Nonmodifiable
Risk Factors
Age: 70 y/o
Family History of Diabetes
and Hypertension
Doctor's Order (DO):
Healthy eating.
Regular exercise.
Blood sugar monitoring.
Diabetes medication or
insulin therapy.
Increase glucose uptake & glycolysis
in glomerular & tubular cells
Increase free radical production
(Oxidative stress)
Aberrant extracellular matrix
protein expression and
accumulation
Mesangial matrix expansion
Tubular fibrosis
Damaged Scarred
nephrons glomeruli
Decreased in glomerular
filtration rate (GFR)
Cigarette smoking since 20 y/o Eating Habits: Modifiable
Frequent eating of meat (e.g. letchon) Risk Factors
Nicotine in cigarette reduce insulin Not eating vegetables Mechanism
release & negatively affect insulin action Signs & Symptoms
High amount of "heme" iron Laboratory Values
Insulin resistance Nursing
Management
(liver, muscle, adipose tissue become less Oxidative stress & inflammation
responsive to insulin, and thus less able to use Medical
glucose as a fuel source) Management
Pharmacological
Management
Insulin Therapy
TYPE II DIABETES COMPLICATION
(Diagnosed at 63y/o) Linagliptin 5g tab 1 tab once a day DISEASE
Poor glycemic control = hyperglycemia Increased glucose load to kidney Increased proximal tubule
reabsorption of Na
Increased activation of Renin-angiotensin system (RAS) Activation of
tubuloglomerular Decreased NaCl to distal
Increased intrarenal angiotensin II positive feedback tubule
Afferent arteriole dilatation, Increased Blood volume next page:
Efferent arteriole constriction Increased Blood pressure HYPERTENSION
Increased Renal perfusion
Increased intraglomerular
Sheer stress to glomerular --> pressure-induced damage capillary pressure
Protein endocytosis into tubular Increased glomerular basement
cells causing inflammation membrane permeability to proteins
KIDNEY DISEASE
 Overtime, smooth Smooth muscle of kidneys
muscles of afferent afferent arterioles Thickening of arteriolar Problem: Patient does not do
arterioles constricts to prevent wall and narrowing of any physical activity at home.
hypertrophy from transmission of increased afferent arterioles Nursing Intervention: Educate
continuation:
prolonged blood pressure to the pt on the importance of
HYPERTENSION vasoconstriction glomerulus physical activity and provide
Increased glomerular
examples like walking around
blood flow
or in front of the house, assisted
Chronic stress and Injury leads to excretion of by his wife.
trauma on cytokines and extracellular Glomerular sclerosis and
Amlodipine endothelial and matrix such as fibrin and tubular atrophy
10mg tab OD smooth muscle cells collagen into DO: Increase physical activity
of kidney subendothelial layer as tolerated
Clonidine 75g tab Further decreased
kidney function
(1tab Sublingual if Trimetazidine 35 tab DO: Smoking cessation
Chest pain Pale skin
BP ≥160/100 1 tab 2x a day Aggravating: DO: Control and manage
Fatigue Shortness of Hypertension & Diabetes
breath
Weakness KIDNEY DISEASE
Pain Azithromycin 500mg tab
FeSO4 (Ferrous Sulfate) Cold hands and 1 tab once a day for 5 days
+ Folic Acid tab feet Headaches Decreased
1 tab once a day erythropoietin Clopidogrel 75mg tab
production by 1 tab once a day
Epoetin 4,000U SubQ ANEMIA kidneys
2x/week Sodium bicarbonate
DO: Low salt, Low fat Increased NaHCO3 650mg tab
Problem: Patient does not diet creatinine and urea 1 tab 3x a day
follow the prescribed diet.
Ketoaminologue tab next page:
2 tabs 3x a day

Febuxostat 40mg tab Increased Fluid Pitting DO: Low salt, Low fat diet
1 tab once a day retention edema DO: 1L of water or less per day

Nonmodifiable Modifiable Nursing Medical Pharmacological

Risk Factors Risk Factors Mechanism Signs & Symptoms Laboratory Values Management Management Management DISEASE COMPLICATION
continuation: Heart needs to pump Stress Nonmodifiable
Risk Factors
blood faster to the kidneys to heart
KIDNEY DISEASE HEART Modifiable
Change in blood pressure DISEASE Risk Factors

Stage 1 Mechanism
GFR>90mL/min/1.73m^2 Signs & Symptoms
Stage 2 Laboratory Values
GFR=60-89mL/min/1.73m^2
Nursing
Management
Stage 3
GFR=30-59mL/min/1.73m^2 Medical
Management
Stage 4 Pharmacological
GFR=15-29mL/min/1.73m^2 Chest pain Pale skin Management
FeSO4 (Ferrous Sulfate)
Shortness of + Folic Acid tab COMPLICATION
Stage 5 Fatigue
GFR=<15mL/min/1.73m^2 breath 1 tab once a day
DISEASE
End-stage kidney disease or Weakness
Pain Epoetin 4,000U SubQ
Chronic Kidney Disease (CKD)
Cold hands and 2x/week
feet Headaches
RBC Count: 3.0x10^12/L
DO: Control and DO: Hemodialysis (IJ
manage Hypertension & graft) 2x a week. ANEMIA Hemoglobin: 94.0 g/L
Hematocrit: 0.28
Diabetes
DO: Increase physical Increased Problem: Patient does not follow the prescribed diet.
DO: Continue Low salt, Nursing Diagnosis: Ineffective Health Management related to failure to follow and
activity as tolerated creatinine and include treatment regimen (i.e. diet plan and food restrictions) to daily living, lack
Low fat diet, No fruits urea of motivation.
DO: Smoking cessation Nursing Intervention:
DO: Continue taking Creatinine: 6.69 mg/dL 1. Review with the patient and SO the disease process and the treatment regimen
medications as DO: 1L of water or less for hypertension, diabetes, anemia, and kidney disease.
2. Explain to the patient about the advantages of adhering to the prescribed
prescribed per day regimen.
3. Coordinate the therapy to the patient’s lifestyle.
4. Involve significant others in explanations and teaching. Encourage their
support and assistance in following plans.