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End

Stage
Renal
Disease

End Stage Renal Disease


End Stage Renal Disease is irreversible and
progressive reduction of functioning renal
tissue.
It occurs when the remaining kidney mass can
no longer maintain the bodys internal
environment which results in renal failure.
It is called Chronic Kidney Disease (CKD) and
is labeled stage 5. ESRD can develop
insidiously over many years or may result from
an episode of renal failure from which the
client has not recovered.

ETIOLOGY
Various injuries and disease process that may result in kidney
failure were
Chronic Glomerulonephritis
Acute Renal Failure
Polycystic Kidney Disease
Obstruction
repeated episodes of Pyelonephritis
Nephrotoxins.
Systemic diseases such as Diabetes Mellitus, Hypertension,
Lupus Erythematous, Sickle Cell Disease and Amyloidosis
may produce chronic kidney disease.

Patients Data
Patients Name: Aling D
Age:

56 years old

Weight

130 lbs or 59kg

Height 410 ft
Gender: Female
Birth date:

September 25, 1953

Address: Dumanlas, Buhangin, Davao City


Nationality: Filipino

Patients Data
Religion [Domination]: Christian [Roman Catholic]
Civil Status: Married
Educational Attainment:

College graduate

Occupation: Teacher (retired)


Chief complaint: Epigastric pain
Admitting Diagnosis: End Stage Renal Disease secondary to
Hydronephrosis secondary to Diabetes Mellitus Type II

Nursing History
i. Chief complaint
The patient is experiencing epigastric pain.
ii. Present History
The patient experienced chest pain. She also experienced dyspnea
occurring at night, accompanied by bipedal edema. The patient also had cough
and abdominal pain. She took a supplement called Relieve for 23 days to
alleviate the symptoms she felt. She tolerated the symptoms until she had
onset of epigastric pain. She had her check-up on UM Multitest. Along with
her laboratory results, she was diagnosed with End Stage Renal Disease.
However, she was not admitted by then. She sought medical attention when
she experienced severe epigastric pain, and thus the admission.

Nursing History
iii. Past History
The patient was born via normal spontaneous vaginal delivery. She did
not have any complications nor unusualities when she was delivered. The
patient did not experience any serious illness or accident during her childhood.
But she did experience, having chicken pox when she was a child. Also, she
had only experienced common minor illnesses such as colds, fever, stomach
aches, headaches, and constipation. She drinks over-the-counter drugs like
paracetamol when she experiences fever. According to the patient, she had
been diagnosed with hypertension 20 years ago and diabetes mellitus 15 years
ago. She takes insulin shots for her Diabetes. She verbalized that she did not
have strict compliance to her medications since her condition was not bad
before.

Nursing History
iv. Personal and Social History
- The patient is a non-smoker and occasionally drinks alcohol.
v. OB History
- The patient has 3 children, but one son is already dead due to cardiac arrest.
The son died at the age of 23 who is the middle child. Her eldest son is 31
years old, and her youngest son is 28 years old.

Nursing History

vi. Developmental History


Erikson's Stages of Psychosocial Development

(Middle Adulthood 25 to 65 years old)


GENERATIVITY vs. STAGNATION

Nursing History
vii. Feeding History
-

Her familys diet is composed of meat, fish and vegetables, however, due
to her hospitalization she has been following a low salt low fat diet. She
also avoids protein-rich foods and foods high in sugar.

viii. Immunization History


- The Patient is fully immunized.

Course in the Ward

Anatomy and Physiology

The kidneys are a pair of bean-shaped organs


found along the posterior wall of the abdominal
cavity.
The kidneys, unlike the other organs of the
abdominal cavity, are located posterior to the
peritoneum and touch the muscles of the back.
The kidneys are surrounded by a layer of adipose
that holds them in place and protects them from
physical damage. The kidneys filter metabolic
wastes, excess ions, and chemicals from the
blood to form urine.

PAT H O P H Y S I O LO G Y

Laboratory/ Diagnostic Tests

Laboratory/ Diagnostic Tests


Laboratory Exam

Result

Normal Values

Specific
gravity

1.042 (high)

1.010- 1.030

Clinical
Significance
Increased urine
specific gravity may
be due to conditions
such as:
Loss of body
fluids
(dehydration)
Diarrhea that
causes
dehydration
Heart failure
Sugar (glucose)
in the urine
Syndrome of
inappropriate
antidiuretic
hormone
secretion
(SIADH)

Clinical
Manifestations
Dehydration

Laboratory/ Diagnostic Tests


Laboratory Exam

Result

Normal Values

Hemoglobin

96 (Low)

115 175 g/L

Hematocrit

0.27 (Low)

0.36 0.48

RBC count

3.58 (Low)

4.20 6.10

Lymphocyte

37 (High)

20 35

Clinical
Significance
A low hemoglobin is
referred to as
anemia.
A low hematocrit is
referred to as
anemia.
Low RBC may
indicate blood loss,
anemia, hemorrhage,
bone marrow failure,
leukemia, and
malnutrition
Abnormally high
levels of
lymphocytes can be
due to flu, chicken
pox, and some viral
and bacterial
infection.

Clinical
Manifestations
Anemia
Anemia

Anemia

Bacterial infection

Laboratory/ Diagnostic Tests


Laboratory
Exam

Sodium

Creatinine

Result

168 (High)

697.90 (High)

Normal Values

Clinical
Significance

136 155

High Serum sodium


indicates retention
of sodium in the
body
and
a
diminished filtration
function
of
the
kidneys.

53 - 115

This measures renal


sufficiency..
The
lower the level of
creatinine in the
body, the healthier
the kidneys are.

Clinical
Manifestations

Hypernatremia
- Dehydration

Hypertension

High blood
pressure
Diabetes
Edema

Treatment

Treatment
ESRD may need to be treated with dialysis or kidney transplant.
1) DIALYSIS
Dialysis does some of the job of the kidneys when they stop working
well.
Dialysis can:
) Remove extra salt, water, and waste products so they do not
build up in your body
) Keep safe levels of minerals and vitamins in your body
) Help control blood pressure
) Help the body make red blood cells

Treatment
Two different methods are used
to perform dialysis:
1. Hemodialysis.
-. During hemodialysis, blood is
removed from a vein. It is run
through
filters
in
a
hemodialysis
machine
to
remove waste products. The
blood is then returned from the
machine
to
the
body.
Hemodialysis usually is done
at a dialysis center. The
treatments are done three
times a week, in three- to fourhour sessions.

Treatment
2. Peritoneal dialysis.
During peritoneal
dialysis, sterile fluid is
infused into the abdomen.
Waste products gradually
accumulate in the fluid,
which is drained several
hours
later.
Peritoneal
dialysis is done at home. It
takes
longer
than
hemodialysis and must be
done four to five times a
day. It can be automated to
occur during sleep.

Treatment
2) KIDNEY TRANSPLANT
) Kidney transplants allow
people
with
severe
kidney disease to avoid
or discontinue dialysis. A
kidney
transplant
is
surgery to place a
healthy kidney into a
person
with
kidney
failure. Your doctor will
refer you to a transplant
center.

DRUG STUDY

L
A
C
I
D
T

E
N
E
M NAG EM
MA

Treatment for anemia, such as extra iron


in the diet, iron pills or shots, shots of a
medicine called erythropoietin, and blood
transfusions.
Medicines to control your blood pressure.

S
G
N
N
O
I
I
S
T
R
N
U
E
N
V
R
E
INT

ACHIEVING FLUID AND ELECTROLYTE


BALANCE
Monitor for signs and symptoms of hypovolemia or
hypervolemia
Monitor urinary output and urine specific gravity;
measure and record intake and output including urine,
gastric suction, stools, wound drainage, perspiration.
Monitor serum and urine specific concentrations.
Weigh patient daily to provide an index of fluid balance;
expected weight loss is to 1 Ib (0.25- 0.5 kg) daily.
Adjust fluid intake to avoid volume overload and
dehydration.
Source: Lippincott Manual of Nursing Practice, 2006

ACHIEVING FLUID AND ELECTROLYTE


BALANCE
Instruct patient about the importance of following
prescribed diet, avoiding foods high in potassium.

PREVENTING INFECTION
Keep your access site clean. If the patient is on
dialysis, they will be instructed on how to keep their
access site clean and look for any signs of infection.
Look for signs of infection. PD patients should look for
damage to or cracks on their catheter. Redness, irritation
or bleeding are indicators of infection. People on
hemodialysis should clean their access site before
treatment.
Wash your hands. Cold and flu germs can be on
doorknobs, sink faucets and newspapers. If you touch
something that someone whos ill has touched, you risk
getting the same infection.

PREVENTING INFECTION
Eat nutritious foods. Consuming adequate amounts of
protein, calories and nutrients build bodys immune
system. If the patient is on dialysis, the renal dietitian
should create an eating plan based on your individual
nutrition needs.

MAINTAINING ADEQUATE NUTRITION


Work collaboratively with dietitian to regulate protein
intake according to impaired renal function.
Offer high carbohydrate feedings because carbohydrates
have a greater protein-sparing power and provide
additional calories.
Weigh daily
Be aware that food and fluids containing large amounts
of potassium, sodium, and phosphorus may need to be
restricted.
Source: Lippincott Manual of Nursing Practice, 2006

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