Question

End-Stage Renal Disease Case Study

KB is a 42-year-old woman presenting to her primary care provider’s office for a routine well visit and discuss a possible kidney transplant. She has a past medical history (PMHx) of Stage 4 chronic kidney disease (CKD), diabetes mellitus type1, and hypertension. She is presently on hemodialysis (HD) Monday, Wednesday, Friday schedule at her local HD clinical. She has a left AV fistula. Besides her past PMHx she states she is in good health and has recently had a viral respiratory infection. She states she is presently going through a divorce and is very anxious about the thought of a kidney transplant.

Vitals signs are as followed:

BP 150/88, HR 100, RR 18, Temp 99.0, O2 sat 98% room air.

Recent labs:

Sodium 145 mEq/L

Potassium 6.0 mEq/L

Chloride 93 mEq/L

Bicarbonate 27 mEq/L

BUN 48 mg/dL

Creatinine 5.0 mg/dL

Glucose 238 mg/dL

HCT 28

Hgb 9

WBC 12.4

Physical exam:

General: Well-dressed female

Neuro: A&Ox3, glascow score 15

Lungs sound: Mild crackles noted bilaterally.

Cardiac: RRR, EKG NSR, normal EKG, mild JVD

Medications:

Avapro 75mg by mouth Once daily

Nephrocap 1cap by mouth once daily

Procrit 50units/kg Subq 3 times a week (with HD)

Lantus 100 units Subq nightly

Lispro Subq AC per sliding scale

Questions

1. Describe the etiology, pathophysiology, of clinical manifestations of CKD.

2. Include all appropriate subjective (health history) and objective data for CKD including how to assess the patency of her AV fistula.

3. Explain any laboratory results or diagnostic tests that might be of concern and why. List any other labs and/or diagnostic testing that might be of value.

4. Are there any dietary concerns that you are going to assess/address with KB concerning her CKD?

5. How can you best relieve some of KB anxiety concerning the possibilities of a renal transplant?

6. What are 3 absolute contraindications to receiving a new kidney?

7. You are developing a care plan for KB. List 2 nursing diagnoses (One needs to be psychosocial) in the order of priority, 2 nursing interventions for each nursing diagnoses. Provide rationales for all 4 interventions. (This can be in a list format)

Answer 1

Hindi laman solution: chronic kidney disease (CKD) Atiology : a main causes of ckd ore diabetes and Ligh blood press Other conser melude polycys de kidney disease causing cyst on kidneys. patro physiology 5- Pathophusiady og cho can be easily underskud on I giver flow chore. Increse blood codium defension level Stomatolog hopar fi thonden , w hy Incretes tubular reasopan en consumption Inchoses → Hypoxig - nestital injuring o be RAS Jose Ampk t sodium selecin and hopesulor hyperfiltraten caused by diabetes and high blood prosme monesel tubulor reaborphs lenty to hypower and other complicada causing CKD. dinical manifestadores in Abnormal heart rhyths, fluid in lungs, insufficibul usine products, swelling are commors symptoms. wafer-elecholyle imbalance and high blood proane is a complicadory function.

medimore A proper analysis of the levels of elseholytes in her body should be monitored eventually .. . She is found to be infective Crina respirdary infection) recently and also hor mental conditions should be balanced while assess ng har av fistula. • Her potassium level is found to be 6.0 mEq/L. are normal potassium level is 3.5 to 5.0 megle. moniter har levels of potassium whether it change consequally of she is slightly infective or prone to be infective. blocy potassing 35.0 → potussium imbalare a cuptor Huper kalema occuring over hours neede treatement Depression and anxiety are most common psychiatric Aconda on organ transplant pasionh. Immuno Sypresant malaked and neuropshiatric side offects and drug-drug interaction with psychotropice should be kept in mind while treating these patient. propose caregivers to support and distress the A psychiatrist in the organ transplant team can help to acheive a better result. contraindications to recove hidney include; congestive hem disease, cardiovascular disese , kidney disenes and other infeefion one major contra indicator i blood rolated oppositions or suppression of padate chaos patient. -

impaired connary Nursing diagnosis : It include mornly elimination Chyper kalowa should be taken into account] Risk for infacher also monitored because padont have hustory of recent viral infection also the loft av fistules of the patent should asserel. . main nursing stramentin include: - maintain fluid and electolyte balance → And infective agent administranchen managemet > pain management of the patient. wound core and pown manganet cone should be taken in assessment of renal function Timely defection of complication after tramplantation is betahen for good outrone.

The above given is the Disease description and other diagnosis and treatment criteria of CKD patient.