FAR EASTERN UNIVERSITY

Nicanor Reyes Street, Sampaloc, Manila

Institute of Health Sciences and Nursing
Second Semester, A.Y. 2022 – 2023

A CASE STUDY OF PATIENT WITH CHRONIC KIDNEY DISEASE

Submitted by: Christine V. Dela Cruz, 310-2B

Submitted to: Sir Jomar M. Rodriguez, R.N.
Date Submitted: April 24, 2023

PATIENT’S INFORMATION
NAME: A.LB.
AGE: 67
GENDER: Male
RELEVANT MEDICAL HISTORY: Hypertension
Diabetes Mellitus
Dyslipidemia
Vit D deficiency
Neurogenic bladder
CHIEF COMPLAINT: Pain in mouth, loss of appetite, difficulty in speech and swallowing
DIAGNOSIS: Chronic Kidney Disease
 FAR EASTERN UNIVERSITY
Nicanor Reyes Street, Sampaloc, Manila
Institute of Health Sciences and Nursing
Second Semester, A.Y. 2022 – 2023

TREATMENT PLAN
CUES NURSING GOALS & NURSING RATIONALE
DIAGNOSIS OBJECTIVES INTERVENTION
Subjective: Risk for Goals:
Impaired Oral After 48 hours of
 “Nahihirapan ako Mucous nursing interventions,
kumain at Membrane the patient will
lumunok.” related to maintain the integrity
decreased of mucous
 “Kumikirot yung salivation and membranes.
singaw ko tapos fluid
mahapdi.” restrictions
Objectives:
 “Opo,
naninigarilyo rin
po ako.” 1. After 2 hours 1. Provide fluids 1. This prevents excessive
of nursing throughout the oral dryness from a
intervention, 24-hour period prolonged period without
Objective: the patient will within the oral intake. The 2010
be able to have prescribed limit. European Food Safety
 Open sores in the controlled Authority guidelines
mouth intake of fluids recommend a total water
 Pain in the mouth as prescribed. intake of 2.5 liters/day for
(with a pain scale men and 2.2 liters/day for
of 8/10) women. The kidneys play
 FAR EASTERN UNIVERSITY
Nicanor Reyes Street, Sampaloc, Manila
Institute of Health Sciences and Nursing
Second Semester, A.Y. 2022 – 2023

 Loss of appetite a central role in

 Difficulty in controlling water balance,
speech/swallowing a function that is impaired
in CKD, which affects 10
to 15% of the population
worldwide. The National
Kidney Foundation
suggests total daily water
entail of 3 liters for men
and 2.2 liters for women
with CKD (Wagner et al.,
2022).

2. After 6 hours
of nursing 2. Teach frequent 2. Mucous membranes may
interventions, mouth care and become dry and cracked.
the patient will rinse with 10% Mouth care soothes,
be able to hydrogen lubricates, and helps
demonstrate peroxide after freshen mouth taste,
mouth care for each meal which is often unpleasant
dryness. regularly and because of uremia and
every 4 hours restricted oral intake.
while awake. One-third of
hemodialyzed clients
present a characteristic
halitosis called “uremic
fetor” and a metallic taste
due to high urea content
in saliva and its
 FAR EASTERN UNIVERSITY
Nicanor Reyes Street, Sampaloc, Manila
Institute of Health Sciences and Nursing
Second Semester, A.Y. 2022 – 2023

breakdown in ammonia.
An important problem is
also represented by
uremic stomatitis, which
consists of painful lesions
on oral mucosal surfaces.
To promote the healing of
the lesions, gargling with
10% hydrogen peroxide
four times a day can be
recommended
(Costantinides, 2018).

3. After 8 hours
of nursing 3. Encourage good 3. This reduces bacterial
interventions, dental hygiene growth and the potential
the client will after meals and at for infection. Dental floss
be able to bedtime. may cut gums,
perform dental Recommend potentiating bleeding.
hygiene to avoidance of Brushing twice daily and
avoid dental floss. using fluoridated
infection.\ toothpaste helps
strengthen teeth against
the development of
cavities (National Kidney
Foundation, 2018).
4. After 24 hours
of nursing 4. Administer
 FAR EASTERN UNIVERSITY
Nicanor Reyes Street, Sampaloc, Manila
Institute of Health Sciences and Nursing
Second Semester, A.Y. 2022 – 2023

interventions, medications as 4. Cyproheptadine

the patient will indicated: (Periactin) is given for
be able to take Cyproheptadine, relief of itching (National
prescribed pilocarpine, and Library of Medicine,
medications. analgesics. 2017). Pilocarpine
stimulates saliva
production. Pilocarpine
has several side effects
and is not suitable for all
clients; however, this may
be prescribed to a client
with CKD to stimulate
salivary production
(Kapourani et al., 2022).
Analgesics/Paracetamol
remains the best choice
for pain management, and
also codeine can be used
without modification of
the dosages
(Costantinides et al.,
2018).
5. After 48 hours
of nursing 5. Educate patient to
interventions, stop smoking and 5. These substances are
the patient will avoid lemon or irritating to the mucosa
be glycerin products and have a drying effect,
knowledgeable or mouthwash potentiating discomfort.
of the containing Tobacco use has
 FAR EASTERN UNIVERSITY
Nicanor Reyes Street, Sampaloc, Manila
Institute of Health Sciences and Nursing
Second Semester, A.Y. 2022 – 2023

restrictions. alcohol. detrimental effects on

health, including oral
health. Tobacco use
increases the risk of oral
diseases such as oral
mucosal lesions,
periodontal disease, and
dental caries. A strong
association has been
found between tobacco
use and mucosal lesions
such as leukoplakia,
smokeless tobacco
keratosis, nicotinic
stomatitis, smoker’s
melanosis, and
erythroplakia (Gajendra et
al., 2023).
 FAR EASTERN UNIVERSITY
Nicanor Reyes Street, Sampaloc, Manila
Institute of Health Sciences and Nursing
Second Semester, A.Y. 2022 – 2023

FOLLOW-UP:
As of April 23, 2023, 48 hours after nursing interventions, the patient is now seen comfortable and relieved from all the
sores present in his mouth, no fatigue and weakness. Moreover, the patient can talk well and is able to swallow when eating. He is not
in distress, and with a pain scale of 4/10 in the mouth. Must be monitored for the continuity of care and risk for bacterial growth and
infections. The patient is also amenable to all medications and treatment given to him.

Discharge plan:
 Mouth care and rinsing with 10% hydrogen peroxide after each meal regularly and every 4 hours while awake
 Dental hygiene

The patient’s medications are the following:

 Ketoanalogue 600 mg tab

 Cyproheptadine (Periactin) for relief from itching
 Pilocarpine for saliva production stimulation
 Analgesics for pain
 FAR EASTERN UNIVERSITY
Nicanor Reyes Street, Sampaloc, Manila
Institute of Health Sciences and Nursing
Second Semester, A.Y. 2022 – 2023

DISCUSSION:

Potential Causes CKD patients have related oral lesions. Patients can develop impaired oral mucous membranes for several
reasons involving NPO for 24 hours or more, prolonged use of steroids, immunosuppressants, or anti-neoplastic
drugs, mechanical irritation, malnutrition, trauma, mouth breathing, inadequate oral hygiene, or decreased
salivation.
Risk Factors Diabetes and high blood pressure are the more common causes of CKD in adults. Other risk factors include:
 heart disease,
 obesity,
 a family history of CKD,
 inherited kidney disorders,
 past damage to the kidneys, and
 older age.
Treatment For the client with chronic kidney disease with impaired oral mucosa, treatment options are the
Options following:
 Controlled intake of fluids
 Medications (Cyproheptadine for itching, Pilocarpine for saliva production stimulation, and Analgesics
for pain)
 Mouth care and rinsing with 10% hydrogen peroxide.
 Dental hygiene with the avoidance of dental floss to prevent cutting of gums and potentiating bleeding.

Other treatments may include:

 Lifestyle changes to help patient stay as healthy as possible.
 Medications to control associated problems, such as high blood pressure and high cholesterol.
 Dialysis to replicate some of the kidney's functions, which may be necessary in advanced (stage 5)
CKD.
 Kidney transplant may also be necessary in advanced (stage 5) CKD.
 FAR EASTERN UNIVERSITY
Nicanor Reyes Street, Sampaloc, Manila
Institute of Health Sciences and Nursing
Second Semester, A.Y. 2022 – 2023

Patient’s response to treatment:

The patient is amenable to treatments and responsive.

References:
 FAR EASTERN UNIVERSITY
Nicanor Reyes Street, Sampaloc, Manila
Institute of Health Sciences and Nursing
Second Semester, A.Y. 2022 – 2023

 Center for Disease Control and Prevention. (2021, March 10). CKD Risk Factors and Prevention. Www.cdc.gov.
https://www.cdc.gov/kidneydisease/publications-resources/annual-report/ckd-risk-prevention.html#:~:text=Diabetes%20and
%20high%20blood%20pressure

 Costantinides, F., Castronovo, G., Vettori, E., Frattini, C., Artero, M. L., Bevilacqua, L., Berton, F., Nicolin, V., & Di Lenarda,
R. (2018). Dental Care for Patients with End-Stage Renal Disease and Undergoing Hemodialysis. International Journal of
Dentistry, 2018, 1–8. https://doi.org/10.1155/2018/9610892

 Gajendra, S., McIntosh, S., & Ghosh, S. (2023). Effects of tobacco product use on oral health and the role of oral healthcare
providers in cessation: A narrative review. Tobacco Induced Diseases, 21(January), 1–16. https://doi.org/10.18332/tid/157203

 Kapourani, A., Kontogiannopoulos, K. N., & Barmpalexis, P. (2022). A Review on the Role of Pilocarpine on the
Management of Xerostomia and the Importance of the Topical Administration Systems Development. Pharmaceuticals, 15(6),
762. https://doi.org/10.3390/ph15060762

 National Library of Medicine. (2017). Cyproheptadine. PubMed; National Institute of Diabetes and Digestive and Kidney
Diseases. https://www.ncbi.nlm.nih.gov/books/NBK548422/

 The Dental / Kidney Disease Connection. (2018, May 22). National Kidney Foundation.
https://www.kidney.org/atoz/content/dental-kidney-disease-connection

 Wagner, S., Merkling, T., Metzger, M., Bankir, L., Laville, M., Frimat, L., Combe, C., Jacquelinet, C., Fouque, D., Massy, Z.
A., Stengel, B., & CKD-REIN study group. The list of members of the CKD-REIN study group are in the Appendix. (2021).
Water intake and progression of chronic kidney disease: the CKD-REIN cohort study. Nephrology, Dialysis, Transplantation:
Official Publication of the European Dialysis and Transplant Association - European Renal Association.
https://doi.org/10.1093/ndt/gfab036