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A Case Study Presented to the Faculty of The Ateneo de Davao University College of Nursing

A Case Study Presented to the Faculty of The Ateneo de Davao University College of Nursing

A Case Study on End-Stage Renal Disease secondary to Hydronephrosis secondary to Diabetes Milletus Type 2

Submitted to:

Remedios Caubang, RN Clinical Instructor – Panelist of the Case Study

Submitted by:

[Group 1B]

Beltran, Maribel S. Bulosan, Von Rainer S. Cabonita, Kristi Ann J. Campaner,Marie Allexis I.

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BSN-3H

November 7, 2009

TABLE OF CONTENTS

2 BSN-3H November 7, 2009 TABLE OF CONTENTS i. Acknowledgement ............................................................................................................... 2 I. Introduction................................................................................4 II. Objectives

i.

Acknowledgement

 

...............................................................................................................

2

I.

Introduction................................................................................4

II.

Objectives (General & Specific)................................................6

III.

Patient’s Data.............................................................................8

IV.

Family Background and Health History.....................................10

V.

Developmental Data...................................................................14

VI.

Definition of Complete Diagnosis..............................................21

VII.

Physical Assessment...................................................................24

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VIII. Anatomy and Physiology...........................................................28

IX.

Etiology and Symptomatology...................................................36

X.

Pathophysiology.........................................................................42

XI.

Doctor’s Order............................................................................47

XII.

Diagnostic Exam........................................................................55

XIII. Drug Study.................................................................................64

XIV. Surgical Procedure.....................................................................74

XV.

Nursing Theories........................................................................81

XVI. Nursing Care Plan......................................................................86

XVII. Discharge

Plan

(M.

E.

T.

H.

O.

D.)

&

Prognosis

....................................................................................................

118

XVIII.Recommendation

....................................................................................................

4

XIX. References ....................................................................................................

131

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i.

ACKNOWLEDGEMENT

5 i. ACKNOWLEDGEMENT In accomplishing great things, we must not only think, but believe in the

In accomplishing great things, we must not only think, but believe in the power of our cognition; not only aim but make our visions tangible; and at the end of the day, not only smile at the thought of accomplishment, but look back to where the strength to achieve such success came from. The proponents would like to extend their warmest gratitude to all the people who helped make the success of this undertaking a reality. First and foremost, to the Almighty Father, for His unceasing love and blessings; for giving us enough power and fortitude to face all the hardships in the making of this task. To Him be all glory and praise!

To our Clinical Instructor, Mrs. Willyn Adrias, RN, for her invaluable time and effort rendered to us; for letting us have the chance to experience the joy and opportunity of learning from you. For being a friend and companion in the area. You have made us realize that not all CIs are intrinsically superfluous. To all other CIs that has been with us in the whole rotation, Maam Baniel and Maam Llamido , for always being there to guide us; for their unending help and understanding. To our dear parents, for supporting us financially in all our endeavors. Thank you for all your love and care. Lastly, to each and every one who helped realize this job into completion, may it be direct or indirect, no matter how minimal, the gratitude and pleasure for the achievement of this task is ours to share.

INTRODUCTION

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INTRODUCTION 6

BSN-3H1 were given the opportunity to have a hospital exposure last November 12-14,2009 at Davao Medical Center – Med Ward; and on the said dates found a commendable case reasonable to be presented for case study agreed by the whole subgroup. The patient, to be mentioned in this paper as Aling D, was one of the patients admitted to Medicine Ward Nephro due to End Stage Renal Disease secondary to Hydronephrosis stage II secondary to Diabetes Mellitus Type II. End-Stage Renal Disease is the complete or almost complete failure of the kidneys to function at a level needed for day-to-day life. The kidneys can no longer remove wastes, concentrate urine, and regulate many other important body functions. It is an irreversible decline in a person's own kidney function, which is severe enough to be fatal in the absence of dialysis or transplantation. It usually occurs when chronic kidney disease has worsened to the point at which kidney function is less than 10% of normal. ESRD almost always follows chronic kidney disease. A person may have gradual worsening of kidney function for 10 - 20 years or more before progressing to ESRD. The most common causes of ESRD in the U.S. are diabetes and high blood pressure. The incidence and prevalence of ESRD continue to grow worldwide. According to data collected from 120 countries with dialysis programs, at the end of 2005 about 1,900,000 people were receiving renal replacement therapy (RRT). Among these individuals, 1,297,000 (68%) received hemodialysis and 158,000 (8%) received peritoneal dialysis; although an additional 445,000 (23%) were living with a kidney

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transplant. Precise estimates of ESRD incidence and prevalence remain elusive, because international databases of renal registries exclude individuals with ESRD who do not receive RRT. (http://clinicalevidence.bmj.com/ceweb/) Worldwide, the highest incidence and prevalence rates are reported from the USA, Taiwan, and Japan. In America, 34% of cases of ESRD each year are caused by diabetes, 25% by hypertension, 16% by glomerulonephritis, and 4% by kidney cysts. (Renal Data Report, ANS, 1999) End Stage Renal Disease is already the 7th leading cause of death among Filipinos. The population of ESRD patients requiring dialysis therapy in Asia is expanding at a faster rate than in the rest of the world. In Philippines, the dialysis population is growing at a rate of 10% or more annually. It is said that a Filipino is having the disease hourly or 120 Filipinos per million populations per year. This shows that about 10, 000 Filipinos need to replace their kidney function. Unfortunately though only 73% or about 7, 267 patients received treatment. An estimate of about a quarter of the whole population probably just died without receiving any treatment. The group chose Aling D as their subject primarily because her case posed a very intricate case requiring due understanding and knowledge. The group recognizes their partial knowledge about End-Stage Renal Disease and the treatments involved in such condition, thus making this case a good avenue to broaden the proponents’ knowledge about the disease and the surgical procedures involved.

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General Objective:

The main

goal of the

group is

to be

able to

present the case study of our

chosen client that would provide a comprehensive discussion of the pathological mechanism of the disease to yield significant information for the case study.

Specific Objectives:

In order to meet the general objective, the group aims to:

establish rapport to the patient and the patient’s significant others;

interpret the pertinent data gathered from the patient and her significant others;

state past and present health history of the patient;

trace the family genogram;

evaluate the present developmental stage of the patient according to the theories

of Erikson, Kohlberg, and Havighurst; define the complete diagnosis of the patient;

present the cephalocaudal assessment obtained from the patient;

discuss the anatomy and physiology of the organ involved in the patient’s disease;

present the etiology and symptomatology of the patient’s disease;

trace the pathophysiology of the patient’s disease;

obtain and rationalize the doctor’s order;

interpret the laboratory test results of the patient;

discuss the nature of the drugs given to the patient;

discuss the surgical procedure performed to the patient;

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relate the patient’s disease with the different nursing theories specifically those of

Nightingale, Orem and King; present a specific, measurable, attainable, realistic and time-bounded nursing care

plans for the client; justify the client’s prognosis according to the different criteria;

provide the patient and family with proper discharge planning (M.E.T.H.O.D); and

outline recommendations based on the case study’s findings.

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PATIENT’S DATA

10 PATIENT’S DATA Personal data: Patients Name: Aling D Age: 56 years old Weight 130 lbs

Personal data:

Patients Name:

Aling D

Age:

56 years old

Weight

130 lbs or 59kg

Height

4’10 ft

Gender:

Female

Birth date:

September 25, 1953

Address:

Dumanlas, Buhangin, Davao City

Nationality:

Filipino

Religion [Domination]:

Christian [Roman Catholic]

Civil Status:

Married

Educational Attainment:

College graduate

Occupation:

Teacher (retired)

Clinical/ Admitting Data:

Date of admission:

Time of admission:

Hospital & Hospital Number:

Ward [Room & Bed Numbers]:

November 9, 2009 11:30 am Davao Medical Center, Davao City [1604730] Medicine Ward- Nephro Bed No. 12

Admitting Physician:

Attending Physician:

Chief complaint:

Admitting Diagnosis:

Source of information:

Dr. Jovino C. Aquino Dr. Gil Florida Epigastric pain End Stage Renal Disease secondary to Hydronephrosis secondary

to Diabetes Mellitus Type II

Patient and Patient’s Chart

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FAMILY BACKGROUND AND HEALTH HISTORY

11 FAMILY BACKGROUND AND HEALTH HISTORY HEALTH BACKGROUND A. Family Background Aling D is 56 years

HEALTH BACKGROUND

  • A. Family Background

Aling D is 56 years old, female. She is the 3 rd child of 5 siblings. Both her parents

are already dead, and she failed to mention the cause of their death. The patient

verbalized that her father was diagnosed with Diabetes Mellitus. She failed to mention if

her mother and siblings also have illnesses.

Aling D has been married for 32 years. She was a gradeschool teacher but she

already retired last 2005. Her husband is a government employee. They are blessed with

3 children, but one son is already dead due to cardiac arrest. The son died at the age of 23

who is the middle child. Her eldest son is 31 years old, and her youngest son is 28 years

old. Her eldest son is already married and doesn’t live with them anymore. Generally,

they have close family ties. Aling D told us that they share their daily experiences with

each other.

The family’s source of income is the patient and the husband. Her youngest son

also contributes to the family’s income, since he is also a government employee

particularly in the Department of Agriculture. Aling D’s pension per month is Php

15,000. Her husband’s income per month is Php 12,000, and her son’s income is Php

8,000. The family lives in Dumanlas, Buhangin, Davao City. Her family’s diet is

composed of meat, fish and vegetables, however, due to her hospitalization she has been

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following a low salt low fat diet. She also avoids protein-rich foods and foods high in

sugar. She is a non-smoker and occasionally drinks alcohol.

  • B. History of Past Illness

The patient was born via normal spontaneous vaginal delivery. She did not have

any complications nor unusualities when she was delivered. The patient did not

experience any serious illness or accident during her childhood. But she did experience

having chicken pox when she was a child. Also, she only experienced common minor

illnesses such as colds, fever, stomach aches, headaches, and constipation. She drinks

over-the-counter drugs like paracetamol when she experiences fever. According to the

patient, she had been diagnosed with hypertension 20 years ago and diabetes mellitus 15

years ago. She takes insulin shots for her Diabetes. She verbalized that she did not have

strict compliance to her medications since her condition was not bad before.

  • C. Present Health History

On October 2009, the patient experienced chest pain. She also experienced

dyspnea occurring at night accompanied by bipedal edema. The patient also had cough

and abdominal pain. She took a supplement called Relieve for 23 days to alleviate the

symptoms she felt. She tolerated the symptoms until she had onset of epigastric pain. She

had her check-up on UM Multitest. Along with her laboratory results, she was diagnosed

with End Stage Renal Disease last October 15, 2009. However, she was not admitted by

then. She sought medical attention when she experienced severe epigastric pain, and thus

the admission.

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  • D. Effects/ Expectations of Illness to Self/ Family

The patient verbalized that after the diagnosis was determined; she and her family

became bothered and worried. They did not expect that she will be diagnosed with a

disease which is already in end stage. The doctor who gave the diagnosis advised dialysis

to the patient, which added to the stress of the family and the patient. On the patient’s

part, she felt nervous because she used to know someone who underwent dialysis and

later died after 2 years of treatment. Nevertheless, she verbalized that she had already

accepted her treatment, its limitations, and consequences. According to her, she does not

want to be a burden to her family. On the family’s part, they worried about the finances

they will have to spend for the treatment. But, they are very positive in facing the disease.

Aling D stated that it must have really been God’s will and that they could do nothing

about it. Despite her health problem, they still have hope and they pray that their family

would be able to endure this and cope with all the inconvenience brought about by her

condition.

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14

E. GENOGRAM

DEVELOPMENTAL DATA

LEGEND: * Deceased ** with Hypertension *** with Diabetes Mellitus
LEGEND:
* Deceased
** with Hypertension
***
with
Diabetes
Mellitus
14 E. GENOGRAM DEVELOPMENTAL DATA LEGEND: * Deceased ** with Hypertension *** with Diabetes Mellitus Human

Human development:

LOLO LOLA** LOLA A *** LOLO A the science that studies how we learn and develop
LOLO
LOLA**
LOLA A ***
LOLO A
the science that studies how we learn and develop psychologically, from birth to the end of life. This very young
MAMA
PAPA***
UNCLE A ***
UNCLE B
14 E. GENOGRAM DEVELOPMENTAL DATA LEGEND: * Deceased ** with Hypertension *** with Diabetes Mellitus Human

science not only enables us to understand how each individual develops, it also gives us profound insights into who we are as adults. Each

theory has its own viewpoint on the development of man.

Erikson's Stages of Psychosocial Development

The Psychosocial Stages of Development developed ALING by D Erikson enumerates eight stages though which healthily developing human

should pass from infancy to late adulthood. Every stage describes a task to be accomplished. These development stages can be seen as a

series of crisis and each stage forms on the successful accomplishment of the earlier stages. Successful resolution of these crises supports

a healthy self-development. Failure to resolve the crises damages the ego and maybe expected to reappear as problems in the future.

Stage

Description

Result

Justification

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According to Erik Erikson,

 

Our clent, Aling D has achieved generativity

Middle

 

the developmental task in middle

ACHIEVED

as she is able to display behaviors that are

Adulthood

adulthood is to form a sense of

well acceptable for his age such as being

(25

to

65

generativity or the concern for

there for her children. She is able to expand

years old)

guiding the next generation. It is

her interests at this time with her family’s

GENERATI

the concentration on this task that

support and has assumed the responsibilities

VITY

vs.

leads to typical adult behavior.

of middle –aged person. Our client usually

STAGNATI

Middle adults must have

takes time to bond with her husband and

ON

motivations for charitable and

children. Even though her children are all

altruistic actions, such as church

grown up and busy with their own life, but

work, social work, political work,

still they make time for each other and share

community fund-raising drives and

to each other their daily experiences.

cultural endeavors. They should

Furthermore, she manages to acknowledge

have time for companionship and

her aging body and sees whatever she has

recreation, thus making marriage

now as part of her existence. According to

more satisfying in the middle years

her as well as her family, her condition never

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of

life.

Generative

middle-aged

 

altered her role of being a wife to his better

persons are able to feel a sense of

half and a mother to her children. She is very

comfort

in

their

lifestyle

and

responsible in her duty to her family, as a

receive

gratification

from

mother to her children, she has molded them

charitable endeavors.

 

into a better person they are today, good and

 

He

knows

well

what his

responsible sons; and as a wife to her

responsibilities

are

and

he

husband, their expression of love is more

recognizes

that

he’s

held

intimate and they cherished every minute

accountable of whatever actions he

they are together. As a middle-aged adult, she

take.

 

is also engaged in various activities in the

 

society in order to maintain a good societal

functioning like participating in the

development of their own community.

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Kohlberg's Stages of Moral Development

This theory specifically addresses moral development in children and adults. The morality of an individual’s decision was not

Kohlberg’s concern; rather, he focused on the reasons an individual makes a decision.

Kohlberg's Stages of Moral Development

This theory specifically addresses moral development in children and adults. The morality of an individual’s decision was not

Kohlberg’s concern; rather, he focused on the reasons an individual makes a decision.

Stage

 

Description

 

Result

 

Justification

 

Conventional

The conventional level of moral

ACHIEVED

In this stage of Kohlberg's Moral

Stage

(Law

reasoning

 

is

typical

Development theory, the client must

and

Order

of

adolescent and adults. Those

go

after

the

laws

in

order to

Orientation)

who reason in a conventional

maintain a good functioning in the

way

judge

the

morality

of

society as a morally upright citizen.

actions by comparing them to

Aling D is a good citizen.

society's

views

and

According to her, she is a registered

expectations. In

this stage, it is

voter in order to exercise her right

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important

to

obey

 

to vote for a leader suited to our

laws,

dictums

and

social

country, she offered her services

conventions

because of their

during election periods when she

importance in maintaining a

was still working as a teacher. She's

functioning society. Moral

also an active GKK or Gagmayng

reasoning in stage four is thus

Kristohanong Katilingban member

beyond the need for individual

in their barangay and actively

approval exhibited in stage

participates for the development of

three which is

interpersonal

their community. For her, it is really

accord and conformity driven.

important to observe the rules

Meaning the self enters society

inculcated by the society in order to

by filling

social roles; therefore

maintain peace and order. She also

society must learn to transcend

stated that as a constituent of the

individual needs. A central

society, she should be a good

ideal or ideals often prescribe

example for the future generations

what is right and wrong, such

to come.

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as

in

the

case

of

 

Aling D said that the simplest way

fundamentalism. If one person

to become a good citizen is that you

violates a law, perhaps

must not disobey any simple rules

everyone would—thus there is

and regulations which the society

an obligation and a duty to

dictates you to follow and abide,

uphold laws and rules. When

because if one does not follow rules

someone does violate a law, it

it is already considered in this stage

is morally wrong;

culpability

is

to be morally wrong. So, one must

thus a significant factor in this

maintain a good reputation without

stage as it separates the bad

any stain of misdemeanor done.

 

domains from the good ones.

 

In the stage four of Conventional

Most active members of society

level,

it

is

said that following

the

remain at stage four, where

 

laws and dictums of the society is

morality is still predominantly

important to

maintain

a

good

dictated by an outside force.

   
 

functioning

in

the society,

so

we

have concluded that

Aling

D

has

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done her

part in

the society

as

a

good citizen. She follows and obeys

the rules and she had become a

good example to everybody,

especially to her children.

 

Havighurst’s Developmental Task

Havighurst (1972) defines a developmental tasks as one that arises at a certain period in our lives, the successful achievement of

which leads to happiness and success with later tasks; while leads to unhappiness, social disapproval, and difficulty with later tasks He

identifies three sources of developmental tasks (Havighurst, 1972).

Tasks that arise from physical maturation

Tasks that arise from personal values

Tasks that have their source in the pressures of society

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Havighurst also identified Six Major Stages in human life covering birth to old age which are the following:

  • 1. & early childhood (Birth till 6 years old)

  • 2. Middle childhood (6-12 years old)

  • 3. (13-18 years old)

  • 4. Early Adulthood (19-30 years old)

  • 5. Middle Age (30-60years old)

  • 6. Later maturity (60 years old and over) Our client belongs to the fifth stage which is the middle age, wherein men and women in this stage reach the peak of their

influence upon society, and at the same time the society makes its maximum demands upon them for social and civic responsibility. It is

the time of life to which they have looked forward during their adolescence and early adulthood.

The following are the developmental task that a middle age adult must fulfill or achieve:

DEVELOPMENTAL TASK

ACHIEVED OR NOT

JUSTIFICATION

ACHIEVED

Helping teenage children to

Achieved

The client's children are all old

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become happy and

 

enough to understand what their

responsible adults

mother taught them; especially

the moral values that would

make them become better

persons and become good

example to others.

 

Achieving adult social and

Achieved

According to

her,

she

 

civic responsibility

participates in barangay activities

for

the

development

of

their

community and she is an active

member

of

their GKK.

She

is

also registered voter in order to

do her duty as a good citizen of

the country.

 

Reaching and maintaining

Achieved

Since the client has already met

satisfactory performance in

her expectations in her job in the

one’s occupational career

past and have already fulfilled

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her dream of becoming a teacher.

Now, she is already retired from

her work.

Developing adult leisure time

Achieved

The client as an adult develops

activities

leisure time activities together

with her family like having

meaningful conversations with

her children or sharing their daily

experiences and watching

television shows to strengthen

their bonding as a family.

Relating oneself to one’s

Achieved

The client and her husband have

spouse as a person

been there for each and never

leave each other’s side. They

have been married for a long

time already. Whenever they

have problems, they’ve

talked

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about it and together they decide

on how to solve their

predicament. Now that the client

has

been

hospitalized,

her

husband has been there to

support her emotionally through

sending

her

text

messages

or

calling her sometime.

 

To accept and

adjust to the

Achieved

The client has adjusted to the

physiological changes

of

changes on her body. She already

middle age.

have wrinkled skin and easily

gets tired but she has learned to

accept this reality.

 

Adjusting to aging parents.

Achieved

The client has already adjusted to

her aging parents in the past

when her parents were still alive.

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DEFINITION OF COMPLETE DIAGNOSIS

14 DEFINITION OF COMPLETE DIAGNOSIS END -STAGE RENAL DISEASE End-stage renal disease occurs when 90% of

END -STAGE RENAL DISEASE

End-stage renal disease occurs when 90% of the nephrons are lost. Patients at this stage experience chronic and persistent

abnormal kidney function.

Hopper P.D., Williams, L.S.; Understanding Medical Surgical Nursing 3 rd edition

Kidney or renal end-stage disease is

defined

as

a

point at which

kidney is

so badly damaged or scarred that dialysis or

transplantation is required for patient survival.

Mosby’s Pocket Dictionary of Medicine, Nursing & Health Professions 5 th edition

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During this stage, renal function is less than 10% to 15% of normal; all renal functions are severely decreased; and homeostasis is

significantly altered.

HYDRONEPHROSIS

Ray A. Hargrove-Huttel; Medical Surgical Nursing

Hypdronephrosis is the abnormal dilation of kidneys caused by obstruction of urine flow.

Hopper P.D., Williams, L.S. ; Understanding Medical Surgical Nursing 3 rd edition

Hydronephrosis develops when urinary obstructions block the outflow of the kidneys. Hydronephrosis may be gradual, partial or

intermittent.

Kowalski, M.T., Rosdahl, C.B.;Basic Nursing

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Enlargement of kidney resulting from urine accumulation in the upper urinary tract caused by a blockage of the urinary tract.

DIABETES MELLITUS

Digiulio, M., Keogh, J., Jackson,D.; Medical-Surgical Nursing Demystified

Diabetes mellitus is a group of metabolic diseases in which defects in insulin secretion or action result in high blood sugar level.

Hopper P.D., Williams, L.S. ; Understanding Medical Surgical Nursing 3 rd edition

Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion,

insulin action, or both (The American Diabetes Association, 1997). Type II DM is formerly known as Non-insulin Dependent Diabetes

Mellitus. Type 2 diabetes usually occurs at any age but most cases occur after age 30. More than 80% of the clients are overweight and do

always experience classic symptoms.

Kowalski, M.T., Rosdahl, C.B.;Basic Nursing

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Diabetes mellitus occurs when beta cells are unable to produce insulin (Type I DM) or produce an insufficient amount of insulin

(Type II DM). As a result, glucose does not enter cells but remains in the blood.

Digiulio, M., Keogh, J., Jackson,D.; Medical-Surgical Nursing Demystified

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PHYSICAL ASSESSMENT

14 PHYSICAL ASSESSMENT I. Personal data: Date of Assessment: November 13, 2009 Time of Assessment: 11:30
  • I. Personal data:

Date of Assessment: November 13, 2009

Time of Assessment: 11:30 pm

Location of Assessment: Bed No. 12, Medicine Ward Nephro, Davao Medical Center

II. General Survey:

During assessment, the patient was lying supine on bed with ongoing Intravenous Fluid infusion of Plain Normal Saline Solution,

1 liter to run at KVO rate at the level of 750 cc, infusing well on her left metacarpal vein. Patient was awake, conscious, coherent, and

oriented to time, place, person and reason for admission. She was calm, cooperative and responsive. The quality and organization of

speech is understandable and in moderate pace and it exhibits thought association. The relevance and organization of thought is also

logical and has a sense of reality. General physical appearance is good; however, poor personal hygiene is evident.

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III. Vital Signs:

Temperature: 36.9°C

Pulse rate: 88 beats per minute

Respiratory rate: 22 cycles per minute

Blood pressure: 150/100 mm Hg

IV. The Integument

  • a. Skin

The patient’s skin color was brown and sallow, and generally uniform in distribution except for areas that are not

usually exposed to the sun. Pallor is noted on her palms, soles and nail beds. The palms and the soles are calloused.

The capillary refill took 3 seconds. Age spots are also highly visible on the face and the body. Poor skin turgor was

noted when the skin was pinched. No other lesions or deformities were noted.

  • b. Hair

Hair is evenly distributed over the scalp. Most hair on the scalp is gray as a result of advanced age. Dandruff is not

present. Fine hairs are evenly distributed on both extremities.

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  • c. Nails

The patient’s nails were untrimmed with pail nail beds, with normal angle curvature. Surrounding tissues were

intact; neither lesions nor lacerations were observed.

  • V. The Head

    • a. Skull and Face

The patient’s head is normocephalic and proportional to body size. The skull is also noted to be smooth in contour.

Presence of nodules or masses is not noted. Facial features and movements are symmetrical. The patient is able to raise

her eyebrows, close her eyes, frown, and smile. Her face manifests a feeling of slight tiredness.

  • b. Eyes

The hairs of the eyebrows are evenly distributed which are also symmetrically aligned. Eyelashes are equally

distributed and slightly curled outward. The skin of the eyelids is intact, no visible discharge, and discoloration is

noted. The eyelids close symmetrically. The sclera is white in color. The conjunctiva is shiny and pink in color. The

color of her iris is dark brown. The details of the iris are also visible. The eyes do not appear sunken. The client’s

pupils are round, black and are 3mm in diameter each pupil. When a pupil is illuminated, both pupils constrict. Both

eyes have coordinated movements; move in unison and with parallel alignment. According to her, when looking

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straight ahead, she can see objects in periphery. There was no edema or tenderness noted over her lacrimal glands. The

patient was not wearing any glasses or contact lenses.

  • c. Nose and Sinuses

The external nose is symmetrical, straight and uniform in color. Nasal flaring was not noted. Color is the same with

the entire face. No tenderness was noted during palpation. Both nares were patent. Air could move freely when

breathing in and out. The nasal septum is intact and is to be found in the midline. The frontal and maxillary sinuses

were not tender. Sense of smell is present and good since the patient was able to differentiate alcohol from coffee by

means of scent.

  • d. Ears

The auricles are smooth. The patient’s ears have the same color with her facial skin. The ears are symmetrical in

terms of size and position. The ears are normoset since both ears are located in line with the outer canthus of his eyes.

The auricles are firm and not tender. The pinna recoils after it is folded. The patient has no difficulty hearing normal

and whispered voice tone. No discharge was noted.

  • e. Mouth and Oropharynx

The lips are pink in color and glistening. The lips are also moist. The patient is able to purse her lips. The teeth are

white and shiny. Some teeth are also missing. The gums are moist and pink in color, with no signs of bleeding. The

15

tongue is positioned in the center. It is pink in color. No lesions observed. The papillae of the tongue are raised. The

tongue is able to move freely and the base has prominent veins. No swelling or ulcerations noted. The uvula is

positioned in midline of the soft palate. Tonsils are pink and not inflamed. The patient is able to swallow with no

difficulty.

VI. Neck

The muscles in the neck are symmetrical and the head movement is coordinated. There was no limited range of motion

noted as the patient turns her head from left to right; up and down; and circular motion. Trachea was located centrally in the

midline of the neck. No lymph nodes noted on any of the areas of the neck. Moreover, no neck blood vessels were distended

around the neck area.

VII.Chest and Lungs

The patient has a regular and normal breathing pattern. She has quiet, rhythmic, and effortless respirations with a

respiratory rate of 22 cycles per minute. There was a full and symmetric chest expansion. Chest pain was not reported.

Crackles were heard on both lung fields upon auscultation.

14

VIII.Heart and Blood vessels

The point of maximal impulse was located at the fifth left intercostal space. The patient has a cardiac rate of 85 beats per

minute. Abnormal heart sounds or murmurs were not noted upon auscultation. The patient’s pulse is regular in rhythm and has

a thrusting characteristic.

IX. Abdomen

As observed, the patient’s abdomen has uniform skin color. Also, the abdominal contour is rounded or convex. The

umbilicus is medially located and shows no signs of inflammation. It also has a symmetric contour. When breathing, there is

symmetric movement which is caused by respiration. Bowel sounds are present upon auscultation.

X. Genito-urinary

The patient reported that there were no lesions, tenderness and masses in her perineum and anus. Patient has dark yellow

colored urine. She also has oliguria. Upon palpation distended bladder was noted.

XI. Musculoskeletal

  • a. Upper Extremities

16

Patient’s peripheral pulses were symmetrical and regular, however, they are weak. The patient’s nails took 3

seconds for the capillary refill. The patient was able to exhibit strong hand grip on both arms. She was able to extend

and flex her both arms. Hand tremors were not noted.

  • b. Lower Extremities

Bipedal pitting edema grade 2+ was noted. She has difficulty ambulating because of the muscle removed from her

right foot.

14

ANATOMY AND PHYSIOLOGY

14 ANATOMY AND PHYSIOLOGY The Urinary System is the system of organs that produces and excretes

The

Urinary

System

is

the system of organs that produces and excretes urine from the body. Urine is a transparent yellow fluid containing unwanted wastes,

mostly excess water, salts, and nitrogen compounds. The major organs of the urinary system are the kidneys, a pair of bean-shaped organs

that continuously filter substances from the blood and produce urine. Urine flows from the kidneys through two long, thin tubes called

ureters. With the aid of gravity and wavelike contractions, the ureters transport the urine to the bladder, a muscular vessel. The normal

adult bladder can store up to about 0.5 liter (1 pt) of urine, which it excretes through the tubelike urethra.

An average adult produces about 1.5 liters (3 pt) of urine each day, and the body needs, at a minimum, to excrete about 0.5 liter (1 pint) of

urine daily to get rid of its waste products.

The kidneys lie embedded in fat tissue on either side of the backbone at about waist level. Each fist-sized kidney is reddish-brown, weighs

140 to 160 g (5 to 6 oz), and is similar in shape to the kidney beans sold at the supermarket.

15

15 On the inner border of each kidney is a depression called the hilum, where the

On the inner border of each kidney is a depression called the hilum, where the renal artery, the renal vein, and the ureter connect

with the kidney (the adjective renal is from the Latin term renalis, meaning of or near the kidneys). The renal artery delivers over 1700

liters (450 gal) of blood to the kidneys each day, which these organs filter and return to the heart via the renal vein. Each kidney contains

16

about 1 million microscopic coiled channels, called nephrons, which perform this critical blood-filtering function and produce urine in the

process.

The bulblike upper portion of the kidney’s nephrons filters water; urea, the nitrogen-containing breakdown product of protein;

salts; glucose; amino acids, the building blocks of proteins; yellow bile compounds from the liver; and other trace substances from the

blood. As this material moves through a long, looped tubule, many of these filtered materials are reabsorbed into the blood to be reused by

the body to maintain normal body functions. Less than 1 percent of the water and other materials remain behind to be excreted as waste

products in the urine.

These waste materials then pass from the nephrons into a funnel-shaped area called the renal pelvis. From the renal pelvis, waste

trickles out of the kidney into the ureter, which is about 25 to 30 cm (10 to 12 in) long and about 0.5 cm (0.2 in) in diameter. The ureter

empties into a hollow, muscular sac called the urinary bladder. A valvelike flap of tissue at the point of entry into the bladder prevents

urine from flowing backward into the ureter. The urinary bladder is able to expand and contract according to how much urine it contains.

As it fills with urine, the walls of the bladder stretch and become thinner, with the bladder itself lengthening to 12.5 cm (5 in) or more and

holding up to about 0.5 liter (1 pt) of urine. A ringlike sphincter muscle surrounds the bladder’s outlet and prevents spontaneous

emptying.

As the bladder becomes full, stretch-sensitive receptors in its walls are stimulated, and the person becomes aware of the fullness.

When the person is ready to urinate, or expel urine, the sphincter relaxes and urine flows from the bladder to the outside through the

17

urethra. In females, the urethra is about 3.8 cm (1.5 in) long and is strictly a urinary passage. In males, the urethra is about 20 cm (8 in)

long; it passes through the penis and also serves to convey semen during sexual intercourse.

Production of Urine. Blood enters the kidney through the renal artery. The artery divides into smaller and smaller blood vessels,

called arterioles, eventually ending in the tiny capillaries of the glomerulus. The capillary walls here are quite thin, and the blood pressure

within the capillaries is high. The result is that water, along with any substances that may be dissolved in it—typically salts, glucose or

sugar, amino acids, and the waste products urea and uric acid—are pushed out through the thin capillary walls, where they are collected in

Bowman's capsule. Larger particles in the blood, such as red blood cells and protein molecules, are too bulky to pass through the capillary

walls and they remain in the bloodstream. The blood, which is now filtered, leaves the glomerulus through another arteriole, which

branches into the meshlike network of blood vessels around the renal tubule. The blood then exits the kidney through the renal vein.

Approximately 180 liters (about 50 gallons) of blood moves through the two kidneys every day.

Urine production begins with the substances that the blood leaves behind during its passage through the kidney—the water, salts, and

other substances collected from the glomerulus in Bowman’s capsule. This liquid, called glomerular filtrate, moves from Bowman’s

capsule through the renal tubule. As the filtrate flows through the renal tubule, the network of blood vessels surrounding the tubule

reabsorbs much of the water, salt, and virtually all of the nutrients, especially glucose and amino acids, that were removed in the

glomerulus. This important process, called tubular reabsorption, enables the body to selectively keep the substances it needs while ridding

itself of wastes. Eventually, about 99 percent of the water, salt, and other nutrients is reabsorbed.

18

At the same time that the kidney reabsorbs valuable nutrients from the glomerular filtrate, it carries out an opposing task, called

tubular secretion. In this process, unwanted substances from the capillaries surrounding the nephron are added to the glomerular filtrate.

These substances include various charged particles called ions, including ammonium, hydrogen, and potassium ions.

Together, glomerular filtration, tubular reabsorption, and tubular secretion produce urine, which flows into collecting ducts, which

guide it into the microtubules of the pyramids. The urine is then stored in the renal cavity and eventually drained into the ureters, which

are long, narrow tubes leading to the bladder. From the roughly 180 liters (about 50 gallons) of blood that the kidneys filter each day,

about 1.5 liters (1.3 qt) of urine are produced.

Other functions. In addition to cleaning the blood, the kidneys perform several other essential functions. One such activity is

regulation of the amount of water contained in the blood. This process is influenced by antidiuretic hormone (ADH), also called

vasopressin, which is produced in the hypothalamus (a part of the brain that regulates many internal functions) and stored in the nearby

pituitary gland. Receptors in the brain monitor the blood’s water concentration. When the amount of salt and other substances in the blood

becomes too high, the pituitary gland releases ADH into the bloodstream. When it enters the kidney, ADH makes the walls of the renal

tubules and collecting ducts more permeable to water, so that more water is reabsorbed into the bloodstream.

The hormone aldosterone, produced by the adrenal glands, interacts with the kidneys to regulate the blood’s sodium and potassium

content. High amounts of aldosterone cause the nephrons to reabsorb more sodium ions, more water, and fewer potassium ions; low levels

19

of aldosterone have the reverse effect. The kidney’s responses to aldosterone help keep the blood’s salt levels within the narrow range that

is best for crucial physiological activities.

Aldosterone also helps regulate blood pressure. When blood pressure starts to fall, the kidney releases an enzyme (a specialized

protein) called renin, which converts a blood protein into the hormone angiotensin. This hormone causes blood vessels to constrict,

resulting in a rise in blood pressure. Angiotensin then induces the adrenal glands to release aldosterone, which promotes sodium and water

to be reabsorbed, further increasing blood volume and blood pressure.

The kidney also adjusts the body's acid-base balance to prevent such blood disorders as acidosis and alkalosis, both of which

impair the functioning of the central nervous system. If the blood is too acidic, meaning that there is an excess of hydrogen ions, the

kidney moves these ions to the urine through the process of tubular secretion. An additional function of the kidney is the processing of

vitamin D; the kidney converts this vitamin to an active form that stimulates bone development.

Several hormones are produced in the kidney. One of these, erythropoietin, influences the production of red blood cells in the bone

marrow. When the kidney detects that the number of red blood cells in the body is declining, it secretes erythropoietin. This hormone

travels in the bloodstream to the bone marrow, stimulating the production and release of more red cells.

ETIOLOGY AND SYMPTOMATOLOGY

14

14 A. ETIOLOGY Predisposing Factors Present/ Absent Rationale Justification Age Present In ESRD, the patient is

A. ETIOLOGY

Predisposing

       

Factors

Present/ Absent

 

Rationale

 

Justification

Age

Present

In ESRD, the patient

is

The patient is aged 56

predisposed to the disease

years old.

by her age because with

increased

age,

there

is

already wear and tear of the

organs and diminished

ability

of

the

kidneys

to

perform

as

they should.

Also, major candidates for

Diabetes

Mellitus

type

2

15

   

are seen to be of the adult

 

population;

 

this

predisposed the patient to

the disease which lead to

ESRD.

 

Family History

Present

The

risk

of

ESRD

Although

 

family

secondary

 

to

history

of

ESRD

is

hydronephrosis

secondary

not

present,

it

is

to

diabetes

mellitus

is

important to note that

substantially

increased

if

ESRD

in

this

either of a patient’s parents

particular

 

patient

had

diabetes.

Diabetes

is

rooted

from

 

the

often

inherited

(passed

existent

disease

from

the

parent

to

the

diabetes

mellitus

child).

 

which

runs

in

the

 

paternal

side

of

the

patient’s family. The

14

     

father of the patient

and

some

of

the

family

members

in

the

father’s

side

of

the

patient

has

diabetes mellitus.

 

Precipitating

     

Factors

Present/ Absent

Rationale

 

Justification

 

Obesity

Absent

Researchers attribute most

The

patient

is

not

cases of Type 2 diabetes to

 

obesity. Studies show that

obese.

Her

weight

the risk for developing

 

Type 2 diabetes increases

which

is

59kg or

130

by 4 percent for every

 

pound of excess weight a

lbs and height of 4’10

person carries. Researchers

are investigating the exact

is suggestive of a BMI

role that extra weight plays

in preventing the proper

of 27 which may be

utilization of insulin and

why some overweight

overweight but is still

people develop the disease

while others do not.

not

considered

as

14

   

Microsoft ® Encarta ®

obese.

2008. © 1993-2007

Microsoft Corporation.

All rights reserved.

Sedentary lifestyle

absent

A sedentary lifestyle may

The

patient

is

not

contribute to obesity which

having

a

sedentary

is said to be a factor which

lifestyle

as

reported.

can cause diabetes mellitus

The patient claims that

type two.

she has been living

a

fairly

active

lifestyle.

Although she does not

exert any effort to jog

or

stretch

habitually;

she reports to do

chores at home such as

doing

the

laundry,

watering her plants and

15

     

others.

Increased

dietary

fat

present

The accumulation of too

The

patient

does

not

 

much fat in the body is

 

intake

associated with a variety of

deny

the fact that

she

health problems. Studies

 

show that individuals who

used

to

have

high

are overweight or obese

 

run a greater risk of

intake of fats

prior to

developing diabetes

mellitus, hypertension,

her hospitalization

 

coronary heart disease,

 

stroke, arthritis, and some

forms of cancer.

Microsoft ® Encarta ®

2008. © 1993-2007

Microsoft Corporation.

All rights reserved.

B. SYMPTOMATOLOGY

Symptoms

Present/Absent

Rationale

 

Justification

Peripheral edema

present

Edema

is

apparent,

Bipedal edema with the score

resulting

from

fluid

of 2+ is noted.

retention

due

to

the

impairment

of

the

15

   

ability of the kidneys

 

to excrete fluids.

 

Increased

present

Increased creatinine

The creatinine

level

of

the

creatinine levels

levels

suggest

renal

patient is 697.90mmOl/L

 

insufficiency.

 

Flank pain

absent

Flank pain

is

one

of

The patient did not report any

the classic symptoms

experience of flank pain.

 

of kidney damage.

   

Massive

absent

Protein is a macro

 

proteinuria

molecule which is not

supposed to cross the

urine,

however,

in

cases

of

renal

impairment,

proper

glomerular

filtration

is

damaged

that

the

16

   

macromolecules

   

causing them to cross

the urine.

 

Electrolyte

present

One

of

the

major

Sodium

levels

are

relatively

imbalances

functions

of

the

high.

kidney is to regulate

electrolyte

levels

in

the body.

 

Anemia

present

The kidneys produce

The

Blood test of the patient

the

hormone

shows abnormally low levels of

erythropoietin

 

in

RBCs, hemoglobin

and

adults. This stimulates

hematocrit.

 

the production of red

Hemoglobin= 77

 

blood cells

which

Hematocrit= 0.22

carry oxygen

in

the

RBCs=2.60

body. Diminished

 

RBCs is termed

15

   

anemia.

 

14

PATHOPHYSIOLOGY

14 PATHOPHYSIOLOGY Heredity Diet Age Lifestyle Glucose in the blood Cells do not respond to the
Heredity Diet Age Lifestyle Glucose in the blood Cells do not respond to the Excessive effects
Heredity
Diet
Age
Lifestyle
Glucose in the blood
Cells do not respond to the Excessive effects thirst, generalized
excessive
of insulin in type 2 diabetes weakness,
urination, blurred vision,
Diet and lifestyle modification
delayed wound healing
Increased blood viscosity
Administration of medications
Stretching of intravascular spaces
Hypertension

14

∑ Excessive ESRD accumulati Stretching of capillaries on of metabolic Renal capillary collapse wastes ∑ Kidneys
Excessive
ESRD
accumulati
Stretching of capillaries
on
of
metabolic
Renal capillary collapse
wastes
Kidneys
Loss/ impaired of nephron function
unable
to
If not treated
maintain
Treatment
homeostasi
A. Medications
s
NaHCO3
Diminished renal reserve
40-50% renal function
Loss of excretory
Psychologi
Diuretics
Chronic
renal function
Renal Disease
cal
DEATH
Antihypertensive
changes
Renal Insufficiency
20-40% renal function
drugs
Antacids
Inefficient
urine
Aluminum Hydroxide
flow/
Multivitamins
Urine
flow
A. Dialysis
Cardiovascular
Neurologic
Hematologic
Musculoskeletal
Peritoneal
HYDRONEPHROSIS
Hypertension
LOC changes
Anemia
Hemodialysis
Edema
Weakness
Loss of muscle strength
Malaise
Fatigue
A. Renal Transplant
B. Lifestyle
and
Diet
ESRD
GOOD PROGNOSIS

16

Due to Diabetes Mellitus type 2 resulting from etiologies, blood glucose levels start concentrating in blood because of the inability

of the cells to respond to the effects of insulin. As blood glucose levels increase, blood viscosity also increases, thereby stretching

intravascular spaces systemically leading to extensive dilation of capillaries. This overstretching also results to hypertension; however, the

worst scenario that it can bring is the collapse of end capillaries especially in vital organs such as the kidneys. In this case, the extensive

dilation of kidney capillaries result in renal capillary collapse which causes impairment in the renal function.

The kidneys function as filtering devices in our body, it also excretes urine as wastes and secrete hormones essential to the body.

With the destruction of proper renal functioning, several problems arise. On one hand, excreting function is impaired thus causing urinary

retention leading to hydronephrosis. On the other end, impaired renal functioning will start progressing into chronic kidney disease in

which leads to several discomforts and changes in the body such as edema, anemia, LOC changes, uremia and many others. These

conditions, if still not properly managed and detected early will all lead to the dreadful end stage renal disease.

18

Date

Order

 

Rationale

 

Remarks

 

Novemb

Pls admit to IMCU

The patient is admitted to IMCU

Done

er

9,

because her condition fits in this

2009

department basing on disease

categorization.

 

Low Fat Low Salt

The patient has hypertension, high

Done

intake of dietary sodium and fat

may worsen the condition of the

patient.

VSq4

This is done in order to constantly

Done

monitor any changes in the vital

DOCTOR’S Orders

signs of

the patient

which may

indicate

new

advances or

worsening of the condition of the

patient

in order

to be addressed

immediately.

Venoclysis:

PNSS is given

to

the

patient in

Done

PNSS@KVO

order

to

serve as

a

line for

her

16

55

DIAGNOSTIC EXAM

A. Actual Laboratory Tests and Diagnostic Examinations

Urinalysis

Urinalysis is performed to screen for urinary tract disorders, kidney disorders, urinary neoplasm and other medical conditions that

produce changes in the urine. This test also is used to monitor the effects of treatment of known renal or urinary condition.

Date

Laboratory Test

Normal Value /

Result

Clinical Significance

Nursing

Results

Interventions

O

Color

Yellow, straw, amber

Dark Yellow

Colorless: overhydration, diuretic therapy,

Pretest:

C

(normal)

diabetes insipidus and mellitus

>Provide

T

Dark red or pink: porphyria, hematuria, ingestion

patient

with

O

of red food coloring, beets, berries, fava beans,

urine

B

rhubarb

container with

E

Dark yellow: bile

lid.

55

R

     

Green:

pseudomonas

bacteriuria,

urinary

bile

>Instruct

the

1

pigments

patient

to

9

collect

a

Appearance

Clear to faintly hazy

Clear

Cloudy, smoky or hazy: pyuria, bacteriuria,

sample

of

2

(normal)

phosphates in urine

 

urine,

0

 

preferably

on

0

Reaction

4.0-8.0

6.0

If >8.0, finding may be the result of UTI If <4.0,

arising in

the

9

(normal)

may indicate respiratory or metabolic acidosis

 

morning;

 

must

not

be

contaminated

Specific gravity

1.003- 1.030

1.042

increased in:dehydration, fever, profuse sweating,

by

toilet

(high)

vomiting, diarrhea, glycosuria, proteinuria, CHF,

paper,

toilet

adrenal insufficiency, SIADH

 

water,

feces

Decreased in: overhydration, diuresis,

or secretions.

hypotension, pyelonephritis, glomerulonephritis,

>Women

 

renal tubular dysfunction, severe renal damage,

should

not

56

       

diabetes insipidus

collect

urine

during

Albumin

Negative

positive

Positive in: nephrotic syndrome, renal

menstruation.

disorders, associated with hypertension,

>Instruct

negative

diabetes mellitus, SLE, amyloidosis

patient

to

Sugar

Negative

Positive in: hyperglycemia, diabetes mellitus

collect

a

midstream

voided

Epithelial

Cells-

+++

5-8

specimen.

Squamous

Posttest:

Pus cells

≤ 4 cells/HPF

0-2 hpf

Positive in: urinary tract infection (UTI)

>The lid must

be

sealed

Red Blood Cells

≤ 2 rbc hpf

Positive in indicates bleeding at some location

completely

in the urinary tract,

from the glomeruli to

and

the

urethra, or leakage of rbc through the

container

56

       

glomerular membrane.

must

be

Mucous threads

++

labeled

properly.

>Specimen

must

be

delivered

to

the laboratory

immediately.

COMPLETE BLOOD COUNT AND PLATELET COUNT

The CBC is a series of different tests used to evaluate the blood and the cellular components of RBC’s, WBC’s and

platelets. The CBC is used to assess the patient for anemia, infection, inflammation, polycythemia, hemolytic disease, and the effects of

ABO incompatibility, leukemia and dehydration status

55

Date

Exam

 

Normal

Rationale

 

Result of

Remearks

Clinical

Nursing Responsibilities

 

Value

 

Patient

Significance

 

Novemb

Hemoglobin

115

175

The

test

that

96

Low

Increased in:

  • 1. Discuss and explain the

er

10,

g/L

measures

the

polycythemia,

procedure and purpose of

2009

amount

of

dehydration,

the test.

hemoglobin

per

acute thermal

liter of blood

injury, COPD

  • 2. Inform the patient that

 

Decreased in:

no fasting is needed.

 

hemorrhage,

 

bleeding,

anemia,

  • 3. patient

Assess

the

for

hemolytic

any

factor

that

will

anemia, fluid

probably

affect

the

overload, fluid

results of the test.

retention,

 

pregnancy,

  • 4. Make sure patient is well

55

Date

Exam

Normal

Rationale

Result of

Remearks

 

Clinical

Nursing Responsibilities

Value

Patient

Significance

           

cirrhosis of the

hydrated. Dehydration

liver,

elevates the test results.

hyperthyroidis

m

A

low

hemoglobin

is

referred to as

anemia.

 
   

The test measures

   

A

low

Hematocrit

  • 0.36 – 0.48

the percentage of

  • 0.27 Low

hematocrit

is

RBC in the total

referred

to

as

blood volume

anemia.

RBC count

  • 4.20 – 6.10

The test measures

 
  • 3.58 Low

Low

 

RBC

may

the circulating

indicate

blood

RBCs in 1 cubic

loss,

anemia,

55

Date

Exam

Normal

Rationale

Result of

Remearks

Clinical

Nursing Responsibilities

Value

Patient

Significance

           

hemorrhage,

 

bone

marrow

  • 5. If patient is connected to

millimeter

of

 
 

failure,

IVF, make sure that the

blood.

leukemia,

and

blood is not taken from

malnutrition

the arm connected to the

   

The test measures

     

IVF. Hemodilution

all leukocytes

causes false decrease of

WBC count

5.0 – 10.0

present in 1 cubic

6.01

Normal

Normal

the test results.

 

millimeter of

 

blood.

  • 6. After

the

puncture,

           

Neutrophil

55 – 75

Neutrophils serve

62

Low

Normal

 

assess

the

site

for

as

the

body's

.

 
 

bleeding or bruising.

 

primary

defense

 
 
  • 7. patient

If

is

under

against

infection

 

treatment

from

an

through

the

 

55

Date

Exam

Normal

Rationale

Result of

Remearks

Clinical

 

Nursing Responsibilities

 

Value

Patient

Significance

 
     

process

of

       

infection,

inform

the

phagocytosis.

patient that the test will

Usually used to

be repeated

to monitor

diagnose specific

progress.

type of illnesses.

 

Lymphocyte

20 – 35

Lymphocytes

37

High

Abnormally

 

8.

Any

abnormality

noted

initiate

high

levels

of

will be reported

to

the

immunologic

lymphocytes can

physician.

cresponses.

The

be

due

to

flu,

 

test

determines

chicken pox, and

lymphocyte blood

some

viral

and

count.

bacterial

infection.

55

Date

Exam

Normal

 

Rationale

 

Result of

Remearks

Clinical

Nursing Responsibilities

Value

 

Patient

Significance

     

Monocytes have

       

phagocytic

 

action. It removes

dead

or

injured

cells,

cell

fragments,

 

and

Monocyte

2 – 10

 
  • 9 Normal

Normal

microorganism.

This

test

is

done

to diagnose an

illness

such

as

inflammatory

diseases.

 

Eosinophils

1 – 8

Eosinophils

   
  • 7 Normal

Normal

 

initiate

allergic

56

55

Date

Exam

Normal

Rationale

 

Result of

Remearks

Clinical

Nursing Responsibilities

Value

 

Patient

Significance

     

responses and act

       

against

parasitic

infestation.

The

test

is

use

to

diagnose

worm

infestation.

 
   

Basophils initiate

     

Basophil

0 – 1

type

1

allergic

1

Normal

Normal

responses

 
   

The test measures

     

all

platelets

Platelet count

150 – 400

present in 1 cubic

214

Normal

Normal

millimeter of

blood.

Chemistry

55

Date

Exam

Normal

Rationale

Result of

Remearks

Clinical

 

Nursing Responsibilities

Value

Patient

Significance

     

The test measures

       

Potassium

3.5 – 5.5

potassium levels

4.0

Normal

Normal

of the blood.

 
         

High

Serum

sodium indicates

retention

of

The test measures

sodium

in

the

Sodium

136 – 155

the sodium levels

168

High

body

and

a

in the blood.

 

diminished

 

filtration

function

of

the

kidneys.

     

The

test

usually