Question

SCENARIO:

Mrs. A, 53-years-old with a 17-year history of type 2 diabetes, hypertension and hyperlipidemia and a 35-year history of smoking. She presents in the ward with shortness of breath, pruritus, and pitting edema of bilateral extremities. Her blood pressure is 165/92 mm Hg, heart rate 94 beats per minute (regular rate and rhythm), and respiration 26 breaths per minute. She is 153cm tall and weighs 91kg (BMI: 38.9).

Mrs. A is diagnosed with stage 3 chronic kidney disease, with a GFR of 49 mL/min/1.73m² and profound microalbuminuria.

QUESTION:

Based on the the above scenario, organize relevant nursing care and management for Mrs. A in order to maximise her overall health and delay the progression of end stage renal disease (ESRD).

requeirment feom rubrics:

Organize relevant nursing care and management for Mrs. A in order to maximise her overall health and delay the progression of end stage renal disease (ESRD

Answer 1

ANSWER : MANAGEMENT OF CHRONIC RENAL FAILURE[END STAGE RENAL DISEASE ]

Mrs. A, 53-years-old with a 17-year history of type 2 diabetes, hypertension and hyperlipidemia and a 35-year history of smoking. She presents in the ward with shortness of breath, pruritus, and pitting edema of bilateral extremities.so mangement include,

1 . The blood pressure is lowered with sodium and water restriction,antihypertensive agents, or both .

2 . weight is monitored daily, and diuretic medications are prescribed to treat fluid overload.

3. proteins of high biologic value are provided to support good nutritional status [diary products , eggs, meats].

4 . urinary tract infections are treated promptly.

5 . dialysis is considered early in the course of disease to keep patient in optimal physical condition , prevent fluid and electrolyte imbalance, and minimize the risk of complications of renal failure.

Pharmacologic therapy:

• Calcium and phosphorus binders treat hyperphosphatemia and hypocalcemia;
• Antihypertensive and cardiovascular agents (digoxin and dobutamine) manage hypertension;
• Anti-seizure agents (IV diazepam or phenytoin) are used for seizures, and;
• Erythropoietin (Epogen) is used to treat anemia associated ESRD.

NURSING CARE

Nursing Assessment

Assessment of a patient with ESRD includes the following:

• Assess fluid status (daily weight, intake and output, skin turgor, distention of neck veins, vital signs, and respiratory effort).
• Assess nutritional dietary patterns (diet history, food preference, and calorie counts).
• Assess nutritional status (weight changes, laboratory values).
• Assess understanding of cause of renal failure, its consequences and its treatment.
• Assess patient’s and family’s responses and reactions to illness and treatment.
• Assess for signs of hyperkalemia.

Diagnosis

Based on the assessment data, the following nursing diagnoses for a patient with chronic renal failure were developed:

• Excess fluid volume related to decreased urine output, dietary excesses, and retention of sodium and water.
• Imbalanced nutrition less than body requirements related to anorexia, nausea, vomiting, dietary restrictions, and altered oral mucous membranes.
• Activity intolerance related to fatigue, anemia, retention of waste products, and dialysis procedure.
• Risk for situational low self-esteem related to dependency, role changes, changes in body image, and change in sexual function

Planning & Goals

Main Article: 6 Chronic Renal Failure Nursing Care Plans

The goals for a patient with chronic renal failure include:

• Maintenance of ideal body weight without excess fluid.
• Maintenance of adequate nutritional intake.
• Participation in activity within tolerance.
• Improve self-esteem

Nursing Priorities

1. Maintain homeostasis.
2. Prevent complications.
3. Provide information about disease process/prognosis and treatment needs.
4. Support adjustment to lifestyle changes.

Nursing Interventions

Nursing care is directed towards the following:

• Fluid status. Assess fluid status and identify potential sources of imbalance.
• Nutritional intake. Implement a dietary program to ensure proper nutritional intake within the limits of the treatment regimen.

• Independence. Promote positive feelings by encouraging increased self-care and greater independence.
• Protein. Promote intake of high-biologic –value protein foods: eggs, dairy products, meats.
• Medications. Alter schedule of medications so that they are not given immediately before meals.
• Rest. Encourage alternating activity with rest.

Evaluation

A successful nursing care plan has achieved the following:

• Maintained ideal body weight without excess fluid.
• Maintained adequate nutritional intake.
• Participated in activity within tolerance.
• Improved self-esteem.