CLIENT / PATIENT CARE STUDY

(NURSING PROCESS APPROACH)

ON A PATIENT WITH A DIAGNOSIS OF

RETROPRETRONIAL FIBROSIS
WITH
AT FETHA 2 TEACHING HOAPITAL

WRITTEN BY

NTAH MFONISO EBONG

(EU/HS/NSC/22/382)
COLLEGE OF HEALTH SCEINCE,DEPARTMENT OF
NURSING EVANGEL UNIVERSITY AKAEZE.
 JANUARY
2024
 TABLE OF CONTENT
TITLE PAGE
TABLE OF
CONTENT……………………………………………………………………I-ii
LIST OF
TABLES…………………………………………………………………………….i
ii
PREFACE……………………………………………………………………………
………….iv
ACKNOWLEDGEMENT…………………………………………………………
………....v
INTRODUCTION…………………………………………………………………
…………..vi

UNIT ONE: ASSESSMENT OF PATIENT AND FAMILY.

Patient Particulars………………………………………………………… …………
Family Medical and Social Economic History……………………….. ………………
Patient Developmental History………………………………………………. ……….
Patient’ lifestyles/Hobbies…………………………………………………………….
Past Medical History……………………………………………………………………
Present Medical history………………………………………………………………...
Admission Of Patient …………………………………………………………………
Patient’s Concept Of illness……………………………………………………………
Literature review on the disease condition……………………………………………..
Validation Of Data……………………………………………………………………..

UNIT TWO: ANALYSIS OF DATA.

Comparison of Data with standard……………………………………………………..
Diagnostic Investigation……………………………………………………………….
Causes of patient illness………………………………………………………………..
Clinical features………………………………………………………………………
Management………………………………………………………..........................
pharmacology of drugs…………………………………………………………….
Complications…………………………………………………………………………
Patient and Family Strength……………………………………………………………..
Health Problems……………………………………………………………………….
Nursing Diagnosis……………………………………………………………………..
UNIT THREE: PLANINING FOR PATIENT CARE.
Objectives or outcome criteria………………………………………………………...
Nursing Care plans………………………………………………………
UNIT FOUR: IMPLEMENTATION OF PATIENT AND FAMILY CARE
PLAN.
Summary of Actual Nursing Care……………………………………
Preparation of Patient and Family for discharge………………………….
Follow-up/Home visit and continuity of care………………………………

UNIT FIVE: EVALUATION OF CARE RENDERED TO PATIENT CARE

PLAN
Statement of Evaluation………………………………………………………
Amendment of Nursing care plan…………………………………………….
Termination of care……………………………………………………………

Summary and Conclusion

References
LIST OF TABLES
TABLE I: DIAGNOSTIC INVESTIGATIONS……………………………………
TABLE II: COMPARISON OF CLINICAL FEATURES OF PATIENT WITH
TEXT BOOK……………………………………………………………………….
TABLE III: PHARMACOLOGY OF
DRUGS……………………………………................................................................
TABLE IV: NURSINNG CARE PLAN…………………………………………….
 PREFACE

The patient / family care plan is to give depth description and explanation of how a
patient response to a specific condition.it involves a record nursing care,
documenting the problems of nursing client and how they are dealt with by the
nurse in the course of finding solution.

The patient and family care plan is designed to enable the student to give a holistic
care to individual. Patient and family care plans the student’s level of
understanding on a particular disease condition, causes, management and
prevention and build upon the capabilities of the student in given a nursing care

Care study offers the nursing student the opportunity to combine class room
academic work with clinical study of the practices of the nursing profession. It
encourages learning by doing, the development of analytical and decision-making
skills as well as reporting skills. Being based on the nursing process, the students
become familiar with the use of the nursing process as a basis for practice thereby
encouraging evidence nursing care.
 INTRODUCTION

Caring for others is an expression of what it means to be fully human-Hillary

Clinton.
The rationale behind care study is to provide a structured method for healthcare
professionals to analyze and document patient experiences, contributing to
ongoing education and professional development. Presented in the care study is a
report of nursing care rendered to Mr. E.N who was diagnosed of retroperitoneal
fibrosis. He was admitted to the surgical ward of Fetha 2 teaching hospital .

At the beginning of night shift ,17th October 2023, MR E.N arrived on the ward
with a wheelchair, accompanied by her husband and two children. He was fairly
ill, weak with persistent abdominal and back pain, with unintentional weight loss
and swelling on the affected area. Happening at the Nurse’s station with the nurses
in charge at the time of arrival, I was subsequently charged with the responsibility
to carry out her admission to the ward. thus began my therapeutic relationship with
patient that has resulted in this care study. Nursing care spanned about two week
from the time of admission to the ward till discharge on the 3rd of November
2023. Her discharge at the time was not satisfactory[due to her death].
She was provided mortuary service, offers grief support resources to the family,
and ensured all necessary paper and procedures are followed in compliance with
hospital protocols and legal requirement.
The care study report is organized into five units with the five Phrases of nursing
process. Unit One is about assessment of MRS E.N . This involves collection of
data about the patient to identify her problem. literature review on Retroperitonal
fibrosis as well as validation of data is also discussed.

Unit two deals with analysis of data . it involves gathering patient data, identifying
patterns and using critical thinking skills to develop care plans or study.
Unit three,
Comprises of the planning phrases of nursing process and it involves setting goals,
establishing priorities, and creating interventions to address the patient’s needs.
Units four tackles the actual implementation of care plans by executing
interventions, administering treatments, and providing patient education.
Unit five, Evaluation of nursing care given to the patient and his family from
encounter till termination of nurses-patient relationship is discussed.
A Summary and conclusion then end this care study report by reviewing thematic
issues that arose in the case study from admission till discharge of death.

UNIT ONE
ADMISSION OF PATIENT AND FAMILY
Nursing assessment begins the nursing process with appraisal of the health status
of the patient. Through observation, questioning and examination data bout the
patient and his family is gathered and analyzed. This unit’s document pertinent
data obtained during interaction with MRA E.N and his family at the assessment
phrase of the nursing process. Its entails biographical data, past and present history.
Family medical and surgical history, patient lifestyles etc. literature review about
the disease condition and the organs affected.
1.1 PATIENT’S PARTICULARS
Name: Mrs. E.N
Age:56years
Sex: Female
Marital Status: widowed
Date of Birth:1st June 1990
Place of Birth: Afikpo South
Hometown: Oso Edda
Ethnicity: Igbo
Language: English and Igbo.
Nationality: Nigerian
Religion: Christian
Educational Background: Graduate
Occupation: Retired teacher
Residence: No 18 Woodberry Street
Next of kin: Adam orocha
Patients Diagnosis: Retropetronial Fibrosis
Date of Admission: 17th October 2023
Date of Discharge: 3rd November 2023
Ward: Female surgical ward
Hospital: Feta 2 teaching hospital
Folder Number: 125798
NHIS no: Registered
Height: No measured
Weight: 71kg
*Vital sign
Blood pressure: 130/80mmhg
Pulse:75b/m
Respiration : 24c/m
Temperature: 37*c

FAMILY MEDICAL/SOCIO ECONOMIC HISTORY

During my time with my patient . I learnt my patient has an history of hypertension
from paternal and maternal side. Though she knew about it she does take her
drugs, but her bills were covered by the comprehensive health insurance. she has a
stable requirement income. After six month she began to experience lower back
pain and discomfort. After multiple visit she diagnosed with Retropertonial
fibrosis. Her treatment involves medication and follow up. Mrs. E.N Lives
independently alone. Her husband died due to stroke. the only family she has is her
daughter who takes care of her grocery shopping and transportation. When she was
taken to the hospital, she was having anxiety during her stay in the ward, and she
want to go back home her soon has possible.

PATIENT DEVELOPMENT HISTORY

Mrs E.N comes from the family of four children one mother and father. He is
the third child of four children and grew up with her parent. She was delivery
normally through vaginal. She was giving to birth without any form of deformities,
and she has a good record of immunization. she had a normal childhood without
any big health issues or delay. After being retired she try to at least live a health
and normal life due to her hypertension being discovered five years ago.

PATIENTS LIFESTYLES/HOBBIES
As a retired teacher MRS E.n preferred to start her day with her normal
routine which includes morning prayers, minimal house chores and eat and
personal care. As well as evening activities she interacts with her friends and
engage in social activities. She loves walking like exercise, and she has her
favorite food but due her health condition she is being restriction due she
healthy. Even with her health challenges she tries to maintain a positive
lifestyle.

PAST MEDICAL HISTORY

According MRS E.n has high blood pressure(hypertension) in which she
has been managing it for five years with medication and follow up. though she
has been hospitalized of malaria and typhoid which was recently like 3month
ago and she was treated. She has no allergies.

PRESENT MEDICAL HISTORY

ON the 1st of October MRS E.n was apparently okay then suddenly she the
pain and discomfort in her abdomen go worse she couldn’t take it anymore
and she decided to visit the hospital with persistent abdominal pain she
discussed the frequency of the abdominal pain, her medication was being
reviewed again which was lisinopril (for high blood pressure) and calcium
supplement. Physical examination was conducted on her due signs of
discomfort then she was giving an adjustment of treatment plans considering
the effect of the medication. She went home after some days her still felt the
pain and her blood pressure to 140/90mmhg. She decided to consult the
physician again.

Assessment of the patient was revealed that there tenderdness at the

adbomianl area which indicate the discomfort particularly around the sides
and lower backand there is a suggesting stiffness and restriction of movement
due to the fibrotic tissue surrounding the tissue. altered of bowel sound was
notices too due to the proximity of the fibrotic tissue to the digestive organs,

At the time od admission the patient was present with complaint of pain at
the left and back side of the abdominal area. The patient manifested facial
grimaces upon the movement or palpation and the was noticetable during the
movement of the acute pain. She was taken to female medical ward, her bed
directly near the window.
ADMISSION OF THE PATIENT
On admission on the 25th of October 2023, MRS E.n was admitted in the
afternoon by 2:00pm on a stretcher accompanied by her daughter with orderly
being admitted by DR. T in female medical ward. In the provision of the diagnosis
retroperitoneal fibrosis. Diagnostic investigations were ordered by the physician.
While on admission, her identity was verified. She was welcome and immediately
admitted in a simple bed I reviewed her medical paper and tried to understand her
health condition. Provision of items needed on admission and educate their use of
this items. And educate the patient about the disease condition. Vitals signs were
then checked and recorded: temperature:37.3*c, blood pressure:140/90mmhg,
heart rate: 95 beat per minute, respiratory rate: 20 breath per minute, spo2:98%.
plan of treatment was to undertake series of investigations including imaging
studies (CT scan, MRI, ultrasound), blood tests, biopsy, urological studies. She
was placed strictly on intake and output and managed on normal saline 0.9% at
125ml/hr, dextrose water5% at 75ml/hr., monitoring her vitals every 4 hours, tab
ibuprofen, prednisone Tab, Tab acetaminophen, Tab azathioprine.
The patient’s name entered the admission and discharge book as well as the
daily ward state. She was told to urinate and being given cup to urinate due to she
is not on urinary catheter. strict intake and output were strictly recorded on the
patient folder and urine and blood sample were taken as ordered. Later the clients
informed consent to the patient to be the patient care study was requested.

THE PATIENTS CONCEPT OF ILLNESS

MRS E.N believed his condition her recent back pain and discomfort
are due to the physical strain from routines are due to physical strain from routines
activities and age-related factors. It has on her ability to perform daily task.
THE LITERATURE REVIEW OF THE CONDITION
The section deals with documented information about the conditions. MRS
E.N was diagnosed with, that is retroperitoneal fibrosis.
RETROPRETONEAL FIBROSIS
Retroperitoneal fibrosis (RPF) also known “Ormond’s disease is rare disorder
catheterized by the development of fibrous tissue in the retroperitoneal space, often
encasing and causing compression of nearby structures, such as the ureters and
blood vessels.
Retroperitoneal fibrosis is a disorder in which inflammation and extensive scar
tissue (fibrosis) occur in the back of the abdominal cavity, behind (retro-) the
membrane that surrounds the organs of the digestive system (the peritoneum). This
area is known as the retroperitoneal space. Retroperitoneal fibrosis can occur at
any age but appears most frequently between the ages of 40 and 60.
Retroperitoneal fibrosis, which is also sometimes referred to as Ormond’s
disease, is a disorder characterized by inflammation and the development of scar
tissue behind the membrane that surrounds the digestive system, called the
retroperitoneal space.
TYPES
RPF can be idiopathic (unknown cause) or secondary to conditions like
infections, malignancies or certain medication.
1. Idiopathic Retroperitoneal Fibrosis (IRPF): means the exact cause is
unknown.
Characteristics: they are more common form of condition, and it typically
occurs without a clear precipitating factor. The immune systems abnormal
response and inflammatory processes are believed to play a role
2. Secondary retroperitoneal fibrosis: means is associated with identifiable
causes or underlying condition.
Causes: can be trigged by various factors such as infection, malignancies,
certain medications and abdominal surgeries, infections like aortitis or
tuberculosis, may be induce an inflammatory response leading to fibrosis

INCIDENCES
RPF is a rare condition , with an estimated incidnces with 1.38 cases per
100,000 per years. The exact cause is often unknown, but inflammatory and
autoimmue factors are implicated. RPF has no reported racial predilection.
This condition occurs in males as in female commonly occurs.the peak of the
incidience of RPF is in adult aged 40-60years. On childhood is extremely rare.
AETIOLOGY
Approximately 70% of cases of retroperitoneal fibrosis are idiopathic.
Idiopathic retroperitoneal fibrosis is considered part of the spectrum of
chronic periaortitis, a large vessel vasculitis. Ceroid, a complex polymer of
oxidized proteins and lipids often found in atherosclerotic plaques, has been
hypothesized as an antigen that initiates the inflammatory response.
Thirty percent of retroperitoneal fibrosis cases are a result of an identifiable
cause. Numerous drugs have been implicated in the development of RPF.
Drugs such as methergines (Sansert) and other ergot alkaloids are most
commonly associated with this condition. Other medications that have been
implicated include beta blockers, methyldopa, hydralazine, and analgesics.
The biological agents etanercept and infliximab have also been identified as
secondary causes. Malignancy (carcinoid, Hodgkin and non-Hodgkin
lymphoma, sarcomas), infections (TB, histoplasmosis, actinomycosis),
radiation therapy for testicular seminoma, colon, and pancreatic cancer,
retroperitoneal hemorrhage and surgery have also been ident ified as
secondary causes of retroperitoneal fibrosis.
In most cases it is unknown , however,the occasssional association of RPF
with automme disease and its response to corticosteroids and
immuneodu[reesive therapy suggest it is probably immunologically mediated .
which is approximately 8% of cases are assocaisted with meastaic malignancy.
Studied linked smoking tobacco amd asbestos exposure to increased risk of
RPF. Pathophysiology refers to the study of how diseases or abnormal conditions
develop within the body and the physiological changes that occur as a result.
When considering pathophysiology in the context of the retroperitoneum, it
involves understanding how various disorders or pathological conditions affect
the organs and structures in this anatomical space.
Let's explore some pathophysiological aspects related to the retroperitoneum:
1. Retroperitoneal Fibrosis:
 Pathophysiology: Retroperitoneal fibrosis involves the abnormal
deposition of fibrous tissue in the retroperitoneal space. This fibrosis
 can compress and obstruct structures such as the ureters, blood
vessels, and nerves.
 Consequences: Compression of the ureters can lead to urinary tract
obstruction, causing hydronephrosis (accumulation of urine in the
kidneys). Vascular compression may affect blood flow, and nerve
involvement can result in pain and neurological symptoms.
2. Renal Disorders:
 Pathophysiology: Conditions affecting the kidneys, such as
glomerulonephritis or polycystic kidney disease, can disrupt normal
renal function.
 Consequences: Impaired filtration and regulation of electrolytes and
fluid balance, leading to conditions like acute or chronic kidney
failure.
3. Adrenal Disorders:
 Pathophysiology: Conditions affecting the adrenal glands, such as
adrenal tumors or Addison's disease, can disrupt hormonal balance.
 Consequences: Hormonal imbalances can impact metabolism, blood
pressure regulation, and the body's response to stress.
4. Pancreatic Disorders:
 Pathophysiology: Pancreatitis, pancreatic tumors, or cystic fibrosis
can affect pancreatic function.
 Consequences: Impaired digestion and nutrient absorption, leading to
malnutrition. Inflammatory processes can cause pain and impact
adjacent structures.
5. Urological Cancers:
 Pathophysiology: Cancers affecting the retroperitoneal structures,
such as renal cell carcinoma or adrenal tumors, can disrupt normal
tissue architecture and function.
 Consequences: Tumor growth can lead to compression of neighboring
structures, impacting organ function and potentially causing pain or
obstructive symptoms.
 6. Vascular Disorders:
 Pathophysiology: Diseases like aortic aneurysms or thrombosis can
affect blood vessels in the retroperitoneum.
 Consequences: Altered blood flow, risk of rupture, and compromised
organ perfusion, which can have severe consequences depending on
the affected vessels.
CLINICAL MANIFESTIION
The clinical manifestations of retroperitoneal fibrosis (RPF) can vary widely and
depend on the extent and location of the fibrous tissue growth, as well as the
structures affected. The condition often presents with nonspecific symptoms that
can be attributed to compression of nearby organs and structures. Here are some
common clinical manifestations of RPF:
1. Flank or Abdominal Pain:
 Persistent or recurrent pain in the flank or abdomen is a common
symptom of RPF. This pain may be dull, aching, or sharp and is often
associated with the compression of nerves and blood vessels in the
retroperitoneal space.
2. Renal Involvement:
 RPF frequently affects the ureters, the tubes that carry urine from the
kidneys to the bladder. Ureteral obstruction due to fibrous tissue
compression can lead to hydronephrosis (enlargement of the kidney
due to urine backup), kidney dysfunction, and renal failure.
 Symptoms related to renal involvement include changes in urination
patterns, flank pain, and swelling of the legs and ankles.
3. Vascular Compression:
 Compression of blood vessels can lead to decreased blood flow to
organs in the retroperitoneal space. This may result in symptoms such
as lower limb edema (swelling), claudication (pain or cramping during
physical activity), or other signs of compromised blood circulation.
4. Gastrointestinal Symptoms:
  Compression of the gastrointestinal structures can cause symptoms
such as nausea, vomiting, abdominal fullness, and changes in bowel
habits.
5. Systemic Symptoms:
 Some individuals with RPF may experience systemic symptoms,
including fatigue, unintentional weight loss, and a general feeling of
malaise.
6. Hypertension:
 In cases where blood vessels, particularly the abdominal aorta or its
branches, are affected, hypertension (high blood pressure) may occur.
7. Testicular Pain or Swelling:
 In men, involvement of the structures around the testes may lead to
testicular pain or swelling.
8 .Fever
In some cases, patients may experience low-grade fever, particularly if there
is an inflammatory component to the disease.
9.lower limb edema : fluid buildup in the legs due to venous compression.

DIAGNOSTIC INVESTIGATION
1. Medical History and Physical Examination:
 A detailed medical history may reveal symptoms such as back or
flank pain, lower urinary tract symptoms, or signs of systemic
inflammation.
 A thorough physical examination may detect abdominal or flank
masses, and assess any neurological deficits.
2. Blood Tests:
 Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)
levels may be elevated, indicating inflammation in the body.
3. Imaging Studies:
  CT Scan (Computed Tomography): This is a key imaging modality
for RPF. CT scans can provide detailed cross-sectional images of the
retroperitoneal space and help visualize the extent and distribution of
fibrous tissue.
 MRI (Magnetic Resonance Imaging): MRI is another imaging
option that can provide detailed soft tissue images and is useful for
assessing the relationship of the fibrous tissue with surrounding
structures.
 Ultrasound: This may be used to evaluate the kidneys and urinary
tract for signs of obstruction, as well as to assess blood flow in the
affected area.
4. Urological Studies:
 Urography: Intravenous urography or retrograde pyelography may be
performed to evaluate the extent of ureteral involvement and the
presence of obstruction.
 Cystoscopy: Direct visualization of the bladder and urethra may be
done to assess for any signs of obstruction or involvement.
5. Biopsy:
 In some cases, a biopsy of the affected tissue may be performed to
confirm the presence of fibrous tissue and rule out other conditions.
However, biopsy is not always necessary and is typically reserved for
cases where the diagnosis is unclear.
6. Nuclear Medicine Studies:
 Gallium-67 Scintigraphy: This imaging technique may be used to
assess the extent and activity of inflammation in the retroperitoneal
area.
7. Serum Immunoglobulin G4 (IgG4) Levels:
 Elevated levels of IgG4 may be associated with IgG4-related disease,
which can include retroperitoneal fibrosis.
Specific surgical and medical treatment
The management of retroperitoneal fibrosis (RPF) typically involves a combination
of surgical and medical treatments. The specific approach may vary depending on
the severity of symptoms, extent of fibrosis, and involvement of adjacent
structures. Here are some common surgical and medical treatments for
retroperitoneal fibrosis:
Surgical Treatment:
1. Ureterolysis:
 Ureteral involvement is common in RPF, leading to obstruction and
potential kidney damage. Ureterolysis involves freeing the ureters
from the surrounding fibrous tissue to restore normal urinary flow.
2. Decortication:
 Surgical removal or decortication of the fibrous tissue may be
necessary in severe cases where there is significant compression of
vital structures. This procedure aims to relieve pressure on affected
organs.
3. Stent Placement:
 In cases of persistent ureteral obstruction, the placement of stents
(tubes) in the ureters may be considered to maintain patency and
allow for the drainage of urine from the kidneys.
4. Vascular Reconstruction:
 If blood vessels are affected, surgical intervention may be required to
address vascular compromise. This could involve bypass procedures
or other vascular reconstruction techniques.
Medical Treatment:
1. Corticosteroids:
 High-dose corticosteroids, such as prednisone, are often used as the
initial medical treatment for RPF. They have anti-inflammatory
effects and can help reduce fibrous tissue formation. A gradual
tapering of the dose is typically done once symptoms improve.
2. Immunosuppressive Medications:
  In cases where corticosteroids alone are not sufficient or if there is a
risk of recurrence upon tapering, immunosuppressive drugs such as
azathioprine or mycophenolate mofetil may be prescribed.
3. Tamoxifen:
 Tamoxifen, a medication commonly used in breast cancer treatment,
has shown efficacy in some cases of RPF. It is thought to have anti-
fibrotic properties.
4. Rituximab:
 Rituximab, a monoclonal antibody targeting B cells, has been
investigated as a potential treatment for RPF in some studies. Its use is
still under research, and its efficacy is not well-established.
5. Supportive Care:
 Symptomatic relief may be provided through the use of pain
management strategies, including non-steroidal anti-inflammatory
drugs (NSAIDs) or analgesics.
Follow-up and Monitoring:
1. Imaging Studies:
 Regular imaging studies, such as CT scans or MRIs, may be
performed to monitor the progression or regression of fibrosis.
2. Laboratory Tests:
 Periodic monitoring of inflammatory markers, such as ESR and CRP,
can help assess the activity of the disease.
3. Long-Term Management:
 Long-term management involves monitoring for disease relapse and
adjusting medications accordingly. Some patients may require
ongoing low-dose corticosteroids or other maintenance therapies.
RISK FACTOR
While the exact cause of retroperitoneal fibrosis (RPF) is often unknown or
idiopathic, certain factors and conditions may increase the risk of developing this
condition. These risk factors include:
1. Age and Gender:
 Retroperitoneal fibrosis is most commonly diagnosed in individuals
between the ages of 40 and 60. Additionally, it appears to be more
prevalent in men than in women.
2. Inflammatory and Autoimmune Disorders:
 Individuals with certain inflammatory or autoimmune conditions, such
as IgG4-related disease, systemic lupus erythematosus (SLE), or
rheumatoid arthritis, may have an increased risk of developing RPF.
3. Medication Use:
 The use of certain medications, particularly long-term use, has been
associated with an elevated risk of retroperitoneal fibrosis. Examples
include methysergide (used for migraines) and certain ergotamine
derivatives.
4. History of Cancer:
 While rare, individuals with a history of cancer, especially cancers in
or around the retroperitoneal area, may have an increased risk of
developing fibrosis.
5. Smoking:
 Some studies suggest that smoking may be a risk factor for the
development of retroperitoneal fibrosis. Smoking has been associated
with various inflammatory and vascular conditions.
6. Genetic Factors:
 There may be a genetic predisposition to developing RPF in some
cases, although the specific genetic factors are not well-understood.
7. Previous Trauma or Surgery:
 Trauma or surgical procedures in the retroperitoneal region may
increase the risk of developing fibrosis as part of the healing process.
8. Vascular Disorders:
 Conditions affecting blood vessels, such as vasculitis, may contribute
to the development of fibrosis in the retroperitoneal space.
 9. Chronic Infections:
 While uncommon, chronic infections may contribute to inflammation
and fibrosis, potentially increasing the risk of RPF

COMPLIACTION
Complications of retroperitoneal fibrosis (RPF) include:
1. Ureteral Obstruction: Can lead to hydronephrosis and kidney damage.
2. Renal Insufficiency: Prolonged obstruction may result in chronic kidney
disease.
3. Vascular Compression: May cause reduced blood flow, ischemia, and
organ damage.
4. Hypertension: Compression of blood vessels can contribute to high blood
pressure.
5. Gastrointestinal and Neurological Issues: Compression of digestive
organs and nerves can lead to symptoms.
6. Bladder Involvement: May cause urinary symptoms and increase the risk
of infections.
7. Complications from Treatment: Surgical interventions and medications
may have potential side effects.
NURSING MANGEMENT
Nursing management for retroperitoneal fibrosis (RPF) involves:

Assessment:

Thorough assessment of symptoms, including pain and urinary issues.

Monitoring vital signs, fluid balance, and laboratory values.
Patient Care:
Pain management using medications and non-pharmacological interventions.
Monitoring and addressing urinary issues, including potential complications.
Education:

Patient education on the nature of RPF, treatment options, and the importance of
adherence to medications.
Emotional support and addressing psychosocial needs.
Collaboration:

Collaboration with healthcare team members, including urologists and

rheumatologists.
Coordinating care, scheduling tests, and ensuring follow-up appointments.
Monitoring:

Regular monitoring of symptoms and response to treatment.

Assessing for complications and addressing them promptly.
Advocacy:

Advocating for patient needs and ensuring their concerns are addressed.
Promoting a patient-centered approach to care.
Documentation:

Accurate and timely documentation of assessments, interventions, and patient

responses.
Collaboration with the healthcare team for comprehensive patient care
VALIDATION OF DATA
Information utilised in rendering care to the patient as reported in t his care study
has been
gathered is from well informed sources and efforts were made to ensure that they
are accurate and valid. Subjective data was taken from the patient herself while
objective data is obtained
from significant others (the patient’s daughter) and various tests to identify the
patient’s problems
and their sources. Data about the plan and progress of treatment as instituted by the
physician team was collected from the patient’s folder, as well as from direct
discussion with them.
Literature reviews on the conditions were obtained from textbooks. Others were
obtained through my own observation and questioning and examination of the
patient.
 UNIT TWO
Analysis generally refers to the systematic examination of the nature or cause
of a phenomenon.
Data analysis is the second phase of the five step nursing process. Data
gathered in the
assessment phase of the nursing process needs to be analysed to enable the
nurse to diagnose the
presence of potential and actual health problems of the patient and how he
responds to them.
This chapter tackles comparison of the data collected about the patient with
standard, exploration
of the strength and weaknesses of the patient and his family as well as
patient’s health problems.
It ends with statement of nursing diagnosis for problems identified.
2.1 COMPARISON OF DATA WITH STANDARD
A comparison is hereby being made between actual experiences of the patient
and standard
documented evidence to identify deviations. This includes the investigations
requested by
physicians for medical diagnosis; causes of the patient’s illness, clinical
patient’s condition as well as pharmacological and non pharmacological
management ordered
2.2 DiIAGNOSTIC INVESTIGATIONS
ii
i

DIAGOSTIC RESULT INTREPRETATION REMARKS NORMAL

INVESTIGATION VALUES
CT scan Evidence of The CT scan reveals the
retroperitoneal presence of fibrous
fibrosis with tissue in the
encasement of both retroperitoneal space,
ureters. Mild causing compression of _ _
hydronephrosis noted both ureters. Mild
bilaterally. No hydronephrosis, a
evidence of dilation of the renal
lymphadenopathy or pelvis and calyces due
masses. to obstruction, is
observed bilaterally.,-,-
Blood Tests ESR: 45 mm/hr Elevated levels of Elevated 0-20
(normal: 0-20 mm/hr) erythrocyte mm/hr
sedimentation rate
(ESR) indicate ongoing
inflammation in the
body, supporting the
diagnosis of
retroperitoneal fibrosis

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