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Renal Disease:
Chronic Kidney Disease Care Plan

Kadeen Westcarr

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Chamberlain College
of Nursing

NR341 Complex Adult
Health

Dr. Richards

January 18, 2018

 

 

 

 

 

 

 

 

 

 

 

 

Demographics

Name: Frazier, Cory

Age: 63 y/o

D.O.B: 10/31/1954

Height: 162 cm

Weight: 104.2 kg

BMI: 39.63

Allergies: NKA

Code Status: Full code

Diet: 1800 KCAL cardiac with fluid
and sodium restrictions

Occupation: Construction worker

Marital Status: Single

Ethnicity: African American

Admitting Diagnosis: Chronic Kidney
Disease

 

Patient history

Patient has a history of Diabetes
Mellitus type 2, hypertension, and obstructive sleep apnea. Patient is a former
smoker (0.5 pack cigarettes/ day) 10 pack years. Patient stated he quit smoking
20 years ago. Patient had a cystoscopy, prostate and bladder biopsy pyelogram
on 2/18/14. Patient also had an intracapsular cataract bilateral extraction in
2011.

History of present illness

Patient presented to the emergency
room on 01/15/2018 with severe swelling bilaterally to lower extremities, with
no aggravating or relieving factors. An IV access was inserted in the left
antecubital.  Patient was sent for a
renal ultrasound that showed chronic renal parenchymal disease. Patient was
placed on fluid and sodium restrictions per MD orders.

Physical assessment

Neurological:
Patient awake, alert and oriented times three (place, person and time).
Calm affect, cooperative and clear speech. Patient denies any dizziness,
weakness, numbness or tingling. Patient denies pain 0 on 0-10 pain scale.
PERRLA, with sluggish pupillary reflexes bilaterally. Movement in all
extremities. Hand grasp +2 bilaterally. Leg strength +2 bilaterally. Cranial
nerves 1-12 intact.

Cardiovascular:
S1 S2 auscultated. No murmurs noted. Patient’s blood pressure was 172/114.
Nifedipine was administered under supervision. Patient was reassessed an hour
later and blood pressure was 152/90.

Respiratory:
Lungs sound clear bilaterally, respirations even and unlabored at 18
breaths on room air.

Gastrointestinal:
Abdomen symmetrical, soft, rounded and non-distended. Patient denies any
abdominal discomfort. Bowel sounds normoactive in all four quadrants. LBM 01/17/18.

Genitourinary:
Patient denies any burning upon urination. Urine clear and odorless. Musculoskeletal: Patient ambulates
without difficulty. Full range of motion is all extremities.

Integumentary:
Skin intact. Warm and dry to touch. Normal skin color for race. Bilateral
skin tautness to lower extremities, shiny appearance with +1 pitting edema, IV
dry and intact, no redness or swelling noted.

 

Laboratory and Diagnostic Test

Laboratory/ Diagnostic

Value

Rationales

BUN

48

Due to the chronic kidney disease, the kidneys cannot
eliminate urea nitrogen effectively from the blood causing a buildup of urea
nitrogen.

Creatinine

4.35

When the kidneys lose their ability to filter blood
effectively, GFR decreases resulting in an increase of serum creatinine in
the blood.

Potassium

3.3

The patient had severe edema upon admission to the
hospital, so to decrease the fluid buildup the patient was given a loop
diuretic (Lasix). With this diuretic potassium is wasted thus reducing the
patients’ potassium level.

Albumin

21

A healthy kidney does not let albumin pass into the
urine. However when the kidneys are damaged albumin is passed into the urine.
Having high albumin in the urine is also a positive indicator of kidney
disease

Renal Ultrasound
1/16/2018

 

Renal ultrasound was done to visualize the kidneys and
identify the extent of damage. The ultrasound showed that the patient had
chronic parenchymal disease.

 

 

Nursing Diagnosis

Fluid
and Electrolyte Imbalance related to side effects of diuretics as evidence
by serum potassium of 3.3 and edema in both legs  (Cox & Murdoch-Newfield,
2007)
Fluid
volume excess related to poor kidney function as evidence by bilateral
swelling to lower extremities  (Cox & Murdoch-Newfield, 2007)
Imbalanced
nutrition more than body requirements related to poor diet and sedentary
lifestyle as evidence by patient stating, “I don’t exercise or eat right”
and a BMI of 39.63 (Cox &
Murdoch-Newfield, 2007)

Medications

 

Brand and Generic    Name

Indications

Adverse Effects

Nursing Implications

Labetalol
/Trandate  (Vallerand, Sanoski, Deglin, & Mansell,
2015)

Management of
hypertension (Vallerand, Sanoski, Deglin,
& Mansell, 2015)

Fatigue,
weakness, orthostatic hypotension, erectile dysfunction (Vallerand, Sanoski, Deglin, & Mansell, 2015)

Monitor blood
pressure and pulse frequently during dose and adjustment and periodically during
therapy. Assess for orthostatic hypotension when assisting the client up from
the supine position. Monitor intake and output ratios and daily weight.
Assess patient routinely for fluid volume excess (edema, rales, crackles) (Vallerand, Sanoski, Deglin, & Mansell, 2015)

Nifedipine/Procardia (Vallerand, Sanoski, Deglin, & Mansell, 2015)

Management of
hypertension  (Vallerand, Sanoski, Deglin, & Mansell,
2015)

Headache,
peripheral edema, flushing (Vallerand,
Sanoski, Deglin, & Mansell, 2015)

Monitor blood
pressure and pulse before therapy, during dose titration, and periodically
during therapy. Monitor ECG periodically during prolonged therapy. Monitor
intake and output ratios and daily weights
(Vallerand, Sanoski, Deglin, & Mansell, 2015).
 

Spironolactone/Aldactone (Vallerand, Sanoski, Deglin, & Mansell, 2015)

Management of
essential hypertension. Treatment of hypokalemia (Vallerand, Sanoski, Deglin, & Mansell, 2015)

Hyperkalemia,
dizziness, headaches (Vallerand, Sanoski,
Deglin, & Mansell, 2015)

Monitor intake
and output ratios and daily weights during therapy. Monitor blood pressure if
given as an adjunct to antihypertensive. Advise patient to notify health care
provider if rash, muscle weakness, fatigue, severe nausea, vomiting or
diarrhea occurs (Vallerand, Sanoski, Deglin,
& Mansell, 2015)

Furosemide/Lasix (Vallerand, Sanoski, Deglin, & Mansell, 2015)

Edema due to
renal disease
Hypertension (Vallerand, Sanoski, Deglin, & Mansell, 2015)

Dehydration,
hypocalcaemia, hypokalemia, hypernatremia, hypervolemia, metabolic alkalosis (Vallerand, Sanoski, Deglin, & Mansell, 2015)

Assess fluid
status, monitor daily weight intake and output, amount and location of edema.
Assess lung sounds, skin turgor and mucus membranes. Notify healthcare
provider if dry mouth, oliguria, thirst, weakness or hypotension occurs.
Monitor blood pressure and pulse before and during administration. Assess
patient for tinnitus and hearing loss
(Vallerand, Sanoski, Deglin, & Mansell, 2015)

 

 

 

Interventions

Interventions

Rationales

Continuous monitoring of signs and
symptoms of hypokalemia to identify if patient status is worsening  (Cox &
Murdoch-Newfield, 2007)

Hypokalemia can be life-threating so
careful assessment is needed to determine patients status  (Cox &
Murdoch-Newfield, 2007)

Monitor serum potassium levels  (Cox &
Murdoch-Newfield, 2007)

This will determine how far levels
have dipped from baseline  (Cox & Murdoch-Newfield, 2007)

Put the patient on an ECG and
monitor continuously for any changes  (Cox & Murdoch-Newfield, 2007)

Hypokalemia can cause arrhythmias
such a premature ventricular and arterial contractions  (Cox & Murdoch-Newfield,
2007)

Take vital signs every 2 hours,
and apical pulse  (Cox & Murdoch-Newfield, 2007)

Permits monitoring of
cardiovascular response to illness state and therapy  (Cox & Murdoch-Newfield,
2007)

Check lung, heart and breath
sounds every 2 hours  (Cox & Murdoch-Newfield, 2007)

Essential monitoring for fluid
collection in the lungs and cardiac overload due to edema  (Cox &
Murdoch-Newfield, 2007)

Monitor intake and output hourly,
observe and document the quantity and character of the urine  (Cox &
Murdoch-Newfield, 2007)

This helps to determine the extent
of fluid balance  (Cox & Murdoch-Newfield, 2007)

Daily weights at the same time
each day with the same clothe  (Cox & Murdoch-Newfield, 2007)

Allows for consistent comparison
of weight  (Cox & Murdoch-Newfield, 2007)

Collaborate with healthcare
provider to develop fluid restriction regimen clearly indicating the amount
per shift  (Cox & Murdoch-Newfield, 2007)

Restricting fluids prevents
cardiovascular system overload and potential pulmonary effects  (Cox &
Murdoch-Newfield, 2007)

Carry out and review daily food
diary (caloric intake, types and amounts of food, eating habits) (Nurse Labs, 2018)

Provides the opportunity for the
individual to focus on a realistic picture of the amount of food ingested and
corresponding eating habits and feelings. Identifies patterns requiring
change or a base on which to tailor the dietary program (Nurse Labs, 2018)

Limit the patient’s
intake to number of calories recommended by the physician/ nutritionist  (Cox &
Murdoch-Newfield, 2007)

Reduces
calories to promote weight loss yet maintain body’s nutritional status  (Cox &
Murdoch-Newfield, 2007)

Collaborate
with dietitian and physical therapy  (Cox & Murdoch-Newfield, 2007)

Developing a
plan that includes activities that client enjoys increases potential for
continuing the activity  (Cox & Murdoch-Newfield, 2007)

 

References

Works Cited

Nurse Labs.
(2018, January 28). Retrieved from https://nurseslabs.com:
https://nurseslabs.com/4-obesity-nursing-care-plans/

Cox, H. C., & Murdoch-Newfield, S. A. (2007). Cox’s
clinical applications of nursing diagnosis : adult, child, women’s, mental
health, gerontic, and home health considerations 5th edition. Philadelphia
: F.A.: Davis Company.

Vallerand, A. H., Sanoski, C. A., Deglin, J. H., &
Mansell, H. G. (2015). Davis’s drug guide for nurses. Philadelphia,
Pennsylvania : F.A. Davis Company.

 

 

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