Question

TOPIC: RENAL NURSING

Objective: This assignment is to evaluate learners' analytical skills in addressing health promotion strategies among chronic kidney disease patients.

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 weight 91kg (BMI: 38.9).

Mrs. A is diagnosed with stage 3 chronic kidney disease, with a GFR of 49 mL/min/1.73m^2 and profound microalbuminuria.

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

Answer 1

Nursing care and management:

In 3rd stage of chronic kidney disease we cannot reverse the kidney disease but we can help it in preventing from further more damage to kidneys. Treatment and diet maintenance is essential in this stage

• Check the weight regularly
• Monitor intake and output
• Educate to eat less processed foods and less saturated fats found in animals
• Encourage to take less protein intake if potassium levels are high
• Cut down the sodium if sodium levels are high
• The patient may experience loss of appetite so provide food in small quantities in frequent intervals to prevent malnutrition
• Plan for moderate activities of exercise at least for 30 minutes per day
• Administer angiotensin converting enzyme and angiotensin 2 receptor blockers to maintain blood pressure and glucose levels and to control microalbuminurea
• To alleviate the side effects of CKD administer iron, calcium and vitamin D supplements
• Administer cholesterol lowering drugs and diuretics to treat edema
• Provide relaxation therapies to manage stress
• Follow up with cardiologist as microalbuminurea increases the risk of cardiovascular diseases
• Provide health education on importance of management of BP, glucose levels and cessation of smoking.