Case Hemo

1860 Rizal Avenue, East Bajac-Bajac, Olongapo City, Philippines 2200 Tel Nos: (047) 224-8042 / (047) 224-1288*
Telefax: (047) 223-5855 / (047)224-6996 Website: www.clcst.edu.ph
CENTRAL LUZON COLLEGE OF SCIENCE & TECHNOLOGY
I.
Introduction
Chronic kidney disease (CKD), also known as chronic renal disease, is a progressive loss of renal function over a period of months or years. The symptoms of worsening kidney function are unspecific, and might include feeling generally unwell and experiencing a reduced appetite. Often, chronic kidney disease is diagnosed as a result of screening of people known to be at risk of kidney problems, such as those with high blood pressure or diabetes and those with a blood relative with chronic kidney disease. Chronic kidney disease may also be identified when it leads to one of its recognized complications, such as cardiovascular disease, anemia or pericarditis. Chronic kidney disease is identified by a blood test for creatinine. Higher levels of creatinine indicate a falling glomerular filtration rate(rate at which the kidneys filter blood) and as a result a decreased capability of the kidneys to excrete waste products. Creatinine levels may be normal in the early stages of CKD, and the condition is discovered if urinalysis (testing of a urine sample) shows that the kidney is allowing the loss of protein or red blood cells into the urine. To fully investigate the underlying cause of kidney damage, various forms of medical imaging, blood tests and often renal biopsy (removing a small sample of kidney tissue) are employed to find out if there is a reversible cause for the kidney malfunction. Recent professional guidelines classify the severity of chronic kidney disease in five stages, with stage 1 being the mildest and usually causing few symptoms and stage 5being a severe illness with poor life expectancy if untreated. Stage 5 CKD is also called established chronic kidney disease and is synonymous with the now outdated terms end-stage renal disease (ESRD), chronic kidney failure (CKF) or chronic renal failure (CRF). There is no specific treatment unequivocally shown to slow the worsening of chronic kidney disease. If there is an underlying cause to CKD, such as vasculitis, this may be treated directly with treatments aimed to slow the damage. In more advanced stages, treatments may be required for anemia and bone disease. Severe CKD requires one of the forms of renal replacement therapy; this may be a form of dialysis, but ideally constitutes a kidney transplant. Objectives General Objective: The purpose of this study is to provide deeper the oretical and practical knowledge and information about chronic kidney disease. Specific Objective: 1. To provide information on the related causes of chronic kidney diseases. 2. To provide information regarding postpartum care for patients who had the similar illness of chronic kidney disease. 3. To provide a framework of study regarding the subject that can serve as the foundation of future studies and research.
1860 Rizal Avenue, East Bajac-Bajac, Olongapo City, Philippines 2200 Tel Nos: (047) 224-8042 / (047) 224-1288* Telefax: (047) 223-5855 / (047)224-6996 Website: www.clcst.edu.ph
II.
Nursing Health History Profile of the Patient Patient's Name: Age: Gender: Civil Status: Date of Birth: Diagnosis: Attending Physician: Nursing Health History History of Present Illness Patient R.E.E. 41 years old Male Married April 05, 1969 CKD V secondary to Obstructive Uropathy Dr. Arnel S. Chua
Patient R.E.E. seek for consultation because he noticed that his feet was swelling, and experienced difficulty in urination. He was on hemodialysis unit on a scheduled basis. His access was on his left AV fistula. His target weight is 81 kg. His attending physician is Dr. Arnel S. Chua. Past Medical History Patient R.E.E. underwent a kidney surgery prior to hemodialysis. He is diagnosed having urinary stones last September 17, 2010. His first hemodialysis was on the same date of his diagnosis. It was hooked on his right internal jugular vein and was also his first chronic diagnosis. His compliance was good (100%) Family Health History Patient R.E.E. has a familial disease of hypertension from both paternal and maternal sides. And relatives has a history of other kidney diseases. Other than that, no other familial diseases of cardiovascular and respiratory diseases. Kidney Disease History Date of First Diagnosis: Date of First Hemodialysis: Date of First Chronic Hemodialysis: Compliance: Clinical Impression: Attending Physician: September 09, 2010 September 09, 2010 September 09, 2010 Good (100%) CKD V 2 Obstructive Uropathy Dr. Arnel S. Chua
Hemodialysis History First hemodialysis was done on September 09, 2010 under his attending physician Dr. Chua. It was hooked on his right internal jugular vein, and was done on NKTI. Frequency of his treatment was twice a week, with a duration of four hours per session. Dialyzer was F8 with a blood flow of 300 mL/min. His Heparin was on given on regular doses with a ratio of 2:1:1:1.
Physical Examination IV. Anatomy and Physiology How do the kidneys and urinary system work? The body takes nutrients from food and converts them to energy. After the body has taken the food that it needs, waste products are left behind in the bowel and in the blood. The kidney and urinary systems keep chemicals, such as potassium and sodium, and water in balance and remove a type of waste, called urea, from the blood. Urea is produced when foods containing protein, such as meat, poultry, and certain vegetables, are broken down in the body. Urea is carried in the bloodstream to the kidneys,where ii is removed. Other important functions of the kidneys include blood pressure regulation and the production of erythropoietin, which controls red blood cell production in the bone marrow. Kidney and urinary system parts and their functions:
Two kidneys - a pair of purplish-brown organs located below the ribs toward the middle of the back. Their function is to remove liquid waste from the blood in the form of urine; keep a stable balance of salts and other substances in the blood; and produce erythropoietin, a hormone that aids the formation of red blood cells. The kidneys remove urea from the blood through tiny filtering units called nephrons. Each nephron consists of a ball formed of small blood capillaries, called a glomerulus, and a small tube called a renal tubule. Urea, together with water and other waste substances, forms the urine as it passes through the nephrons and down the renal tubules of the kidney. Two ureters - narrow tubes that carry urine from the kidneys to the bladder. Muscles in the ureter walls continually tighten and relax forcing urine downward, away from the kidneys. If urine backs up, or is allowed to stand still, a kidney infection can develop. About every 10 to 15 seconds, small amounts of urine are emptied into the bladder from the ureters. Bladder - a triangle-shaped, hollow organ located in the lower abdomen. It is held in place by ligaments that are attached to other organs and the pelvic bones. The bladder's walls relax and expand to store urine, and contract and flatten to empty urine through the urethra. The typical healthy adult bladder can store up to two cups of urine for two to five hours. Two sphincter muscles - circular muscles that help keep urine from leaking by closing tightly like a rubber band around the opening of the bladder. Nerves in the bladder - alert a person when it is time to urinate, or empty the bladder. Urethra - the tube that allows urine to pass outside the body. The brain signals the bladder muscles to tighten, which squeezes urine out of the bladder. At the same
time, the brain signals the sphincter muscles to relax to let urine exit the bladder through the urethra. When all the signals occur in the correct order, normal urination occurs. Facts about urine:

Adults pass about a quart and a half of urine each day, depending on the fluids and foods consumed. The volume of urine formed at night is about half that formed in the daytime. Normal urine is sterile. It contains fluids, salts and waste products, but it is free of bacteria, viruses and fungi. The tissues of the bladder are isolated from urine and toxic substances by a coating that discourages bacteria from attaching and growing on the bladder wall.
VI.
Course In the Ward Present February 07, 2013
Patient R.E.E. was already in his 54th treatment. He was a regular OPD patient and was on scheduled basis. He has a target weight of 81 kg. His pre HD weight was 84.3 kg. His access is located at his left AV fistula. Ultrafiltration volume was set to 2200 mL. Pre-treatment, facial edema, peri-orbital edema and slight lower extremity edema was noted. He was then hooked to hemodialysis machine and started. Previous health teachings was reinforced. Monitored BP every 30 minutes. His post-treatment weight was 83.7. No complications observed, and went home after. January 31, 2013 Patient's pre-treatment weight was 82.5 kg. Peri-orbital, facial, and lower extremity edema is noted. And still with a target weight of 81 kg. Access was still on his left AV fistula, patent. His UFV was set to 2000 mL. HIs post-treatment weight was 81.5 kg. No other significant details. January 17, 2013 Patient's pre-treatment weight was 82.8 kg. Peri-orbital and facial edema is noted. And still with a target weight of 81 kg. Access was still on his left AV fistula, patent. His UFV was set to 2200 mL. His post-treatment weight was 81.5 kg. No other significant details. January 10, 2013 Patient's pre-treatment weight was 84.6 kg. Peri-orbital and facial edema is noted. And still with a target weight of 81 kg. Access was still on his left AV fistula,
patent. His UFV was set to 2000 mL. His post-treatment weight was 82.5 kg. No other significant details. December 27, 2012 Patient's pre-treatment weight was 83 kg. Peri-orbital and facial edema is noted. And still with a target weight of 81 kg. Access was still on his left AV fistula, patent. His UFV was set to 2400 mL. His post-treatment weight was 81.3 kg. No other significant details. December 20, 2012 Patient's pre-treatment weight was 82 kg. Peri-orbital and facial edema is noted. And still with a target weight of 81 kg. Access was still on his left AV fistula, patent. His UFV was set to 2200 mL. His post-treatment weight was 81.1 kg. No other significant details. November 29, 2012 Patient's pre-treatment weight was 83 kg. Peri-orbital and facial edema is noted. And still with a target weight of 81 kg. Access was still on his left AV fistula, patent. His UFV was set to 2000 mL. His post-treatment weight was 81 kg. No other significant details. Previous May 21, 2012 Patient R.E.E. was transfer in from Medicine ward, with ongoing IVF of D5W at 500 cc level regulated at KVO. Pre-treatment weight was 76.2 kg. Peri-orbital and facial edema noted. UFV was set to 1500 mL/min. At around 10:35 p.m., patient R.E.E. experienced dizziness and dimming of vision. Thus, UF was off, and referred to Dr. Chua. 200 cc level of Saline was flushed. Patient was placed on Trendelenburg position and dialysate temperature to 36.0C. Due D5050 50 cc vial given via IV. At 10:40 p.m., UF was hold as ordered by Dr. Chua.. His post-treatment weight was 75.9 kg. No other significant details. May 22, 2012 Patient R.E.E. has a slight edema on his lower extremities. Pretreatment weight is 73 kg. With an ongoing IVF of D5W at 200 cc level regulated at KVO. UFV was set to 0 net plus NSS flushing. Informed Dr. Chua about patient's arrival at the HD unit. Patient has loss of appetite for one week, hence referred to Dr. Chua, and ordered Appetens
one tablet daily. Patient also experienced vomiting, Metoclopramide 10mg via IV every 12 hours for vomiting. May 23, 2012 Patient has a slight lower extremity edema. Patient's pre-treatment weight is 73.4 kg, referred to Dr. Chua. UFV was set to NSS flushing. While treatment is ongoing, at around 10:45 p.m., patient experience seizure, hence referred to Dra. Pablo. He was hooked to O2 inhalation. He was then seen by Dra. Pablo ordered Phenytoin 150 mg via IV. Requested CBC, Crea, Na, K and sent to laboratory. RBS monitored, with a result of 180 mg/dL, then referred to Dra. Pablo. Post-treatment weight was 73.4 kg. May 26, 2012 Patient has to obtain a dry weight of 81 kg, as ordered by the physician. Patient has a jugular vein distention, slight lower extremity edema, and peri-orbital edema. His pre-treatment weight was 76.6 kg. UFV was set to 0 net plus NSS flushing and 1 unit PRBC. Closely monitored for any blood transfusion reaction. After HD, no BT reaction noted. Posttreatment weight was 76.6 kg. May 30, 2012 Patient R.E.E. has facial edema and swelling of the knees, wrist, and elbows. His pre-treatment weight was 76.6 kg. He was referred to Dr. Chua for HD UF and regarding the swelling of his knees, wrist, and elbows. Hence, Dr. Chua ordered new medications; Hydrocortisone 100 mg via IV to be given every 8 hours in 3 doses, Colchicine 1 tablet daily, and UFV was set to 2800 mL/min. At around 9:05 p.m., he was seen by Dr. Chua with orders carried out. His post-treatment weight 73.6 kg. Reinforce health teachings.
IX.
Conclusion and Recommendation

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1860 Rizal Avenue, East Bajac-Bajac, Olongapo City, Philippines 2200 Tel Nos: (047) 224-8042 / (047) 224-1288*

Telefax: (047) 223-5855 / (047)224-6996 Website: www.clcst.edu.ph

CENTRAL LUZON COLLEGE OF SCIENCE & TECHNOLOGY

CENTRAL LUZON COLLEGE OF SCIENCE & TECHNOLOGY

CENTRAL LUZON COLLEGE OF SCIENCE & TECHNOLOGY

CENTRAL LUZON COLLEGE OF SCIENCE & TECHNOLOGY

CENTRAL LUZON COLLEGE OF SCIENCE & TECHNOLOGY

CENTRAL LUZON COLLEGE OF SCIENCE & TECHNOLOGY

Course In the Ward Present February 07, 2013

CENTRAL LUZON COLLEGE OF SCIENCE & TECHNOLOGY

CENTRAL LUZON COLLEGE OF SCIENCE & TECHNOLOGY

CENTRAL LUZON COLLEGE OF SCIENCE & TECHNOLOGY

Conclusion and Recommendation

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