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cervical cancer, colon cancer, enlarged prostate, kidney stones and nerve damage
involving the nerves that control the bladder.
5. Explain the laboratory/ancillary results of the patient.
The kidneys may fail to function for many different reasons. Either directly
reduced blood flow into the kidney or inflammation and necrosis of the tubules
cause obstruction and back pressure. Due to the functions that the kidneys fail to
fulfill, it might not produce enough erythropoietin (EPO) which is a glycoprotein
hormone responsible for the regulation of red blood cell production. When EPO
decreases, there would be less production of red blood cells and less protein
hemoglobin that would facilitate the delivery of oxygen to the bodys organs.
Decreased red blood cell count results in anemia. This is also manifested by low
hemoglobin and hematocrit count which is manifested by malaise, dizziness and
shortness of breath. Elevated creatinine and blood urea nitrogen (BUN) levels that
are revealed in the blood chemistry are likely evidence of decreased kidney
function. Creatinine and urea nitrogen are waste products that the kidneys normally
remove from the blood. If the kidneys are not working properly, these substances
may build up in the blood. Another laboratory test is the HbA1C or glycosylated
hemoglobin which shows the average blood sugar over the past 2-3 months. For
people without diabetes, the normal range for the hemoglobin A1c test is between
4% and 5.6%. Hemoglobin A1c levels between 5.7% and 6.4% indicate increased
risk of diabetes, and levels of 6.5% or higher indicate diabetes and in this case, the
patient has 9% which indicates diabetes. Fasting Blood Sugar test (FBS) measures
blood glucose after fasting to check for diabetes due to the lack of insulin that
causes the rates to rise.
As for the electrolytes, hyperkalemia, hyponatremia, hyperphosphatemia, and
hypocalcemia were noted. The kidneys help to control the levels of potassium in the
body and hyperkalemia may be caused by the impaired functioning of the kidneys
due to renal failure. Hyponatremia also occurred due to impaired sodium excretion
which is the factor leading to the patients edema and recurrent hypertension.
Albuminuria was also noted in the urinalysis. Albuminuria means that the
kidney has some damage and is starting to spill some albumin into the
urine. Some causes of this includes hypertension, heart failure or kidney
damage.
6. Enumerate Nursing diagnosis and Nursing Intervention.
Alteration in fluid volume
Decreased glomerular filtration rate and/or obstruction to urinary output
results in oliguria, fluid overload and electrolyte imbalance.
INTERVENTIONS
1) Assess fluid status of the patient and maintain intake-output records meticulously
2) Weigh the patient daily at the same time, scale and clothing
3) Observe for skin turgor and mucous membranes
4) Note orthostatic changes in blood pressure, pulse, and respiratory rate
5) Monitor vital signs
6) Monitor urine specific gravity
7) Monitor serum electrolytes
Alteration in nutrition
INTERVENTIONS
1) Maintain accurate record of dietary intake
2) Assess response to prescribed diet therapy: appetite, daily weight, muscle mass
and strength, wound healing
3) Frequent mouth care to prevent stomatitis and promote salivation
Potential for injury secondary to infection
INTERVENTIONS
1) Monitor vital signs especially temperature
2) Check for lab results especially leukocyte count and differential
3) Inspect skin for breaks in integrity: redress wounds using aseptic techniques, use
aseptic technique during insertion and daily dressing changes of IV cannulas
4) Provide oral hygiene
5) Provide assistance when needed
INTERVENTIONS
1) Monitor for the blood pressure and heart rate
2) Assess skin integrity and mucous membranes
3) Monitor ECG changes
4) Maintain bed rest or encourage adequate
rest and provide assistance when needed
5) Monitor laboratory
studies on electrolytes (K, Na, Ca, P, Mg)