Patients Profile

General Data: Name: Ralphfaniel D. Selim Gender: Male Age: 8 years old Address: Calero, iloan, Ce!" Date of #irth: $an"ary %&, '(() Religion: Roman Catholi* +ather: Ro*,ie P. Selim Mother: Melona C. De G"ma Admission Date: April (-, '(%. /ime: 0:.( PM Chief Complaints1Reason for see,ing *are: Admitting Do*tor: Mary Cla"dette M. A!ad +inal Diagnosis: %. Chroni* 2idney Disease '. Nephroti* Syndrome .. Anemia S1P !lood transf"sion3 S1P Peritoneal Dialysis 4peration done: %. /en*,hoff insertion '. Peritoneal Dialysis Attending Physi*ian: Dr. Ca!ral *Health Assessment upon Admission* 5P6: A!o"t . 7ee,s prior to admission, mother noted that the *hild had generali8ed edema and de*reased "rine o"tp"t. So"ght *ons"lt 7ith the physi*ian and 7ere gi9en Medrol %- mg ta!3 % ta! afer !rea,fast and ' : ta!s after dinner, Cal*i"m Car!onate ;CaCo.< )(( mg ta! 4D ;on*e a day<. Past 5istory: Patient 7as admitted at =SMMC last '(%% for Peritoneal Dialysis for AR+ ;a*"te renal fail"re< se*ondary to RPGN ;rapid progressi9e glomer"lonephritis<. >nremar,a!le Al*ohol: ;?< Dr"g allergies ;?< Condition on admission: *ons*io"s, *oherent, oriented =ital Signs: #P? %-(1%(( mmhg 3 PR? &% !pm 3 RR?.'*pm S,in: ;@< pallor red"*ed s,in t"rgor 5AAN/: Ani*teri* s*leras, pin, *onB"n*ti9a, PARR A Cardio9as*"lar: 6n*reased Respiratory Rate, Normal 5eart Rate A!domen: distended 7ith edema ;@< g"arding ;?< tenderness on a!domen Re*t"m: aCed sphin*ter ;?< !lood *Health History*

Pre9io"s hospitali8ations and s"rgeries: Admited at Ce!" =ele8 General 5ospital for D days 7ith the Diagnosis: Nephroti* Syndrome. Childhood 6llness: none prior to first admission 6mm"ni8ations: +6C ;f"lly imm"ni8ed *hild< Allergies: No ,no7n allergies

*Family Health History* +amilial Diseases: ;@< 5PN Stat"s of +amily: 6nta*t and eCtended +amily Attit"de of +amily: /he family is optimisti* and hopef"l for the re*o9ery of the si*, family mem!er. *Social History* Prior to admission, the patient 7as noted to !e so*ially intera*ti9e and 7as *losely *onne*ted 7ith his fello7 peers at s*hool and in their neigh!orhood. Ad"*ation: Grade % ;elementary< A!ility to "nderstand instr"*tion: ;@< Signifi*ant 4thers: /he patient's mother, grandmother and yo"nger sister are an asset to the s"**ess of the *are plan. *Review of Systems* %. Cir*"latory System: no *ir*"latory pro!lems noted. ;?< *yanosis '. Digesti9e System: Anal sphin*ter m"s*le is relaCed . ;@< irreg"lar !o7el f"n*tion ;@< *onstipation .. Ando*rine System: slo7 meta!olism 0. 6mm"ne System: 6nflammatory System at 7or,. ;?< snee8ing ;@< fe9er ). ymphati* System: +l"ids and n"trients are not distri!"ted 7ell as e9iden*ed !y ;@< tiss"e s7elling as e9iden*ed !y edema. -. M"s*"lar System: de*reased m"s*"lar *ontrol on "pper and lo7er !ody d"e to
generali8ed 7ea,ness. D. Ner9o"s System: Ner9e imp"lses and sensory re*eptors are f"n*tioning 7ell 7ith no a!normalities noted. 8. Reprod"*ti9e System: ;@< edema &. Respiratory System: Deep !reathing3 6n*reased Respiratory Rate: .' *pm %(. S,eletal System: No spinal a!normalities noted. %%. >rinary System: ;@< >rinary Retention3 de*reased "rine o"tp"t. *Functional Assessment* +"n*tional Performan*e of AD s: /he patient is dependent in performing AD s !e*a"se

his a!ility to perform AD s is *ompromised d"e to 7ea,ness and general edeama. 5e *an perform a*ti9ities limited only 7ith the "se of his "pper eCtremities.
Self?Care A!ility: ;@< self?*are defi*it.

*Gordons Functional Health Problems*

%. 5AA /5 PARCAP/64N AND MANAGAMAN/ S"!Be*ti9e C"es: un!od n!a admit a"on! ana"# ma undan! nani siya o! s"wela o! dili na siya "ayo "a dula# maluoy "o pero "asa$ot naman ni siya n!a di sa niya pwede ma $uhat iyan! m!a !usto $uhaton "ay naa paman siyay sa"it. . 4!Be*ti9e C"es: AChi!its a normal attit"de to7ards the present sit"ation. /he patient and his family are hopef"l for his re*o9ery. '. N>/R6/64N AND MA/A#4 6SM S"!Be*ti9e C"e: %ermi man mi hatdan sa dietary dri o! pa!"aon pero dili lan! na"o ipa "aon sa a"on! ana" "ay mahadlo" "o $asin parat o! $awal an! pa!"aon n!a !i hatod sa amo# as ver$ali&ed $y the mother. 4!Be*ti9e C"es: /he patient eats . times a day. ;@< 5ydration Stat"s ;?< star9ation1h"nger. .. A 6M6NA/64N: S"!Be*ti9e C"e: 'a"a li$an! siya pero dili permi. %ana!sa ra !yud "ay !amay raman sad ni siya o! "ao# as ver$ali&ed $y the mother. 4!Be*ti9e C"es: 6rreg"lar #o7el mo9ement ;@< Constipation. >se of ind7elling *athether ;Drained e9ery 0ho"rs<. 0. AC/6=6/E AND AFARC6SA S"!Be*ti9e C"es: Dili mani siya "a liho"(liho" o! ayo tun!od sa iyan! hupon!. 'a! lisud !yud ni siya o! liho" o! dili siya "a la"aw n!a siya ra as ver$ali&ed $y the mother. 4!Be*ti9e C"es: Dependent on AD s ;limited only to the a*ti9ities "sing the "pper eCtremities<. 2ept side rails "p d"e to ris, for inB"ry related to immo!ility and 7ea,ness. imited so*iali8ation a!ility d"e to ina!ility to 7al, dependently and so*iali8e 7ith peers.

). S AAP AND RAS/ S"!Be*ti9e C"e: 'a! lisud a"on! ana" o! tulo! usahay "ay sa"itan sa iyan! tiyan o! ma! lisud siya o! liho" as ver$ali&ed $y the mother. 4!Be*ti9e C"es: /he patient sleeps atleast &ho"rs a day and appears 7ell rested. -. C4GN6/6=A PARCAP/64N 4!Be*ti9e C"es: ;@< Alert ;@< Cons*io"s ;@< 4riented. /he Primary *aregi9er is the Mother. D. SA + PARCAP/64N AND SA + C4NCAP/ 4!Be*ti9e C"es: Patient appears timid and silent. 8. R4 A AND RA A/64NS56P /he *hild eChi!its a healthy relationship 7ith his family. A9en tho"gh he is eCperien*ing a si*, role, he still manages to *omm"ni*ate and intera*t 7ith is family mem!ers. &. SAF>A 6/E AND RAPR4D>C/64N G not yet appli*a!le to patient sin*e he is only 8 yo. %(. C4P6NG AND S/RASS /4 ARANCA 4!Be*ti9e C"es: Sleep, rest and playing *ell phone games are his 7ay of *oping 7ith stress. %%. =A >AS AND #A 6A+S G no ,no7n "se of alternati9e medi*ine and therapies.

Dis*harge Care Plan

D6SC5ARGA P ANN6NG 4!Be*ti9e: /his dis*harge plan aims to *ontin"e the *are of the *lient !y in9ol9ing the signifi*ant others to parti*ipate in the plan of *are. 6t is presented in s"*h a 7ay that the patient is 9ie7ed holisti*ally and as a "niH"e indi9id"al, that the disease pro*ess, *ondition, prognosis and management regimen are "nderstood. /his is in pla*e to meet the patients need after dis*harge.

Area Medi*ations

6nstr"*tions Rationale ?Dis*"ss or reinfor*e the importan*e of A**ording to #are ta,ing medi*ations as pres*ri!ed. ;'(('< patient needs to "nderstand the ?Gi9e signifi*ant other1s 7ritten o**"rren*e of its effe*ts information regarding eCpe*ted effe*ts in order for them to and side effe*ts of the medi*ation. ,no7 7hen and 7hom to report. ?6nstr"*t signifi*ant other1s not to s"!stit"te a pres*ri!ed dr"g. ?Stri*t and follo7 orders for 5ome Medi*ation "pon dis*harge as pres*ri!ed !y the physi*ian.

AFARC6SA

?6mplement doing of passi9e range A**ording to of motion eCer*ises in a *ephalo?*a"dal #are;'(((< pro9iding manner this promotes *ir*"lation. f"ll range of motion fo"r or fi9e times a day ?A!d"*tion?mo9ement a7ay from the maintain Boint mo!ility3 midline of the !ody. regain motor *ontrol, and pre9ent *ontra*t"re ?Add"*tion?mo9ement to7ard the midline de9elopment, enhan*e of the !ody. *ir*"lation and pre9ent 9eno"s stasis. ?+leCion?!ending of a Boint so that the angle of the Boint diminishes. ?Rotation?t"rning or mo9ement of a part aro"nd its aCis.

?ACer*ise the affe*ted eCtremities passi9ely thro"gh range of motion 0?) times a day 7hile on !ed rest to maintain Boint mo!ility and enhan*e *ir*"lation3 en*o"rage a*ti9e R4M as a!le. ?6nstr"*t *lient and family on these as 7ell as proper positioning. ?Conser9e energy !y !alan*ing a*ti9ity and rest periods.

/reatment

5ealth /ea*hings

Contin"e peritoneal dialysis if ne*essary and *ontin"e the pharma*ologi* therapy as pres*ri!ed !y M.D. and ret"rn to hospital for s*hed"led follo7?"p 9isits to M.D. ?6nstr"*t the signifi*ant others regarding stri*t medi*ation *omplian*e ?+reH"ent oral hygiene to red"*e r"ino"s !reath odor. ?>se lip !alms 1 petrole"m Belly to moisten *ra*,ed lips and m"*o"s mem!ranes. ?Ad"*ate the *lient and family a!o"t the food and !e9erages to a9oid and pre9ent re*"rren*e of symptoms. ?Ad"*ate the *lient and family to al7ays follo7 the pres*ri!ed amo"nt of fl"id to !e *ons"med in a day. .?/ea*h also the family to adapt home en9ironment that is safe from fall and inB"ries. An*o"rage *onsisten*y in the en9ironment 7itho"t distra*tion. ?/ea*h the family on ho7 to fa*ilitate *omm"ni*ation 7ith the *lient. ?Ad9i*e the signifi*ant others to att end to the s*hed"led follo7? "p*he*,?"p of the *lient 7ith the physi*ians to e9al"ate *lients o9er?all health *ondition.

4"tpatient

6nstr"*t the famil y to report to the physi*ian for any re*"rren*e or se9erity of symptoms, any ad9erse effe*ts of the medi*ations ta,en, and any de9elopment of *ompli*ations.

Spirit"ality

?An*o"rage family to attend mass e9ery S"nday or any time 7hen they are free. ?Ad9ise family to tr"st the pla*e their faith in him. ord and

?An*o"rage the family to read the !i!le and meditate on the 7ords of God.

*Nursing Care Plan*

PR4# AM: )mpaired physical mo$ility related to !enerali&ed wea"ness. DA/A 6DAN/6+6AD: April -, '(%. C>AS: Su$*ective +ues: ,Dili "a liho"(liho" a"on! ana" tun!od "ay !a luya !yud "aayo siya.I As 9er!ali8ed !y the mother. -$*ective +ues: 6na!ility to 7al, 7itho"t assistan*e, limited !ody mo9ements, fa*ial grima*e. ANA ES6S 4+ /5A PR4# AM: ?Chroni* ,idney disease happens 7hen the ,idneys do not ta,e o"t 7aste prod"*ts for at least three months in a ro7. Chroni* ,idney disease sometimes *a"ses anemia. Symptoms of anemia in*l"de feeling tired and 7ea, hen*e pre9enting the affe*ted person from mo9ing dependently most espe*ially in *ases 7herein there is se9ere and generali8ed 7ea,ness. S/A/AMAN/ 4+ PA/6AN/ CARA 4#$AC/6=AS: At the end of 8 ho"rs of n"rsing inter9ention, the patient 7ill demonstrate te*hniH"es or !eha9iors that ena!le res"mption of tolera!le a*ti9ities N>RS6NG AC/64NS 6ndependent: %. Assess le9el of 7ea,ness. %. /o determine1plan tolera!le a*ti9ities for the patient. '. Ana!les patient to ha9e sense of *ontrol, and .. Red"*es fear of !eing left alone After 8 ho"rs of n"rsing inter9entions, the patient 7as a!le to demonstrate te*hniH"es or !eha9iors that ena!le res"mption of tolera!le a*ti9ities. RA/64NA A A=A >A/64N

'. Pro9ide means to s"mmon help .. Assist in range of motion eCer*ises on all eCtremities and Boints, "sing slo7, smooth mo9ements.

0. Plan a*ti9ities to pro9ide "ninterr"pted rest periods. An*o"rage in9ol9ement 7ithin indi9id"al toleran*e or a!ility ). Reposition periodi*ally e9en 7hen sitting in *hair. /ea*h patient ho7 to "se 7eight?shifting te*hniH"es -. 6nspe*t the s,in daily. 4!ser9e for press"re areas, and pro9ide meti*"lo"s s,in *are.

0. Anhan*es *ir*"lation, restores or maintains m"s*le tone and Boint mo!ility, and pre9ent dis"se *ontra*t"res and m"s*le atrophy.

). Pre9ents fatig"e, allo7ing opport"nity for maCimal efforts or parti*ipations !y patient. -. Red"*es press"re areas, promotes peripheral *ir*"lation, altered *ir*"lation, loss of sensation, and paralysis potentiate press"re sore formation.

Colla!orati9e: %. Cons"lt 7ith physi*al or o**"pational therapist. %. 5elpf"l in planning and implementing indi9id"ali8ed eCer*ise program.

*Nursing Care Plan*

PR4# AM: Ris" for infection due to %eritoneal Dialysis. Ris, +a*tors: Contamination of *atheter d"ring insertions, periodi* *hanging of t"!ings1!ags, s,in *ontaminants at *atheter insertion site, sterile peritonitis ;response to the *omposition of dialysate<. Possi!ly e9iden*ed !y: Reports of pain, self?fo*"sing, g"arding1distra*tion !eha9io"rs, restlessness. ANA ES6S 4+ /5A PR4# AM: ?Peritoneal dialysis is a treatment for people 7hoa ha9e *hroni* ,idney disease or ,idney fail"re. 4ne thing yo" ha9e to !e *aref"l a!o"t in PD is peritonitis3 this is an infe*tion of the peritone"m ;the lining of the !elly<. Peritonitis happens 7hen germs get into the peritoneal *a9ity thro"gh the *atheter this is the reason 7hy patients 7ho are "ndergoing peritoneal dialysis are indeed, ris, for infe*tion and needs proper and appropriate *are. S/A/AMAN/ 4+ PA/6AN/ CARA 4#$AC/6=AS:
At the end of 8 ho"rs of n"rsing inter9ention *lient 7ill !e a!le to: %. 6dentify inter9entions to pre9ent1red"*e ris, of infe*tion. '. ACperien*e no signs1symptoms of infe*tion.

N>RS6NG AC/64NS 6ndependent: %. 4!ser9e meti*"lo"s asepti* te*hniH"es and 7ear mas,s d"ring *atheter insertion, dressing *hanges, and 7hene9er the system is opened. Change t"!ings per proto*ol. '. Change dressings as indi*ated, !eing *aref"l not to dislodge the *atheter. Note *hara*ter, *olor, odor, or drainage from aro"nd insertion site.

RA/64NA A

A=A >A/64N

%. Pre9ents the introd"*tion of organisms and air!orne *ontamination that may *a"se infe*tion.

After 8 ho"rs of n"rsing inter9entions, the patient 7as a!le to: %. 6dentify inter9entions to pre9ent and red"*e ris, of infe*tion. '. ACperien*e no signs1symptoms of infe*tion.

'. Moist en9ironment promotes !a*terial gro7th. P"r"lent drainage at insertion site s"ggests presen*e of lo*al infe*tion. Note: Poly"rethane adhesi9e film ;e.g., !lister

film< dressingsha9e !een fo"nd to de*rease amo"nt of press"re on *atheter and eCit site as 7ell as in*iden*e of site infe*tions. .. 4!ser9e *olor and *larity of effl"ent. 0. Apply po9idone?iodine ;#etadine< !arrier in distal, *lamped portion of *atheter 7hen intermittent dialysis therapy "sed. ). 6n9estigate reports of na"sea19omiting, in*reased1se9ere a!dominal pain3 re!o"nd tenderness, fe9er, and le",o*ytosis. -. Monitor J#C *o"nt of effl"ent .. Clo"dy effl"ent is s"ggesti9e of peritoneal infe*tion.
0. Red"*es ris, of !a*terial

entry thro"gh *atheter !et7een dialysis treatments 7hen *atheter is dis*onne*ted from *losed system ). Signs1symptoms s"ggesting peritonitis, reH"iring prompt inter9ention.

-. Presen*e of J#Cs initially may refle*t normal response to a foreign s"!stan*e3 ho7e9er, *ontin"ed1ne7 ele9ation s"ggests de9eloping infe*tion. D. 6dentifies types of organism;s< present, *hoi*e of inter9entions

D. 4!tain spe*imens of !lood, effl"ent, and1or drainage from insertion site as indi*ated for *"lt"re1sensiti9ity 8. Monitor renal *learan*e1#>N, Creatinine

8. Choi*e and dosage of anti!ioti*s are infl"en*ed !y le9el of renal f"n*tion.

&. Administer anti!ioti*s &. /reats infe*tion, systemi*ally or in dialysate pre9ents sepsis as indi*ated.