Ckd presentation

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

2. ACKNOWLEDGEMENT
I, Chinmayi, 2nd 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: 10th 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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.

21. 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.

22. 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.