DEMOGRAPHIC DATA

 Name: PATIENT K
 Age: 55 years
 Marital Status: Unmarried
 Religion: Islam
 Education: BSc
 Diagnosis and Surgery: Chronic Renal Failure and Dialysis
 Allergies: None
SCENARIO
55 year old female patient came in for hemodialysis she si scheduled twice a week, with a complicated
past medical history. She was known case of DM, HTN. She was diagnosed with Renal Failure about 3
years back and since then she has been on dialysis. She is Hypertensive since 22 years. DM was
diagnosed about 28 years back
SURGERIES
She had breast cancer and right breast mastectomy was done about 23 years back. She had cataract and a
surgery was done for both the eyes.
LAB RESULT:

MEDICATIONS

 Erythropoietin
 allopurinol
 Ferrous Sulphate- Iron
 Sodium Bicarbonate
PATHOPHYSIOLOGY

ADDITIONAL INFORMATION
CAUSES

 The most common causes of chronic renal failure are diabetes mellitus (type 1 or type 2 diabetes)
and high blood pressure.
 The most common cause of end-stage renal failure worldwide is IgA nephropathy (an
inflammatory disease of the kidney).
 One of the complications resulting from diabetes or high blood pressure is the damage to the
small blood vessels in the body. The blood vessels in the kidneys also become damaged, resulting
in CKD.
SIGN AND SYMPTOMS

 Decreased urination Blood in the urine (not a common symptom of chronic renal failure)
 Urine that is cloudy or tea-colored
 Fatigue
 Shortness of breath
 Loss of appetite
 Nausea and vomiting (this is a common symptom)
 Thirst
 Bad taste in the mouth or bad breath
 Weight loss
 Generalized, persistent itchy skin
 As the kidney failure gets worse and the toxins continue to build up in the body, seizures and
mental confusion can result.
COMPLICATIONS

 Anemia
 High blood pressure (hypertension)
 Increased risk of bleeding
 Increased risk of infection
 Fluid overload (called edema)
 Dehydration
 Electrolyte abnormalities (e.g., hyperkalemia, high levels of potassium in the blood)
MEDICAL AND SURGICAL MANAGEMENT
People with chronic Kidney failure have 3 treatment choices
1. Dialysis
2. Renal Transplant
3. Conservative Treatment
DIALYSIS (DIA- THROUGH, LYSIS – LOOSENING)
INDICATIONS

 Serum creatinine> 4.0g/dL

 GFR falls to <20 mL/min
In the patient with acute kidney injury -vowel acronym of “AEIOU” is followed
1. Acidemia from metabolic acidosis
2. Electrolyte abnormality, such as severe hyperkalemia,
3. Intoxication that is acute poisoning with a dialyzable substance.
4. Overload of fluid
5. Uremia complications, such as pericarditis, encephalopathy, or gastrointestinal bleeding.
PATIENT ASSESSMENT
FAMILY HISTORY
Two of her elder sisters had been diagnosed with the Renal Failure and 1 of them died. Diabetes and
Hypertension ran in the family.
HEALTH PERCEPTION HEALTH MANAGEMENT PATTERN

 General state of health: Client stated that

 No medications were taken at home.
 Immunization Status: Full
 Pt. was aged, weak, neat and clean and was lying on the bed.
 Pt. was treated previously for HTN, DM, cataract surgery and mastectomy.
ACTIVITY EXERCISE PATTERN
Reparatory rate: 20 breaths/min, Regular and normal breaths, no use of accessory muscles, breath sounds
were normal and no cyanosis observed. No accessory devices were used by the patient
CIRCULATION
Temperature was 37OC, BP was 124/64 mmHg & Pulse rate was 130 bpm, regular. Capillary refill within
2 seconds. Extremities were pale and warm with no edema.
COGNITIVE PERCEPTUAL PATTERN

 Patient was conscious and was oriented to time, place and person.
 Memory: Recent: Active
 Speech: Clear
 Was able to share her feelings
 Pain score was zero
NUTRITION METABOLIC PATTERN

 Patient's Weight was 63 Kg and Height

 Skin was intact, lesions (1-2cm) and stage:1( Dryness) present on iliac region and on back of the
neck and turgor was loose due to aging. Verbalized itching per sessions.
 Weight loss in last six months: Approx. 6-7 kg.
ELIMINATION PATTERN

 Abdomen: Soft, Distended, Bowel sounds present

 Bladder: Soft, Urine clear
 Bowel function normal
 No stomach cramping
SLEEP AND REST PATTERN
According to the family, patient used to sleep for1– 2 hours in the afternoon and 8 hours at night. Feel
rested and relaxed when awaked. Quality of sleep was good. No use of sleeping aids