Chronic Kidney Disease Nursing case presentation

Ckd presentation

1. C ASE PRESENTATION BY : CHINMAYI Roll No. 8 2 nd year CHRONIC KIDNEY DISEASE (CKD) ON

2. ACKNOWLEDGEMENT I, Chinmayi , 2 nd year student of B.Sc( Hons .) Nursing in CON. LHMC, was posted in the Nephrology Department of the Medical Super Speciality Ward (MSSW) in the Dr. Ram Manohar Lohia Hospital (Dr. RML Hospital). I was posted there on 19/02/2024 and 20/02/2024 under the guidance of our clinical tutor, Mrs. Savita Gahalain Ma’am. We were given orientation of the ward by the nursing officers. I would like to thank our Principal, Mrs. Chandan Kashyap ma’am and our teachers, Mrs. Niranjana Bhaduri ma’am and Mrs. Mary Hongsha ma’am, for providing us with this opportunity. I would like to thank our clinical tutor for providing us with her guidance during our posting. I would like to thank nursing officers and doctors for sharing their invaluable knowledge with us and the hospital staff for cooperating with us.

3. IDENTIFICATION DATA Patient Name: Bheem Prakash Age/Sex: 36Y/M CR No.: 202410462 DOA: 12/02/24 Diagnosis: CKD 5 with systemic HTN Ward: MSSW Bed No.: 10 Religion: Hindu Qualification: 10 th pass Marital Status: Married Occupation: Daily Wage Labourer

4. INTRODUCTION My patient, Mr. Bheem Prakash , a 36 year old male was bought to Emergency of RML Hospital at 10:15 am on 12/02/2024 with the complaint of pain, vomiting, fever, fatigue and swelling. He was suffering from pain on the upper quadrant of abdomen and on his back. He had 2-3 episodes of vomiting since past 3 days. He also had high fever in past 2 days. He complained of swelling in the lower limbs and neck. He was diagnosed with CKD 2 years ago and has been undergoing haemodialysis for past 1 year. He was admitted to MSSW Bed No. 10.

5. SOCIOECONOMIC STATUS My patient, Mr. Bheem Prakash , belongs to low-class family. He was the sole earning member of the family, working as a daily wage labourer, until he was diagnosed with CKD. For the past 2 years, his wife worked as a daily wage labourer until Mr. Bheem Prakash was admitted into the hospital. They live in slum area and their basic needs are not fulfilled. They don’t have access to proper sanitation and housing conditions.

6. FAMILY GENOGRAM Prema Devi Rajesh Roshni Rakesh Bheem Prakash

7. FAMILY HISTORY OF ILLNESS Family history of hypertension ( both father and brother suffered from HTN) No history of diabetes No history of tuberculosis No history of any surgery No history of cardiac disorders No history of renal diseases No history of hyperthyroidism and hypothyroidism No history of cancer No history of medical illness

8. HISTORY OF PAST ILLNESS High blood pressure (BP=165/83 mm Hg) controlled with Antihypertensive Drugs, Hypertension since past 5 years No history of diabetes No history of TB, cardiac disorders and cancer No history of cancer History of surgery: formation of AV fistula Suffers from Renal disorder: CKD from past 2 years and undergoing haemodialysis for the past year

9. HISTORY OF PRESENT ILLNESS High Blood pressure (BP=165/90 mmHg): controlled with Antihypertensive drugs c/o vomiting c/o weakness, fatigue c/o fever (101.2 ° F) c/o swelling in lower limbs and neck c/o pain in upper quadrant region of abdomen c/o pain in the back Decreased urine output and frequency despite normal consumption of water

10. PERSONAL HISTORY SLEEPING PATTERN: Patient takes adequate sleep (6-8 hours a day) BOWEL-BLADDER HABIT: Normal bowel habit Abnormal bladder habit: decreased urine frequency and output EATING PATTERN: Breakfast: Tea and biscuit Lunch: Chapati , Dal and Sabzi Dinner: Rice, Dal, Sabzi ADDICTION: History of alcohol consumption for past 12 years Chronic Smoker for past 10 years No history of chewing tobacco

11. CONDITION OF PATIENT ON ADMISSION Pain on the upper quadrant of abdomen and his back Vomiting since past 3 days Fever:101.2 ° F Patient was fatigued, swelling present on the legs and neck region Decreased urine output and frequency Vitals: PR: 98 beats/min RR: 26 breaths/min SpO2: 99% BP: 156/88 mmHg RBS: 108 mg/ dL

12. PHYSICAL EXAMINATION GENERAL APPEARANCE Nourishment- Malnourished Body build- Weak Active- Physically inactive and Mobile Height- 5’7” Weight-58 KG [PREVIOUS-63KG ] MENTAL STATUS Consciousness- Well oriented to time, place and person POSTURE Body Curve- Normal Gait- Normal SKIN CONDITION Color-No pallor, cyanosis Texture- Normal, wrinkled & no lesions Temperature: Febrile

13. DIAGNOSTIC FINDINGS Creatinine Clearance: It is a measure of amount of creatinine the kidneys are able to clear in 24 hour period. Blood Tests : It tests for 1. Serum Creatinine 2. Blood Urea Nitrogen 3. Glomerular Filtration Rate(GFR) 4. Arterial pH 5. Bicarbonate Concentration 6. Serum Calcium, Sodium, Potassium and Phosphate Levels

14. DIAGNOSTIC FINDINGS Urine Tests: Urine analysis is check for proteinuria, hematuria, specific gravity and urine albumin to creatinine ratio. Imaging Studies: Ultrasound, CT Scan, MRI, Radiography, IV Pyelography, Renal Scan, Renal Arteriography, Nephrotomography , Intravenous Urography, Plain Abdominal Radiography Other Tests: Hb and HCT levels and electrolyte levels Kidney Biopsy Medical History and Physical Examination

15. MEDICAL MANAGEMENT The medical management of patients with CKD focuses on: Treatment of the underlying causes. Referral for initiation for renal replacement therapies Prevention of complications. Slowing the progression of disease Managing symptoms Regular clinical and laboratory assessment

16. MEDICAL MANAGEMENT Blood Pressure Control : Maintaining blood pressure through lifestyle modifications and medications. eg - Diuretics, ACE Inhibitors, Angiotensin II Receptor Blockers, Calcium Channel Blockers, Beta-blockers, Alpha-blockers, Vasodilators Diabetes Control : Tight glycemic control is done for patients with diabetes to prevent further kidney damage. This involves lifestyle modifications, oral antidiabetic medications, or insulin therapy as appropriate. eg - Sulfonylureas , Meglitinides , DPP-4 inhibitors

17. MEDICAL MANAGEMENT Medication Review : Regular review and dose adjustments are essential due to minimize potential nephrotoxic effects. Dietary Management : Diet should be low in sodium, potassium, and phosphorus, and monitor protein intake to reduce the burden on the kidneys. Alcohol intake should be stopped. Fluid Management : Monitoring fluid intake to prevent fluid overload and electrolyte imbalances

18. MEDICAL MANAGEMENT Anemia Management : Supplementing with erythropoiesis-stimulating agents (ESA) and iron therapy to manage anemia associated with CKD. Cardiovascular Risk Reduction : Addressing cardiovascular risk factors such as smoking, dyslipidemia, and obesity to reduce the risk of cardiovascular disease

19. Nursing Diagnosis Risk for disturbed body image related to changes in physical appearance due to CKD. Impaired urinary elimination related to decreased renal function. Risk for impaired skin integrity related to edema and compromised circulation. Risk for infection related to compromised immune function and frequent access to the healthcare system. Imbalanced nutrition: less than body requirements related to dietary restrictions and metabolic alterations. Activity intolerance related to fatigue and weakness associated with CKD. Anxiety related to uncertainty about the disease progression and treatment. Deficient knowledge about the disease process, management, and self-care requirements. Fluid volume excess related to impaired renal function.

20. NURSING MANAGEMENT Regularly assess for renal function, fluid balance, electrolyte levels, blood pressure and blood glucose levels. Monitor for signs of complications such as hypertension, anemia, and fluid overload. Provide thorough education about CKD, including its causes, progression, treatment options, and self-care strategies. Empower patients to actively participate in their care and decision-making process. Monitor fluid intake and output closely to prevent fluid overload or dehydration. Manage electrolyte imbalances through dietary modifications and medication management.

21. NURSING MANAGEMENT Monitor nutritional status and provide supplements when necessary. Ensure adherence to medication regimens, monitor for adverse effects, and educate patients about the purpose and potential side effects of prescribed medications. Provide support to patients undergoing dialysis, including monitoring for complications such as infection and providing care and education related to vascular access maintenance. Assess and manage symptoms such as pain, fatigue, nausea, and pruritus through pharmacological and non-pharmacological interventions.