Nursing Care Plan for an 80-year-old female with Chronic Kidney Disease Case study
An 80-year-old female presents to the clinic with grievances of asthenia, malaise, headache, weight gain, and a decrease in urination. A tentative diagnosis of acute renal failure is made. She has a history of alcohol and drug abuse. Her medical history is unremarkable, and she has not been taking any medicines. The laboratory results include values of a serum sodium level of 151mg/dl. The potassium level is 2.7mg/dl, chloride is 123mg/dl, and bicarbonate is 14mg/dl. Blood urea nitrogen is 95mg/dl. Blood glucose is 757mg/dl. Serum calcium is 7.5mg/dl, and leukocyte counts are 8000/mm3. The patient is hydrated. She is diagnosed with diabetic ketoacidosis.
Chronic Kidney Disease Patient Questionnaire
- Have you been diagnosed with kidney disease? Y / N
- How long has it been your first diagnosed? ____Months / ____years
- Do you take pain or anti-inflammatory medication? Y / N
- Do you use herbal treatments? Y / N
- Do you take blood pressure medication? Y / N
- Do you check your blood pressure at home? Y /N
- Have you heard any family heart diseases? Y /N
- Have you had a history of diabetes or prediabetes? Y /N
- Have you ever been diagnosed with anemia, or low hemoglobin count? Y / N
- Have you had any history of osteoporosis, osteopenia, brittle, thin or broken bones? Y / N
- If you responded yes to any of the questions above, please give more detail___
- Do you have any question about your Kidney disease that we can help you? ___
Chronic kidney disease (CKD) according to (Bomback and Bakris, 2011) is a continuous decrease of working renal tissue whereby the residual kidney mass cannot sustain the body’s internal environment. CKD is an illness that progressively develops for years or as an effect from an occurrence of kidney related diseases from which the patient has not improved. Acute Renal Failure (ARF) is a continuous and quick weakening of the working of the kidneys (Healthy people 2010, 2013). It occurs when there is a high accumulation of toxic substances in the kidney and left unattended. Development of ARF happens when the kidney fails to remove waste materials from the kidney in the form of urine. Therefore kidney disorders have stopped functioning and lost their strength to remove water and waste from the blood. Deterioration of kidney functioning will lead to other problems in the body such as anemia, poor nutritional health, high blood pressure and nerve damage (Wong et al., 2010). Early diagnosis of this disorder is essential when it comes to its management. Researchers assert that when CKD is detected early, its progression is slowed down and managed (Bomback and Bakris, 2011). The national kidney foundation report stipulates that failure to treat kidney organs will lead to a transplant or dialysis in order to maintain the affected patient.
The kidneys play vital functions in the body including the removal of waste products, help balance the salt, water, and other minerals in the blood. Chronic kidney disease loses the capacity to eliminate toxically and concentrate urine without losing electrolytes (Healthy people 2010, 2013). Kidney failure is categorized as (1) Pre Renal which happens as a result of renal hypo perfusion or from a condition that diminishes the flow of blood to the kidneys. (2) Intra Renal results from the damage to the kidneys, usually from acute tubular necrosis. Lastly is (3) Post Renal which blocks the bilateral urine pathways (Wong et al., 2010).
The various diagnostic test has been proved by experts in the prognosis of CKD. They include (1) arterial blood gases (ABG) analysis, which shows metabolic acidosis. (2) The blood chemistry shows increased blood mineral components as evidenced by our case study. (3) An ultrasound scan shows kidney may be enlarged. (4) Renal scan to visualize obstruction, and tumors. (5) Glomerular filtration analysis as well (Bomback and Bakris, 2011).
Some symptoms of CKD include: decreased urine production, Anuria absence of urine excretion, swelling of body parts. There are problems with concentration and confusion. The patient may feel tired and fatigued, and the patient may be lethargic. In most cases the signs and symptoms of CKD are nonspecific (Wong et al., 2010), implicating other illness can also trigger them. Kidneys are exceedingly adaptable and capable of compensating for lost function, signs and symptoms may not appear until permanent impairment has happened. Nursing Care Plan for an 80-year-old female with Chronic Kidney Disease Case study.
Nursing care plan goals
The nursing aim for patients with CKD is to avoid more problems and supportive care. Patient training is also significant as this chronic sickness and therefore needs continuing management. The patient should be able to work to improve self-management skills, an advance organization of care, ease communication among the affiliates of the healthcare group, as well as offer psychosocial support. First, to maintain fluid volumes, the plan for the patients is to show behaviors to observe fluids status and diminish relapse of fluid excess. Also, the patient must be able to manifest in stabilizing liquid volume daily intake to achieve a balance of normal versus steady mass and free from signs of edema (Healthy people 2010, 2013).
The second plan is on how to manage acute pain. Any trauma that the kidney experiences is detected as pain to the nerve endings. The idea for the patient is to exhibit use of moderation abilities to relieve pain and also, patient to report relief of pain. The nurse intervention is to monitor and perform pain assessment as well as assisting in treating underlying diseases. The third care plan is assessing the Altered Renal Tissue Perfusion. This care plan involves the patient to exhibit contribution in the suggested management programs (Healthy people 2010, 2013). Also patient should present behavior changes to avoid complications. Fourth is Impaired Urinary Elimination. CKD is a result of renal failure, and the planning for patients is to articulate indulgent of the disorder and partake in actions to correct the faults (Wong et al., 2010). Lastly is the altered nutrition. This is demonstrated by the patient when he/she has fewer nutrients than body requirements. Nutrition care plan that the patient must follow is the patient to express standardization of laboratory principles and be free of signs of malnutrition. Also, patient to reveal conducts, lifestyle change to recover and sustain an appropriate weight.
The assessment and supervision of patients with CKD need analysis and understanding of the associated diseases and development of CVD. The importance of early detection of the CKD is essential to the patient to adopt tools and plans to enable them to take much of the care. Multi-morbidity of the disease is the norm for patients with CKD, contributing factors of socioeconomic status, gender, age, and kidney function and comorbidities are the threatening factors which increase death rate for patients with CKD and also with high registered cardiovascular comorbidity (Bomback and Bakris, 2011). Nursing Care Plan for an 80-year-old female with Chronic Kidney Disease Case study.
Bomback, A. S., & Bakris, G. L. (2011). Chronic kidney disease (CKD) and hypertension essentials. Sudbury, Mass: Physicians’ Press/Jones & Bartlett Learning.
Etats-Unis. Department of health, human services, Centers for disease control, prevention (Etats-Unis), & National Center for health statistics (Etats-Unis). (2013). Healthy people 2010: a Final review. Government Printing Office. Retrieved from: https://www.healthypeople.gov/2020/topics-objectives/topic/chronic-kidney-disease
Wong, F. K. Y., Chow, S. K. Y., & Chan, T. M. F. (2010). Evaluation of a nurse-led disease management programme for chronic kidney disease: a randomized controlled trial. International journal of nursing studies, 47(3), 268-278.