https://t.

me/nurse_helping

ADULT HEALTH NURSING II

CLINICAL (NUR 312)
chronic renal failure
Case Study
First Semester 2023-2024
Table of contents

01 Client's Health Profile

02 Disease Process

03 Physical
Examination
04 Diagnostic Tests and Procedures

05 Drug Study

06 Nursing Care Plan

07 Reference
https://t.me/nurse_helping

01
Client's Health
Profile (Narrative)

https://t.me/nurse_helping
 Client's Health Profile
Name AUWAD BADI AWAD ALGHEMER

(Date&Time of
29/ 09 / 2023 9: 29
Admission):

File Numbers 10101587 Department ICU

Gender Male Nationality Saudi

Age 41 years old Marital Status Married

Education level High school Occupation None

Client's Health Profile
Chief Complaint • 41-year-old male Medically
normal complaining of
generalized abdominal pain
Mainly lower abdomen pain
lasting 1 week The pain
naturally colic comes and
goes.
• Not associated with fever No
nausea No vomiting No
diarrhea No constipation
Present history • 41-year-old male sedated, on
ventilator, on 02
vasopressors, pt is critical
condition PT was admitted to
ICU from surgical ward on
26/09 with acute abdominal
distention and extubation.
Client's Health Profile

PAST HISTORY

History of Past Illness

Previous Immunization

Previous surgery

https://wtspee.com/967716954868
 Client's Health Profile
Family History

Parents:

Patient
and Siblings:

Genogram
Symbols:
https://t.me/nurse_helping

02
Disease Process
• Chronic renal failure is defined as kidney damage or a
glomerular filtration rate less than 60 ml/min for three
months or longer.
• This is invariably a progressive process leading to end-stage
kidney disease.
• Chronic kidney disease (CKD) is a
progressive, irreversible loss of kidney
function over time that continues until
residual kidney function is insufficient to
sustain life.
 Pathophysiology
adaptive hyper filtration&
Compensatory hypertrophy hypertrophy
of surviving nephrons

Decreased pH, k, nitrogenous

waste excretion.
Loss of excretory function

Loss of non-excretory renal

function
↓ Like failure to produce
erythropoietin & to convert inactive
form of calcium

sclerosis of remaining nephrons,

total function loss.
 Causes
• The main causes of chronic renal
failure include
• diabetes, hypertension,
• chronic glomerulonephritis,
• chronic pyelonephritis,
• chronic use of anti-inflammatory
drugs,
• autoimmune diseases, polycystic
kidney disease,
• Alport disease, congenital
malformations, and
• prolonged acute renal failure.
Signs and symptoms
signs and symptoms

System Effects
Weakness and fatigue, confusion, seizures
Neurologic Tremors, restlessness of the legs, burning
in the soles of the feet.
Dry, flaky skin, ecchymosis, thin, brittle
Integumentary
nails, coarse, thinning hair
Hypertension, pitting edema (feet, hands,
sacrum), periorbital edema, congested
Cardiovascular
neck veins, pericarditis, hyperkalemia,
hyperlipidemia.
Crackles, depressed cough reflex, pleural
Pulmonary
pain, dyspnea, tachypnea.
signs and symptoms

Organ Effects
Metallic taste, mouth ulcers and bleeding,
Gastrointestinal anorexia, nausea and vomiting, hiccups,
constipation or diarrhea
Hematologic Anemia, thrombocytopenia
Amenorrhea, testicular atrophy, infertility,
Reproductive
decreased libido
Muscle spasms, loss of muscle strength,
Musculoskeletal renal osteodystrophy, bone pain, fractures,
foot drop.
 Risk factors
Non-Modifiable Modifiable
• Family history of kidney disease, • Diabetes
diabetes, or hypertension • Hypertension
(genetic make-up) • History of AKI
• Age 60 or older (GFR declines • Frequent NSAID use
normally with age) • Obesity
• Smoking
• Race/U.S. ethnic minority status
• Low birth weight
 Diagnostic Measures

● Laboratory studies
○ Full Electrolyte serum's levels of sodium, potassium,
calcium, phosphate, uric acid, magnesium and
albumin levels
○ Renal function tests and creatinine clearance test
○ Complete blood count
● Radiographic studies
○ Renal Ultrasound evaluate for obstruction, stones,
tumor, kidney size, chronic change
○ Magnetic resonance
○ Doppler flow study (to rule out renal artery stenosis/
thrombosis) are performed to ensure correct
diagnosis.
Diagnostic Measures

● Urinalysis:
○ Urinalysis: dipstick test, urine albumin
&creatinine.
○ 24-hour urine tests: Urine can be analyzed
for proteins and residues (urea, nitrogen
and creatinine).
○ Glomerular filtration rate: as kidney
disease progresses, GFR decreases
 Complications

❖ If chronic kidney disease persists uncontrolled,

uremic toxins accumulate and produce life-
threatening physiological changes in all major organ

▪▪ systems.
Anemia

▪▪ peripheral neuropathy
skeletal abnormalities

▪ sexual dysfunction
cardiopulmonary & gastrointestinal complication
 Nursing Management

● Fluid deficiency or excess should be monitored for edema

and the patient weighed daily.
● In case of unbalanced nutrition, reduce proteins in the diet,
but increase carbohydrates and fats.
● Safety is important because the patient may become confused;
therefore, reorient the patient and help him out of bed.
● Assess signs of bleeding and prevent infections; monitor
laboratory values.
● Ineffective coping and poor cognition are diagnoses that
require the nurse to address supportive emotional care and
explain everything that is happening to the patient and any
tests that are needed.
● Complications of kidney failure require lifelong dialysis, and
in some cases death will occur if kidney transplantation is not
an option.
 https://wtspee.com/967716954868

Physical Examination
 https://wtspee.com/967716954868

∙ General Appearance : PT looks well oriented alert

and conscious
∙ V/S : TEMP : 36.9 c, BP: 111/70 (hypotension )mmhg,
PULSE : 108 bpm (tachycardia),RR : 26 bpm(tachypnea),
SPO2: 100 %
• Genitourinary System: The
Cardiovascula
r system

Abdomen Palpitations: ABD Soft and lax, with

tenderness on epigastric area
Inspection : present Abdominal midline
lap wound dressing, two drains on RT
and LT active tension the abdomen.
Severe sepsis due to peritonitis
Diagnostic test & procedure
Laboratory Purpose Reference Values Results value Interpretation
Test
WBC Assess for infection 4 – 10.5 *10^9 /l 20.14 *10^9 /ul leukocytosis
and inflammation
RBC Assess for anemia 4.4 – 6.00 3.74 *10^12 /ul Anemia)
*10^12 /ul
Hematocrit Assess for anemia 40 - 50 % 34.4 % Anemia
HGB Assess for anemia 13.00 – 17.5 g/dl 11.1 g/dl Normal
Neutrophil Assess for infection 40- 60 % 79.5 % High
Lymph Assess for infection 20- 40 % 7.2 % Low
Platelets use to perform the 150–450 *10^3/ul 122 *10^3 /ul Thrombocytope
count platelet count nia
PH: measure of the acids 7,35- 7.45 7.35 Normal
and bases in blood.
PaO2 The measurement of 80 – 100 mmhg 71.9 mmHg Alkalosis
oxygen in the blood,
Paco2 measurement of the 35 – 45 mmhg 42.4 mmhg Normal
carbon dioxide in the
blood
 Diagnostic test
Test name Result Normal range
URIC ACID investigate the 845 umol/l (220- 547 ) umol/l hyperuricemia
association
between uric acid
levels and kidney
function
Calcium It is used to 1.78 mmol /L (2,08 - 2,65) Low
diagnose or
monitor how the
kidneys are
working.
RDW.CV help diagnose 86.7 mmol /L (98-107) macrocytosis
anemia,
inflammation
D-DIMER check blood 0.97 mmol /L (1.60-2.60) Normal
clotting problems
FIBRONOGEN used to detect 7.36 g/l (2.0 to 4.0 g/L) hyperfibrinogenem
deep vein ia
thrombosis
Diagnostic test & procedure

Diagnostic procedures
NAME OF THE RESULT /purpose
TEST
Biopsy PATIENT HAD BIOPSY FOR A
SUSPECTED PELVIC MASS IN THEIR
CT Features are suggestive of a mid-bowel
loop neoplastic process... DD includes a
small collection of free fluid from the
pelvis. Calculus GB. A repositioned
paraumbilical vein was noted.
Drug Study
Name of Medication Dosage, Route Actions Possible Side Nursing
Frequency Effects Implications

Generic name: 4 mg Uses • CNS: Anxiety, • Check blood

Intravenous dizziness, pressure every 2
norepinephrine Infusion adjunct in treatment of headache, to 3 minutes,
CONTINUOUS cardiac arrest and acute insomnia, preferably by
Brand name: hypotension, shoc
For 1 Days nervousness. direct intra-
Levophed arterial monitoring,
Action • CV: angina, until it stabilizes,
Classification: bradycardia, then every 5
It inhibits adenylyl
ECG changes, minutes.
cyclase and directly
Therapeutic class edema, • Monitor
stimulates alpha-
hypertension, continuous ECG
Adrenergic adrenergic receptors,
hypotension, during treatment.
thereby inhibiting cAMP
palpitations, • Assess nailbed
Pharmacologicclass. production. Inhibition of
: Catecholamine cAMP constricts arteries• capillary refill.
GI: nausea,
and veins and increases • Monitor I&O;
vomiting
peripheral vascular hourly,
resistance and systolic • GU: decreased • Patient Education
blood pressure. renal perfusion Ask the patient to
immediately
• RESP: apnea, report any
dyspnea burning, leakage,
or tingling in the
• SKIN: pallor area of the IV
tubing. website.
Name of Dosage, Actions Possible Side Nursing Implications
Medication Route Effects
Frequency
Generic name: .2410 Indications CV: atrial Monitor 1&O closely,
EVERY fibrillation, restrict intake as
Fentanyl citrate ONE To increase blood bradycardia, necessary to prevent
HOUR IV pressure in patients in myocardial water intoxication.
Brand name: INFUSION vasodilatory shock (post- ischemia, right Check B/P, pulse
For 4 cardiotomy or sepsis) heart failure frequently
Sublimaze who remain hypotensive ENT: circumoral
Day(s) Use with caution in
despite catecholamines pallor patients with impaired
Classification:
and fluid ENDO: reversible cardiac response as
Therapeutic diabetes insipidus vasopressin may impair
Actions GI: elevated cardiac output.
class
bilirubin levels, Monitor the patient's
Stimulates a family of
Opioid analgesic mesenteric serum electrolytes, fluid
arginine vasopres- sin
Pharmacologic. ischemia status, and urine output
(AVP) receptors.
class.: Synthetic GU: acute renal after discontinuation of
phenylpiperidin Therapeutic Effect: failure vasopressin.
e Controlled Increases systemic SKIN: Pruritus, Keep in mind that some
vascular resis- tance and rash, urticaria patients may require
mean arterial BP; Others: repeated administration
increases water Hypersensitivity of vasopressin or
permeability at renal reaction, administration of
tubules, causing a hyponatremia desmopressin to correct
decreased urine volume fluid and electrolyte
and increased osmolality; changes.
causes smooth muscle Teache patients to:
contraction in GI tract. Promptly report headache,
chest pain, shortness of
breath, other symptoms.
 Name of Dosage, Actions Adverse Effects Nursing Implications
Medicatio Route
n Frequency
Generic 200 meg Indications Frequent: IV: • Resuscitative equipment,
name: Postop drowsiness, opioid antagonist
EVERY Controls moderate to nausea, vomiting. (naloxone 0.5 mcg/kg)
Fentanyl ONE severe pain; Transdermal should be available for
citrate HOUR preoperatively, (10%–3%): initial use.
postoperatively; adjunct Headache, • Establish baseline B/P,
Brand IV to general anesthetic, pruritus, nausea, respirations.
name: INFUSION adjunct to regional vomiting, • Assess type, location,
For 4 Day( anesthesia diaphoresis, intensity, duration of pain.
Sublimaze
diarrhea, • Monitor respiratory rate, B/
Action decreased appetite. P, heart rate, oxygen
Classificat
ion: saturation.
Binds to opioid
• Assess for relief of pain. In
receptors in the CNS, Occasional: IV:
Therapeut pts with prolonged high-
reducing stimuli to Postop confusion,
ic class dose, continuous infusions
sensory nerve endings; blurred vision, (critical care, ventilated
Inhibits ascending pain chills, orthostatic
Opioid pts), consider weaning drip
pathways. Therapeutic hypotension,
analgesic gradually or transition to a
effect: Alters pain
Pharmaco fentanyl patch to decrease
reception, increases Transdermal
logic. symptoms of opioid
pain threshold. (3%–1%):
class.: withdrawal.
Synthetic • Teach pt proper
Chest pain,
phenylpip transdermal, buccal,
arrhythmias,
eridine lozenge administration.
erythema,
Controlled • Report constipation,
pruritus, syncope,
absence of pain relief.
agitation, skin
irritations.
Nursing care plan
Assessment Diagnoses Planning Interventions/ Evaluation
Rationale
Subjective
Data:

Objective Data:
Assessment Nursing diagnosi (Expected Nursing Rationale Evaluation
outcome) interventio
subjective Data Risk for infection Short Term Independent • To establish After the Nursing
Patient reports related to After 1 hours of• Assess vital baseline intervention and
redness and Decreased nursing signs and observations health teaching
warmth in the immune intervention monitor the and check the the patient was
affected area function & Patient will not signs of progress of able to dentify
Broken skin experience signs infections the infection behavior and
Pt complains of barrier of systemic Dependent as the patient practices to
pain that’s can't infection (fever,• Administer receives prevent and
sleep tachycardia, antibiotics as medical reduce the risk
confusion) prescribed treatment for infection
• The usual
Objective Data • Monitor lab pathogen is
Long term work. either
/Physical After 1day of Collaborative streptococci
examination nursing • Use of proper or
reveals an area of intervention and hand hygiene staphylococcu
erythema and health teaching, (washing s and the
edema on the the Pt will be able hands, using antibiotic
finger to identify hand sanitizer, prescribed
Hot to touch behaviors and wiping down should
practices to surface areas). address this
prevent and• Teach the• It will be
reduce the risk patient about expected for
for infection signs of the WBC and
infection. CRP to be
Patient will take elevated..
antibioties as • It's helps in
prescribed until preventing
completion the spread of
the infection
• Encourage
the patient to
monitor the
skin for
worsening
redness or
References

❖ Smeltzer, S. C. O. (2010). Brunner and Suddarth’s

Textbook of Medical-Surgical Nursing (12th ed., Vol. 1).
Lippincott Williams & Wilkins.
❖ Fiseha, T. , Kassim, M. , & Yemane, T. (2015). Chronic
kidney disease and underdiagnosis of renal
insufficiency among diabetic patients attending a
hospital in Southern Ethiopia. BMC Nephrol, 15 (1). doi:
10.1186/1471-2369-15-198
https://wtspee.com/967716954868

Thank
you!