ABSTRACT

This is a case study of an adult woman who had End-Stage Renal Disease Secondary
to Diabetic Nephropathy admitted at Capitol University Medical City.

INTRODUCTION
According to Dorothea Orem, who presented Self-Care Deficit Theory Her thought
about nursing is, it must legitimate, based on the relationship between the patient and
nurse that establishes a need for nursing and not some other condition, such as a
medical condition (Hartwig, 2001). Orems grand theory continues to be modified and
used around the world, encouraging people to take on the responsibility of their own
physical health and psychological wellness. In life there are un-expectations with illness
and disease causing the balance to shift from self-care abilities to self-care demands
that the nurse compensates for (Johnson & Webber, 2010). As nursing students, family
members, human beings, we can each do our part to promote wellness thru the use of
self-care agencies and help others who are unable to do so.
Background of the Study
Patient X is a 60-year-old, female, admitted at Capitol University Medical City last
January 27, 2013. She was admitted to the said hospital with chief complaint of
seizure. This was later on diagnosed as End-Stage Renal Disease secondary to
Diabetic Neuropathy.
End-stage kidney disease is the complete, or almost complete failure of the kidneys to
function. The main function of the kidneys is to remove wastes and excess water from
the body. End-stage kidney disease (ESRD) occurs when the kidneys are no longer
able to function at a level needed for day-to-day life. It usually occurs when chronic
kidney disease has worsened to the point at which kidney function is less than 10% of
normal. This is almost always follows chronic kidney disease. A person may have

per million populations (pmp) to 340 pmp. The prevalence of ESRD can be more
accurately recorded as the number of patients receiving renal replacement therapy.
http://www.umm.edu/ency/article/000500.htm#ixzz2L3rQwIJp

It is very important to take really good care of our kidneys because they play a big role
to our body which it filters our body wastes. Having discipline to ourselves regarding our
health could be a big help to prevent disease because most of us abuse thats why we
had a lot diseases which developing to our body and most of them could lead to death.
Having a good health is one of the largest treasures we could have; this could make us
disease free of such serious illness. Regarding ESRD, we could only say that proper
nutrition and proper care of our kidneys is one of the important ways to prevent and to
eliminate this disease to occur within us. As what we said earlier is that, one of the best
way to a good health is to have a self-discipline regarding health care because we are
the one who are deciding whether to have a disease or not. Living with a healthy
lifestyle and good health is one of the achievable and could have a satisfying life.
As student nurses, we could help our patient by having a deep understanding of the
disease, that we may learn the proper intervention of the end-stage renal disease
patients. In this way, we could render quality care for them. We could as well lead them
to the proper treatment to lessen their agony brought by the kidney failure, in anyhow.
By having a wide understanding of the disease, we could impart teachings on how we
could prevent the occurrence of the disease. It is our responsibility to render information
and impart health teachings to improve the condition to our patients to the best of our
abilities. One of the characteristics that we, student nurses, should have is to be
informative and only through a keen of disease such as this way for us to gain all the
information that we need to learn.

The scope of this study would include:

Data collected via assessment, interviews with the patient, family members and clinical
records,any health problems for 3 days including the initial assessment and its
appropriate nursing intervention that would be applied within her stay in the hospital,
developing a plan of care that will reduce identified predicaments and complications, coordinating
and delegating interventions within the plan of care to assist the client to reach maximum
functional health.Further evaluations of the effectiveness of nursing interventions have been rendered

interaction, assessment and care were only limited to a total of 8 hours (2 days clinical
duty) with actual nursing intervention done.

SIGNIFICANCE OF THE STUDY

Nursing Education
This study can be a useful learning guide in nursing education as this can be used by
students as a reference for future studies regarding End-Stage Renal Disease and
related cases. This case study will enable the students to learn how to assess patients
with any signs of kidney disorders and be able to provide appropriate nursing care and
management.
Furthermore, the students will learn about the nursing interventions and have an idea of
the rationale behind its actions. They can apply these interventions in the real setting
when they encounter the same or similar condition. In this way, they are acquiring more
knowledge about the disease that they can use to further develop their skills as student
nurses and future nurses. It may open a new door in the practice of getting quality care.
This study might also inspire other individuals to come up with their own research about
this disorder or any similar condition.
Nursing Practice
This case study can be used as a tool in nursing practice because it provides nursing
interventions for patients with End-Stage Renal Disease. This study can give a good
introduction to the disorder so that an established nursing action can be quickly utilized.
Through this study, important information regarding this illness has been gathered
which will be helpful on the researchers to have an in-depth understanding on the said
disorder.

The case can be used as a baseline data for further research of the current
management of patients with End-Stage Renal Disease. There might be some
information in this study that can be of good use for future research. It is important to do
research every now and then to gain new information, better interventions and
techniques to provide to the patients. Aside from being beneficial as a simple academic
informative material, this study might serve as a guide for orienting people about the
substance of the disease, and how this disease affects people. Therefore through this
study, the researchers should have introduced the symptoms (for early detection),
treatment (for information), and management.

OBJECTIVES OF THE STUDY:

General Objective
This study aims to convey familiarity and to provide an effective nursing care to a patient
diagnosed with End-stage Renal Disease through understanding the patient history, disease
process and management.
Specific Objectives
1.

To present a thorough assessment, through Nursing Health History,

Gordons Typology 11 Functional Pattern, Physical Assessment, and the

interpretation of the laboratory examination done on the patient.
2.

To discuss the anatomy and physiology, pathophysiology of the patients

condition, usual clinical manifestations and possible complications of this condition.

3.

To have knowledge to the client medication and be familiar to that

medication.
4.

Thoroughly discuss, explain and elaborate the nature of the disease

process.
5.

To formulate a workable nursing care plan on the subjective and objective

cues gathered through nurse-patient interaction to be able to help the patient

recover.

PATIENTS PROFILE
Nursing Health History
The following nursing health history includes the health history of the patient. The
researchers deemed it important to include assessing factors which may have
contributed to the patients present condition.
Bibliographical Data
Patient X, a 60-years-oldwoman , Filipino, residing in Tagoloan, Misamis Oriental was
admitted at Capitol University Medical City Intensive Care Unit last January 27, 2013.
The whole familys religion is Roman Catholic. She weighs 72 kg and 154 cm long.
Upon admission her vital signs are: BP: 170/90 mmHg, Temperature: 36.8C, Pulse
rate: 75 beats per minute and Respiratory rate: 28 cycles per minute.
Chief Complaint
According to her husband, she had episodes of seizure, had muscle twitching and body
weakness and brought to the emergency room in Capitol University Medical City.
History of Present Illness
Patient X is diagnosed of End-stage Renal Disease secondary to Diabetic Neuropathy.
She was admitted at Northern Mindanao Medical Center at January 2013, advised for
hemodialysis but unable to comply. Since then patient had episodes of muscle twitching
with body weakness. Family decided to allow patient to have hemodialysis in this
institution.
Family History of Illnes
Patient X parents are both positive for Diabetes Mellitus and Hypertension.
Functional Health Pattern
Patient X used to smoke 1 pack per week for 10 years and used to drink alcoholic
drinks 1 bottle a week for 15 years. She also drinks coffee and cola almost every day,
She had no allergies and taking a maintenance drug for hypertension.
Nutritional and Metabolic Pattern
When Patient X was not yet hospitalized she used to eat high fat foods, she ate 3 times

Elimination Pattern
Patient Xs usual elimination pattern is firm brownish stool 2 times a day without drinking
any laxatives. She doesnt have discomforts, incontinence or hemorrhoids. Her last
bowel movement was on last February 6, 2013. She used to urinate 4 times a day with
dark yellow to yellowish urine for about 1 cup urine per urination.
Activity-Exercise Patterns
Patient X exhibited decreased tolerance to activities; the reason for mobility limitation is
due to weakness of the muscles, had muscle twitching and pain. She was totally
dependent in feeding, dressing, grooming and toileting (ADL=4), assisted with person in
bathing, bed mobility, general mobility (ADL=2), andtotally dependent in meal
preparation, and cleaning (ADL=4).
Legend:
Level (0) - Full Self care
Level (1) - Requires use of equipment or device
Level (2) - Requires assistance or supervision from another person
Level (3) - Requires assistance or supervision from another person or device
Level (4) - dependent and does not participate
Sleep-Rest Pattern
Patient X usually sleeps at 9 PM and awakens at 6 AM in the morning. She also had
time to have a nap in the afternoon.
Cognitive-Perceptual Pattern
Patient Xs hearing is decreased but doesnt use hearing aid. She uses reading eye
glasses when he read books and newspapers. Her primary language is Cebuano and
she has no speech deficit. She is a college undergrad. She always complained pain on
her stomach and her feet.
Self-Perception and Self-Concept Pattern
I feel so sickly nowadays, as verbalized by the patient. He feels lucky because her
family is there to help her in times of difficulties. She will be in debt when she will be
discharged due to the long stay in hospital but shes still happy that she was given

Role-Relationship Pattern
She lived with her husband, children and grandchildren. Her three children was married
and one is still single. Shes a housewife making some opportunity to work. She had
financial support on her children but not so often. She doesnt have problem with her
children because they have work and had been supporting her.
Sexuality-Reproductive Pattern
She understood that shes getting told and her husband too so their sexual relationship
has been stopped but still happy to be together. She had undergone oophorectomy
when she was 40 years old. Her husband had no problem with the prostate and didnt
perform monthly self-testicular exam.
Coping-Stress Tolerance Pattern
In the hospital, she experienced a quality nurse-service experience. Everything was in
order and on time. At home, she managed stress by watching television and
conversations with her family and neighbors. She asked support from his family which is
always there.
Value-Belief Pattern
The family is Roman Catholic. They always go to church every Sunday. This is very
important tothem because this is the only way to have them courage whenever aches
and problems brought them down.
Developmental data
Erik Eriksons Stages of development: Generativity vs. Stagnation
During middle age the primary developmental task is one of contributing to society and
helping to guide future generations. When a person makes a contribution during this
period, perhaps by raising a family or working toward the betterment of society, a sense
of generativity- a sense of productivity and accomplishment- results. In contrast, a
person who is self-centered and unable or unwilling to help society move forward
develops a feeling of stagnation- dissatisfaction with the relative lack of productivity.
She is in the stage of Generativity vs. Stagnation.

PHYSICAL ASSESSMENT
Integumentary System
Her skin was warm to touch, dehydrated, rough and her general color is pallor and
dusky. Poor skin Turgor.
Head, Eyes, Ears, Nose and Throat (HEENT)
Her head is normocephalic with closed fontanels, clean scalp, coarse hair and
symmetrical facial movements. Pale lips, gums and mucosa.. The tongue is midline.
Eyes are aligned and non-edematous. There is positive blink reflex and positive corneal
reflex. Trachea is midline and thyroid is non-palpable.
The pinnas of the ears are flexible, without deformity and are aligned with the external
cantus of eyes.
Respiratory System
There was irregular breathing pattern. Respiratory rate is 28cpm. With mechanical
ventilator upon admission. Crackles heard upon auscultation on both lungs.
Cardiovascular System
There is no cyanosis. Apical pulse is 75bpm. Precodial area is flat; point of maximal
impulse is in the 5th intercostal space midclavucular line. Peripheral pulses are
symmetrical and capillary refill is 3 seconds.
Gastrointestinal System
The abdomen is protuberant and the bowel sounds are normoactive. Percussion is
tympanic and configuration is symmetrical. Anus is patent. .
Genitourinary System
He has yellowish urine 3 times daily with no discomfort.
Reproductive System
The genitalia is normal and no problem.
Musculoskeletal System
He has a complete set of fingers and toes.Edematous Feet and fingers. No dimpling is

Neurological
Unconscious upon admission.

Day 1 (February 1, 2013)

Neurological:
Unconscious

Respiratory: RR 28
cpm,crackles on both lungs

Head, Eyes, Ears,

Nose and Throat
(HEENT): skull
symmetrical, fontanels
closed, eyes: positive
blink reflex and positive
corneal reflex. Trachea
is midline and thyroid is
non-palpable.

Cardiovascular: BP
170/90 mmHg, HR: 75
bpm.
Integumentary: Pallor,
dusky, rough texture,
poor turgor, dry
moisture, Temp: 36.8
degrees Celsius

Genitourinary: no
nodules and discharges

Gastrointestinal:No
rmoactive bowel
sounds, muscle
guarding, pain in
abdominal area

Capillary refill time: 3

seconds

Musculoskeletal:
Generalized weakness,
decreased range of
motion of extremities,

Day 3 (February 8, 2013)

Neurological:
Conscious and
drowsy

Respiratory: RR 27
cpm,crackles on both lungs

Head, Eyes, Ears,

Nose and Throat
(HEENT): skull
symmetrical, fontanels
closed, eyes: positive
blink reflex and positive
corneal reflex. Trachea
is midline and thyroid is
non-palpable.

Cardiovascular: BP
150/90 mmHg, HR: 76
bpm,
Integumentary: Pallor,
dusky, rough texture,
poor turgor, dry
moisture, Temp: 36.5
degrees Celsius

Gastrointestinal:No
rmoactivebowel
sounds.

Genitourinary: no
nodules and discharges
Capillary refill time: 3
seconds

Musculoskeletal:
Generalized weakness,
decreased range of
motion of extremities.

Day 2 (February 11, 2013)

Neurological:
Conscious and
responsive

Respiratory: RR 25
cpm,crackles on both lungs

Head, Eyes, Ears,

Nose and Throat
(HEENT): skull
symmetrical, fontanels
closed, eyes: positive
blink reflex and positive
corneal reflex. Trachea
is midline and thyroid is
non-palpable.

Cardiovascular: BP
140/90 mmHg, HR: 71
bpm.
Integumentary: Pallor,
dusky, rough texture,
poor turgor, dry
moisture, Temp: 36.9
degrees Celsius

Gastrointestinal:No
rmoactivebowel
sounds.

Genitourinary: no
nodules and discharges
Capillary refill time: 3
seconds

Musculoskeletal: Weak,
decreased range of
motion of extremities.

ANATOMY AND PHYSIOLOGY OF THE KIDNEY

The

kidneys

are

two

main

shape

structures which lie in the retroperitoneal

space between the 12 thoracic and third
lumbar vertebra. The left kidney sets
slightly behind the spleen, while the right
kidney sets behind the liver and is slightly
lower than the left. Each kidney is
enclosed in a tough fibrous capsule and
is supported and protected by fat tissue.
There is a fissure in the central content
portion of the kidney where the blood
vessels enter and leave. This is called the
hilus. Also coming from the hilus, are to
the ureters which connect the kidney to
the bladder. The cortex is a brownishtissue which covers the outer third of the
kidney. The medulla are light-colored and cone-shaped, these are the renal pyramids.
The papilla are formed by the free ends of the pyramids which opens into the renal
pelvis. Therenal pelvis is made up of calyces, which drained up or lower hands of the
kidney. Days unite with a renal pelvis at the upper end of the ureter. The functional unit
of the kidney are the nphrons, each kidney contains approximately 1.2 million of these.
Within each nephron there is a glomerulus and a tubule.
Within the glomerulus, there is a structure called Bowman's Capsule which contains a
network of capillaries. fluid in particles from the blood and are filtered through this
membrane. Water, nutrients and electrolytes, as well as other substances, are
reabsorbed as they pass through these tubulars. There is collecting duct which collects
fluid from several nephrons and passes this fluid into the renal pelvis.
Two capillary beds, a glomerulus, and a peritubular network supply the nephron. The
glomerulus is a unique, high pressure capillary filtration system that is located between
two arterioles, the afferent and efferent arterioles. The low-pressure reabsorptive
system of the peritubular capillary network arises from the efferent arteriole.
Excretory functions

a. the glomerulus, which lies between two arterioles, allows for high-pressure filtration
system. Capillary filtration pressure in the glomerulus is 2-3 times as high as that of
other capillary beds in the body. The filtration pressure and the glomerular filtration rate
(GFR) are regulated by the constriction or relaxation of the afferent and efferent
arterioles. During strong sympathetic stimulation, which causes marked constriction of
the afferent arteriole, the filtration pressure is reduced to the point where GFR drops to
almost 0.
b. Capillary membrane of the glomerulus is composed of 3 layers:
1. endothelial layer of the capillary
2. basement membrane
3. a layer of epithelial cells that line Bowman's capsule
c. Glomerular capillary permeability is 100-1000 times as great as capillaries elsewhere
in the body. All 3 layers allow water and dissolved particles, such as electrolytes, to
leave the blood and pass rapidly into Bowman's capsule. Blood cells and plasma
proteins are too large to pass through the glomerular membrane of a healthy kidney.
d.Glomerular filtration rate (GFR) is normally about 125 ml per minute. GFR can provide
a measure to assess renal function, and can be measured clinically by collecting timed
samples of blood and urine.
2. Creatinine - product of creatine metabolism by the muscle. Is filtered by the kidney,
but not absorbed in the renal tubule.
Formula for creatinine clearance: C=UV P
C = clearance rate
U = urine concentration
V = urine volume
P = plasma concentration
Normal creatinine clearance is 115-125 ml/min (corrected for body surface area)
Usually 24 hour collection with blood drawn when urine collection is completed.
3. Tubular reabsorption and secretion
The filtrate from the glomerulus passes through:
1. proximal tubule

Then it reaches the pelvis and kidney

Reabsorption: water, sodium, and other substances leave the lumen of the tubule and
enter the blood.
Secretion: substances from the blood enter lumen of the tubule.
Glucose and amino acids - completely reabsorbed
Filtered water - 99% reabsorbed
Urea - about 50% reabsorbed
Creatinine - none
Electrolytes - determined by need

3. Urine concentrating ability of the kidney: 2 mechanisms (SLIDE)

1. Increased solute concentration in the medullary area surrounding the collecting
tubules. Loop on Henle and peritubular capillary (vasa recta) descending into the renal
medulla. Here a countercurrent mechanism controls water ans solute flow. As a result,
water is kept out of the peritubular area surrounding the tubules, and sodium and urea
are retained.
2. Selective permeability of collecting tubules (controlled by ADH) During dehydration,
the kidney plays a major role in maintaining water balance. Osmoreceptors in the
hypothalamus sense the increase in extracellular osmolality and stimulate release of
ADH from posterior pituitary. Collecting tubules (under influence of ADH) become
permeable to water. In the absence of ADH, the renal tubules remain impermeable to
water and a dilute urine is formed. Specific gravity (osmolality) of urine varies with its
concentration of solutes. Specific gravity provides index of hydration status and
functional ability of the kidneys. Concentrated urine: 1.030 - 1.040 (SLIDE) Marked
hyration or dilute: 1.000
4. Sodium and potassium regulation
Sodium and potassium regulation (SLIDE) glomerular filtrate reabsorbed in proximal
tubule. Na and KC1 pumped (requires energy) into intercellular spaces, and absorbed
into peritubular capillaries. Water movement accompanies the movement of these

5. Potassium regulation
Potassium regulation - aldosterone mediated secretion of K into tubular fluid. (Can be
reabsorbed in distal and collecting tubules, but since dietary intake far exceeds need,
secretion usually exceeds reabsorption.)
6. Endocrine fuctions
1. Renin - released by special cells located near the glomerulus (juxtaglomerular cells)
in response to:
Reduction in GFR
Sympathetic stimulation - Combines with angiontensinogen, a plasma protein that
circulates in the blood to form angiotensin I, then converted to angiotensin II (potent
vasoconstrictor and stimulator of aldosterone release).
2. Erythropoietin - released in response to hypoxia. Acts on bone marrow to stimulate
production and release of RBCs. Persons with chronic hypoxia often have increased
RBCs (polycythemia) due to increased erythropoietin levels. Examples: congestive
heart failure, chronic lung disease, living at high altitude.
3. Vitamin D - activated and converted in kidney. Affects calcium metabolism.

DECREASED CARDIAC OUTPUT

Subjective:

Objective:
-Non-pitting edema
-Cold Clammy skin
-Prolonged capillary refill
-Decreased peripheral pulses
-Increased Blood pressure
-Oliguria

NURSING DIAGNOSIS:
Decreased Cardiac Output related to altered heart rate and increased blood pressure
of /

Goals and Objectives:

Long Term: After 8 hours of nursing care the patient will be able to lower her blood
pressure from 148/84 to 130/80 .

INTERVENTION:

INDEPENDENT:

Keep client on bed in position of comfort

R: Decreases oxygen consumption and risk of decompensation
Monitor vital signs frequently
R: To note response to activities interventions
Monitor rate of Intravenous drugs closely using infusion pup as appropriate
R: To prevent from overdose
Assess urine output hourly noting total fluid balance
R: To allow for timely alterations in therapeutic regimen

Encourage relaxation techniques

R: To reduce anxiety and conserve energy
Dependent:
Administer blood or fluid replacement ,antibiotics and diuretics per doctors order
as indicated
R: To determine therapeutic ,adverse or toxic effects of therapy.
Use sedation and analgesics as indicated with caution
R: To achieve desired effect without compromising hemodynamic readings.
EVALUATION:
After 8 hours of nursing care goals partially met the patients blood pressure
lowers down from 148/84 to 135/85

FLUID VOLUME EXCESS

SUBJECTIVE:

OBJECTIVE:
Non- pitting edema
Weight gain over short period of time
Oliguria
Pulmonary Congestion
Blood pressure changes
Decreased hemoglobin
Nursing Diagnosis:
Fluid Volume excess related to blood pressure changes , intake exceeds output
such as oliguria as evidenced by non pitting edema

Planning:
After 8 hours of nursing care the patient will be able to stabilize fluid volume as
evidenced by balanced Intake and Output vital signs within clients normal limits
and free from signs of edema
Intervention:

Place in semi-fowlers position as appropriate

R: To facilitate movement of diaphragm thus improving respiratory effort
Assess neuromuscular reflexes
R: To evaluate for presence of electrolyte imbalances such as hypernatremia
Observe skin and mucous membranes
R: For presence of decubitus or ulceration
Note fever
R: Client could be at increased risk of infection
Set an appropriate rate of fluid intake or infusion throughout 24 hours period
R: To prevent peaks and valleys in fluid level and thirst

DEPENDENT:

Administer medications such as diuretics and plasma or albumin volume per

doctors order

After 8 hours of nursing care goals partially met the patient was able to have a stabilize
blood pressure from 148/84 to 135/85 and was free from any signs of edema

IMPAIRED GAS EXCHANGE

SUBJECTIVE:

OBJECTIVE:

Lethargic
Dusky skin
Nasal flaring

Nursing diagnosis:
Impaired Gas Exchange related to irregular breathing rate and rhythm and altered
oxygen supply
Planning:
After 30 minutes of nursing care the patient will improve ventilation and adequate
oxygenation
After 8 hours of nursing care the patient will be able to have an absence of symptoms of
respiratory distress
Intervention:

Elevate head of Bed and position client appropriately provide airway adjuncts
and suction as needed
R: To maintain airway
Evaluate Pulse oximetry
R: To determine oxygenation and level of carbon dioxide retention

Maintain adequate Intake and Output

R: For mobilization of secretions, but avoid fluid overload
Avoid use of face mask in emaciated client
R: As oxygen can leak out around the mask because of poor fit and mask can
increase clients agitation
Encourage adequate rest and limit activities to within client tolerance .Promote
calm ,restful environment
R: Helps limit oxygen needs and consumption
Minimize blood loss from procedures (hemodialysis)
R: To limit adverse affects of anemia

INEFFECTIVE PERIPHERAL TISSUE PERFUSION

Subjective:

Objective:
Diminished pulses
Altered skin characteristics (color, elasticity ,nails ,sensation and temperature)
Skin color pale on elevation
Non pitting edema
Altered motor function

Nursing Diagnosis:
Ineffective Peripheral Tissue perfusion related to non pitting edema
Planning :
After 8 hours of nursing care the patient will be able to minimize perfusion and
free from discomfort

Intervention:
Assess presence, location and degree of swelling or edema formation .Measure
circumference of extremities, noting differences in size.
R: Useful in identifying or quantifying edema in involved extremity
Measure capillary refill
R: To determine adequacy of systemic circulation
Inspect lower extremities for skin texture(reddened skin) and skin breaks or
ulcerations
R: That often accompany diminished peripheral circulation
Provide interventions
R: To promote peripheral circulation and limit complications associated with poor
perfusion and tissue injury
DEPENDENT:
Administer medications such as antiplatelet agents, and antibiotics per docrors
order
R: To improve tissue perfusion or organ function
Administer fluids ,electrolytes and oxygen as indicated by the doctor
R: To promote optimal blood flow, organ perfusion and function
Collaborative:
Collaborate in treatment of underlying conditions such as diabetes, hypertension
and other conditions
R: To maximize systemic circulation and organ perfusion.

ACUTE PAIN
SUBJECTIVE:

OBJECTIVE:

Guarding behavior
Facial mask
Restless
Change in blood pressure
Increased heart rate and respiratory rate
Reduced interaction with people
NURSING DIAGNOSIS:
Acute pain related to stomach pain secondary to peptic ulcer
Planning :
Short Term:
After 30 minutes of nursing care the patient will be able to relieve the pain from
8/10 to 6/10.
Long Term: After 8 hours of nursing care the patient will be able to reduce the
pain and have a facial grimace and guarding behavior noted.

Intervention:
Assess for referred pain, as appropriate ,
R: To help determine possibility of underlying condition or organ dysfunction
requiring treatment.
Monitor skin color and temperature and vital signs ( increased
temperature,pulserate,respiratory rate and blood pressure)
R: Which are usually altered in acute pain
Provide comfort measures (touch, repositioning,quite environment and calm
environment)
R: To promote non pharmacological pain management
Encourage adequate rest periods
R: To prevent fatigue
DEPENDENT:
Administer analgesics as indicated per doctors order
R: To maintain acceptable level of pain and meet pain control goal

IDEAL DIAGNOSTIC/LABORATORY TEST

Complete blood count is monitored for any hematologic abnormalities and to
monitor presence of infections. The complete blood count or CBC test is used as a
broad screening test to check for such disorders as anemia, infection, and many other
diseases. It is actually a panel of tests that examines different parts of the blood and
includes the following:

White blood cell (WBC) count is a count of the actual number of white
blood cells per volume of blood. Both increases and decreases can be
significant.

White blood cell differential looks at the types of white blood cells present.
There are five different types of white blood cells, each with its own
function in protecting us from infection. The differential classifies a
person's white blood cells into each type: neutrophils (also known as segs,
PMNs, granulocytes, grans), lymphocytes, monocytes, eosinophils, and
basophils.

Red blood cell (RBC) count is a count of the actual number of red blood
cells per volume of blood. Both increases and decreases can point to
abnormal conditions.

Hemoglobin measures the amount of oxygen-carrying protein in the blood.

Hematocrit measures the percentage of red blood cells in a given volume

of whole blood.

The platelet count is the number of platelets in a given volume of blood.

Both increases and decreases can point to abnormal conditions of excess
bleeding or clotting. Mean platelet volume (MPV) is a machine-calculated
measurement of the average size of your platelets. New platelets are
larger, and an increased MPV occurs when increased numbers of
platelets are being produced. MPV gives your doctor information about
platelet production in your bone marrow.

Mean corpuscular volume (MCV) is a measurement of the average size of

your RBCs. The MCV is elevated when your RBCs are larger than normal
(macrocytic), for example in anemia caused by vitamin B12 deficiency.

Mean corpuscular hemoglobin (MCH) is a calculation of the average

amount of oxygen-carrying hemoglobin inside a red blood cell. Macrocytic
RBCs are large so tend to have a higher MCH, while microcytic red cells
would have a lower value.

Mean corpuscular hemoglobin concentration (MCHC) is a calculation of

the average concentration of hemoglobin inside a red cell. Decreased
MCHC values (hypochromia) are seen in conditions where the hemoglobin
is abnormally diluted inside the red cells, such as in iron deficiency anemia
and in thalassemia. Increased MCHC values (hyperchromia) are seen in
conditions where the hemoglobin is abnormally concentrated inside the
red cells, such as in burn patients and hereditary spherocytosis, a
relatively rare congenital disorder.

Red cell distribution width (RDW) is a calculation of the variation in the

size of your RBCs. In some anemias, such aspernicious anemia, the
amount of variation (anisocytosis) in RBC size (along with variation in
shape poikilocytosis) causes an increase in the RDW.

BLOOD GLUCOSE TEST

Blood glucose test is done to monitor serum glucose, patient may risk for
hypoglycemia since patient will be on NPO status.
A blood glucose test measures the amount of a type of sugar, called glucose, in
your blood. Glucose comes from carbohydrate foods. It is the main source of energy
used by the body. Insulin is a hormone that helps your body's cells uses the glucose.
Insulin is produced in the pancreas and released into the blood when the amount of
glucose in the blood rises.
Normally, your blood glucose levels increase slightly after you eat. This increase
causes your pancreas to release insulin so that your blood glucose levels do not get too
high. Blood glucose levels that remain high over time can damage your eyes, kidneys,
nerves, and blood vessels.

BLOOD TYPING TEST

Blood type tests are done before a person gets a blood transfusion and to check
a pregnant woman's blood type. Human blood is typed by certain markers (called
antigens) on the surface of red blood cells.
Blood is often grouped according to the ABO blood typing system. This method
breaks blood types down into four categories:

Type A

Type B

Type AB

Type O
Your blood type (or blood group) depends on the types that are been passed

down to you from your parents.

BLOOD CROSSMATCH

A blood crossmatch (BCM) is performed to detect serological incompatibility by

identifying antibodies in donor or recipient plasma against recipient or donor red blood
cells. A BCM is divided into two parts: the major crossmatch consists of mixing the
patients plasma with the donors red blood cells; the minor crossmatch consists of
mixing the donors plasma with the patients red blood cells. Of the two tests, the major
blood crossmatch is much more important in determining survival of the transfused red
blood cells.

ACTUAL DIAGNOSTIC/LABORATORY TEST

February 08, 2013
TEST
Potassium

CLINICAL CHEMISTRY

RESULTS
6.3

NORMAL VALUE
3.5-5.3 mg/dl

INTERPRETATION
Hyperkalemia. Due to
decreased renal excretion
of potassium and renal
failure. Decreases the
resting membrane
potential.

Calcium

11.3

8.4-10.4 mg/dl

Sodium

128

135-145 mg/dl

Hypercalcemia. Can
cause muscle spasms.
Caused by an increased
protein binding which
elevates the serum total
calcium concentration
without any rise in the
serum ionized calcium
concentration
Hyponatremia.

Phosphorus

5.0

3.0-4.5 mg/dl

Hyperphosphatemia

BUN

27

8-25 mg/ml

Creatinine

1.9

0.6-1.5 mg/ml

The body is either splitting

off too much Nitrogen, or
the body is not excreting it
like it should.
kidneys aren't working
well. Creatinine level may
temporarily increase if
dehydrated, have a low
blood volume, eat a large
amount of meat or take
certain medications.

February 08, 2013

TEST

URINALYSIS

RESULTS

NORMAL VALUE

Protein

Traced + 3

RBC

Traced 6

February 09, 2013

TEST
RBC Count
WBC Count

0-8 mg/dl
0-4/hpf

INTERPRETATION
Proteinuria.
Hematuria

COMPLETE BLOOD COUNT

RESULTS
3.10
13,600

NORMAL VALUE
3.8-5.1cell/mm
5,000-10,000 cell/mm

INTERPRETATION
Anemia
The body is attempting
to fight an infection and
response to injury

IDEAL MEDICAL MANAGEMENT

Hemodialysis
In hemodialysis, blood is removed from the body and filtered through a man-made
membrane called a dialyzer, or artificial kidney, and then the filtered blood is returned to
the body. The average person has about 10 to 12 pints of blood; during dialysis only
one pint (about two cups) is outside of the body at a time. To perform hemodialysis
there needs to be an access created to get the blood from the body to the dialyzer and
back to the body. There are three access types for hemodialysis: arteriovenous (AV)
fistula, AV graft and central venous catheter. The AV fistula is the vascular access most
recommended by the dialysis community; however, you and your doctor will decide
which access is best for you.
When a patient goes to hemodialysis, a nurse or technician will check vital signs and
get the patients weight. The weight gain will tell how much excess fluid the patient has
to have removed during the treatment. The patient is then put on the machine. Patient
with a vascular access (AV fistula or AV graft) will get two needle sticks in their access;
one needle takes blood out of the body, the other needle puts it back. Patients with a
central venous catheter will have the two tubes from their access connected to the
blood tubes that lead to the dialyzer and back to the body. Once the patient is put on
the machine, the dialysis machine is programmed and then treatment begins.
Blood never actually goes through the dialysis machine. The dialysis machine is like a
big computer and a pump. It keeps track of blood flow, blood pressure, how much fluid
is removed and other vital information. It mixes the dialysate, or dialysis solution, which
is the fluid bath that goes into the dialyzer. This fluid helps pull toxins from the blood,
and then the bath goes down the drain. The dialysis machine has a blood pump that
keeps the blood flowing by creating a pumping action on the blood tubes that carry the
blood from the body to the dialyzer and back to the body. The dialysis machine also has
many safety detection features. If you visit a dialysis center, you will likely hear some of
the warning sounds made by a dialysis machine.
Renal Transplant Therapy (Kidney Transplant)
A kidney transplant is a surgical procedure to place a functioning kidney from a donor
into a person whose kidneys no longer function properly.

Only one donated kidney is needed to replace two failed kidneys, making living-donor
kidney transplantation an option. If a compatible living donor isn't available for a kidney
transplant, your name may be placed on a kidney transplant waiting list to receive a
kidney from a deceased donor. The wait could be a few years.
Peritoneal Dialysis
Peritoneal dialysis (PD) is a treatment for patients with severe chronic kidney disease.
The process uses the patient's peritoneum in the abdomen as a membrane across
which fluids and dissolved substances (electrolytes, urea, glucose, albumin and other
small molecules) are exchanged from the blood. Fluid is introduced through a
permanent tube in the abdomen and flushed out either every night while the patient
sleeps (automatic peritoneal dialysis) or via regular exchanges throughout the day
(continuous ambulatory peritoneal dialysis). PD is used as an alternative to
hemodialysis though it is far less commonly used in many countries, such as the United
States. It has comparable risks but is significantly less costly in most parts of the world,
with the primary advantage being the ability to undertake treatment without visiting a
medical facility. The primary complication of PD is infection due to the presence of a
permanent tube in the abdomen.

ACTUAL MEDICAL MANAGEMENT

Clonidine is a generc name of Catapres an Antihypertensive drug, given 10 mg
four times daily for the first 2-4 days, increase to 25 mg four times daily for the balance
of the first week. This drug is centrally acting antiadrenergic derivative. Stimulates
alpha2-adrenergic receptors in CNS to inhibit sympathetic vasomotor centers. Central
actions reduce plasma concentrations of norepinephrine. It decreases systolic and
diastolic BP and heart rate. Orthostatic effects tend to be mild and occur infrequently.
Also inhibits renin release from kidneys. This is use to treat hypertension, either alone
or with diuretic or other antihypertensive agents. Epidural administration as adjunct
therapy

for

severe

dizziness,nervousness,

pain.Adverse
nightmares,

effects

hypotension

are

drowsiness,

(especially

with

depression,
epiduraluse),

palpitations, bradycardia, nausea, vomiting, constipation, drymouth, urinary retention,

nocturia, erectiledysfunction, sodium retention, rash, sweating, pruritus, and dermatitis.
Contraindicated

to

patientshypersensitivity

to

components

of

adhesive

layer

(transdermal form), infection at epidural injection site, bleeding problems (epidural use)
and concurrent anticoagulant therapy. For nursing responsibilities, monitor patient for
signs and symptoms of adverse cardiovascular reactions, frequently assess vital signs,
especially blood pressure and pulse and monitor patient for drug tolerance and efficacy.
Hydralazine is a generic name of Apresoline an Antihypertensive drug. It relaxes
vascular smooth muscles of arteries and arterioles, causing peripheral vasodilation and
decreasing peripheral vascular resistance. These actions decrease blood pressure and
increase heart rate, stroke volume, and cardiac output.Indicated as essential
hypertension, alone or as an adjunct. Adverse effects are,dizziness, drowsiness,
headache,peripheral neuritis,tachycardia, angina, orthostatic hypotension,lacrimation,
nasal congestion, nausea, vomiting, diarrhea, constipation,anorexia, sodium retention,
joint

pain,

arthritis,rash,

lymphadenopathy,

edema,

blisters,

flushing,

lupuslike

syndrome.

pruritus,

urticaria,chills,

Contraindicated

with

fever,
patients

hypersensitive to drug or tartrazine, patients with coronary artery disease and mitral
valvular rheumatic heartdisease. The nurse is responsible to monitor CBC, lupus
erythematosus cell studies, and antinuclear antibody titers before and periodically
during therapy, monitor blood pressure, pulse rate and regularity, and daily weight and
to avoid rapid blood pressure drop, taper dosage gradually before discontinuing.

treatment

for

urinary

tract

infections

(UTIs)

caused

by

Escherichia

coli,

Klebsiellapneumoniae, and Proteus mirabilis. Its adverse effects are phlebitis,

hypotension, palpitations, chest pain, vasodilation,hearing loss, nausea, vomiting,
diarrhea,

abdominal

cramps,

oral

candidiasis,

pseudomembranous

colitis.

Contraindicated to patients hypersensitive to cephalosporins or penicillins. The nurse

should assess baseline CBC and kidney and liver function test results.Monitor for signs
and symptoms of superinfection and other serious adverse reactions, monitor for
inflammation at infusion site and be aware that cross-sensitivity to penicillins may occur.
Hydrocortisone is a geneic name of Cortef Fluid, is an anti-inflammatory
(steroidal) drug that suppresses inflammatory and immune responses, mainly by
inhibiting migration of leukocytes and phagocytes and decreasing inflammatory
mediators.

Indicated

as

replacement

therapy

in

adrenocortical

insufficiency;

hypercalcemia due to cancer; arthritis; collagen diseases; dermatologic diseases;

autoimmune and hematologic disorders; trichinosis; ulcerative colitis; multiple sclerosis;
proctitis;

nephrotic

syndrome;

aspiration

pneumonia

hydrocortisone,

hydrocortisonecypionate. Adverse effects are,headache, nervousness, depression,

euphoria, personality changes, psychoses, vertigo, paresthesia, insomnia, restlessness,
conusmedullaris

syndrome,

meningitis,

increased

intracranialpressure,

seizures,hypotension, hypertension, thrombophlebitis,heart failure, shock, fatembolism,

thromboembolism, andarrhythmias. This drug is contraindicated with patients
hypersensitive to drugs, alcohol, bisulfites, or tartrazine (with some products), patients
with systemic fungal infections, concurrent use of other immunosuppressant
corticosteroids and concurrent administration of livevirus vaccines. The nurse should
monitor blood pressure, weight, and electrolyte levels regularly.Assess blood glucose
levels in diabetic patients. Expect to increase insulin or oral hypoglycemic dosage.

Albuminis a generic name of Buminate, a volume expanders, colloid drug that

provides colloidal oncotic pressure, which serves to mobilize fluid from extravascular
tissues back into the intravascular space and requires concurrent administration of
appropriate crystalloid. It indicates expansion of plasma volume and maintenance of
cardiac output in situations associated with fluid volume deficit, including shock,
hemorrhage, and burns and temporary replacement of albumin in diseases associated
with low levels of plasma proteins, such as nephrotic syndrome or end-stage liver

and normal or increased intravascular volume. The nurse should monitor vital signs,
CVP, and intake and output before and frequently throughout therapy. If fever,
tachycardia, or hypotension occurs, stop infusion and notify physician immediately.
Antihistamines may be required to suppress this hypersensitivity response.
Hypotension may also result from infusing too rapidly. May be given without regard to
patient's blood group.Assess for signs of vascular overload (elevated CVP,
rales/crackles, dyspnea, hypertension, jugular venous distention) during and after
administration.
Furosemide is a generic name of Lasix, a loop diuretic given 80 mg per orem
once a day. It inhibits reabsorption of sodium and chloride from the proximal and distal
tubules and ascending limb of the loop of Henle, leading to a sodium-rich
diuresis.Indicated as a treatment for edema associated with CHF, cirrhosis, renal
disease, and hypertension.Adverse effects are dizziness, vertigo, paresthesias,
xanthopsia, weakness, headache, drowsiness, fatigue, blurred vision, tinnitus,
irreversible hearing loss, polyuria, nocturia, glycosuria, urinary bladder spasm muscle
cramps and muscle spasms. Contraindicated to patients with allergy to furosemide,
sulfonamides, allergy to tartrazine(in oral solution), anuria, severe renal failure, hepatic
coma, pregnancy, lactation, use cautiously with SLE and gout, diabetes mellitus.The
nurse should record intermittent therapy on a calendar or dated envelopes. When
possible, take the drug early so increased urination will not disturb sleep. Take with
food or meals to prevent GI upset. Weigh yourself on a regular basis, at the same time
and in the same clothing, and record the weight on your calendar.Blood glucose levels
may become temporarily elevated in patients with diabetes after starting this
drug.Report loss or gain of more than 3 pounds in 1 day, swelling n youre ankles of
fingers, unusual bleeding or bruising, dizziness, trembling, numbness, fatigue muscle
weakness or cramps.
Combivent

(albuterol

sulfate)is

generic

name

of

Novo-Salmol,

Sympatomimetic drug given 4mg per orem three times a day. This drug acts relatively
selectively at beta2 adrenergic receptors to cause bronchodilation and vasodilatation; at
higher doses, bta2 selectivity is lost, and the drug acts at beta2 receptros to cause
typical sympathomimetic cardiac effects. An adjunct in treating serious hyperkalemia in
dialysis patients; seems to lower potassium concentrations when inhaled by patients on
hemodialysis. Adverse effects are, increased incidence of leiomyomas of uterus when

hypertension; coronary insufficiency, CAD; history of CVA and COPD patients with
degenerative heart disease. The nursing consideration are, use minimal doses for
minimal periods; drug tolerance can occur with prolonged use.Maintain a betaadrenergic blocker (cardio selective beta-blocker, such as atenolol, should be used with
respiratory distress) on standby in case cardiac arrhythmias occur.
Omeprazole is a generic name of Prilosec, an Antisecretory drug given 20 mg
per orem once a day. A gastric acid-pump inhibitor: Suppresses gastric acid secretion
by specific inhibition of the hydrogen-potassium ATPase enzyme system at the
secretory surface of the gastric parietal cells; blocks the final step of aid production.
Forshort-term treatment of active duodenal ulcer and first-line therapy in treatment of
the heart burn of symptoms of GERD. Adverse effect are rash, inflammation, urticaria,
prurits, alopecia, dry skin, cancer in preclinical studies, back pain and fever.
Contraindicated to patients with hypersensitivity to omeprazole or its components and
use cautiously with pregnancy, lactation. The nurse should administer before meals.
Caution patient to swallow capsules wholenot to open, chew, or crush them. If using
oral suspension, empty packet into a small cup containing 2 tbsp of water. Stir and have
patient drink immediately, fill cup with water and have patient drink this water. Do not
use any other diluents.
Insulin Glulisine is a generic name of Apidra, an Antidiabetic drug injected
100units/ml intramuscular once a day. insulin is a hormone secreted by beta cells of the
pancreas that, by receptor-mediated effects, promotes the storage of the bodys fuels,
facilitating the transport of metabolites and ions (potassium0 through cell membranes
and stimulating the synthesis of glycogen from glucose, of fats from lipids, and proteins
from amino acids. Treatment for type 1 diabetes mellitus and type 2 diabetes mellitus
that cannot be controlled by diet or oral drugs. Adverse effects are hypersensitivity:
Rash, anaphylaxis or angioedema. Metabolic: Hypoglycemia and ketoacidosis.
Contraindicated with allergy to pork products (varies with preparation; human insulin not
contraindicated with pork allergy); history of smoking or lung disease (inhaled insulin).
The nurse should ensure uniform dispersion of insulin suspensions by rolling the vial
gently between hands; avoid vigorous shaking and give maintenance doses
subcutaneously, rotating injection sites regularly to decrease incidence of lipodystrophy;
give regular insulin IV or IM in severe ketoacidosis of diabetic coma.

Nitroglycerin is a generic name of Nitrolingual, an Antianginal drug given

5mg/ml IVTT as needed. This drug relaxes vascular smooth muscle with a resultant
decrease in venous return and decrease in arterial BP, which reduces left ventricular
workload and decreases myocardial oxygen consumption.Treatment for acute angina
and prophylaxis for angina. Adverse effects are headache, apprehension, restlessness,
weakness, vertigo, dizziness, faintness and ethanol intoxication with high-dose IV use
(alcohol in diluents). Contraindicated to patients with allergy to nitrates, severe anemia,
early MI, head trauma, cerebral hemorrhage, hypertrophic cardiomyopathy, pregnancy,
lactation. The nurse should give sublingual preparations under the tongue or in the
buccal pouch. Encourage patient not to swallow. Ask patient if the tablet fizzles or
burns. Always check the expiration date on the bottle; store at room temperature,
protected from light. Discard unused drug 6 months after bottle is opened (conventional
tablets); stabilizes tablets (Nitrostat) are less subject to loss of potency.

DISCHARGE PLANNING
Medication
o Informed client to take medications on time, or as directed for the full course of
therapy, even feeling better.
o Inform the client about the possible side effects of the medication.
o Encouraged the client to report or inform the physician, if any of these side
effects occur.
o Informed and explained to the client in simple terms that the other drugs, such
over the counter drugs that she is taking, will probably have other effects of the
medication given moreover emphasize the right of timing or taking the right
interval of these drugs to maximize its effects and avoid further complications
o Provided information for better understanding regarding the therapeutic
regimen.

Exercise
o Remember, its normal to have times when you feel energetic and times when
you feel exhausted. Daily changes in your energy level are common.
o Plan your daily activities around the times when you feel more energetic. These
periods are usually in the morning or after a nap.
o Rest frequently throughout the day.
o Avoid strenuous exercise. Short walks spread out through the day will keep you
fit without exhausting you.
o Do one thing at a time.
o To save energy while getting dressed, lay out your clothes and accessories in
one area where its easy for you to reach everything. Try to avoid making extra
trips back and forth to your closet or dresser drawers.
o Install grab bars in your shower or tub to make it easier to get in and out. A
shower chair may also be helpful.
o

Exercise can help keep your blood sugar level steady and decrease your risk of
heart disease. Exercise for at least 30 minutes, 5 days a week. Work with your
primary healthcare provider to plan the best exercise program for you. You may
need to eat a carbohydrate snack before, during, or after you exercise. Do not

Treatment
o Lifestyle changes often help you continue your daily activities.
o Scheduling rest periods
o Avoiding stress and heat exposure, which can make symptoms worse
o Several medications may make symptoms worse and should be avoided.
Therefore, it is always important to check with your doctor about the safety of a
medication before taking it.
o Crisis situations, where muscle weakness involves the breathing muscles, may
occur without warning with under- or overuse of medications. These attacks
seldom last longer than a few weeks. Hospitalization and assistance with
breathing may be required during these attacks.
Health teaching
o You may need yearly eye exams to check for retinopathy and yearly urine tests
to check for kidney problems. Write down your questions so you remember to
ask them during your visits.
o You will be taught how to use a glucose monitor. You may need to check your
blood sugar level at least 3 times each day. Ask your primary healthcare provider
when and how often to check during the day. Ask what your blood sugar levels
should be before and after you eat. Write down your results, and show them to
your primary healthcare provider. He may use the results to make changes to
your medicine, food, or exercise schedule
o Protect yourself from infection.
o Wash your hands often; keep them away from your face. Most germs are spread
by hand-to-mouth contact.
o Get a flu shot every year. Ask your doctor about a pneumonia vaccination.
o Stay out of crowds, especially in rainy days when more people have colds and
flu.
o Avoid drinking alcohol. Alcohol can increase weakness.
Out Patient
o Remind client on the arrangements to be made with a physician for follow up checkups.

o Diet
o Limit in phosphorus, potassium, sodium.
o Low fat for heart disease.
o Encourage the client take well-balanced diet.
o Advice the guardians to be watchful/ careful enough of the diet that could
promote proper nutrition of the patient.
Spiritual
o Always ask God for guidance in everything especially with her condition.
o Praying also for all the people who are helping her with her ups and downs.

CONCLUSION AND RECOMMENDATIONS

End-stage Renal Disease is an irreversible and progressive disease. It is causeby many factors.
Knowing the precipitating factors leading to the development of this health problem, people should have
an extra care when it comes to health.
Giving care to a patient whether pediatric, geriatric, a medical case
or surgical case makes no difference. Rendering care to everyone who needs it is areal sense of
responsibility. In making this case study, We were able to work the best we can be
because this may help for the patients coping strategy regarding his/her condition by encouraging them
either medical or nursing management and also we help them enable for better understanding towards
therapeutic regimen. On the other hand, this study also helps us enhance our capability for future nurses
and helps us obtain more knowledge.
We

can

say

that nursing

Itis therefore significant for

is

significant

therapeutic

and

dynamic

the nurse caring for the

process.
patient

to wholeheartedlyunderstand what he/she is doing like in carrying out some basic

skills in relation toidentified goals, comfort and care, interventions and prevention of illness.

DEFINITION OF TERMS
Blood clot is a thickened mass in the blood formed by tiny substances called platelets.
Clots form to stop bleeding, such as at the site of cut. But clots should not form when
blood is moving through the body; when clots form inside blood vessels or when blood
has a tendency to clot too much, serious health problems can occur.
Blood Urea Nitrogen (BUN) Testmeasures the amount of urea nitrogen that's in your
blood. It reveals important information about how well your kidneys and liver are
working.
Calciumis a major mineral and is the most abundant mineral in the human body. Most
of it is stored in the bones and teeth (about 99 percent), and the rest is in your blood,
muscles and extracellular fluid. It is necessary for strong bones and teeth, plus it plays
an important role in blood clotting, muscle contraction, hormonal secretion and normal
nervous system function.
Creatinin is a chemical waste molecule that is generated from muscle metabolism.
Creatinine is produced from creatine, a molecule of major importance for energy
production in muscles. Approximately 2% of the body's creatine is converted to
creatinine every day. Creatinine is transported through the bloodstream to the kidneys.
The kidneys filter out most of the creatinine and dispose of it in the urine.
Diabetic Nephropathyis a progressive kidney disease caused by angiopathy of capillaries in
the kidney glomeruli. It is characterized by nephrotic syndrome and diffuse glomerulosclerosis. It
is due to longstanding diabetes mellitus, and is a prime indication for dialysis in many Western
countries.

Glomerular filtrationthe filtrate, free of cells and major plasma proteins, that passes
from the blood through a renal glomerulus into the lumen of a nephron in the kidney.
Phosphorusis a major mineral and most of it is stored in your bones. Lesser amounts
are found in your teeth, DNA, and cell membranes throughout your body. It's necessary
for building strong bones and is important for many biochemical reactions such as
converting the foods you eat into the energy your body needs every day. Phosphorus
also helps with muscle contraction, nerve conduction and normal kidney function.
Potassium is a major mineral that is necessary for normal growth and for making

Sodium is the major positively charged ion (cation) in the fluid outside of cells of the
body. The chemical notation for sodium is Na. When combined withchloride (Cl), the
resulting substance is table salt (NaCl)
Staghorn Calculiis the stone that is formed occupies parts of the kidney called the
"renal pelvis" and two or more "calyces" and form an "antler-like" stone formation.
Seventy-five percent of staghorn stones are of the struvite variety.