MODIFIABLE

NON-MODIFIABLE

Family history of Kidney

disease
High Blood
Pressure Family history of HPN
High Sodium Diet Asian origin
Age (55 y.o.)

walls of arteries
supplying the kidney High Damaged blood Impaired Kidney can't filter
Proteinuria Increased
begin to thicken in intraglomerular vessels in the glomerular fluid and waste
Microalbuminuria fluid volume
order to withstand pressure kidney filtration from blood
the pressure

Lung consolidation H BUN

H 300 mg/dL Cholesterol H Creatinine
L 40 mg/dL HDL L protein in blood
H 250 mg/dL LDL L Albumin in blood
H 180 mg/dL Triglycerides H K level
Dark yellow urine L Ca level
(+) protein in urine H P level
L Mg level
CHRONIC
KIDNEY
DISEASE

Headache
Productive cough Discomfort
Poor appetite Anxious
Difficulty breathing
signs and symptoms high blood pressure signs and symptoms Facial flushing
RR: 30 cpm
Fatigue PR: 105 bpm
Rales on both lung fields
H BUN RR: 30 cpm
Reduced lung excursion
Increased fremitus H Creatinine
Edema
Lung consolidation

Ineffective breathing pattern related to Anxiety related to change in health

fatigue and decreased lung expansion Ineffective tissue perfusion related to
status and role function as evidenced by
as evidenced by productive cough, inability of the kidneys to produce renin as
concerns about life events, restlessness,
dyspnea, fremitus and use of evidenced by high blood pressure
and distress.
accessory muscles.

INDEPENDENT:
>Assess and record respiratory rate and depth at least INDEPENDENT:
every 4 hours. INDEPENDENT: >Observe how the patient uses coping techniques and
>Utilize pulse oximetry to check oxygen saturation and pulse >Administer medication as ordered. defense mechanisms to cope with anxiety.
rate. >Review lab results such as BUN and creatinine levels. >Use presence, touch (with permission), verbalization, and
>Monitor for diaphragmatic muscle fatigue or weakness >Monitor BP periodically and ascertain patient?s usual range. demeanor to remind patients that they are not alone and to
(paradoxical motion). >Observe for dependent generalized edema. encourage expression or clarification of needs, concerns,
>Observe presence of sputum for amount, color, consistency. DEPENDENT:
unknowns, and questions.
DEPENDENT: >Administer hypertensive drugs such as Telmisartan (ARB) and > Explain all activities, procedures, and issues that involve the
>Suction airway, as needed. Amlodipine (Calcium Antagonist) as ordered.
patient; use nonmedical terms and calm, slow speech.
>Provide respiratory medications and oxygen, as ordered by the >Provide diet restriction as ordered, while providing adequate DEPENDENT:
physician. calories. >Administer medications (anti-anxiety agents/sedatives) as
> Ambulate patient as tolerated with physician?s order three times COLLABORATIVE: ordered.
daily. >Collaborate with a dietician to create an individualized diet, COLLABORATIVE:
COLLABORATIVE: preferably a low salt low fat diet. >Refer to individual/group therapy, as appropriate.
> Send specimen for culture and sensitivity testing if
sputum appears to be discolored.

DRUGS DRUGS

After 8 hours of continuous nursing interventions, the patient

was: After 8 hours of continuous nursing interventions, the patient After 8 hours of continuous nursing interventions, the patient:
>Able to maintain a better breathing pattern, without the was able to: >Appear more relaxed and anxiety is reduced to a
presence of dyspnea. >demonstrate behavioral and lifestyle changes such as manageable level.
>Respiratory rate is has lowered from 30cpm down to limiting the sodium intake, bad cholesterol intake, doing >Verbalized awareness of feelings of anxiety.
22cpm. physical activities like walking and light exercises for at least >Identified ways to reduce anxiety like talking to her spouse,
>Verbally indicated she feels more comfortable now when 30 minutes a day. being in a quiet environment and watching some light T.V.
breathing. >Strictly follow and take the medications as prescribed by shows.
>Not having a hard time doing ADLs and breathing pattern is the physician.
more stable.

Aspirin 80mg/tab OD
Atorvastatin 40mg/tab ODHS
Telmisartan 80mg/tab OD
Amlodipine 10mg/tab OD
Metoprolol 5mg/tab BID
NO MEDS FOR CKD