124519364 case-hemo

CENTRAL LUZON COLLEGE OF SCIENCE & TECHNOLOGY
1860 Rizal Av enue, East Bajac-Bajac, Olongapo City, Philippines 2200
Tel Nos: (047) 224-8042 / (047) 224-1288* Telefax: (047) 223-5855 / (047)224-6996
Website: www.clcst.edu.ph
I. Homework Help
II. https://www.homeworkping.com/
III.
IV. Research Paper help
V. https://www.homeworkping.com/
VI.
VII. Online Tutoring
VIII. https://www.homeworkping.com/
IX.
X. click here for freelancing tutoring sites
XI. Introduction
Chronic kidney disease (CKD), also known as chronic renal disease, is a progressive
loss of renal function over a period of months or years. The symptoms of worsening kidney
function are unspecific, and might include feeling generally unwell and experiencing a reduced
appetite. Often, chronic kidney disease is diagnosed as a result of screening of people known
to be at risk of kidney problems, such as those with high blood pressure or diabetes and those
with a blood relative with chronic kidney disease. Chronic kidney disease may also be identified
when it leads to one of its recognized complications, such as cardiovascular disease, anemia
or pericarditis. Chronic kidney disease is identified by a blood test for creatinine. Higher levels
of creatinine indicate a falling glomerular filtration rate(rate at which the kidneys filter blood) and
as a result a decreased capability of the kidneys to excrete waste products. Creatinine levels
may be normal in the early stages of CKD, and the condition is discovered if urinalysis (testing
of a urine sample) shows that the kidney is allowing the loss of protein or red blood cells into
the urine. To fully investigate the underlying cause of kidney damage, various forms of medical
imaging, blood tests and often renal biopsy (removing a small sample of kidney tissue) are
employed to find out if there is a reversible cause for the kidney malfunction.
Recent professional guidelines classify the severity of chronic kidney disease in five
stages, with stage 1 being the mildest and usually causing few symptoms and stage 5being a
severe illness with poor life expectancy if untreated. Stage 5 CKD is also called established
chronic kidney disease and is synonymous with the now outdated terms end-stage renal
disease (ESRD), chronic kidney failure (CKF) or chronic renal failure (CRF). There is no
specific treatment unequivocally shown to slow the worsening of chronic kidney disease. If
there is an underlying cause to CKD, such as vasculitis, this may be treated directly with
treatments aimed to slow the damage. In more advanced stages, treatments may be required
for anemia and bone disease. Severe CKD requires one of the forms of renal replacement
therapy; this may be a form of dialysis, but ideally constitutes a kidney transplant.

Tel Nos: (047) 224-8042 / (047) 224-1288* Telefax: (047) 223-5855 / (047)224-6996
Objectives
General Objective: The purpose of this study is to provide deeper the oretical and practical
knowledge and information about chronic kidney disease.
Specific Objective:
1. To provide information on the related causes of chronic kidney diseases.
2. To provide information regarding postpartum care for patients who had the similar illness of
chronic kidney disease.
3. To provide a framework of study regarding the subject that can serve as the foundation of
future studies and research.
XII. Nursing Health History
 Profile of the Patient
Patient's Name: Patient R.E.E.
Age: 41 years old
Gender: Male
Civil Status: Married
Date of Birth: April 05, 1969
Diagnosis: CKD V secondary to Obstructive Uropathy
Attending Physician: Dr. Arnel S. Chua
 Nursing Health History
 History of Present Illness
Patient R.E.E. seek for consultation because he noticed that his feet was
swelling, and experienced difficulty in urination. He was on hemodialysis unit on a scheduled
basis. His access was on his left AV fistula. His target weight is 81 kg. His attending physician
is Dr. Arnel S. Chua.
 Past Medical History
Patient R.E.E. underwent a kidney surgery prior to hemodialysis. He is
diagnosed having urinary stones last September 17, 2010. His first hemodialysis was on the
same date of his diagnosis. It was hooked on his right internal jugular vein and was also his
first chronic diagnosis. His compliance was good (100%)

Tel Nos: (047) 224-8042 / (047) 224-1288* Telefax: (047) 223-5855 / (047)224-6996
 Family Health History
Patient R.E.E. has a familial disease of hypertension from both paternal and
maternal sides. And relatives has a history of other kidney diseases. Other than that, no other
familial diseases of cardiovascular and respiratory diseases.
 Kidney Disease History
Date of First Diagnosis: September 09, 2010
Date of First Hemodialysis: September 09, 2010
Date of First Chronic Hemodialysis: September 09, 2010
Compliance: Good (100%)
Clinical Impression: CKD V 2º Obstructive Uropathy
Attending Physician: Dr. Arnel S. Chua
 Hemodialysis History
First hemodialysis was done on September 09, 2010 under his attending
physician Dr. Chua. It was hooked on his right internal jugular vein, and was done on NKTI.
Frequency of his treatment was twice a week, with a duration of four hours per session.
Dialyzer was F8 with a blood flow of 300 mL/min. His Heparin was on given on regular doses
with a ratio of 2:1:1:1.

Tel Nos: (047) 224-8042 / (047) 224-1288* Telefax: (047) 223-5855 / (047)224-6996
 Physical Examination
IV. Anatomy and Physiology
How do the kidneys and urinary system work?
The body takes nutrients from food and converts them to energy. After the body
has taken the food that it needs, waste products are left behind in the bowel and in the
blood. The kidney and urinary systems keep chemicals, such as potassium and sodium,
and water in balance and remove a type of waste, called urea, from the blood. Urea is
produced when foods containing protein, such as meat, poultry, and certain vegetables,
are broken down in the body. Urea is carried in the bloodstream to the kidneys,where ii
is removed. Other important functions of the kidneys include blood pressure regulation and
the production of erythropoietin, which controls red blood cell production in the bone
marrow.
Kidney and urinary system parts and their functions:
 Two kidneys - a pair of purplish-brown organs located below the ribs toward the
middle of the back. Their function is to remove liquid waste from the blood in the
form of urine; keep a stable balance of salts and other substances in the blood; and
produce erythropoietin, a hormone that aids the formation of red blood cells. The
kidneys remove urea from the blood through tiny filtering units called nephrons.
Each nephron consists of a ball formed of small blood capillaries, called a
glomerulus, and a small tube called a renal tubule. Urea, together with water and
other waste substances, forms the urine as it passes through the nephrons and
down the renal tubules of the kidney.

Tel Nos: (047) 224-8042 / (047) 224-1288* Telefax: (047) 223-5855 / (047)224-6996
 Two ureters - narrow tubes that carry urine from the kidneys to the bladder. Muscles
in the ureter walls continually tighten and relax forcing urine downward, away from
the kidneys. If urine backs up, or is allowed to stand still, a kidney infection can
develop. About every 10 to 15 seconds, small amounts of urine are emptied into the
bladder from the ureters.
 Bladder - a triangle-shaped, hollow organ located in the lower abdomen. It is held in
place by ligaments that are attached to other organs and the pelvic bones. The
bladder's walls relax and expand to store urine, and contract and flatten to empty
urine through the urethra. The typical healthy adult bladder can store up to two cups
of urine for two to five hours.
 Two sphincter muscles - circular muscles that help keep urine from leaking by
closing tightly like a rubber band around the opening of the bladder.
 Nerves in the bladder - alert a person when it is time to urinate, or empty the
bladder.
 Urethra - the tube that allows urine to pass outside the body. The brain signals the
bladder muscles to tighten, which squeezes urine out of the bladder. At the same
time, the brain signals the sphincter muscles to relax to let urine exit the bladder
through the urethra. When all the signals occur in the correct order, normal urination
occurs.
Facts about urine:
 Adults pass about a quart and a half of urine each day, depending on the fluids and
foods consumed.
 The volume of urine formed at night is about half that formed in the daytime.
 Normal urine is sterile. It contains fluids, salts and waste products, but it is free of
bacteria, viruses and fungi.
 The tissues of the bladder are isolated from urine and toxic substances by a coating
that discourages bacteria from attaching and growing on the bladder wall.

Tel Nos: (047) 224-8042 / (047) 224-1288* Telefax: (047) 223-5855 / (047)224-6996
VI. Course In the Ward
 Present
 February 07, 2013
Patient R.E.E. was already in his 54th treatment. He was a regular OPD
patient and was on scheduled basis. He has a target weight of 81 kg. His pre HD weight was
84.3 kg. His access is located at his left AV fistula. Ultrafiltration volume was set to 2200 mL.
Pre-treatment, facial edema, peri-orbital edema and slight lower extremity edema was noted.
He was then hooked to hemodialysis machine and started. Previous health teachings was
reinforced. Monitored BP every 30 minutes. His post-treatment weight was 83.7. No
complications observed, and went home after.
 January 31, 2013

Tel Nos: (047) 224-8042 / (047) 224-1288* Telefax: (047) 223-5855 / (047)224-6996
Patient's pre-treatment weight was 82.5 kg. Peri-orbital, facial, and lower
extremity edema is noted. And still with a target weight of 81 kg. Access was still on his left AV
fistula, patent. His UFV was set to 2000 mL. HIs post-treatment weight was 81.5 kg. No other
significant details.
 January 17, 2013
Patient's pre-treatment weight was 82.8 kg. Peri-orbital and facial
edema is noted. And still with a target weight of 81 kg. Access was still on his left AV fistula,
patent. His UFV was set to 2200 mL. His post-treatment weight was 81.5 kg. No other
 January 10, 2013
Patient's pre-treatment weight was 84.6 kg. Peri-orbital and facial
edema is noted. And still with a target weight of 81 kg. Access was still on his left AV fistula,
patent. His UFV was set to 2000 mL. His post-treatment weight was 82.5 kg. No other
 December 27, 2012
Patient's pre-treatment weight was 83 kg. Peri-orbital and facial edema
is noted. And still with a target weight of 81 kg. Access was still on his left AV fistula, patent.
His UFV was set to 2400 mL. His post-treatment weight was 81.3 kg. No other significant
details.
 December 20, 2012
His UFV was set to 2200 mL. His post-treatment weight was 81.1 kg. No other significant
details.
 November 29, 2012
His UFV was set to 2000 mL. His post-treatment weight was 81 kg. No other significant details.
 Previous
 May 21, 2012

Tel Nos: (047) 224-8042 / (047) 224-1288* Telefax: (047) 223-5855 / (047)224-6996
Patient R.E.E. was transfer in from Medicine ward, with ongoing IVF of
D5W at 500 cc level regulated at KVO. Pre-treatment weight was 76.2 kg. Peri-orbital and facial
edema noted. UFV was set to 1500 mL/min. At around 10:35 p.m., patient R.E.E. experienced
dizziness and dimming of vision. Thus, UF was off, and referred to Dr. Chua. 200 cc level of
Saline was flushed. Patient was placed on Trendelenburg position and dialysate temperature to
36.0ºC. Due D5050 50 cc vial given via IV. At 10:40 p.m., UF was hold as ordered by Dr. Chua..
His post-treatment weight was 75.9 kg. No other significant details.
 May 22, 2012
Patient R.E.E. has a slight edema on his lower extremities. Pre-
treatment weight is 73 kg. With an ongoing IVF of D5W at 200 cc level regulated at KVO. UFV
was set to 0 net plus NSS flushing. Informed Dr. Chua about patient's arrival at the HD unit.
Patient has loss of appetite for one week, hence referred to Dr. Chua, and ordered Appetens
one tablet daily. Patient also experienced vomiting, Metoclopramide 10mg via IV every 12
hours for vomiting.
 May 23, 2012
Patient has a slight lower extremity edema. Patient's pre-treatment
weight is 73.4 kg, referred to Dr. Chua. UFV was set to NSS flushing. While treatment is
ongoing, at around 10:45 p.m., patient experience seizure, hence referred to Dra. Pablo. He
was hooked to O2 inhalation. He was then seen by Dra. Pablo ordered Phenytoin 150 mg via
IV. Requested CBC, Crea, Na, K and sent to laboratory. RBS monitored, with a result of 180
mg/dL, then referred to Dra. Pablo. Post-treatment weight was 73.4 kg.
 May 26, 2012
Patient has to obtain a dry weight of 81 kg, as ordered by the physician.
Patient has a jugular vein distention, slight lower extremity edema, and peri-orbital edema. His
pre-treatment weight was 76.6 kg. UFV was set to 0 net plus NSS flushing and 1 unit PRBC.
Closely monitored for any blood transfusion reaction. After HD, no BT reaction noted. Post-
treatment weight was 76.6 kg.
 May 30, 2012
Patient R.E.E. has facial edema and swelling of the knees, wrist, and
elbows. His pre-treatment weight was 76.6 kg. He was referred to Dr. Chua for HD UF and
regarding the swelling of his knees, wrist, and elbows. Hence, Dr. Chua ordered new
medications; Hydrocortisone 100 mg via IV to be given every 8 hours in 3 doses, Colchicine 1

Tel Nos: (047) 224-8042 / (047) 224-1288* Telefax: (047) 223-5855 / (047)224-6996
tablet daily, and UFV was set to 2800 mL/min. At around 9:05 p.m., he was seen by Dr. Chua
with orders carried out. His post-treatment weight 73.6 kg. Reinforce health teachings.
IX. Conclusion and Recommendation
Homework Help
https://www.homeworkping.com/
Math homework help

Tel Nos: (047) 224-8042 / (047) 224-1288* Telefax: (047) 223-5855 / (047)224-6996
Research Paper help
Algebra Help
Calculus Help
Accounting help
Paper Help
Writing Help
Online Tutor
Online Tutoring

124519364 case-hemo

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Viewers also liked

Viewers also liked (9)

Similar to 124519364 case-hemo

Similar to 124519364 case-hemo (20)

Recently uploaded

Recently uploaded (20)

124519364 case-hemo