Acute-On Chronic Renal Failure
|
|
|
|
|
|
|
|
|
|
|
|
Cruicial Data from Case Scenario:
58 year old male
difficulty catching his breath
swelling all over
weak and tired
polyuria with burning
Aleve 2-3x/day for leg pain from swelling
denies constipation
nausea and decreased appetite
hypertension x 10 years
borderline diabetes
hyperlipidemia
hx kidney stones and frequent UTI which led to kidney failure last year
military vet
5'11" and 240 lbs
last weight was 207 last month; gain of 33 lbs
|
|
abnormal assessment data:
T: 100 degrees F
P: 104
R: 32
BP: 100/160
Dyspnea noted. Bilateral crackles per lower lobes posteriorly. Heart rate irregularly irregular. 4+ pitting edema in legs bilaterally, 2+ noted arms and hands. Facial and generalized edema also present.
|
|
2 nursing diagnosis
fluid volume overload
|
| |
| |
|
|
|
|
|
|
|
|
|
| |
|
Area 7 you need to create a decline in patient condition that is plausibleto be able to list the 3 nurse initiated interventions
|
|
then Area 8 the I-SBAR-R
|
|
Area 9, the medications ordered by the healthcare provider that already provided in the original scenario, or would be added, appropriate, held or discontinued.
---------------------------------------
9. Medications.
Home Meds:
Maxzide - diuretic with hydrochlorothyazide. Potassium sparing
Zocor - simvestatin. for high cholesterol
Inpatient meds:
Lasix - diuretc. Non potassium sparing
Zocor
Maxzide
Zestril - ACE inhibitor for high bp
IVF: D5NS: D5 NS (560 mOsm/L) = Hypertonic Solution: Osmolarity higher than serum, draws fluid into the intravascular compartment from cells and interstitial compartments.
Potassium protocol:
|
|
Prior to doing the I-SBAR-R of Area 8 on the rubric, in Area 7 you need to create a decline in patient condition that is plausibleto be able to list the 3 nurse initiated interventions, then Area 8 the I-SBAR-R, followed by Area 9, the medications ordered by the healthcare provider that already provided in the original scenario, or would be added, appropriate, held or discontinued. In Area 10 you will have all of the collaborative care.
Please contact me if you have questions. Remember you do not need a key on the map as long as you are using terms well understood such as QID, HS, PRN, etc.
|
|
|
|
|
|
|
|
|
|
|
In Area 10 you will have all of the collaborative care
|
|
Patients with chronic renal failure are at risk for infection related to a compromised immune system. A nursing care plan should include the use of standard precautions and proper hand-washing techniques. The white blood cell count should also be monitored because that will help indicate whether an infection is present. Intravenous lines also provide another entrance for harmful microorganisms. IV lines, sites and vital signs should be assessed every four to six hours for infection, redness or abnormality. Encourage ambulation, position changes, coughing and deep breathing exercises as soon as the patient is able because they will help prevent respiratory infections.
http://www.ehow.com/way_5291713_nursing-plan-chronic-renal-failure.html
|
|
Most patients with chronic renal failure will have to undergo hemodialysis or a kidney transplant. Nursing care for these two procedures involve regular assessment. A nursing care plan for chronic renal failure will include asking the patient about urine output or any difficulty in urinating. The color and quantity of urine should also be assessed, with any abnormal discoloration promptly reported to the physician. The patient should also be assessed for and asked about any weight fluctuations or edema in the extremities. Medical history, vital signs, skin turgor, and level of consciousness or mental clarity should also be assessed. If the patient is in post-operative condition, vital signs should be assessed every two to four hours, or as directed by a physician.
Read more: http://www.ehow.com/way_5291713_nursing-plan-chronic-renal-failure.html#ixzz2h3uHVoWD
|
|
A nursing care plan for patients with chronic renal failure will most likely include the nursing diagnosis of imbalanced nutrition. The imbalance in nutrition is related to urinemia and restrictions on what the patient is allowed to eat. Dietary intake might be less than what is required to maintain nutrition balance. The nursing care plan will use nursing interventions such as monitoring intake and output and administering antiemetics, if ordered. Small meals and nutritious snacks should also be provided and encouraged. Mouth care before eating might help improve the patient's appetite and sense of taste. If the imbalance in nutrition becomes more serious, total parenteral nutrition (TPN) might become necessary. The TPN site should be monitored regularly, as well as all other IV lines.
Read more: http://www.ehow.com/way_5291713_nursing-plan-chronic-renal-failure.html#ixzz2h3uJssQw
|
| |
|
|
|
|
|
|
|
|
|
| |
| |
| |
| |
| |
|
|
|
|
|
|
|
|
|
| |
| |
| |
| |
| |
|
|
|
|
|
|
|
|
|
| |
| |
| |
| |
| |
|
|
|
|
|
|
|
|
|
| |
| |
| |
| |
| |
|
|
|
|
|
|
|
|
|
|
Acute-On Chronic Renal Failure
