Question

pls i need more detailed information based on this case Scenario

ments for thh This assignment will require you to integrate several aspects of a patient's heath and well-being by developing an Educational Packet for your patient. You will need to consider a patient's physical, pathological, cultural, and social health. Create an entire education packet for your patient. This should include what the patient needs to know from all aspects of care. Include Care Plans for the pathology and treatment, and an Educational Packet with all information needed from the start of treatment to potential outcomes related to that treatment. You have an entire week to complete the assignment. Be creative and make your Packet as unique as you would like. If you were in this type of position, what would you want to know about a new diagnosis? What should you expedt to happen at different stages or with each encounter into the unknown? How would you like it presented to you? How would patients we encounter form different cultures handle such information? The Scenario- A 65 year old woman has just been admitted to your unit. She is Middle Eastern and this is her first hospital experience. She was admitted with ESRD and is very "fragile at this time from a physical aspect. She has been in fair health and recently moved in with her eldest son and his family. The house is two stories and her bedroom is on the second floor. Until this time she has been independent and caring for herself. Recently she became a widow and it was decided she would move in with the family Her medical history is not extensive and she is not willing to seek help very often. Only since the recent onset of signs and symptoms that have weakened her has she began to be more consistent in her willingness to seek out care. She is nervous and anxious. She is skeptical of others and asks if her family can stay with her during this time. She has a history of Hypertension and takes medication for it. She has had a history of multiple UTIs and vesicoureteral reflux Her medication list is as follows-Zestril 20mg Po QD, Ferrous sulfate 325mg PO QD, Vitamin B 1 PO QD, Vitamin D 50mcg PO QD

Answer 1

The patient is a case of End stage renal disease and has to undergo dialysis three times a week. The patient has no knowledge about the disease and the treatment modalities and is anxious about it so being a nurse it's my responsibility to clear all her doubts by encouraging her to express her concerns and providing a health teaching about the disease condition :- ESRD is the loss of renal funciton characteried by a glomeular filtration rate (GFR) less htan 20% of normal The final stage of chronic renal failure (slow, progressive loss of kidney function & glomerular filtration) Ends fatally with uremia (urine in the blood) # The most common causes of ESRD :- Diabetic Neuropahty, hypertenson, glomerulonephritis, systemic lupus, cystic kidney disease

# Clinical Manifestations of ESRD :- Early: Nausea, apahty, weakness, fatigue Late: may have frequent vomiting, increasing weakness, lethargy & confusion; may complain of restless leg syndrome, paresthesia, sensory loss, persnality changes, anxiety, irritability, hallucinations, seizures & coma in late stages # Respirations in ESRD may change to Kussmaul patern (deep & rapid respiration), with deep coma following Skin becomes pale and dry with yellowish hue; metaboloic waste cause itching and uremic frost (crystallized deposits of urea on the skin) Urnialysis shows fixed specificgravity approximately 1.010 equivalent to plasma; abnormal proteins, blood, cells adn casts are present.

Nursing care plan :-

# Subjective Data includes :-

- Loss of appetite

- Nausea

- Fatigue and weakness

- Muscle twitches and cramps

- Peripheral edema

- Persistent itching

- Urinary frequency, nocturia

- Chest pain

- Shortness of breath

# Objective Data:

- Decreased mental agility

- Swelling of feet and ankles

- Weight gain

- Poorly controlled hypertension

- Elevated serum creatinine

# Nursing Interventions and Rationales:

- Monitor vitals

- Maintain reasonable blood pressure to help protect the kidneys from further damage

- Tachycardia may indicate fever , fever may indicate infection and further disease progression

- Monitor and manage blood sugar - keeping blood sugar in the optimal range if diabetic can help reduce the stress on the kidneys

- Assess cardiopulmonary system: Auscultate heart and lungs for abnormal sounds

- Fluid retention from improper glomerular filtration may collect in the myocardium resulting in stress on the heart and in the lungs. Listen for friction rub and pulmonary crackles or congestion

- Monitor lab/diagnostic studies: Glomerular Filtration Rate (GFR) <60 indicates kidney disease, <15 indicates kidney failure, CT / Ultrasound Kidney biopsy (if necessary), Chest x-ray - if indicated

- GFR- is a blood test that can show the degree of kidney function available. It is a calculation of creatinine levels, race, age, gender and other factors.

- Albumin- urine albumin test- healthy kidneys do not allow albumin into the urine. Albumin in the urine may indicate decreased kidney function.

- CT / Ultrasound- this imaging may be helpful to view the kidneys to determine if there are tumors or other unusual characteristics of the kidneys

- Evaluate mental status - notice changes in mental status and confusion. Cerebral edema and stroke are possible complications.

- Monitor I & O

- Monitor kidney function and calculate fluid retention.

- Daily weights at the same time each day on the same scale can also help determine amount of fluid being retained.

- Measure for decreased output <400 mL/24 hr period may be evidenced by dependent edema

- Insert indwelling catheter as appropriate to help monitor fluid balance and characteristics of urine

- Palpate abdomen to assess for fluid retention

- Restrict fluids

- Closely monitor fluid intake to prevent overload and help reduce retention and promote emptying of the bladder.

# Nutrition education - A renal diet is low in protein and sodium. The kidneys are compromised and unable to remove the waste produced by processing proteins (BUN).

Choose foods low in saturated and trans fat to prevent and lower fat deposits in the blood vessels.

Choose lower potassium foods to avoid hyperkalemia caused by excess potassium retention