Filipino patients due to transplant costs, low organ donations, lack of capable
infrastructures, and long term immunosuppression therapy. (Bayani D. Almirol B. Uy G. et al. 2021).
In addition to the substantial economic burden, patients with PKD have a high burden of disease and
remain at a high risk of associated complications. The objective of this review is to summarize the
evidence available from studies that report the burden of illness among patients with PKD. This
literature review aimed to present the evidence on the profile of patients, incidence, prevalence,
mortality, progression, diagnosis and screening rates, and CV events among the specified populations.
ETIOLOGY
PKD is a genetic disease. "Autosomal dominant" means that if one parent has the diseasecausing
genetic variation, each child will have a 50 percent chance of getting the disease. If a child doesn't
inherit the variation, he or she can't pass along disease risk to the next generation. Ninety percent of
PKD cases are autosomal dominant. In the rarer autosomal recessive version of PKD, the cysts start to
form in infancy or even in the womb. There are two forms of autosomal dominant PKD, each caused by
an abnormality in a different gene: PKD1 or PKD2. The PKD1 form is more common, accounting for
85 percent of cases, and more severe. Symptoms usually start when patients are in their 30s and the
disease often progresses more rapidly to kidney failure. The milder form, PKD2 disease, usually
manifests later in life, and is less likely to result in kidney failure except at much older ages.
DIAGNOSIS
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The severe symptoms of autosomal recessive PKD usually result in a prompt diagnosis. As a first step
toward diagnosis of kidney disease, your doctor discusses your personal and family history with you.
Among other things, your doctor might ask questions about whether you've been diagnosed with high
blood pressure, if you've taken a medication that might affect kidney function, if you've noticed changes
in your urinary habits and whether you have family members who have kidney disease. However, in
most cases of autosomal dominant PKD, for many years there are no signs that a person has the
condition. Physical check-ups or blood and urine tests may not always identify the disease. It is often
detected during medical investigations for other health problems, such as urinary tract infections. At
other times, the disease isn't discovered until the kidneys begin to fail.
Diagnosis of PKD may involve a number of tests including:
•
Physical examination – can detect symptoms such as high blood pressure or enlarged kidneys
•
Blood tests – to assess kidney function
•
Urine tests – blood or protein (or both) may be found in the urine
•
Ultrasound
•
Genetic testing – this is not a routine test but may be used for family testing. The presence of the
– a simple, non-invasive test that can identify even quite small cysts
abnormal genetic material can be detected with special blood tests. Genetic counselling is
available for affected couples.
RISK FACTOR o PKD1 genotype o Kidney size o First
episode of hematuria before age 35 years o Severe and
frequent kidney infections o Hypertension onset before
age 35 years o Multiple pregnancies o Black racial
background o Male sex
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SIGN AND SYMPTOMS
In many cases, ADPKD doesn’t cause signs or symptoms until cysts are a half inch or larger in size. For
this reason, you should meet with a health care provider if you are at risk for PKD before your
symptoms start. The most common warning signs of autosomal dominant PKD are pain in the side or
lower back. Some people also experience blood in the urine, high blood pressure and kidney stones,
frequent urinary tract infections, and eventually, loss of kidney function (chronic kidney disease). Most
often, symptoms surface when patients are in their 30s or 50s, though occasionally they begin in
childhood. Patients with a family history of PKD may be tested and diagnosed before experiencing any
symptoms.
o Pain in the abdomen, side or lower back - Often the first noticeable symptom of ADPKD. This
can be severe, but is usually short-lived, lasting from a few minutes to several days. Common
causes of pain associated with ADPKD include: a cyst becoming larger, bleeding into 1 or more
cysts, a kidney stone, a kidney or another part of your urinary system, such as your bladder,
becoming infected (a UTI).
o Increased size of the abdomen – PKD may cause the kidneys to enlarge, causing an enlarged
abdomen o Blood in your urine (haematuria) is another common initial symptom of ADPKD.
Although it can often be a frightening symptom, it's not usually a cause for concern and most
cases will resolve. But you should see a GP if you notice blood in your urine so that other
possible causes, such as a growth in your bladder, can be investigated and excluded.
o High blood pressure (hypertension) that's difficult to control - Caused by abnormal water
balance due to poor renal function. Almost all people with ADPKD who have kidney failure
have high blood pressure. High blood pressure increases your chances of heart disease and
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stroke. High blood pressure can also damage your kidneys even more. Keep your blood pressure
under control to help delay kidney damage.
o Kidney stones (nephrolithiasis) - Having ADPKD puts you at an increased risk of developing
kidney stones. Smaller kidney stones may pass out of your kidneys without causing any
symptoms. But larger stones can get blocked in your kidney or the tube that connects your
kidney to your bladder (ureter), causing problems such as: intense pain in the back or side of
your tummy the pain may last for minutes or hours, with pain-free intervals in between; being
unable to lie still; needing to pee more often than normal, and blood in your urine.
o Recurrent urinary tract infections (UTIs) – indicated by symptoms such as painful urination,
blood in the urine, frequent urination or inability to urinate, cloudy or foul-smelling urine, back
pain, fever, chills. Urinary tract infection are broadly classified into 1 of 2 groups: lower UTIs
and upper UTIs. A lower UTI is an infection that develops in your bladder or urethra, the tube
that carries urine out of the body. An upper UTI is an infection that develops in your kidneys or
ureters. ADPKD does not increase your risk of developing lower UTIs, such as bladder
infections (cystitis), but it can mean that any lower UTIs you do develop could spread to your
kidneys and become potentially serious upper UTIs.
o Loss of kidney function (CKD). Most people with ADPKD will eventually lose a significant
amount of kidney function. Loss of kidney function caused by kidney damage is known as
chronic kidney disease. CKD does not usually cause symptoms until it's reached an advanced
stage, known as CKD stage 4, when around 75% of kidney function has been lost. The most
advanced stage of CKD (stage 5) is called kidney failure or endstage renal disease. This is when
dialysis, where waste products and excess fluid from the blood are removed, is essential to keep
the person alive.
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o Other symptoms/signs: headache, dizziness, fatigue, weakness, loss of appetite, nausea,
vomiting, frequent night-time urination, anemia
Signs and symptoms of polycystic kidney disease are often nonspecific. This means they can also be
caused by other illnesses. Because your kidneys are able to make up for lost function, you might not
develop signs and symptoms until irreversible damage has occurred.
COMPLICATIONS
The abnormal renal function brought about by PKD affects a lot of the body’s physiology, giving rise to
a multitude of disorders. Complications of PKD include:
o Hypertension – An elevated blood pressure is a common complication of PKD. High blood
pressure can cause further damage to the kidneys and other organs such as the heart and the
brain.
o Renal failure – A progressive loss of renal function is one of the most serious complications of
PKD. Almost half of PKD patients develop renal failure by the age of 60 or 70.
o Growth of cysts in the liver – PKD can cause the growth of cysts in the liver, which tends to
affect older PKD patients.
o Brain aneurysms – People with PKD have a higher risk of developing a brain aneurysm, which
is a balloon-like swelling of the blood vessel in the brain. This is a severe lifethreatening
complication as it increases the risk of a hemorrhagic stroke.
o Complications during pregnancy – Pregnant women with PKD may be at risk of developing preeclampsia, a life-threatening disorder characterized by high blood pressure and declining renal
function.
o Heart valve abnormalities – Approximately 1 in 4 persons with PKD can develop mitral valve
prolapse (MVP), causing an abnormal backflow of the blood during heart contraction. Patients
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with MVP may be asymptomatic or have symptoms such as abnormal heart rhythms
(arrhythmias), chest pain, dizziness, and fatigue.
TREATMENTS
Treatment usually consists of measures to help control signs and symptoms, reduce complications, and
slow progression of the disease. As PKD is a genetic condition, currently, there is no definitive
treatment, and most patients eventually require renal replacement therapy (regular dialysis or kidney
transplantation). Keeping your kidneys as healthy as possible may help in delaying the progression of
the disease. This includes lifestyle changes to keep your body in a state of overall health as much as
possible.
o Consult a doctor if you have a family history of renal disease and/or have abnormal symptoms.
o To manage back pain, have your pain medications approved by your healthcare provider before
intake.
o To manage hypertension, take your prescribed medications as advised in order to keep your
blood pressure in check.
o Abstain from smoking and alcoholic beverages.
o Maintain a healthy weight according to your ideal body mass index (BMI). Excessive weight
burdens the work of your kidneys.
o Exercise regularly. However, if you have been diagnosed with PKD, seek the advice of a health
practitioner before engaging in sports or extraneous activities that may cause blunt force trauma
or injury to your back, causing rupture of the renal cysts.
o Eat a low-salt diet.
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o If with renal disease, restrict the intake of food with high levels of phosphorus, potassium, and
protein. Ask a dietician or healthcare provider about proper meal portions and healthier food
alternatives.
o Stay hydrated. If diagnosed with PKD, follow the recommendation of your nephrologist on
appropriate fluid volumes.
o Limit your ingestion of caffeinated food and drinks. o Prior to taking supplements and
medications, confer with your doctor.
o Regularly follow up with your attending physician. If diagnosed with renal disease, seek
immediate medical attention for any of the following symptoms: inability to urinate, difficulty
of breathing, chest pain, swelling of the legs or feet, confusion or altered mental state.
o Get adequate sleep.
o Limit stress. Seek relaxing activities.
If your kidneys become severely damaged, you might need treatment for end-stage kidney disease. Also
depending on the cause, some types of kidney disease can be treated. Often, though, chronic kidney
disease has no cure.
Treatment for end-stage kidney disease
If your kidneys can't keep up with waste and fluid clearance on their own and you develop complete or
near-complete kidney failure, you have end-stage kidney disease. At that point, you need dialysis or a
kidney transplant.
•
Dialysis. Dialysis artificially removes waste products and extra fluid from your blood when
your kidneys can no longer do this. In hemodialysis, a machine filters waste and excess fluids
from your blood.
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•
Kidney transplant. A kidney transplant involves surgically placing a healthy kidney from a
donor into your body. Transplanted kidneys can come from deceased or living donors.
NUSING ASSESSMENT
o Take patient history and perform assessment. o Monitor vital signs especially blood pressure. o
Monitor renal function and urine elimination, hydration, fluid and electrolyte balance.
o Monitor daily weights o Assess edema and promote skin integrity. o Access site for dialysis (if
appropriate) o Give prescribed drugs, including ACE inhibitors to control hypertension (if
giving diuretics, obtain specimens for serum electrolyte levels, especially potassium, which may
be decreased) o Provide comfort measures, including opioid analgesics; assist the patient with
relaxation techniques and the use of TENS.
o Provide fluids and foods based on the patient’s condition, encourage increased fluids if the
patient has a urinary tract infection, and restrict fluids if the patient has renal failure.
o Provide supportive care to minimize symptoms.
o Obtain specimens for urinalysis and culture and sensitivity as ordered to evaluate for hematuria,
proteinuria, and infection; obtain specimens for laboratory tests, such as electrolyte levels, as
ordered.
o Individualize patient care, as appropriate.
o Allow the patient to verbalize his feelings and concerns, especially related to possible
progression of the disease and renal failure; provide support and guidance.
o Prepare the patient for dialysis or renal replacement therapy as indicated.
o Encourage the parents of a child with the infantile form to obtain genetic counseling.
o Prepare the patient and his family for possible renal transplant or surgery.
o Refer the patient and his family to community and social services for support.
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DIAGNOSTIC TEST
Tests might include:
•
Screening the whole family: Hereditary disease. PKD has a 50:50 chance that each child will
have it. So screening or testing each family member with PKD helps in its early detection.
•
Blood tests. Kidney function tests look for the level of waste products, such as creatinine and
urea, in your blood.
•
Urine tests. Analyzing a sample of your urine can reveal abnormalities that point to kidney
failure and help identify if it may cause of chronic kidney disease.
•
Imaging tests. Your doctor might use ultrasound to assess your kidneys' structure and size.
Other imaging tests might be used in some cases.
-
Kidney ultrasound: Most often used to diagnose PKD because it is reliable, easy to perform,
painless, inexpensive, and can easily identify kidney cysts.
-
CT or MRI scan: These tests are more specific but more expensive. These tests can detect
much smaller cysts than can be seen on ultrasound.
•
Removing a sample of kidney tissue for testing. Your doctor might recommend a kidney
biopsy, which involves removing a sample of kidney tissue. Kidney biopsy is often done with
local anesthesia using a long, thin needle that's inserted through your skin and into your kidney.
The biopsy sample is sent to a lab for testing to help determine what's causing your kidney
problem.
PREVENTION
Since polycystic kidney disease is an inherited genetic disorder, you’re either born with the
condition or you’re not — even though it typically takes decades to develop symptoms of the
most common form of PKD. But it may be possible to delay or slow the development of cysts in
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your kidneys through lifestyle measures, such as; drinking lots of water and avoiding caffeinated
beverages. If you have polycystic kidney disease and you're considering having children, a
genetic counselor can help you assess your risk of passing the disease to your offspring.
Keeping your kidneys as healthy as possible may help prevent some of the complications of this
disease. One of the most important ways you can protect your kidneys is by managing your
blood pressure. Take the blood pressure medications prescribed by your doctor as directed. To
manage back pain, have your pain medications approved by your healthcare provider before
intake. Eat a low-salt diet containing plenty of fruits, vegetables and whole grains. Maintain a
healthy weight, ask your doctor what the right weight is for you. If you smoke, quit. Exercise
regularly, aim for at least 30 minutes of moderate physical activity most days of the week. Limit
stress. Seek relaxing activities.
And limit alcohol use or stop drinking alcohol.
MEDICAL MANAGEMENT
Management of ADPKD includes the following:
o Control blood pressure: Drugs of choice are ACEIs (eg, enalapril, lisinopril) or ARBs (eg,
valsartan, telmisartan, losartan, irbesartan, candesartan, olmesartan) o Control abnormalities
related to advanced CKD: Drugs to maintain electrolyte levels (eg, calcium carbonate, calcium
acetate, sevelamer, lanthanum carbonate, calcitriol, diuretics) o Treat kidney and liver cyst
infections: Gyrase inhibitors (eg, ciprofloxacin, ceftriaxone, clindamycin); dihydrofolic acid
inhibitors (TMX/SMP) o Treat hematuria: Copious oral hydration; consider analgesics o
Reduce abdominal pain caused by enlarged kidneys o Slow kidney function decline in adults at
risk of rapidly progressive ADPKD (tolvaptan)
Surgical intervention in ADPKD includes the following:
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o Surgical drainage: Usually in conjunction with ultrasonography- or CT-guided puncture; in
cases of infected kidney/liver cysts not responding to conventional antibiotics o Open or
fiberoptic-guided surgery: For excision/drainage of the outer walls of cysts to relieve symptoms
o Nephrectomy: Last resort for control of pain or hematuria in patients with inaccessible cysts
in the renal medullae; bilateral nephrectomy in patients with severe hepatic involvement o
Partial hepatectomy: To manage massive hepatomegaly
o Liver transplantation: In very rare cases of portal hypertension due to polycystic liver or
hepatomegaly with nonresectable areas
Patients with ADPKD who progress to KRT may require the following procedures:
o Discuss dialysis and transplantation. Patients with CKD who experience serious
complications like metabolic acidosis, hyperkalemia, pericarditis, encephalopathy, intractable
fluid retention, and malnutrition will need renal replacement therapy.
o Prepare the patient for vascular access creation. When hemodialysis is anticipated, vascular
access will need to be surgically created.
-
An AV (arteriovenous) graft is created by surgically implanting a tube into the arm to
connect the artery and vein. An AV graft can be utilized within days to weeks.
-
An AV fistula is the recommended vascular access. The AV fistula has a good incidence of
patency, and infections are rare, though fistulas take time to mature and cannot be used for
months.
o Educate on peritoneal dialysis.This dialysis option may be ideal for some patients depending
on their kidney function, overall health, and ability to perform their own dialysis at home. With
PD, a catheter is inserted into the abdomen, and the dialysate flows into the peritoneum, which
acts as a natural filter to remove waste products.
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o Anticipate a possible kidney transplant. Both living and deceased donors can provide kidneys
for transplant. Transplantation will require lifelong medication to prevent the body from
rejecting the new kidney. To qualify, the patient must meet certain requirements, such as good
general health and no use of drugs or cigarettes.
o Support the patient in coping with a chronic disease. It can be unsettling for the patient to
receive a chronic renal disease diagnosis. Give the patient time to adjust and accept the
diagnosis. Answer their inquiries and eliminate any misconceptions.
o Collaborate with the interdisciplinary team. Nephrologists are the providers who manage and
guide the treatment of patients with CKD. The nurse may also collaborate with dieticians who
create meal plans specific for patients on renal diets. Additional healthcare providers may
include cardiologists, endocrinologists, social workers, and the transplant team
EPIDEMIOLOGY
Worldwide, ADPKD affects approximately 4 to 7 million individuals and accounts for 715% of patients
on kidney replacement therapy (KRT). In North America and Europe, ADPKD is responsible for 6-10%
of KRT cases. Approximately one per 800-1000 population carries a pathogenic variant for this
condition. Approximately 85-90% of those individuals have PKD1 pathogenic variants; most of the
remainder have PKD2 disease-causing variants.
ADPKD is slightly more severe in males than in females. Symptoms generally increase with age.
Children very rarely present with advanced chronic kidney disease from ADPKD.
PROGNOSIS
The prognosis in patients with ADPKD covers a wide spectrum. Typically, however, ADPKD causes
progressive kidney dysfunction, resulting in grossly enlarged kidneys and kidney failure by the fourth to
sixth decade of life. There is an inverse association between the size of polycystic kidneys and the
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glomerular filtration rate (GFR). By the time kidney function begins to decline, the kidneys are usually
markedly enlarged and distorted, with little visible parenchyma on imaging studies. At this stage, the
average rate of estimated GFR decline is 4.4 to 5.9 mL/min per year. Up to 77% of patients are alive
with preserved kidney function at age 50 years, and 52% at age 73 years. Men tend to progress to
advanced chronic kidney disease more rapidly and require kidney replacement therapy (KRT) at a
younger age than do women.
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PATIENT HEALTH HISTORY
BIOGRAPHIC DATA
Name:
Patient K
Case No:
101248
Date of Birth:
July 23, 1974
Age:
49 y/o
Sex:
Female
Civil Status:
Married
Address:
KM. 4 Luna, Surigao City, Surigao del
Norte
Occupation:
Nurse
Father’s Name:
[Not Stated]
Mother’s Name:
[Not Stated]
Date and Time of Clinical Encounter:
November 06, 2023/ 8:13 PM
ADMISSION DATA
Hospital:
Surigao Medical Center
Room Number:
310
Room Type:
Private Room
Date and Time admitted:
November 06, 2023/ 8:13 PM
Mode of Admission:
Ambulatory
Admitting Vital Signs:
Blood Pressure: 130/80 mmHg
Temperature: 38.5 °C
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Pulse Rate: 115 bpm
Respiratory Rate: 23 cpm
SPO2: 98%
Weight:
123 lb
Height:
162 cm
Chief Complaint:
Shortness of breath, Fever and Flank pain
Admitting Physician:
Charmaine Altiche Arcenas, M.D.
Attending Physician:
Marlowe Tumulak Dumangas, MD
Impression:
Recurrent UTI and Polycystic Kidney
Disease; Bilateral
Diagnosis:
Chronic Kidney Disease Secondary to
Autosomal Dominant Polycystic Kidney
Disease (ADPKD)
Source of Information:
Primary source
:
Patient K
Secondary source
:
SO and Patient’s Chart
19
FUNCTIONAL HEALTH PATTERN
A. Clients Profile
Patient K is a 49-year-old female Filipino citizen, born on July 23, 1974, permanently residing at
Km. 4 Luna, Surigao City, Surigao Del Norte. She currently lives with her daughter after separating
from her husband and has been employed at Surigao Medical Center as a nurse in the ward station for
an extended period. Patient K enjoys traveling with her co-workers and her daughter.
She was diagnosed with Chronic Kidney Disease (CKD) and Autosomal Dominant Polycystic
Kidney Disease (ADPKD) on November 13, 2023, at Surigao Medical Center, following complaints of
shortness of breath, fever, and flank pain. According to Patient K, she inherited Chronic Kidney Disease
from her mother and hypertension from her father. During her teenage years, she was hospitalized for a
urinary tract infection (UTI), and by the age of 18, her condition worsened, leading to the identification
of cysts on her kidneys.
Treatment/Medication :
1. Prescribed : Meropenem (Meromax) 500 mg IV
Tramadol 50 mg IVTT
Paracetamol 300 mg PRN
Pantaprazole 40 mg IVTT
Cefixime 200 mg PRN
Morphine 5 mg IVTT
Nubain 5 mg IVTT
2. OTC : None
Past illnesses/ Hospitalization :
1. Urinary Tract Infection
Allergies :
None
20
B. Developmental History
Developmental level : Generativity vs Stagnation
Patient K has been married for 17 years and is blessed with one daughter. However, she
separated from her husband a long time ago. She raised her daughter while working as a nurse at
Surigao Medical Center. She was devastated at the time but was able to accept it in the long run.
She is currently happy, spending her time at work and enjoying the company of her family and daughter.
She continues to engage in daily activities, including chores, and occasionally reads books during her
free time. She also visits neighbors and a few close friends. Although she has some regrets in life, she
expresses gratitude and overall contentment now with her family.
C. Health Perception - Health Management Pattern
1. Clients rating of health:
Patient K has no vices but drinks alcoholic beverages occasionally. She rated her health five
years ago at 9 out of 10 of any major health problems. Presently employed at a hospital, her current
health assessment stands at 8 out of 10. As she ages, she acknowledges certain limitations in activities
compared to her earlier years, which now interfere with her desired daily activities. Despite these
challenges, she remains capable of performing both daily and work-related activities. The use of
medications supports her in maintaining her strength and overall health. However, she is contending
with a loss of appetite attributed to her medication regimen.
Reflecting on her health journey, Patient K acknowledges the impact of aging on her abilities
and recognizes the need for medical support to navigate these changes. While her present health rating
suggests a slight decline, her determination to manage her health with medications reflects her proactive
approach to maintaining a robust and active lifestyle.
D. Nutritional -Metabolic Pattern
Patient K states she experienced a slight loss of appetite due to side effects of her drug regimen
and adheres to a soft meal diet, comprising a breakfast at 7:00 am consisting of 1/2 cup of rice,
scrambled eggs, 1 banana, a bowl of soup, and a glass of milk, and lunch at noon with 1 cup of rice,
cooked veggies, chicken soup, and avocado. She has no food allergies but mentions a recent aversion to
21
certain foods due to the drug regimen, occasionally drinks coffee when sleepy during at her work, does
not wear dentures, has intact teeth, and is currently experiencing weight loss. The patient notes nausea
and vomiting when displeased with food and describes her scalp and skin as dry, without the use of
lotions or moisturizers. She states she has bruises on her back and arms, she had easy bruising on her
skin, and denies pruritus or nonhealing sores. The patient reports that her nails are hard and brittle,
while her hair is fine and soft.
Current weight: 49 kg;
Previous weight: 72 kg; desired to maintain previous weight.
E. Elimination Pattern
Bowel habits: The patient states she has experienced difficulty in defecating for up to 3 to 4 days.
According to her soft, formed, brown bowel movements every other day. Denies mucous, bloody, or
tarry stools. Denies rectal bleeding, changes in color, consistency, and habits.
Bladder habits:
Voids 3–4x/day, in a light yellow color. Denies difficulty in urinating, urinary
incontinence, and urinary retention.
F. Activity Exercise Pattern
1.
ADLs on an average day: On her working days she arises at 6 a.m. Eat breakfast and prepare to
work at Surigao Medical Center by riding a tricycle, and go home after her shifts. At her home, she
watches television with her daughter sometimes as they bond talking about how their day went out. On
her day off she visits her family, neighbors, and a few close friends, having chitchat while hanging out.
The patient states that her only exercise was doing home basic chores and going out to grocery stores
and shopping in the malls. The patient states after her admission she experienced body weakness and
loss of appetite. She expresses her satisfaction with his daily activities in life, which are not limited. For
now, her determination to manage her health with medications reflects her proactive approach to
maintaining a robust and active lifestyle.
2.
Hygiene: Showers and washes her hair every other day.
22
3.
Occupational Activities: Patient K was a ward nurse, her everyday activities include assessing
and monitoring people’s health, administering medications, coordinating and implementing care plans,
providing emotional support, and collaborating with other healthcare professionals.
G. Sexually - Reproduction Pattern
Patient K first menstruation start when she’s just 13 years old and menopausal at the age of 40
her LMP is on October 2014. Sexual activities are not active; she denies a ligation or any birth control;
she denies a history of any sexually transmitted disease; cervical cancer; and ovarian cancer.
H. Sleep Pattern
Goes to bed at 8 p.m. Has difficulty sleeping at times and patient that it is because of her
insomnia, she kept on make herself busy when her insomnia attack and able to sleep at 3am. She doesn’t
take any sleeping pills because she said that she used to experienced insomnia which is the reason why
she can’t sleep early. Arises around 6am to 7am. Denies nocturnal dyspnea.
I. Sensory Pattern
1. Vision. she doesn’t have problem regarding in her eyes such as reading and seeing in low light or
night. But she has reading glasses where she used it when she reads her book with a small font
size. Denies: diplopia, itching, redness, excessive tearing, discharge, or trauma to the eyes.
2. Hearing. She states that "she still can hear clearly" and has never had hearing problems. Denies:
tinnitus, pain, discharge, or trauma to the ears and does not ask twice or repeat the questions
when asked at a normal voice tone or level.
3. Smell. Denies: difficulty with smells, pain, postnatal drip, sneezing, or frequent nosebleeds.
23
4. Touch. She can identify temperature (hot and cold), textures (smooth and rough), substances, and
feel pain. She rates his pain at 7 out of 10. Denies: having problems with touch senses, tingling,
pricking, or numbness.
5. Taste. She doesn’t have any problem with taste in her normal days but when she was being
admitted at the hospital and take her medication she claimed it as a reason why her taste changed
sometimes and does not feel to take foods by her mouth. Factors that can cause taste changes
include: growth of tongue mass into areas related to taste; nerve damage; low levels of nutrients
(for example, zinc, copper, and niacin); and medicines.
J. Cognitive Pattern
Her speech is clear; she doesn’t slur while talking, and there are no disturbances in her speech
and she is responsive. Follow verbal cues. Expresses feelings clearly and concisely. Fortunately, she
states that she never had a gradual loss of memories. She can recall the time, date, and place of events.
K. Role Relationship Pattern
Patient K has been separated by her husband for 7 years. She doesn’t feel to talk about her
husband because when we ask something related with his husband she abruptly changed the topic.
Describe how her past was difficult when their husband left them with their daughter. But eventually she
learned to accept it with the help of his family. Fortunately, she has her siblings who are very supportive
and caring to her physically, and emotionally. She lives at home with her daughter, but with the guidance
of her siblings, who visit her most of the time. Has a casual relationship with the neighbors, some of
them are their relatives.
L. Self- Perception - Self Concept Pattern
24
Patient describe herself as a normal person. She doesn’t smoke but drink alcoholic drinks
occasionally. She is a hardworking and happy person who likes to be around her siblings, close friends,
especially at gathering events like birthdays, etc., and she also loves to travel with her daughter. Her
greatest concern now is to get well and to be physically fit so she can able to do anything such as
traveling in any places to have more time with her daughter and go back to her normal life with her
family.
M. Coping -Stress Tolerance Pattern
She states that her coping mechanism with stress is keeping herself busy with home chores and
bonding with her family at the beach and travel in different places. Shares confidence with family, a few
close friends and neighbors. She states that she experienced stress most of the time in her field of work.
But with the help and support of her family, she was able to handle it.
N. Value- Belief Pattern
Religious preference is Pentecostal. Values relationships with family and God. States that all her
family goes to church every Sunday and hears the words of God.
25
PHYSICAL ASSESSMENT
A. General Physical Survey
Ht: 5'4", Wt: 123lb, Radial pulse: 89bpm, Resp: 20cpm, BP: 110/80mmHg, Temp: 36.7°C
Patient K is properly dressed, lying in bed awake and responsive. With an on-going IVF of PNSS
1L@ 15gtts/min hooked at right metacarpal vein infusing well and regulated. She responds
appropriately and shows coordinated movements. He wears black colored shirt and pants appropriate for
the temperature of the room. Patient shows expressions relevant to his mood. Patient K is conscious,
oriented and aware of place, time, and people. He listens and responds appropriately as asked and
examined.
B. Skin, Hair, and Nail Assessment
Patient’s skin color is light brown, skin is dry and firm to touch, have buises in right hand and in
her back, but shows no signs of fever and no edema. Hair color is black with a little strands of gray hair ,
evenly distributed on head and has normal integrity. No scalp lessions or dandruff upon inspection.
Fingernails are finely cut, clean and has medium thickness, no clubbing.
C. Head and Neck Assessment
Head symmetrically rounded upon palpation. No inflammation, lumps and masses on the skull
upon inspection and palpation. No scalp lesions or flaking.
Patient K’s neck moves freely without discomfort and no redness noted upon inspection. Upon palpation,
no masses or tenderness were noted on the anterior, posterior, lateral, and medial part of the neck.
Trachea is in mid placement in midline of neck.
D. Eye Assessment
Both eyes were symmetrical, lower eyelids are slightly pale. Eyebrows sparse with equal
distribution, conjuctiva is pink, sclera white, without jaundice. Bilateral corneal reflexes are intact.
Eyebrows distributed equally. Irises are uniformly dark-brown. Pupils are round and reactive to light.
E. Ear Assessment
26
Patient K’s ears are equal in size, no deformities, swelling, and redness were noted in auricle upon
inspection. No ear discharge upon inspection. No lumps or tenderness upon palpation.
F. Nose and Sinuses Assessment
Upon inspection, Patient K’s external nose is uniform in color and size, both nostrils were patent,
without any deformity, or inflammation. Has no visible scars, lesions, and abrasions. No nasal discharge
or nasal clogging were noted. No masses or tenderness that indicates inflamed sinuses upon palpation.
G. Mouth and Pharynx Assessment
Patient K’s lips is pinkish in color. Gums are moist and have a bright pink color, tongue is light pink in
color and no swelling upon inspection. Teeth are complete and is yellowish in color. No lesions, sores,
and bleeding upon inspection.
H. Cardiac Assessment
No heaves, lifts, or vibrations were noted; no gallops, murmurs, or rubs were noted, and there
were clear, brief sounds throughout the examination. Present vital signs: blood pressure: 110/80 mmHg;
pulse rate: 89 bpm; respiratory rate: 20 cpm; oxygen saturation: 98%; and body temperature: 36.7°C.
I. Peripheral Vascular System Assessment
Arms: The size and symmetry of both patient’s arms are equal, with no redness, lesion, and
swelling upon inspection. Has scars visible on both arms. No masses or tenderness upon palpation.
Brachial and radial pulses are palpable. Three flexion creases present in palm.
Legs: No edema were inspected. No masses or tenderness upon palpation. Femoral and popliteal
pulses are palpable. Have no abrasion and wound. Skin is intact, brown, pale and firm to touch. Toenails
are finely cut, and clean. No clubbing.
J. Thorax and Lung Assessment
27
Patient K’s thorax expands bilaterally, no cough and scars upon inspection. Chest movement is apparent
during inhaling and exhaling. Regular breathing, respiratory rate of 20cpm. No tenderness or swelling
upon palpation. No rales, rhonchi, or any adventitious breath sounds upon auscultation.
K. Breast Assessment
Patient K’s nipple lines are bilaterally symmetrical, skin is light brown with light-brown areola
and nipples not inverted upon inspection. No scars, lesions, discharge, no thickening or tenderness noted
upon palpation.
L. Abdomenal Assessment
Symmetrical contour and uniform in color. Patient is in pain at the right and left upper quadrant
at a rate of 7 out of 10 according to patient K. Bulging in right and left hypochondriac region upon
palpation. Patients bowel sound consist of clicks and gurgles, heard occasional borborygmus, normal
active bowel sounds upon auscultation.
M. Genitourinary-Reproductive Assessment
No history of bulging or masses in the inguinal area. No bleeding or unusual discharge when
urinating. Mons pubis has small amount of hair, no lesions and masses noted. Anal area is light brown
with small amount of hair noted.
N. Musculoskeletal Assessment
Poor reflexes, smooth and coordinated with even base. Muscles moderately firm bilaterally, no
deviations, edema or inflammation at both upper and lower extremities. Patient has no bony deformities.
O. Neurologic Assessment
Patient K moves freely with tolerable pain in the abdomen, Patient is awake and responsive,
oriented and aware of place, time, and people. Patient listens and responds appropriately as
asked and examined. Patient shows expressions relevant to his mood.
28
REVIEW OF SYSTEM
General Survey
Prior to admission as verbalized by the patient, she is experiencing severe abdominal pain. We
received Patient K lying in bed awake, conscious, and responsive. Upon inspection and palpation, the
skin is clean and warm to touch, clothes are fit and appropriate. Patient have a bruises in her hand and
back.
Integumentary System
Patient had no history of edema , burns, scalp lesions or flaking, pigmented lesions, jaundice,
cellulitis, or adenopathy.Patient skin complexion is fair, good skin turgor when pinched, it goes back to
previous state after 1 second, firm to touch and have a bruises. Nail bed is pinkish in color.
Head, Eyes, Ears, Nose, and Throat (EENT)
Head: Patient had no dandruff, hair is color black with small amount of white hair, and distribution
consistent with no dryness or oiliness and no lesions present.
Eyes: Patient had history of blurred vision and tearing eyes. The patient pupil are equal, round and
symmetric. Pupil constricts as exposed to bright light. Pale in lower eyelid. Patient only wear reading
glasses if needed.
Ears: The patient had no history of ear infection, draining ears, lumps or lesions. No discharged
(Otorrhea). No history of ear pain (otalgia). Ear Ringing (Tinnitus).
Nose: Patient had history of nasal stuffiness, dust allergies, and sinus infection.
Throat: Patient has no palpable lymph node in digastric anterior belly muscle. The pharynx is normal in
appearance without tonsillar swelling.
29
THORAX AND LUNGS
Patient had history of difficulty in breathing. Respiratory rate of 20 cycle per minute. There is no
presence of wheezing and crackles sound upon auscultation.
CARDIOVASCULAR SYSTEM
Patient had no history of cardiopulmonary disease. The patient’s heart rate has a regular rhythm
of 89 beats per minute. Capillary refill time of less than 2 seconds. Apex beat was palpated in the 5th
intercostal space, midclavicular line. There is no presence of clubbing nails.
Gastrointestinal System
The patient had history of abdominal pain at upper left and right abdominal quadrants. Patient
experience heart burn, change in appetite, nausea and vomiting. Patient has difficult in defecating. No
abnormal bowel sounds upon auscultation. Enlarged kidney seen in apperance upon inspection
Musculoskeletal system
Patient had history of sudden muscle pain in legs. No edema at both lower extremities. No bony
deformities.
Neurological System
Patient had experience cluster headache. She experience mood swings and has a problem with
sense of taste. The patient has no history of memory loss, seizure. Patient was conscious to time, place,
and people.
Urinary System
Patient had history of urinary tract infection, multiple cysts in both kidney and liver. She
experienced abdominal and flank pain. Urinates 4 to 5 times a day. Color of the urine is yellow.
30
No hematuria noted. No dysuria noted. No pain in urination.
Reproductive System
No history of bulging or masses in the inguinal area. No vaginal discharge.
Hematologic or Lymphatic
Patient had history of Blood transfusion last May 24, 2023. Patient had varicose veins. Patient
had an anemia and having an easy bruising. Lymphatic areas are symmetrical on each side with no
discolouration, swelling, or visible or palpable nodes.
Endocrine
No history of Diaphoresis. No polyuria. Patient is both heat intolerance and cold intolerance.
Psychiatric
A patient had experience depression sometimes, mood swings and memory changes.
31
LABORATORY RESULT
HEMATOLOGY
November 6, 2023
Examination Test
Result
Unit
Normal Value
Significance
Decreased level
of hemoglobin
may
cause
anemia.
Decreased level
of hematocrit
may
cause
anemia.
Decreased level
of RBC (red
blood cells) may
sign of anemia.
Hemoglobin
9.1
g/dL
12.0 – 17.0
Hematocrit
26.4
%
37 – 54
RBC
2.98
x10^12/L
4.0 – 6.0
MCV
88.6
fL
87+-5
Normal.
MCH
30.6
pg
29+-2
Normal.
MCHC
34.5
g/dL
34+-2
Normal.
RDW
13.0
11.6 – 14.6
Normal.
Platelet Count
269
150 – 450
Normal.
4.5 – 10.0
Increased level of
WBC (white
blood cells) may
indicate
infection and
inflammation in
the body.
WBC
21.70
x10^9/L
x10^9/L
Increased level
of neutrophils
may indicate
infection.
Decreased level of
lymphocytes may
result of infection.
Neutrophils %
92.9
%
50 – 70
Lymphocytes%
2.5
%
20 – 40
Monocytes %
3.2
%
0–7
Normal.
Eosinophils %
0.6
%
0–5
Normal
Basophils %
0.8
%
0–1
Normal
32
Remarks:
After a thorough analysis of laboratory results, we noticed the patient has decreased level of
hemoglobin 9.1 g/dL from normal range 12.0-17.0 grams per deciliter that may indicate anemia.
Patient has Low level of hematocrit with a result 26.4% from normal range 37-54% that may indicate
anemia too. Decreased RBC (red blood cell) 2.98 x10^12/L from 4.0-6.0 x10^12/L may indicate sign
of anemia. Increased WBC (white blood cells) 21.70 x10^9/L from normal range 4.5-10.0 x10^9/L
indicate of infection and inflammation in the body. High level of Neutrophils with 92.9 % result from
normal range 50-70% and decreased Lymphocytes 2.5% from normal range 20-40% are indicate
infection.
BLOOD CHEMISTRY
November 06, 2023
Examination Test
SODIUM
POTASSIUM
CREATININE
Result
136.31
4.87
9.33
Reference/Unit
135.00 – 148.00
mmol/L
3.50 – 5.30 mmol/L
0.73 – 1.36 mg/dL
Significance
Normal.
Normal.
Increased level of
creatinine may
indicate kidney failure.
Remarks:
After thorough analysis of the laboratory results, we found that the sodium and potassium level of the
patient from the examination test for blood chemistry are normal in values and only creatinine has the
increased level which is 9.33 mg/dL from normal value of 0.73-1.36 mg/dL that indicate of kidney
failure.
33
ARTERIAL BLOOD GAS
November 06, 2023
Examination Test
PH
pCO2
pO2
Result
Reference/Unit
Significance
7.380
7.35 – 7.45
Normal.
17.2
35 – 45 mmHg
Decreased level of
partial pressure of
carbon dioxide may
indicate respiratory
alkalosis.
92
80 – 100 mmHg (for
<60y/o)
80 of years over 60
(for>60y/o)
Normal.
cHCO2
9.9
22 – 26 mmol/L
Decreased level of
partial pressure of
carbon dioxide may
indicate respiratory
acidosis.
cSO2
97%
95 – 100 %
Normal.
Remarks:
After thorough analysis of the laboratory results, we found that the pH, pO2, and cSO2 level of the
patient in arterial blood gas examination test are in a normal range while the pCO2 (partial pressure of
carbon dioxide in arterial blood) is decreased in level with a result of 17.2 mmHg from the normal
range 35-45 mmHg that indicates of respiratory alkalosis. The cHCO2 () has a result of 9.9 mmol/L
where it is in a decreased level from a noraml range 22-26 mmol/L that indicates respiratory acidosis.
34
ANTIGEN SWAB TEST
November 6, 2023
SARS-COV-2 RAPID ANTIGEN TEST
NEGATIVE
Remarks:
After analyzing for laboratory results, patient antigen swab test for SARS-COV-2 RAPID
ANTIGEN TEST has a result of negative which indicate that the patient is negative for covid-19 virus.
CHEST PA X-RAY
35
November 6, 2023
Chief complaint: flank pain.
FINDINGS:
Both lung are clear.
The vascular markings are within normal limits.
The tracheae at the middle.
The heart is not enlarged.
The rest of the structures are unremarkable.
IMPRESSION:
no acute cardiopulmonary findings.
36
URINALYSIS
November 07, 2023
Color
transparency
Protein
pH
Specific gravity
Glucose
Ascorbic acid
Bilirubin
Erobiiinogen
Ketones
Nitrite
Leukocytes
Yellow
Turbid
3+++
5.0
1.015
1+
WBC
RBC
Epithelial cell
Casts
Crystals
Bacteria
Mucous threads
Others
TNTC
6-10
Moderate
Hyaline 8-10
Remarks:
in urinalysis examination the patient has a color yellow urine that imply a normal color of urine that
has a turbid transparency which indicate the presence of protein or excess cellular material and with a
3+++ protein which may indicate nephrotic-range proteinuria. The pH level of the urine of the patient is
5.0 that which is normal, specific gravity with a 1.015 which above normal 1.010 can indicate mild
dehydration, and patient has a presence 1+ of glucose that may be a sign of diabetes or gestational
diabetes. The WBC (white blood cells) in the urine is TNTC or too numerous to count which indicates
an infection or inflammation somewhere in urinary tract and RBC (red blood cell) in the urine is 6 -10
that indicates a kidney failure. The presence of epithelial cell is moderate and the cast has a hyaline 810 that indicate kidney issues or failure.
37
WHOLE ABDOMEN ULTRASOUND
38
November 07, 2023
Interpretation:
Follow-up to prior exam dated 05/24/2023. The liver appears normal in size, with stable
thin walled cystic foci, measuring up to 5.1 cm. the gallbladder is normally dilated. No lithiasis
seen. No intra nor extra -hepatic duct dilations. The spleen and pancr eas are not enlarged. The
right kidney measures 13.7 x 7.3 cm (LXW) with 1.3 cm cortex, while the left kidney measures
14.5 x 9.1 cm (LXW) with 0.8 cm cortex. There are multiple cystic foci at both kidneys,
measuring the largest on the right by 5.2 cm and
on the left by 7.5 cm. the largest at the left
superior renal pole shows internal echoes/ layering debris. No hydronephrosis. The ureters are
not dilated. The urinary bladder is fairly distended with no lithiasis or intra nor extra
-vesical
mass noted. Ther e is no intraabdominal free fluid. The uterus measures 4.2 x 5.5 x 4.5 cm. The
endometrial cavity thickness measures 0.5 cm. No focal mass noted. The posterior cul-de-sac is
empty. No masses noted at both adnexae.
Impression:
Stable polycystic liver disease.
Polycystic kidneys, with the largest at the left superior pole appearing complicated.
Negative for perinephric or intraabdominal free fluid.
Clinical correlation is recommended.
39
HEMATOLOGY
November 8, 2023
Examination Test
Result
Unit
Normal Value
Significance
Decreased level
of hemoglobin
may
cause
anemia.
Decreased level
of hematocrit
may
cause
anemia.
Decreased level
of RBC (red
blood cells) may
sign of anemia.
Hemoglobin
9
g/dL
12.0 – 17.0
Hematocrit
26.9
%
37 – 54
RBC
3.04
x10^12/L
4.0 – 6.0
MCV
88.4
fL
87+-5
Normal.
MCH
30.1
pg
29+-2
Normal.
MCHC
34.1
g/dL
34+-2
Normal.
RDW
13.1
11.6 – 14.6
Normal.
Platelet Count
269
150 – 450
Normal.
4.5 – 10.0
Increased level of
WBC (white
blood cells) may
indicate
infection and
inflammation in
the body.
WBC
21
x10^9/L
x10^9/L
Increased level
of neutrophils
may indicate
infection.
Decreased level of
lymphocytes may
result of infection.
Neutrophils %
87.9
%
50 – 70
Lymphocytes%
6.9
%
20 – 40
Monocytes %
4.1
%
0–7
Normal.
Eosinophils %
0.9
%
0–5
Normal.
Basophils %
0.2
%
0–1
Normal.
Remarks:
40
After a thorough analysis of laboratory results, we noticed the patient has decreased level of
hemoglobin 9 g/dL from normal range 12.0-17.0 grams per deciliter that may indicate anemia. Patient
has Low level of hematocrit with a result 26.9 % from normal range 37-54% that may indicate anemia
too. Decreased RBC (red blood cell) 3.04 x10^12/L from 4.0-6.0 x10^12/L may indicate sign of
anemia. Increased WBC (white blood cells) 21 x10^9/L from normal range 4.510.0 x10^9/L indicate of
infection and inflammation in the body. High level of Neutrophils with
87.9 % result from normal range 50-70% and decreased Lymphocytes 6.9 % from normal range 2040% are indicate infection.
ARTERIAL BLOOD GAS
November 08, 2023
Examination Test
pH
pC02
p02
Result
Reference/Unit
Significance
7.38
7.35 – 7.45
Normal.
17
35 – 45 mmHg
Decreased level of
partial pressure of
carbon dioxide may
indicate respiratory
alkalosis.
80
80 – 100 mmHg (for
<60y/o)
80 of years over 60
(for>60y/o)
Normal.
cHC02
9.9
22 – 26 mmol/L
Decreased level of
partial pressure of
carbon dioxide may
indicate respiratory
acidosis.
cS02
96
95 – 100 %
Normal.
Remarks:
After thorough analysis of the laboratory results, we found that the pH, pO2, and cSO2 level of the
patient in arterial blood gas examination test are in a normal range while the pCO2 (partial pressure of
carbon dioxide in arterial blood) is decreased in level with a result of 17 mmHg from the normal range
35-45 mmHg that indicates of respiratory alkalosis. The cHCO2 () has a result of 9.9 mmol/L where it
is in a decreased level from a normal range 22-26 mmol/L that indicates respiratory acidosis.
41
BLOOD CHEMISTRY
November 08, 2023
Examination Test
POTASSIUM
CREATININE
Result
4.34
8.55
Reference/Unit
Significance
3.50 – 5.30 mmol/L
Normal.
0.73 – 1.36 mg/dL
Increased level of
creatinine may
indicate kidney failure.
Remarks:
After thorough analysis of the laboratory results, we found that the sodium and potassium level of the
patient from the examination test for blood chemistry are normal in values and only creatinine has the
increased level which is 8.55 mg/dL from normal value of 0.73-1.36 mg/dL that indicate of kidney
failure.
42
HEMATOLOGY
November 10, 2023
Examination Test
Result
Unit
Normal Value
Significance
Decreased level
of hemoglobin
may
cause
anemia.
Decreased level
of hematocrit
may
cause
anemia.
Decreased level
of RBC (red
blood cells) may
sign of anemia.
Hemoglobin
9
g/dL
12.0 – 17.0
Hematocrit
23.5
%
37 – 54
RBC
2.64
x10^12/L
4.0 – 6.0
MCV
89.1
fL
87+-5
Normal.
MCH
30.3
pg
29+-2
Normal.
MCHC
34.0
g/dL
34+-2
Normal.
43
RDW
12.5
Platelet Count
269
WBC
21
11.6 – 14.6
Normal.
150 – 450
Normal.
4.5 – 10.0
Increased level of
WBC (white
blood cells) may
indicate
infection and
inflammation in
the body.
x10^9/L
x10^9/L
Increased level
of neutrophils
may indicate
infection.
Decreased level of
lymphocytes may
result of infection.
Neutrophils %
93.2
%
50 – 70
Lymphocytes%
4.2
%
20 – 40
Monocytes %
4.5
%
0–7
Normal.
Eosinophils %
1.0
%
0–5
Normal.
Basophils %
0.1
%
0–1
Normal.
Remarks:
After a thorough analysis of laboratory results, we noticed the patient has decreased level of
hemoglobin 9 g/dL from normal range 12.0-17.0 grams per deciliter that may indicate anemia. Patient
has Low level of hematocrit with a result 23.5 % from normal range 37-54% that may indicate anemia
too. Decreased RBC (red blood cell) 2.64 x10^12/L from 4.0-6.0 x10^12/L may indicate sign of
anemia. Increased WBC (white blood cells) 21 x10^9/L from normal range 4.510.0 x10^9/L indicate of
infection and inflammation in the body. High level of Neutrophils with
93.2 % result from normal range 50-70% and decreased Lymphocytes 4.2 % from normal range 2040% are indicate infection.
HEMATOLOGY
November 10, 2023
Examination
test
Hemoglobin
Result
Unit
Normal Value
g/dL
12.0 – 17.0
%
37 – 54
RBC
x10^12/L
4.0 – 6.0
MCV
fL
87+-5
Hematocrit
44
Significance
MCH
MCHC
pg
29+-2
g/dL
34+-2
11.6 – 14.6
RDW
Platelet Count
x10^9/L
150 – 450
WBC
x10^9/L
4.5 – 10.0
Neutrophils %
%
50 – 70
Lymphocytes%
%
20 – 40
Monocytes %
%
0–7
Eosinophils %
%
0–5
Basophils %
%
0–1
Blood type
A Rh positive
Remarks:
After thorough analysis of the laboratory results, we found that the patient has a A Rh positive
(+) blood type.
45
BLOOD CHEMISTRY
November 10, 2023
Examination Test
POTASSIUM
CREATININE
Result
3.65
7.35
Reference/Unit
Significance
3.50 – 5.30 mmol/L
Normal.
0.73 – 1.36 mg/dL
Increased level of
creatinine may
indicate kidney failure.
Remarks:
After thorough analysis of the laboratory results, we found that the sodium and potassium level of the
patient from the examination test for blood chemistry are normal in values and only creatinine has the
increased level which is 7.55 mg/dL from normal value of 0.73-1.36 mg/dL that indicate of kidney
failure.
46
DRUG STUDY NO. 1
Generic Name: Meropenem
Brand Name: Meromax
Classification: Antibiotics
Prescribed & recommended dosage: 1 gm amd 500mg Vial
Frequency: q 12hrs
Route of administration: IV
Mechanism of action: Inhibits cell-wall synthesis in bacteria.Redaily penetrates cell wall of most
gram-positive and gram-negative bacteria to reach penicillin -binding protein targets.
Indication:
• Complicated skin and skin-structure infections from staphylococcus aureus
(methicillin -susceptible isolates only),Streptococcus pyogenes,streptococcus
agalactiae,viridans group streptococci,Enterococcus faecalis),Escherichia coli,
mirabilis,Bacteroides fragilis, or PeptostreptococcuPepto streptococcus
•
Proteus
species.
Complicated intra-abdominal infections (including appendicitis and peritonitis)
caused
by viridans group streptococci,E,coli,KlebsielllKlebsiella pneumoniae,P.
aeruginosa,B.fragilis,Bacteroides
thetaiotaomicron,or
species.
47
Peptostreptococcus
•
Bacterial meningitis caused by S. pneumoniae,Haemophilus influenzae, or
Neisseria meningitidis. Contraindication:
•
Contraindicated in pateintpatients hypersensitive to components of drug or other
drugs in same class and in patients who have had anaphylactic reactions to
•
or
beta -lactams.
Use cautiously in elderly patients and in those with a history of brain lession,
seizure
disorders, or impaired renal function.
•
Severe cutaneous adverse reactions,such as SJS, toxic epidermal necrolysis,
syndrome,erythema multiforme,and acute generalized exanthematous .
DRESS
pustulosis,have
been reported with meropenem use.
•
Long-term administration of bicarbonate with calcium or milk can causemilk-alkali
syndrome
Adverse Reaction:
CNS: headache.
CV: phlebitis,thromphlebitis,peripheral vascular disorder.
EENT: oral candidiasis,pharyngitis
GI: CDAD,constipation, diarrhea, glossitis,nausea,vomiting.
GU: hematuria
Hematologic: anemia,
Hepatic: hyperbilirubinemia.
Respiratory:apnea, pneumonia.
Skin: injection-site inflammation,pruritus,rash.
Other:anaphylaxis,sepsis,hypersensitivity reactions,inflammation, pain.
Nursing implications:
48
•In patients with CNS disorders,bacterial meningitis, and compromised renal
function,drug
may cause seizures and other CNS adverse reactions.
• If seizures occur during therapy,stop influsion and notify prescriber.Dosage
adjustment
may be needed.
• Monitor patient for signs and symptoms of superinfection Drug may cause
overgrowth of nonsusceptibkno susceptible bacteria or fungi.
• Periodic
assessment
of
organ
system
functions
including
renal,hepatic
and
hematopoietic function is recommended during prolonged therapy.
•
Monitor patients fluid balance and weight carefully.
•
IF patient develops signs and symptoms suggestive of a severe cutaneous reaction,stop drug
immediately and consider an alternative treatment.
•
CDAD may occur up to months after last dose and range from mild diarrhea to fatal colitis.If
CDAD occurs,drug will need to be stopped and appropriate treatment begun.
DRUG STUDY NO. 2
Generic Name: Tramadol hydrochloride
Brand Name:
Classification: Analgesics
Prescribed & recommended dosage: 50 mg
Frequency: q8hrs,q6hrs
Route of administration: IVTT
49
Mechanism of action: Unknown.Thought to bind to opioid receptors and inhibit reuptake of
norepinephrine and serotonin.
Indication:
•
Moderate to moderately severe chronic pain Contraindication:
•
Contraindicated in patients hypersensitive to drug or opioids,in patients with severe renal or
hepatic
impairment,suicidal
patients
and
in
those
with
acute
intoxication
from
alcohol,hypnotics,centrally acting analgesics opioids or psychotropic drugs.
•
Contraindicated in patients with GI obstruction,including paralytic ileus.
•
Contraindicated with concomitant use oor within 14 days of MAO inhibitor therapy.
•
Contraindicated in patients with significant respiratory depression or acute or severe bronchial
asthma or hypercalnihypercapnia in unmonitored settings or where resuscitative equipment
isnisn't available. Adverse Reaction:
CNS: dizziness,
headache,
stimulation,confusion,coordination
somnolence,vertigo,seizures,anxiety,asthenia,CNS
disturbance,euphoria,malaise,nervousnes,sleep
disorder,fever,paresthesia,tremor,depression,agitation,apathy.
CV: vasodilation,HTN,peripheral edema
EENT: visual disturbances,nasopharyngitis,pharyngitis,rhinitis,sinusitis.
GI:
constipation,nausea,vomiting,abdominal
pain,anorexia,diarrhea,dry
mouth,dyspepsia,flatulence.
GU:
menopausal
symptoms,proteinuria,urinary
pain,UTI,prostatTate disorder.
Metabolic: weight loss
Musculoskeletal: hypertonia,arthralgia,neck pain,myalgia
Respiratory: bronchitis,respiratory depression.
Skin: diaphoresis,pruritus,rash
Other: chills,withdrawal syndrome,accidental injury
50
frequency,urine
retention,pelvic
Nursing implications:
•
Reassess patients level of pain at least 30 minutes after administration.
•
Monitor bowel aband bladder function.Anticipate need for stimulant laxative.
•
Monitor patients at risk for seizures.Drug may reduce seizure threshold .
•
In the case of an overdose,naloxone may also increase risk of seizures.
•
Monitor patient for drug dependence Drug can produce dependences similar to that of codeine
and thus has potential for abuse.
51
Generic Name:
Brand Name:
DRUG STUDY NO. 3
Paracetamol
Classification: Analgesic
Prescribed & recommended dosage: 300 mg Vial
Frequency: q 5hrs
Route of administration: IVTT
Mechanism of action: Thought to produce analgesia by inhibiting prostaglandin and other substances
that sensitize pain receptors.Drug may relieve fever through central action in the hypothalamic heatregulating center.
Indication:
•
Mild pain or fever
•
Mild to moderate pain;mild ttto moderate ate pain with adjunctive opioid analgesics;fever
Contraindication:
•
Contraindicated in patients hypersensitive to drug.IV form is contraindicated in patients with
severe hepatic impairment or severe active liver disease.
•
Use cautiously in patients with any type of liver disease,G6PD deficiency,chronic
malnutrition,severe hypovolemia (dehydration,blood loss), or severe renal impairment (CrCI of
30 ml minute or less).
•
Use cautiously in patients with long term alcohol use because therapeutic doses cause
hepatotoxicity in the patients.Chronic alcoholics shouldnshouldn't take more than 2 g of
acetaminophen every 24 hours.
•
Caution patient to contact health care provider if signs and symptoms of liver damage
52
(illogical thinking,severe dyspepsia,jaundice,inability to eat,weakness) occur.
Adverse Reaction:
CNS: agitation (IV),anxiety,fatigue,headache,insomnia,pryrexia.
CV: HTN,hypotension,peripheral edema,periorbital,edwedema,tachycardia (IV).
GI: nausea,vomiting,abdominal pain,diarrhea,constipation (IV).
GU: oliguria (IV).
Hematologic: hemolytic anemia,leukopenia,neutropenia,pancytopenia,anemia.
Hepatics: jaundice.
Metabolic:hypoalbuminemia
(IV),hypoglycemia,hypokalemia,hypervolemia,
hypomagnesemia,hypophosphatemia(IV).
Musculoskeletal: muscle spasms,extremity pain (IV).
Respiratory: abnormal breath sounds,dyspnea,hypoxia,atelectasis,pleuraUral effusion,pulmonary
edema,stridor,wheezing (IV).
Skin: rash,urticaria,infusion-site pain (IV),pruritus.
Nursing implications:
•
Condsider reducing total daily dose and increasing dosing intervals in patients with
hepatic or renal impairment.
53
Generic Name:
Brand Name:
DRUG STUDY NO. 4
Pantoprazole sodium
Classification: Antiulcer drugs
Prescribed & recommended dosage: 40 mg
Frequency: Once a day (OD)
Route of administration: IVTT
Mechanism of action: Inhibits proton pump activity by binding to hydrogen-potassium adenosine
triphosphatase,located at secretory surface of gastric cells to suppress gastric acid secretion.
Indication:
54
•
Short-term treatment of erosive esophagitis associated with GERD.
•
Long-term maintenance of healing erosive esophagitis and reduction in relapse
rates
of daytime and nighttime heartburn symptoms in patients with GERD.
•
Treatments
of
pathologipathologic
hypersecretion
caused
by
Zollinger-Ellision
syndrome.
•
Dyspepsia
Contraindication:
•
Contraindicated in patients hypersensitive to any components
•
PPI therapy may be
associated with
of the formulation.
ab increased risk of
osteoporosis-related
fractures.Patient should use lowest dose and shortest duration of therapy
appropriate to
condition being treated.
•
Cutaneous lupus erythematosuerythematous (CLE) and SLE have been reported,
occuring as both new onset and ablb exacerbation of existing autoimmune disease
of all ages within weeks to years after continuous drug therapy.
Adverse Reaction:
CNS: anxiety,asthenia,dizziness,headache,insomnia,migraine,pain,depression,vertigo.
CVS: chest pain, edema,thrombophlebitis.
EENT: blurred vision,pharyngitis,rhinitis,sinusitis.
GI: abdominal pain,constipation,diarrhea,dyspepsia,eructation,flatulence, gastroenteritis,
55
in patients
Generic Name:
Brand Name:
GI disorder,nausea,rectal
disorder,vomiting
GU:
urinary frequency,UTI.
Hematologic: leukopenia,thrombocytopenia.
Hepatic: elevated liver enzyme levels.
Metabolic: hyperglycemia,hyperlipidemia.
Musculoskeletal: arthralgia,back pain,hypertonia,neck pain.
Respiratory: bronchitis,dyspnea,increased cough,URI.
Skin: rash, pruritus,urticaria.
Other:flulike syndrome,infection,injection-site reaction,photosensitivity reactions.
Nursing implications
•
Symptomatic
response
to
therapy
doesndoesn't
preclude
the
presence
of
gastric
malignancy.
•
If signs are symptoms consistent with CLE or SLE to noted,discontinue drug and
patient to the appropriate specialist for evaluation.Most patients improve with
of the PPI alone in 4 to 12 weeks.
56
refer
discontinuaction
DRUG STUDY NO. 5
Morphine hydrochloride
Classification: Opioid analgesics
Prescribed & recommended dosage: 5 mg Ampule
Frequency:
Route of administration: IVTT
Mechanism of action: Unknown Binds with opioid receptors in the CNS,altering perceptioperception
of and emotional response pain.
Indication:
•
Moderate to severe pain
•
Moderate to severe pain requiring continuous,around-the-clock oral opioid.
Contraindication:
•
Contraindicated in patients hypersensitive to drug and in those with conditions that
preclude IV administration of opioids (acute bronchial asthma or upper
•
Contraindicated in patients with GI obstruction.
57
would
airways obstruction).
Generic Name:
Brand Name:
•
Use with caution in elderly or debilitated patients and in those with head injury,
ICP,seizures,chronic,severe
hepatic
or
renal
disease,acute
increased
abdominal
conditions,hypothyroidism,Addition disease, and urethral stricture.
•
Use with
caution in patients
wotwith
circulatory shock,biliary tract
disease,CNS
depression,toxic psychosis,acute alcoholism,delirium trementtremens, and seizures
disorders.
Adverse Reaction:
CNS:
dizzinedizziness,drowsiness,headache,euphoria,light-
headness,nightmares,sedation,somnolence,seizure,,depression,hallucinations,nervousness,physic
al
dependence,syncope,anxiety.
CV:
bradycardia,cardiac
arreest,shock,HTN,hypotension,tachycardia,palpitations,
peripheral
circulatory collapse,peripheral edema,chest pain,syncope.
EENT: miosis,blurred vision.
GI:
constipation,nausea,vomitiinvomiting,anorexia,biliary
tract
flatulence,abdominal pain.
GI: urine retention
Hematologic: thrombocytopenia,anemia,leukopenia.
Respiratory: apnea,respiratory arrest,respiratory depression
diaphoresis,edema,pruritus,skin flushing,pain at injection site.
Other: decreased libido.
Nursing implications:
58
Skin:
spasms,dry
mouth,ileus,
•
Reassess patients level of pain at least 15 and 30 minutes after giving parenterally
and 30 minutes after giving orally.
•
Monitor circulatory,respiratory,bladder,and bowel function,carefully.Drug may
cause
hypotension,urine retention,nausea,vomiting,ileus or altered level of
consciousness regardless of the route.
•
If respirations drop below 12 breaths/minute,withdholwithhold dose and notify prescriber.
•
Preservative-free preparations are available for epidural and intrathecal use.
administration had been associated with less potential for immediate or
than intrahecal administration;use epidural route whenever
•
Epidural
late adverse effects
possible.
A constant IV infusion of naloxone, 0.6 mg/hour,for 24 hours after intrathecal
injection
may be used to reduce potential adverse effects.
•
When drug is given epidurally,monitor patient closely for respiratory depression up
to 24
hours after the injection,Check respiratory rate and depth every 30 to 60
minutes for 24 hours.Watch for pruritus and skin flushing.
•
Morphine is drug of choice in relieving MI pain;may cause transient decrease in BP.
•
An around -the-clock regimen best man ages severe, chronic pain. Verify patients
breakthrough pain medication prescribed in addition to the around- the-
59
has a
clock medication.
•
Morphine may worsen or mask gallbladder pain.
•
Constipation is commonly severe with maintenance dose.Ensure that stool
stimulant laxative is ordered.
•
Taper morphine sulfate therapy gradually when stopping therapy.
60
softener or
DRUG STUDY NO. 6
Generic Name: Nalbuphine hydrochloride
Brand Name: Nubian
Classification: Opioid analgesics
Prescribed & recommended dosage: 5 mg Ampule
Frequency: PRN
Route of administration: IVTT
Mechanism of action: Unknown. Binda with opioid receptors in the CNS, alternating
perception of and emotional response to pain.
Indication:
•
Moderate to severe pain (non- opioid- tolerant patients).
•
Adjunct to balanced anesthesia; preoperative and postoperative analgesia; obstetric
analgesia during labor a band delivery.
Contraindication:
•
Contraindicated in patients hypersensitive to drug or its components and in those
significant respiratory depression, known or suspected GI obstruction
61
with
(including paralytic ileus),
and acute or severe asthma in an unmonitored setting
or in the absence of resuscitative
equipment.
•
Use cautiously and at low doses in patients with preexisting respiratory
•
Use cautiously in patients with history of drug abuse and in those with emotional in
compromise
stability, head injury, increased ICP, impaired ventilation, MI accompanied by nausea
and
vomiting, upcoming biliary surgery, or hepatic, renal or adrenal insufficiency.
•
Drug may cause mood disorders and osteoporosis.
Adverse Reaction:
CNS: dizziness, headache, sedation, vertigo.
CV: bradycardia, hypotension.
EENT: dry mouth.
GI: nausea, vomiting.
Respiratory: respiratory depression.
Skin: clamminess, diaphoresis
Nursing implications:
•
Reassess patients level of pain at least 15 and 30 minutes after parenteral
•
Drug acts as an opioid antagonist and may cause withdrawal syndrome.For
administration.
patients who
have received long-term opioids, give 25% of the usual dose initially.
Watch for signs of withdrawal.
•
Monitor circulatory and respiratory status and bladder and bowel function if
are shallow or rate is below 12 breaths/ minute, with hold dose and
notify prescriber.
62
respirations
•
Constipation is commonly severe with maintenance therapy. Make sure stool
softener
or other stimulant laxative is ordered.
• Psychological and physical dependence may occur with prolonged use.
• Don't confuse Nubian with Navane or Nebcin.Dont confuse nalbuphine with
DRUG STUDY NO. 7 Generic
Name: Cefixime
Brand name:
Classification: third-generation cephalosporins
Prescribed and recommended Dosage: 200 mg
Frequency: BID (twice a day)
Route of administration: Oral
Mechanism of action: Binds to the bacterial cell wall membrane, causing cell death.
Indication: Treatment of Urinary and gynecologic infections, including gonorrhea,
Respiratory tract infections, Otitis media.
63
naloxone.
Contraindication: Contraindicated in patients with known allergy to the cephalosporin group of
antibiotics.
Adverse Reactions:
CNS: seizures ( every high doses).
GI: pseudomembranous colitis, diarrhea, nausea, vomiting, cramps.
Derma: rashes, urticarial.
Hemat: bleeding, blood dyscrasias, hemolytic anemia.
Misc: allergic reaction, anaphylaxis and serum sickness, superinfection.
Nursing Implications:
•
Watch for seizures; notify physician immediately if patient develops or increases seizure activity.
•
Monitor signs of pseudomembranous colitis, including diarrhea, abdominal pain, fever, p us or
mucus in stools, and other severe or prolonged GI problems (nausea, vomiting, hear tburn).
Notify physician or nursing staff immediately of these signs.
•
Monitor signs of allergic reactions and anaphylaxis, including pulmonary symptoms (tigh tness
in the throat and chest, wheezing, cough dyspnea) or skin reactions (rash, pruritus, u rticaria).
Notify physician or nursing staff immediately if these reactions occur.
•
Assess muscle aches and joint pain (arthralgia) that may be caused by serum sickness. No tify
physician if these symptoms seem to be drug related rather than caused by musculosk eletal
injury or if muscle and joint pain are accompanied by allergy-like reactions (fever, r ashes, etc.)
•
Monitor signs of blood dyscrasias, including hemolytic anemia (unusual weakness and fat igue,
dizziness, jaundice, abdominal pain) and thrombocytopenia (bruising, nose bleeds, b leeding
gums, other unusual bleeding). Report these signs to the physician.
64
HUMAN ANATOMY AND PHYSIOLOGY
OF RENAL SYSTEM
65
The renal system consists of the kidney, ureters, and the urethra. The overall function of the
system filters approximately 200 liters of fluid a day from renal blood flow which allows for toxins,
metabolic waste products, and excess ion to be excreted while keeping essential substances in the blood.
KIDNEY ANATOMY
The kidneys are two bean-shaped organs responsible for
filtering minerals from the blood, maintaining overall fluid
balance, excreting waste products, and regulating blood volume to
name a few.
The kidneys are located on either side of the spine, in the retroperitoneal space. The left kidney is
situated a little higher than the right one, because of the liver on the right side of the abdominal cavity,
above the right kidney.
Parts of the Kidney
•
Kidney capsule (renal capsule) - The renal capsule consists of three layers of connective tissue
or fat that cover your kidneys. It protects your kidneys from injury, increases their stability and
connects your kidneys to surrounding tissues.
66
•
Renal Artery- The renal artery is a large blood vessel that controls blood flow into your kidneys.
For most people at rest, the renal kidneys pump a little over 5 cups (1.2 liters) of blood to your
kidneys each minute.
•
Renal cortex- The outer layer of your kidney, where the nephrons (blood-filtering units) begin.
The renal cortex also creates the hormone erythropoietin (EPO), which helps make red blood
cells in your bone marrow.
•
Renal medulla- The renal medulla is the inner part of your kidney. It contains most of the
nephrons with their glomeruli and renal tubules. The renal tubules carry urine to the renal pelvis.
•
Renal papilla-These pyramid-shaped structures transfer urine to the ureters. Dehydration and
certain medications, especially nonsteriodal anti-inflammatory drugs (NSAIDs) — may damage
your renal papilla.
•
Renal pelvis- This funnel-shaped structure collects urine and passes it down two ureters.
Urine travels from the ureters to the bladder, where it’s stored.
•
Renal vein- This vein is the main blood vessel that carries filtered blood out of your kidneys
and back to your heart. Each of your kidneys has a renal vein.
Ureter
•
Duct that transmits urine from the kidney to the bladder. There normally is one ureter for each
kidney. Each ureter is a narrow tube that is about 12 inches (30 cm) long. A ureter has thick
contractile walls, and its diameter varies considerably at different points along its length.
Urinary Bladder
67
•
This triangle-shaped, hollow organ is located in the lower abdomen. It is held in place by
ligaments that are attached to other organs and the pelvic bones. The bladder's walls relax and
expand to store urine, and contract and flatten to empty urine through the urethra.
Urethra
•
Duct that transmits urine from the bladder to the exterior of the body during urination. The
urethra is held closed by the urethral sphincter, a muscular structure that helps keep urine in the
bladder until voiding can occur.
ANATOMY AND PHYSIOLOGY
OF NEPHRONS
The nephron is the functional unit of the kidney, responsible for filtering and processing blood to
produce urine. Each kidney contains approximately one million nephrons, which are responsible for
regulating the body’s fluid and electrolyte balance.
THE BASIC PHYSIOLOGY OF A NEPHRON WITHIN A KIDNEY:
•
THE GLOMERULUS
The glomerulus is a capillary tuft that receives its blood supply from an afferent arteriole of the renal
circulation. Here, fluid and solutes are filtered out of the blood and into the space made by Bowman’s
capsule.
68
A group of specialized cells known as juxtaglomerular apparatus (JGA) are located around the
afferent arteriole where it enters the renal corpuscle. The JGA secretes an enzyme called renin, due to a
variety of stimuli, and it is involved in the process of blood volume homeostasis.
The Bowman’s capsule (also called the glomerular capsule) surrounds the glomerulus. It is
composed of visceral (simple squamous epithelial cells; inner) and parietal (simple squamous epithelial
cells; outer) layers. The visceral layer lies just beneath the thickened glomerular basement membrane
and only allows fluid and small molecules like glucose and ions like sodium to pass through into the
nephron.
Red blood cells and large proteins, such as serum albumins, cannot pass through the glomerulus
under normal circumstances. However, in some injuries they may be able to pass through and can cause
blood and protein content to enter the urine, which is a sign of problems in the kidney.
•
PROXIMAL CONVOLUTED TUBULE
The proximal tubule is the first site of water reabsorption into the bloodstream, and the site where
the majority of water and salt reabsorption takes place. Water reabsorption in the proximal convoluted
tubule occurs due to both passive diffusion across the basolateral membrane, and active transport from
Na+/K+/ATPase pumps that actively transports sodium across the basolateral membrane.
•
THE LOOP OF HENLE
The loop of Henle is a U-shaped tube that consists of a descending limb and ascending limb. It
transfers fluid from the proximal to the distal tubule. The descending limb is highly permeable to water
69
but completely impermeable to ions, causing a large amount of water to be reabsorbed, which increases
fluid osmolarity to about 1200 mOSm/L.
•
DISTAL CONVOLUTED TUBULE AND COLLECTING DUCT
The distal convoluted tubule and collecting duct is the final site of reabsorption in the nephron.
Unlike the other components of the nephron, its permeability to water is variable depending on a
hormone stimulus to enable the complex regulation of blood osmolarity, volume, pressure, and ph.
70
71
72
PATHOPHYSIOLOGY
(Narrative)
The predisposing factors that contribute to Autosomal polycystic kidney disease are gender, age,
genetic predisposition and heredity. Heredity is the main risk factor in acquiring APKD, it includes the
causative gene mutation within the context of family history. Age is also a major factor to acquire
APKD. Ages 30 to 50 above, for both males and females is common to have Autosomal polycystic
kidney disease. The patient’s age was 49 which still belong to the age group that commonly experiences
APKD. Males and females are approximately 90% common to have early exposure to APKD because
most of them acquire it through heredity. The patient had family history of Autosomal polycystic kidney
disease. The patient inherits the disease from her mother.
The precipitating factors for Autosomal polycystic kidney disease is UTI, smoking, stress,
hypertension, proteinuria, and diet. Recurrent UTI is one of the precipitating factors for the patient since
patient K had history of recurrent UTI since she was a child. Patient K had flank pain in which pale to
look and lethargic prior to hospitalization. This is the reason why the patient K was hospitalized. Poor
diet is also manifested on the client as one of the factors that contributed to
APKD.
Autosomal Polycystic Kidney Disease (APKD) is an inherited disorder in which fluid – filled
cysts develop in the nephrons. Cyst develop anywhere in the nephrons as in the renal parenchyma as a
result of kidney cell mutation and division, altered secretion, and abnormal cell matrix biology. Over
time, small cysts become larger up to a few centimeters in diameter and more widely distributed. The
growing cysts damage the glomerular and tubular membranes of the nephrons and the renal parenchyma.
As the cyst fill with fluid and enlarge, the nephron functions becomes less effective, meaning impaired
73
glomerular filtration, impaired reabsorption, impaired secretion, and impaired excretion. This will
eventually leads to decreased glomerular filtration rate causing hypertension.
Eventually, the kidney tissues are replaced by nonfunctioning cysts, which look like clusters of
grapes. The kidneys are grossly enlarged, each cystic kidney enlarges to two or three times its normal
size, becoming as large as a football. Other abdominal organs are displaced, and the patient has
discomfort of flank pain and abdominal pain. The fluid – filled cysts are also at increased risk for
infection, rupture of cysts, and bleeding. And all of this will lead to Chronic Kidney Disease and
possibly will become an End Stage Kidney disease.
If the illness is left untreated, the patient will have hypertension. The cause of hypertension is
thought to be related to renal ischemia from the enlarging cysts. As the blood vessels are compressed
and renal blood flow decreases, the renin-angiotensin system (RAAS) is activated resulting to high
blood pressure. If hypertension is untreated, this can disrupt the process that leads to renal ischemia or
even necrosis.
Eventually, the cysts may also occur in other neighboring tissues and system, such as liver,
blood vessels of the brain, and cardiac blood vessels. Cysts reduce liver function or results in bleeding
into the brain from ruptured intracranial vascular cysts (brain aneurysm). And in the colonic area
growing cysts causes diverticula, and herniation. And Heart abnormalities also occur like mitral valve
prolapse, and left ventricular hypertrophy, and even anemia. Because of the increased cysts expansion to
all neighboring systems it causes multiple organ ischemia, then multiple tissue sepsis and necrosis
causing multiple organ dysfunction, then multiple organ failure causing death.
Meanwhile, when the said illness will be treated properly through medications or surgical
interventions, there will be a restored blood flow. Through surgical interventions and renal replacement
74
therapy (hemodialysis) , the patient will experience restored blood flow and restored oxygen flow.
Managing the cysts growth and hypertension will slow the progression of the ESKD. So Kidney
transplant is likely to be the top most intervention to be given to the patient. Then this will give the
patient a continuous circulation of blood into the body, establishing good prognosis.
75
ASSESSMENT
Subjective cues:
NURSING CARE PLAN NO.1
“sakit ako kilid maam” as verbalized by the patient
-
pain scale of 7 out of 10
Objective cues:
-
Evidence of pain using standardized pain such as pain scale
-
Facial expression of pain V/S:
BP : 120/70 mmHg
TEMP: 36.9 °C
PR: 110 bpm
SPO2: 98%
RR: 20 cpm
Nursing Diagnosis:
Acute pain related to biological injury agent as evidenced by urinary tract infection
Planning:
After 2 hours of nursing intervention, patient will follow prescribed pharmacological regimen
Intervention:
Independent Interventions
Rationale
76
Encouraged patient the importance of taking the
prescribed medication
To improve overall health
Note client’s attitude toward pain and use of pain Patients may resist medication due to personal
medications, including any history of substance beliefs, have increased drug tolerance from
abuse.
recent use, or be unable to take pain medications
during substance abuse recovery.
Dependent Intervention
Tramadol
To manage moderate to moderately severe pain
Paracetamol
Pain reliever
Morphine, nubain PRN
opioid analgesic which is used in the treatment
of pain
Collaborative Interventions
Collaborate with medical providers in pain
assessment, including neurological and
psychological factors as appropriate when pain
persist
Enhances the accuracy of diagnosis and
facilitates the development of effective, holistic
treatment plans for improved patient outcomes.
Collaborate in treatment of underlying condition
or disease processes causing pain and proactive
management of pain
Addressing the root causes ensures targeted and
effective interventions, improving the overall
management of pain
EVALUATION
77
ASSESSMENT
Subjective cues:
Goal partially met after 2 hours of nursing intervention, patient was able to follow prescribed
pharmacological regimen.
NURSING CARE PLAN NO.2
“Ginagmay rakan ako kaon ma’am kay hamok naman bawal sa ako na pagkaon” as
verbalized by the patient Objective cues:
-
Weakness of muscles resulting from insufficient muscle tone.
-
Laboratory results (Hemoglobin: 9.2 g/dl, Hematocrit 26.9%, RBC: 3.04/L)
-
eyelid is pale
V/S:
TEMP: 36.9 °C
BP : 120/70 mmHg
PR: 110 bpm
SPO2: 98%
RR: 20 cpm
78
Nursing Diagnosis:
Impaired Nutrition: related to Insufficient dietary Intake associated with the effects of chronic kidney
disease, as evidenced by the presence of anemia.
Planning:
After 3 hours of nursing intervention, patient will verbalized understanding of causative factors
when known and necessary interventions.
Intervention:
Independent Interventions
Rationale
Conduct a thorough assessment of the patient's
current dietary habits, including their
understanding of dietary restrictions and
adherence to prescribed diets.
ensure they comprehend any dietary restrictions,
and assess whether they are following the diets
recommended by their healthcare provider
Explain the rationale behind dietary restrictions,
emphasizing the impact on kidney function and
overall health.
to maintain optimal kidney health by avoiding
foods that can stress the kidneys. This helps in
preserving proper fluid and electrolyte balance,
promoting overall wellbeing.
Dependent Intervention
Review indicated laboratory data
identify any abnormalities, monitor trends, and
informs clinical decision-making for appropriate
interventions and patient care.
79
ASSESSMENT
Subjective cues:
Determine psychological factors, perform
psychological assessment, as indicated
To assess body image and congruency with
reality
Collaborative Interventions
Consult with dietitian or nutritional support
team
For long term needs
Recommend and support hospitalization
For controlled environment in severe
malnutrition or life-threatening situations
EVALUATION
Goal met after 3 hours of nursing intervention, patient will verbalized understanding of causative
factors when known and necessary interventions.
NURSING CARE PLAN NO.3
“Hikapa nijo dire sa ako bat-ang” as verbalized by the patient
Pain scale: 7 out of 10 Objective cues:
80

Enlarge in right and left upper quadrant

Facial expression of pain V/S:
BP : 120/70 mmHg
TEMP: 36.9 °C
PR: 110 bpm
SPO2: 98%
RR: 20 cpm
Nursing Diagnosis:
Chronic pain related to enlarging kidneys compressing abdominal contents
Planning:
After 3 hours of nursing intervention patient will demonstrate and initiate behavioral
modifications of lifestyle and appropriate use of therapeutic interventions
Intervention:
Independent Interventions
Rationale
Evaluate client’s pattern of coping, and locus of
control
to identify how individuals manage stressors and
challenges in their lives.
Major effects of chronic pain on the clients life
Note Lifestyle effects of pain.
can include depressed mood, fatigue, weight loss
or gain, sleep disturbances, etc.,
Dependent Intervention
Administer Tramadol as Pysician order
to reduce the amount of pain
Morphine, nubain PRN
For pain relief
Collaborative Interventions
81
ASSESSMENT
Subjective cues:
Encourage participation in multidiscplinary pain
management plan
to address the complex nature of pain
Recommned or employ nonpharmacological
interventions, methods of pain control
To obtain comfort, improve healing, and
decrease dependency on analgesics
EVALUATION
Goal partially met After 3 hours of nursing intervention patient was able to demonstrate and initiate
behavioral modifications of lifestyle and appropriate use of therapeutic interventions.
82
83
NURSING CARE PLAN NO.
ASSESSMENT
4
Subjective cues:
“Naghubag ako mga kilid kay tungod sa ako sakit” as verbalized by the patient Objective cues:

Enlarged in right and left upper quadrant

WBC result 21.70 V/S:
BP : 120/70 mmHg
TEMP: 36.9 °C
PR: 110 bpm
SPO2: 98%
RR: 20 cpm
Nursing Diagnosis:
Infection related to the presence of cysts and decreased renal blood flow as evidenced by
increased WBC which is 21.70 Planning:
After 3 hours of nursing intervention patient will understand causative or risk factor.
Intervention:
Independent Interventions
Rationale
Monitor Vital Signs and WBC Trends
Regular monitoring of vital signs and tracking
trends in WBC counts helps detect early signs of
worsening infection.
84
Practice and emphasize strict aseptic technique
minimizes the risk of introducing additional
pathogens, preventing secondary infections.
Dependent Intervention
cefixime
antibiotic used to treat many different types of
infections
Meromax
broad-spectrum antibiotic which treat a variety
of bacterial infections.
Collaborative Interventions
Assess with medical procedure as indicated
Encourage early ambulation, deep breathing,
coughing, position changes
romoting optimal recovery and preventing
complications.
EVALUATION
After 3 hours of nursing intervention goal partially met patient able to understand causative or risk
factor.
85
NURSING CARE PLAN NO.
ASSESSMENT
5
Objective cues:
 Decrease hemoglobin (8.0 g/dl) and hematocrit (23.5 %) V/S:
BP : 120/70 mmHg
TEMP: 36.9 °C
PR: 110 bpm
SPO2: 98%
RR: 20 cpm
Nursing Diagnosis:
Risk for excess fluid volume possibly evidence by chronic kidney disease seconday to
autosomal dominant polycystic kidney disease
Planning:
86
After 2 hours of nursing interventions list signs that require further evaluation
Intervention:
Independent Interventions
Rationale
Note the presence of medical conditions or
situations
vital for accurate diagnosis, treatment planning,
and the provision of appropriate medical care.
Measure abdominal girth
Changes may indicate increasing fluid
retention/edema.
Collaborative Interventions
Measure vital signs and invasive hemodynamic
parameters, pulmonary capillary wedge pressure
when indicated.
Pressure may be high because of excess fluid
volume or low if cardiac failure is occurring.
Prepare for and assist with procedures when
indicated
May be done to correct fluid volume overload,
correct electrolyte and acid-base imbalances, or
improve cardiac function and support individual
during shock state
EVALUATION
After 2 hours of nursing interventions goal partially met, list signs that required further evaluation and
were able to be assessed.
87
NURSING CARE PLAN NO.
ASSESSMENT
88
6
“maglisod ko pag higda, naghubag ang ako duha ka kidney ma’am” as verbalized by the patient
Objective cues:
- Differential count (Segmenters 93.2%)
V/S:
BP : 120/70 mmHg
TEMP: 36.9 °C
PR: 110 bpm
SPO2: 98%
RR: 20 cpm
Nursing Diagnosis:
Impaired comfort related to inflammation both left and right upper quadrant possibly evidence by
chronic kidney disease secondary to autosomal dominant polycystic Planning:
After 2 hours of nursing intervention patient will engage in behaviour or lifestyle changes to increase
level of ease
Intervention:
Independent Interventions
Rationale
Determine type of discomfort client is
experiencing
Help client identify the focus of discomfort
89
NURSING CARE PLAN NO.
ASSESSMENT
Subjective cues:
Note coping skills have been used previously to
promote well-being
Bring clients awareness and promotes use in the
current situation
Dependent Intervention
cefixime
Meromax
antibiotic used to treat many different types of
infections
broad-spectrum antibiotic which treat a variety
of bacterial infections
Collaborative Interventions
Colloborate in treating or managing medical
conditions
Promote physical stability
Discuss interventions/activities
Promote ease and relaxation and to refocus
attention
EVALUATION
After 2 hours of nursing intervention goal partially met, patient was able to engaged in behaviors or
lifestyle changes to increased level of eased
90
7
Objective cues:
laboratory result (creatinine 7.35mg/dl)
 Enlarge V/S:
BP : 120/70 mmHg
TEMP: 36.9 °C
PR: 110 bpm
SPO2: 98%
RR: 20 cpm
Nursing Diagnosis:
91
NURSING CARE PLAN NO.
ASSESSMENT
Subjective cues:
Risk for renal failure possibly evidenced by elevated laboratory result of creatinine 7.35mg/dl
Planning:
After 3 hours of nursing intervention patient will display hemodynamic stability
Intervention:
Independent Interventions
Rationale
Monitor vital signs
allows for early detection of subtle changes
Monitor Fluid Intake and Output
assess renal perfusion and function
Dependent Intervention
Administer medication as indicated
Review Diagnostic test
essential for early detection, accurate diagnosis,
and effective management
Collaborative Interventions
Assess urine output hourly or peridically; weigh
daily, nothing total fluid balance
Allow timely alterations in therapeutic regimen
Assist with preparations for and monitor
response to support procedures or devices as
indicated
Close monitoring is essential to detect any
adverse responses promptly and ensure the
safety and well-being of the patient.
EVALUATION
92
After 3 hours of nursing intervention goal partially met, patient was able to display hemodynamic
stability
8
93
NURSING CARE PLAN NO.
ASSESSMENT
Subjective cues:
“Maglisod lagi ko tuyog kay ining may insomnia ko” as verbalized by the patient Objective cues:

reports difficulty falling sleeping

Patient appears fatigued and sleepy
V/S:
BP : 120/70 mmHg
TEMP: 36.9 °C
PR: 110 bpm
SPO2: 98%
RR: 20 cpm
Nursing Diagnosis:
Disturbed sleep pattern possibly evidenced by Insomnia Planning:
"After three hours of nursing intervention, patient will demonstrate ability to identify appropriate
interventions for promoting sleep."
Intervention:
Independent Interventions
Rationale
Identify presence of of factors known to
interfere with sleep
Sleep problems can arise from internal and
external factors and may require assessment
over time to differentiate specificic causes
Listen to report of sleep quality
Helps clarify clients perception of sleep quantity
and quality and response to inadequate sleep
94
Dependent Intervention
administering prescribed sleep medications as
indicated
to ensure that the chosen medication is
appropriate for the patient's condition
Collaboration
Refer to sleep physician or sleep specialist as
indicated
For specific interventions and/or therapies,
including medications, biofeedback
EVALUATION
After three hours of nursing intervention goal partially met, patient demonstrated ability to identify
some appropriate interventions for promoting sleep
95
NURSING CARE PLAN NO.
ASSESSMENT
Subjective cues:
96
DISCHARGE PLAN
MEDICATIONS:
•
Instructed the patient to take Cefixime twice a day orally.
•
Emphasized the medications to manage blood pressure, slow cyst growth, and address specific
CKD-related issues.
•
Established a routine for medication administration, and use pill organizers to enhance
adherence.
ENVIRONMENT:
•
Designate comfortable and socially engaging spaces within the home for family interactions and
support.
•
Minimize environmental stressors by creating a quiet and calming living space.
•
Maintain a comfortable room temperature, especially if the patient experiences temperature
sensitivity.
TREATMENT:
•
Advised the patient to follow and take the medications properly as prescribed by the physician
and discussed on the importance of strict adherence to medications.
•
Instructed the patient to follow proper instructions of medications prescribed by the physician
(dosage).
•
Instructed the patient to understand and follow discharge plan instructions religiously and
accurately.
HEALTH TEACHING:
•
Emphasized the role of blood pressure medications in slowing CKD progression.
97
•
Discussed symptoms that may indicate worsening kidney function.
•
Stressed the importance of regular follow-up appointments with nephrologists and other
healthcare providers.
OPD-FOLLOW-UP:
•
Instructed the patient to have check-ups or to consult the physician once in a while to monitor
patient’s condition and for detection of recurrences and other complications that
may arise.
•
Reminded the patient to consult the physician when signs and symptoms are observed
DIETARY MANAGEMENT:
•
Discussed restrictions on sodium, potassium, phosphorus, and protein intake.
•
Ensured the availability of kidney-friendly foods in the home.
•
Emphasized a well-balanced diet with a variety of fruits, vegetables, whole grains, lean proteins,
and healthy fats.
•
Considered high-quality protein sources, such as lean meats, fish, poultry, and plant-based
proteins.
•
Increased fluid intake up to 3 liters a day to control and managing blood pressure.
SPIRITUAL:
•
Collaborated on incorporating spiritual coping techniques into the patient's daily life.
•
Explored prayer, meditation, mindfulness, or other practices that align with their beliefs.
•
Explored ways in which their spiritual beliefs contribute to a sense of meaning and purpose.
•
Assisted in creating a sacred or peaceful space within the patient's home for reflection and
spiritual practices.
98
APPENDICES
GENOGRAM
Chronic Kidney
Disease
86 Y/O
Diabetes/
Hypertension
63 Y/O
Diabetes/
Hypertension
61 Y/O
Heart Failure
42 Y/O
High blood/
Polycystic
Kidney Disease
55 Y/O
Chronic Kidney
Disease 2°
Autosomal Polycystic
Kidney Disease
49 Y/O
Alive
27 Y/O
99
Alive
50 Y/O
LEGENDS:
Mother
Father
Patient
Patient’s Brothers
Husband
Child (Female)
Deceased
IVF CHART
NO. OF
BOTTLE
DATE
11/6/23
11/8/23
11/9/23
11/9/23
11/11/23
1
2
3
4
5
SOLUTION
VOLUME
1L
1L
1L
1L
1L
ADDITIVE
PNSS
PNSS
PNSS
PNSS
PNSS
RATE OF
FLOW
15 gtts/min
15 gtts/min
15gtts/min
15gtts/min
15gtts/min
TIME
8 AM
4 AM
4:50 AM
9 AM
Sodium Bicarbonate
NO. OF
BOTTLE
DATE
11/6/23
11/7/23
11/7/23
11/8/23
11/9/23
1
2
3
4
5
SOLUTION
VOLUME
250 ml
250 ml
250 ml
250 ml
250 ml
ADDITIVE
NaHCO3
NaHCO3
NaHCO3
NaHCO3
NaHCO3
100
RATE OF
FLOW
10 gtts/min
10 gtts/min
10 gtts/min
10 gtts/min
10 gttts/min
TIME
11:40 PM
9:30 AM
11:20 PM
12:00 AM
2:25 AM
VITAL MONITORING SHEET
Blood
pressure
Pulse Rate
9:30 PM
130/80
115
23
37.4
98%
12:00 MN
120/80
89
20
36.5
98%
4:00 AM
120/70
70
20
36.4
98%
8:00 AM
120/80
80
21
36
99%
12:00 NN
120/90
89
20
36.8
99%
4:00 PM
110/80
85
20
38.5
99%
Date/Time
Respiratory Rate
Temperature
Oxygen Saturation
11/6/23
11/7/23
101
8:00 PM
12:00 MN
ASLEEP
110/80
79
4:00 AM
5:00 AM
20
36.3
97%
ASLEEP
110/80
80
20
36.9
97%
8:00 AM
120/80
91
20
36.8
98%
12:00 NN
130/80
76
20
36.7
99%
4:00 PM
140/80
98
21
37.5
99%
11/8/23
5:00 PM
37.9
8:00 PM
110/80
99
20
37.2
98%
12:00 MN
130/90
112
21
38
98%
6:00 AM
110/80
101
21
37.3
97%
8:00 AM
140/90
107
20
37.3
99%
12:00 NN
130/90
108
21
36.6
99%
11/9/23
2:30 PM
38.1
4:00 PM
120/70
110
20
36.9
98%
8:00 PM
130/80
101
21
37.1
97%
12:00 MN
4:00 AM
ASLEEP
110/80
98
21
36
99%
8:00 AM
120/90
104
20
36.8
99%
12:00 NN
110/80
89
20
36.7
98%
11/10/23
102
INPUT AND OUTPUT
Date
Clinical
shift
IVF
Credit
Consumed
ML
750ml
250ml
SD
250ml
250ml
Oral
Fluid
Intake
Total
Urine
Vomitus
Stool
Total
350ml
850ml
-
-
-
0ml
9PM4AM
11/6/23
TOTAL =
850ml
TOTAL =
0ml
6AM6PM
11/7/23
ML
200ml
550ml
SD
250ml
250ml
50ml
150ml
1,000ml
1,800ml
1,000ml
1X
-
1,000ml+1X
1,000ml
1,450ml
1,000ml
1X
-
1,000ml+1X
3250ml
TOTAL =
6PM6AM
ML
SD
200ml
300ml
TOTAL =
2,000ml+2X
6AM6PM
ML
11/8/23
SD
600ml
450ml
260ml
230ml
ML
NH
600ml
SD
320ml
270ml
800ml
1,480ml
600ml
1X
-
600ml+1X
400ml
1,270ml
600ml
-
-
600ml
2,750ml
TOTAL=
880ml
650ml
6PM6AM
TOTAL=
1,200ml+1X
6AM6PM
11/9/23
ML
700ml
300ml
SD
140ml
180ml
400ml
103
-
-
650ml
6PM6AM
ML
NH
700ml
400ml
SD
0ml
1,240ml
1000ml
2,120ml
TOTAL=
-
-
1,000ml
140ml
TOTAL=
1,650ml
DEFINITION OF TERMS
Chronic Kidney Disease(CKD) - CKD is a condition in which the kidneys are damaged and cannot filter blood
as well as they should.
Polycystic Kidney Disease - PKD is an inherited disorder in which clusters of cysts develop primarily within
your kidneys, causing your kidneys to enlarge and lose function over time.
Autosomal Dominant - is a pattern of inheritance characteristic of some genetic disorders. “Autosomal” means
that the gene in question is located on one of the numbered, or non-sex, chromosomes. “Dominant” means that a
single copy of the mutated gene (from one parent) is enough to cause the disorder.
Glomerular filtration rate (GFR) - is a blood test that checks how well your kidneys are working. Your
glomerular filtration rate is the rate at which your blood is filtered each minute.
Glomerular hyperfiltration - is a situation where the filtration elements in the kidneys called glomeruli produce
excessive amounts of pro-urine. It can be part of a number of medical conditions particularly diabetic nephropathy
(kidney damage associated with diabetes).
Renal insufficiency (also called renal failure, kidney failure, end-stage renal disease, ESRD) - is a condition in
which the kidneys can no longer function correctly to filter the blood, control fluid levels in the body, and
maintain proper blood pressure and chemistry.
Hematuria - blood in the urine is called hematuria.
Hypertension - is blood pressure that is higher than normal.
Anemia - is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide
oxygen to body tissues.
104
Hemodialysis - is a procedure where a dialysis machine and a special filter called an artificial kidney, or a
dialyzer, are used to clean your blood. To get your blood into the dialyzer, the doctor needs to make an access, or
entrance, into your blood vessels. This is done with minor surgery, usually to your arm.
Peritoneal dialysis - is a treatment for kidney failure that uses the lining of your abdomen, or belly, to filter your
blood inside your body. Health care providers call this lining the peritoneum. A few weeks before you start
peritoneal dialysis, a surgeon places a soft tube, called a catheter, in your belly.
Kidney transplant or Renal transplant - is the organ transplant of a kidney into a patient with end-stage kidney
disease. Kidney transplant is typically classified as deceased-donor or living-donor transplantation depending on
the source of the donor organ.
Nephrolithiasis - is the term employed for kidney stones, also known as renal calculi, and they are crystal
concretions formed typically in the kidney. Calculi typically form in the kidneys and ideally leave the body via the
urethra without pain. Larger stones are painful and may need surgical intervention.
Urinary Tract Infections (UTIs) - are common infections that happen when bacteria, often from the skin or
rectum, enter the urethra, and infect the urinary tract. The infections can affect several parts of the urinary tract,
but the most common type is a bladder infection (cystitis).
Cystitis - is inflammation of the bladder, usually caused by a bladder infection. It's a common type of urinary tract
infection (UTI), particularly in women, and is usually more of a nuisance than a cause for serious concern.
Mitral valve prolapse, also known as Barlow syndrome - is a type of heart valve disease in which the flaps
(also called leaflets or cusps) of the mitral valve become enlarged or stretched. These enlarged flaps bulge
(prolapse) into the left atrium as the heart contracts with each heartbeat.
Surgical drainage - are tubes placed near surgical incisions in the post-operative patient, to remove pus, blood or
other fluid, preventing it from accumulating in the body.
Fiberoptic intubation (FOI) - is an effective technique for establishing airway access in patients with both
anticipated and unanticipated difficult airways.
Nephrectomy - is a surgery to remove all or part of a kidney. Most often, it's done to treat kidney cancer or to
remove a tumor that isn't cancerous. The doctor who does the surgery is called a urologic surgeon.
Partial hepatectomy - is the surgical removal of a portion of the liver. Also called a liver resection, the procedure
is meant to remove parts of the liver affected by cancerous tumors and leave behind other liver sections to perform
normal functions.
105
Hepatomegaly - is enlargement of the liver beyond its normal size. Certain conditions such as infection, parasites,
tumors, anemias, toxic states, storage diseases, heart failure, congenital heart disease, and metabolic disturbances
may all cause an enlarged liver.
Liver transplant - is surgery to replace a diseased liver with a healthy liver from another person. A whole liver
may be transplanted, or just part of one. In most cases the healthy liver will come from an organ donor who has
just died. Sometimes a healthy living person will donate part of their liver.
Nephron - is the basic structural and functional unit of the kidney. They are the microscopic structure composed
of a renal corpuscle and a renal tubule. The word nephron is derived from the Greek word – nephros, meaning
kidney. There are about millions of nephrons in each human kidney.
Glomerulus- is the main filtering unit of the kidney. It is formed by a network of small blood vessels (capillaries)
enclosed within a sac called the Bowman's capsule. The space inside the capsule that surrounds the glomeruli is
known as the Bowman's space. Each glomerulus is located at the beginning of the nephron.
Glomeruli - are the tiny network of blood vessels that are the “cleaning units” of your kidney. They filter waste
and remove extra fluids from your blood.
REFERENCES
Book References:
•
Doenges, M.E., Nurse’s Pocket Guide; 11th edition, California, 2007
•
Marieb, E 2008, Essesntials of Human Anatomy and Physiology 9th edition, Pearson,
Philippines •
•
Johnson, J.Y., Textbook of Medical Surgical Nursing, 11th edition, 2008
106
•
Brunner and Suddarth’s Textbook of Medical – Surgical Nursing 15th edition
•
Ignatavicius and Workman Medical – Surgical Nursing Critical Thinking For Collaborative
Care 5th edition
Electronic References:
Bayani D. Almirol B. Uy G. et al. An economic evaluation of policy options for kidney
replacement coverage in the Philippines. Nephrology. 2021; 26: 170-177
Schrier RW, McFann KK, Johnson AM. Epidemiological study of kidney survival in autosomal
dominant polycystic kidney disease., Kidney Int 2018;63(2):678-85. [Pubmed]
Vicente E Torres MD, William M Bennett MD. Diagnosis of and screening for autosomal
dominant polycystic kidney disease. UpToDate website. Updated: September 2, 2015. Accessed
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