Renal Disease:Chronic Kidney Disease Care Plan Kadeen WestcarrChamberlain Collegeof NursingNR341 Complex AdultHealth Dr. RichardsJanuary 18, 2018 DemographicsName: Frazier, Cory Age: 63 y/oD.O.B: 10/31/1954Height: 162 cmWeight: 104.2 kgBMI: 39.63Allergies: NKACode Status: Full codeDiet: 1800 KCAL cardiac with fluidand sodium restrictionsOccupation: Construction worker Marital Status: SingleEthnicity: African AmericanAdmitting Diagnosis: Chronic KidneyDisease Patient historyPatient has a history of DiabetesMellitus type 2, hypertension, and obstructive sleep apnea. Patient is a formersmoker (0.
5 pack cigarettes/ day) 10 pack years. Patient stated he quit smoking20 years ago. Patient had a cystoscopy, prostate and bladder biopsy pyelogramon 2/18/14. Patient also had an intracapsular cataract bilateral extraction in2011.
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History of present illnessPatient presented to the emergencyroom on 01/15/2018 with severe swelling bilaterally to lower extremities, withno aggravating or relieving factors. An IV access was inserted in the leftantecubital. Patient was sent for arenal ultrasound that showed chronic renal parenchymal disease. Patient wasplaced on fluid and sodium restrictions per MD orders. Physical assessmentNeurological:Patient awake, alert and oriented times three (place, person and time).
Calm affect, cooperative and clear speech. Patient denies any dizziness,weakness, numbness or tingling. Patient denies pain 0 on 0-10 pain scale.PERRLA, with sluggish pupillary reflexes bilaterally. Movement in allextremities. Hand grasp +2 bilaterally.
Leg strength +2 bilaterally. Cranialnerves 1-12 intact. Cardiovascular:S1 S2 auscultated. No murmurs noted. Patient’s blood pressure was 172/114.Nifedipine was administered under supervision.
Patient was reassessed an hourlater and blood pressure was 152/90.Respiratory:Lungs sound clear bilaterally, respirations even and unlabored at 18breaths on room air. Gastrointestinal:Abdomen symmetrical, soft, rounded and non-distended. Patient denies anyabdominal discomfort. Bowel sounds normoactive in all four quadrants. LBM 01/17/18.
Genitourinary:Patient denies any burning upon urination. Urine clear and odorless. Musculoskeletal: Patient ambulateswithout difficulty.
Full range of motion is all extremities. Integumentary:Skin intact. Warm and dry to touch. Normal skin color for race. Bilateralskin tautness to lower extremities, shiny appearance with +1 pitting edema, IVdry and intact, no redness or swelling noted.
Laboratory and Diagnostic Test Laboratory/ Diagnostic Value Rationales BUN 48 Due to the chronic kidney disease, the kidneys cannot eliminate urea nitrogen effectively from the blood causing a buildup of urea nitrogen. Creatinine 4.35 When the kidneys lose their ability to filter blood effectively, GFR decreases resulting in an increase of serum creatinine in the blood. Potassium 3.
3 The patient had severe edema upon admission to the hospital, so to decrease the fluid buildup the patient was given a loop diuretic (Lasix). With this diuretic potassium is wasted thus reducing the patients’ potassium level. Albumin 21 A healthy kidney does not let albumin pass into the urine. However when the kidneys are damaged albumin is passed into the urine.
Having high albumin in the urine is also a positive indicator of kidney disease Renal Ultrasound 1/16/2018 Renal ultrasound was done to visualize the kidneys and identify the extent of damage. The ultrasound showed that the patient had chronic parenchymal disease. Nursing Diagnosis Fluid and Electrolyte Imbalance related to side effects of diuretics as evidence by serum potassium of 3.3 and edema in both legs (Cox & Murdoch-Newfield, 2007) Fluid volume excess related to poor kidney function as evidence by bilateral swelling to lower extremities (Cox & Murdoch-Newfield, 2007) Imbalanced nutrition more than body requirements related to poor diet and sedentary lifestyle as evidence by patient stating, “I don’t exercise or eat right” and a BMI of 39.
63 (Cox & Murdoch-Newfield, 2007)Medications Brand and Generic Name Indications Adverse Effects Nursing Implications Labetalol /Trandate (Vallerand, Sanoski, Deglin, & Mansell, 2015) Management of hypertension (Vallerand, Sanoski, Deglin, & Mansell, 2015) Fatigue, weakness, orthostatic hypotension, erectile dysfunction (Vallerand, Sanoski, Deglin, & Mansell, 2015) Monitor blood pressure and pulse frequently during dose and adjustment and periodically during therapy. Assess for orthostatic hypotension when assisting the client up from the supine position. Monitor intake and output ratios and daily weight. Assess patient routinely for fluid volume excess (edema, rales, crackles) (Vallerand, Sanoski, Deglin, & Mansell, 2015) Nifedipine/Procardia (Vallerand, Sanoski, Deglin, & Mansell, 2015) Management of hypertension (Vallerand, Sanoski, Deglin, & Mansell, 2015) Headache, peripheral edema, flushing (Vallerand, Sanoski, Deglin, & Mansell, 2015) Monitor blood pressure and pulse before therapy, during dose titration, and periodically during therapy. Monitor ECG periodically during prolonged therapy.
Monitor intake and output ratios and daily weights (Vallerand, Sanoski, Deglin, & Mansell, 2015). Spironolactone/Aldactone (Vallerand, Sanoski, Deglin, & Mansell, 2015) Management of essential hypertension. Treatment of hypokalemia (Vallerand, Sanoski, Deglin, & Mansell, 2015) Hyperkalemia, dizziness, headaches (Vallerand, Sanoski, Deglin, & Mansell, 2015) Monitor intake and output ratios and daily weights during therapy. Monitor blood pressure if given as an adjunct to antihypertensive. Advise patient to notify health care provider if rash, muscle weakness, fatigue, severe nausea, vomiting or diarrhea occurs (Vallerand, Sanoski, Deglin, & Mansell, 2015) Furosemide/Lasix (Vallerand, Sanoski, Deglin, & Mansell, 2015) Edema due to renal disease Hypertension (Vallerand, Sanoski, Deglin, & Mansell, 2015) Dehydration, hypocalcaemia, hypokalemia, hypernatremia, hypervolemia, metabolic alkalosis (Vallerand, Sanoski, Deglin, & Mansell, 2015) Assess fluid status, monitor daily weight intake and output, amount and location of edema. Assess lung sounds, skin turgor and mucus membranes.
Notify healthcare provider if dry mouth, oliguria, thirst, weakness or hypotension occurs. Monitor blood pressure and pulse before and during administration. Assess patient for tinnitus and hearing loss (Vallerand, Sanoski, Deglin, & Mansell, 2015) Interventions Interventions Rationales Continuous monitoring of signs and symptoms of hypokalemia to identify if patient status is worsening (Cox & Murdoch-Newfield, 2007) Hypokalemia can be life-threating so careful assessment is needed to determine patients status (Cox & Murdoch-Newfield, 2007) Monitor serum potassium levels (Cox & Murdoch-Newfield, 2007) This will determine how far levels have dipped from baseline (Cox & Murdoch-Newfield, 2007) Put the patient on an ECG and monitor continuously for any changes (Cox & Murdoch-Newfield, 2007) Hypokalemia can cause arrhythmias such a premature ventricular and arterial contractions (Cox & Murdoch-Newfield, 2007) Take vital signs every 2 hours, and apical pulse (Cox & Murdoch-Newfield, 2007) Permits monitoring of cardiovascular response to illness state and therapy (Cox & Murdoch-Newfield, 2007) Check lung, heart and breath sounds every 2 hours (Cox & Murdoch-Newfield, 2007) Essential monitoring for fluid collection in the lungs and cardiac overload due to edema (Cox & Murdoch-Newfield, 2007) Monitor intake and output hourly, observe and document the quantity and character of the urine (Cox & Murdoch-Newfield, 2007) This helps to determine the extent of fluid balance (Cox & Murdoch-Newfield, 2007) Daily weights at the same time each day with the same clothe (Cox & Murdoch-Newfield, 2007) Allows for consistent comparison of weight (Cox & Murdoch-Newfield, 2007) Collaborate with healthcare provider to develop fluid restriction regimen clearly indicating the amount per shift (Cox & Murdoch-Newfield, 2007) Restricting fluids prevents cardiovascular system overload and potential pulmonary effects (Cox & Murdoch-Newfield, 2007) Carry out and review daily food diary (caloric intake, types and amounts of food, eating habits) (Nurse Labs, 2018) Provides the opportunity for the individual to focus on a realistic picture of the amount of food ingested and corresponding eating habits and feelings.
Identifies patterns requiring change or a base on which to tailor the dietary program (Nurse Labs, 2018) Limit the patient’s intake to number of calories recommended by the physician/ nutritionist (Cox & Murdoch-Newfield, 2007) Reduces calories to promote weight loss yet maintain body’s nutritional status (Cox & Murdoch-Newfield, 2007) Collaborate with dietitian and physical therapy (Cox & Murdoch-Newfield, 2007) Developing a plan that includes activities that client enjoys increases potential for continuing the activity (Cox & Murdoch-Newfield, 2007) ReferencesWorks CitedNurse Labs.(2018, January 28). Retrieved from https://nurseslabs.com:https://nurseslabs.com/4-obesity-nursing-care-plans/Cox, H.
C., & Murdoch-Newfield, S. A. (2007).
Cox’sclinical applications of nursing diagnosis : adult, child, women’s, mentalhealth, gerontic, and home health considerations 5th edition. Philadelphia: F.A.
: Davis Company.Vallerand, A. H., Sanoski, C. A., Deglin, J. H.
, &Mansell, H. G. (2015). Davis’s drug guide for nurses.
Philadelphia,Pennsylvania : F.A. Davis Company.