This document provides information about chronic kidney disease including: 1. Chronic kidney disease is the slow loss of kidney function over time that can be caused by conditions like diabetes or high blood pressure. 2. As kidney function declines, waste builds up in the body and patients may experience symptoms like fatigue or swelling. 3. When kidney function drops below 10%, the final stage of kidney disease called end-stage renal disease is reached requiring dialysis or transplant.

1. 1
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CHAPTER I
INTRODUCTION
Chronic kidney disease is the slow loss of kidney function
over time. The main function of the kidneys is to remove wastes
and excess water from the body. Chronic kidney disease (CKD)
slowly gets worse over time. In the early stages, there may be

2. 2
no symptoms. The loss of function usually takes months or years
to occur. It may be so slow that symptoms do not appear until
kidney function is less than one-tenth of normal.
The final stage of chronic kidney disease is called end-
stage renal disease (ESRD). At this stage, the kidneys are no
longer able to remove enough wastes and excess fluids from the
body. The patient needs dialysis or a kidney transplant.
Diabetes and high blood pressure are the two most common
causes and account for most cases.
Goal:
 Within two weeks of Hospital duty, we will be able to
implement health promotion to our patient.
Objectives:

3. 3
 To develop effective communication skills that are
congruent with cultural values and beliefs for us to
collect data
 Promotion of proper hand hygiene through health
education to decrease the spread of microorganisms
 Promotion of good nutrition by emphasizing the
importance of following his diet for the betterment of
health
 To maintain a balance of electrolytes, minerals, and
fluid in our patient
LABORATORY FINDINGS
Fecalysis
Date: 09-08-2012
Physical Examination:
Color: Dark green

4. 4
Consistency: Semi-formed
Microscopic Examination:
No ova or cyst of any intestinal parasite seen
Cellular Elements:
Pus Cells: Negative
Red Cells: Negative
Others:
Occult blood: Negative
Hematology Report
Date: 09-08-2012
Result Reference Value Indication
WBC
RBC
Hemoglobin
Hematocrit
Platelet Count
5.7 x10 /VL
2.77 x10 /VL
74 Grams/L
0.234 L/L
223 x10/ VL
4.0 – 10.0
4.00 – 5.50
120 – 160
0.400 – 0.500
150.0 – 450.0
Normal
Decreased
Decreased
Decreased
Normal
This implies that RBC is decreased in patient’s with CKD due
to the inability of the failing kidneys to secrete the hormone
erythropoietin. This hormone is a necessary stimulus for normal
bone marrow to produce red blood cells. Hematocrit and
hemoglobin are below normal indicating the signs of anemia.
WBC Differentiated Count
Date:09-08-2012
Result Reference Value Indication
Neutrophils 0.78 0.40-0.70 Increased
Neutrophils is increased in chronic kidney disease patients
under hemodialysis and its relationship with resistance to
recombinant human erythropoietin and to the hemodialysis
procedure.

5. 5
Blood Type Result Reference Value Indication
MCV
MCH
MCHC
84.5 prn
26.7 Pcg
316 g/L
82.0 – 95.0
27.0 – 31.0
320 - 360
Normal
Decreased
Decreased
Prothrombin Time
Date: 09-08-2012
Result: 13.8 seconds
% ACTIVITY: 71.7%
INR: 1.16
Reference Value: 10.3 – 13.1
Indication: Increased
HEMODIALYSIS TREATMENT Time ON: 1:45
Time OFF: 5:45
HbsAgs: Negative
Anti HCV: Negative
Vascular Access: Left (AV Fistula – Strong thrill)
Heparin: NSS Flushing
Needle Cannulation: With ease, no difficulty
ANATOMY AND PHYSIOLOGY
URINARY SYSTEM
The Urinary system is also known as excretory system
of human body. It is the system of production, storage
and elimination of urine. The urinary system contributes
to homeostasis by altering blood composition, pH, volume

6. 6
and pressure; maintaining blood osmolarity; excreting
wastes and foreign substances; and producing hormones.
Components of urinary system:
Human urinary system consists of two kidneys, two
ureters, a urinary bladder, and a urethra.
1. KIDNEYS
Kidneys are the major organs of urinary system.
Formation of urine takes place in kidneys which are two
bean shaped organs lying close to the lumbar spine, one
on each side of the body.Functions of the kidneys include
regulation of blood ionic composition, regulation of
blood pH, regulation of blood volume, regulation blood
pressure, maintenance of blood osmolarity, production of
hormones, regulation of blood glucose level, excretion of
wastes and foreign substances.
2. URETERS
These are muscular tubes extending from the kidneys to
the urinary bladder. Each of two ureters transports urine
from renal pelvis of one kidney to the urinary bladder.
Peristaltic contractions of the muscular walls of the

7. 7
ureters push urine toward the urinary bladder, but
hydrostatic pressure and gravity also contribute.
3. URINARY BLADDER
Urinary Bladder collects urine before it is excreted
from the body. Urinary bladder is a hollow muscular and
elastic organ sitting on the pelvic floor. In males, it
is directly anterior to the rectum; in females, it is
anterior to the vagina and inferior to the vagina.
Urinary bladder capacity averages 700-800ml. It is
smaller to the females because the uterus occupies the
space just superior to the urinary bladder. Discharge of
urine from the urinary bladder, called micturition is
also known as urination or voiding.
4. URETHRA
Urethra is a small tube leading from the internal
urethral orifice in the floor of the urinary bladder to
the exterior of the body. In both males and females, the
urethra is the terminal portion of the urinary system and
the passageway for discharging urine from the body. In
males, it discharges semen as well.
PATHOPHYSIOLOGY

8. 8
Autoimmune Disorder
Decrease renal blood flow; urine out
flow obstruction
Glomelular filtration
BUN Serum
Creatinine
Inability to concentrate urine
Further loss of nephron function
Loss of non renal excretory
function
Chronic Renal Failure
NSG DIAGNOSIS:
>ineffective airway
clearance
>excess gluid volume
>risk for infection
>altered role performance
A. Schematic Diagram
Hypertension
SIGNS AND SYMPTOMS:
>asymptomatic at first
>decreased fluid volume
>peripheral edema
>high blood pressure
>fatigue and weakness
>chest pain
>bleeding

9. 9
B. Narrative
Chronic kidney disease (also known as chronic renal disease)
can arise from progression of acute renal failure or congenital
or familial diseases, or as the result of acquired conditions
affecting glomerulotubular function that have developed over a
period of months or years. There are many different causes of
Chronic Renal Failure includes congenital malformation of the
kidneys (birth defects),chronic bacterial infection of the
kidneys with or without kidney stones (pyelonephritis),high
blood pressure (hypertension),diseases associated with the
immune system ( glomerulonephritis, systemic lupus).Decreased
renal function interferes with the kidneys' ability to maintain
fluid and electrolyte homeostasis. Remaining intact nephrons
undergo a compensatory hypertrophy in order to maintain
function. The maladaptive mechanisms that occur as a result of
nephron damage further contribute to the progressive decline in
kidney function. Among the homoeostatic derangements that may
contribute to further progression are mineral imbalance, for
example phosphorus retention and secondary hyperparathyroidism,
and renal hypertension. For substances whose secretion is
controlled mainly through distal nephron secretion, adaptation
usually maintains plasma levels at normal until renal failure is

10. 10
advanced. K-sparing diuretics, ACE inhibitors, β-blockers,
NSAIDs, cyclosporine, angiotensin II receptor blockers may raise
plasma K levels in patients with less advanced renal
failure.Although no treatment can repair irreversible renal
lesions, the clinical consequences of reduced renal function can
be minmized by appropriate medical management.

11. 11
NURSING MANAGEMENT
1. Treatment
Hemodialysis 3x a week
2. Drug Study
DRUG MODE OF ACTION INDICATION ADVERSE
EFFECTS
NURSING CONSIDERATIONS
 Furosem
ide
(Divisp
ec) 40
mg 1tab
BID
 Drug
Class:
Loop
Diureti
c
 Inhibits
reabsorpti
on of
sodium and
chloride
form of
the
proximal
and distal
tubules
and
ascending
limb of
the loop
of Henle,
leading to
a sodium-
rich
diuresis.
 Therapeuti
c Effect:
 Oral, IV:
Edema
associated
with heart
failure,
cirrhosis,
renal
disease
 IV: Acute
pulmonary
edema
 Oral:
Hypertensi
on
 Dizziness
,
parasthes
ias,
weakness,
headache,
drowsines
s,
fatigue,
blurred
vision,
tinnitus,
irreversi
ble
hearing
loss,
Nausea,
anorexia,
vomiting,
oral and
gastric
 Reduce dosage if given
with other
antihypertensives;
readjust dosage
gradually
as BP responds.
 Give early in
the day so that
increased
urination will not
disturb sleep.
 Measure and record
weight
to monitor fluid
changes.
 Blood glucose levels ma
become temporarily
elevated
in patients with
diabetes
after starting this

12. 12
Produces
Diuretic
Effect
irritatio
n,
constipat
ion,
diarrhea,
,
jaundice
drug.
 Arrange to monitor
serum
electrolytes, hydration,
liver and renal
function.

13. 13
DRUG
MODE OF ACTION INDICATION ADVERSE EFFECTS NURSING
CONSIDERATIONS
 Amlodipin
e
(Rovasc)
10 mg 1
tab BID
 Drug
Classes:
Antiangin
al,
Antihyper
tensive,
Calcium
Channel
Blocker
 Inhibits calcium
movement across
cell membranes
of cardiac and
vascular smooth
muscle
 Therapeutic
Effect: Dilates
coronary
arteries,
peripheral
vascular
resistance by
vasodilation.
 Managemen
t of
hypertens
ion,
chronic
stable
angina,
vasospast
ic
(Prinzmet
al’s or
variant)
angina.
May be
used
alone or
with
other
antihyper
tensive
or
antiangin
als.
 Dizziness,
light –
headedness,
headache,
fatigue,
lethargy,
peripheral
edema,
arrythmias
>Monitor BP
carefully if
patient is also
on nitrates.
>Monitor cardiac
rhythm regularly
during
stabilization of
dosage.
>Take meals if
stomach upset
occurs.
>Report irregular
heartbeat,
shortness of
breath, swelling
of the hands or
feet, pronoun
dizziness,constip
ation
>side effects:
Nausea, vomiting
(eat frequent
meals);headache
(adjust lighting,
noise and
temperature;
medication may be
ordered)

14. 14
DRUG MODE OF ACTION INDICATION ADVERSE EFFECTS NURSING
CONSIDERATIONS
 TUMS
calcium
carbonate
1 tab OD
 Drug
Classes:
Electroly
te
replenish
er,
Antacid,
antihypoc
alcemic
>Calcium is
essential for
function, integrity
of nervous,
muscular, skeletal
system. Important
role in normal
cardiac, renal
function,
respiration, blood
coagulation, and
cell membrane and
capillary
permeability.
Assists in
regulating
release/storage of
neurotransmitter/hor
mones.
>Therapeutic Effect:
Replaces calcium in
deficiency states,
controls
hyperphosphatemia in
end-stage renal
disease.
>Symptomatic
relief of
upset stomach
associated
with
hyperacidity;
gastritis,
peptic
esophagitis,
gastric
hyperacidity,
hiatal hernia
>Prophylaxis
of GI
bleeding,
stress ulcers,
and aspiration
of pneumonia;
possibly
useful
>Dietary
supplement
when calcium
intake is
adequate
 Hypercalcemia,
rebound
hyperacidity
and milk –
alkali
syndrome,
alkalosis,
renal damage.
>Have patient
chew antacid
tablets
thoroughly
before
swallowing;
following with a
glass of water
or milk.
>Give calcium
carbonate
antacid 1 and 3
hr after meals.
>Report loss of
appetite, nausea
and vomiting,
abdominal pain,
constipation,
dry mouth,
thirst,
increasing
voiding

15. 15
DRUG MODE OF ACTION INDICATION ADVERSE EFFECTS NURSING
CONSIDERATIONS
 Ferrous
Sulfate 1
tab OD
 Drug
Classes:
Enzymatic
Mineral,
Iron
Preparati
on
Essential component
in formation of Hgb,
myoglobin, and
enzymes.
Therapeutic Effect:
Necessary for
effective
erythropoieses and
for transport and
utilization of O2
Prevention and
treatment of
iron
deficiency
anemia due to
inadequate
diet,
malabsorption,
and/or blood
loss.
CNS toxicity,
acidosis, coma and
death with overdose
 Take drug on
an empty
stomach with
water. Take
after meals if
GI upset is
severe.
 Have periodic
blood tests
during therapy
to determine
appropriate
dosage.
 You may
experience
theses side
effects: GI
upset, nausea,
vomiting,
diarrhea or
constipation;
dark or green
stools.

16. 16
DRUG MODE OF ACTION INDICATION ADVERSE EFFECTS NURSING
CONSIDERATIONS
Isosurbide
dinitrate
(Isolet) 1 tab
OD
 Drug
Class:
Antiangin
al,
Nitrate,
Vasodilat
or
 Stimulates
intracellular
cyclic GMP
 Therapeutic
Effect:
Relaxes
vascular
smooth muscle
of both
arterial and
venous
vasculature.
Decreases
preload and
afterload
Prophylaxis
and
treatment of
angina
pectoris.
Unlabeled:
CHF, pain
relief,
dysphagia,
relief of
esophageal
spasm with
GE reflux.
 Drug should be
discontinued if
blurred vision,
dry mouth
occurs. Severe
postural
hypotension
manifested by
fainting,
pulselessnes,
cold/clammy
skin, profuse
sweating.
 Give
sublingual
preparations
under
the tongue
or in the
buccal
pouch;
discourage
the patient
from
swallowing.
 Monitor
number of
angina
episodes,
orthostatic
episodes.
 Assists with
ambulation
if
lightheadedn
ess,
dizziness
occurs.

17. 17
DRUG MODE OF ACTION INDICATION ADVERSE EFFECTS NURSING
CONSIDERATIONS
 Ceftriaxo
ne sodium
2gms. IV
OD
 Drug
Classes:
Third
generatio
n
Cephalosp
orins,
Antibioti
c
 Binds to
bacterial
membranes
 Therapeutic
Effect:
Inhibits
synthesis of
bacterial cell
wall.
Bacteriacidal.
 Treatment
of
respirator
y and GU
tracts,
skin,
bone,
intra-
abdominal,
biliary
tract
infections
 Antibiotic –
associated
colitis, other
superinfections
may result from
altered
bacterial
balance.
Nephrotoxicity
may occur, esp.
with preexisting
renal disease.
 Culture
infection
site, and
arrange for
sensitivity
tests before
and during
therapy if
expected
response is
not seen.
 Give oral
drug with
food to
decrease GI
upset.
 Take full
course of
therapy even
if you are
feeling
better.
 Discontinue
if
hypersensiti
vity
reaction
occurs.

18. 18
DRUG MODE OF ACTION INDICATION ADVERSE EFFECTS NURSING
CONSIDERATIONS
 Seretide
250 gms.
BID 1
Puff
 Drug
Classes:
Antiasthm
atic,
Beta2 –
selective
adrenergi
c
agonist,
Bronchodi
lator,
Sympathom
imetic
 Stimulates
beta2 –
adrenergic
receptors in
the lungs,
resulting in
relaxation of
bronchial
smooth muscle.
 Therapeutic
Effect:
Relieves
bronchospasm,
reduces airway
resistance.
 Relief of
bronchospa
sm due to
reversible
obstructiv
e airway
disease,
exercise -
induced
bronchospa
sm.
 Excessive
sympathomimetics
stimulation may
produce
palpitations,
extrasystoles,
tachycardia,
chest pain,
slight increase
in BP, followed
by substantial
decrease,
chills,
sweating,
blanching of
skin.
 Monitor
rate, depth,
rhythm, type
of
respiration;
quality and
rate of
pulse; EKG;
serum
potassium,
ABG
determinatio
ns.
 Assess lung
sounds for
wheezes and
rales.
 Instruct on
proper use
of inhaler.
 Instruct
patient to
increase
fluid intake
 Avoid
excessive
use of
caffeine
derivatives.

19. 19
DRUG MODE OF ACTION INDICATION ADVERSE EFFECTS NURSING
CONSIDERATIONS
 Levopront
10 ml
10ml TID
 Drug
Class:
Anti
tussive
 Anesthetizes
stretch
receptors in
respiratory
passages,
lungs, and
pleura.
 Therapeutic
Effect:
Reduces cough
production.
 Relief of
nonproduct
ive cough,
including
acute
cough or
minor
throat/bro
nchial
irritation
.
 Paradoxical
reaction
(Restlessness,
insomnia,
euphoria,
nervousness,
tremors) has
been noted.
 Give with
meals if GI
upset
occurs; give
after meals
if drooling
or nausea
occurs.
 Ensure
patient
voids before
receiving
each dose if
urinary
retention is
a problem.
 Take this
drug exactly
as
prescribed.
 Report
difficult or
painful
urination,
constipation
, rapid or
pounding
heartbeat,
confusion,
eye pain.

20. 20
PRN MEDS:
DRUG MODE OF ACTION INDICATION ADVERSE EFFECTS NURSING
CONSIDERATIONS
Clonidine
(Catapres)
Drug
Classeses:
Antiadrenergic
,Sympatholytic
,Antihypertens
ive
 Epidural:
Prevents pain
signal
transmission
to the brain
and produces
analgesia at
pre- and post-
alpha
adrenergic
receptors in
the spinal
cord.
 Therapeutic
Effect:
Reduces
peripheral
resistance;
decreases BP,
heart rate
 Treatment
of
hypotensio
n alone or
in
combinatio
n with
other
antihypert
ensive
agents.
 Overdosage
produces
profound
hypotension,
irritability,
bradycardia,
respiratory
depression,
hypothermia,
milosis,
arrhythmias,
apnea.
 Take this
drug exactly
as
prescribed.
Do not
discontinue
the drug
unless
instructed
by your
healthcare
provider.
 Attempt
lifestyle
changes that
will reduce
your BP:
stop smoking
and using
alcohol;
restrict
intake of
salt;
exercise
regularly.
 Report
urinary
retention,
changes in
vision,

21. 21
blanching of
fingers,
rash.
DRUG MODE OF ACTION INDICATION NURSING CONSIDERATIONS
 Metoclopr
amide IV
 Drug
Classes:
Antiemeti
c,
Dopaminer
gic
blocker,
GI
stimulant
 Stimulates motility of
upper GI tract.
Decreases reflux into
esophagus. Raises
threshold activity of
chemoreceptor trigger
zone.
 Therapeutic Effect:
Accelerates intestinal
transit and gastric
emptying. Produces
antiemetic activity.
 To facilitate small
bowel intubation;
stimulate gastric
emptying, intestinal
transit.Relieves
symptoms of acute,
recurrent
gastroparesis.
 Take this drug
exactly as
prescribed.
 Do not use
alcohol, sleep
remedies, or
sedatives;
serious sedation
could occur.
 Report
involuntary
movement of the
face, eyes,
limbs, severe
diarrhea.
 Assess for
dehydration (poor
skin turgor, dry
mucous membranes,
longitudinal
furrows in
tongue.

22. 22
DRUG MODE OF ACTION INDICATION ADVERSE
EFFECTS
NURSING CONSIDERATIONS
 Ipatropiu
m bromide
+
salbutamo
l
 Drug
Classes:
Anticholi
nergic,
Antimusca
rinic,
Bronchodi
lator,
Paramsymp
atholytic
 Blocks
action of
acetylchol
ine at
parasympat
hetic
sites in
bronchial
smooth
muscle.
 Therapeuti
c Effect:
Causes
bronchodil
ation,
inhibits
secretions
from the
glands
lining
the nasal
mucosa.
 Bronchodi
lator for
maintenan
ce
treatment
of
broncho-
spasm
associate
d with
COPD
(solution
,
aerosol),
chronic
bronchiti
s, and
emphysema
.
 Worsening
of
narrow-
angle
glaucoma,
acute eye
pain,
hypotensi
on occurs
rarely.
 Ensure adequate
hydration;
control environment
(temperature) to prevent
hyperpyrexia.
 Have patient void before
taking medication to
avoid
urinary retention.
 Teach patient proper use
of inhaler.
 Protect solution for
inhalation from light.
Store
unused vials in foil
pouch.
 Teach patient proper use
of inhaler.

23. 23
3.Nursing Care Plan
ASSESSMENT EXPLANATION OF THE
PROBLEM
OBJECTIVES INTERVENTION RATIONALE EVALUATION
Subjective:
“Nahirapan
ako huminga”
Objective:
>Adventitious
breath sounds
(crackles)
heard upon
auscultation
>Non-
productive
cough noted
>Restlessness
>Difficulty
of breathing
Nursing
Diagnosis:
Ineffective
Airway
Clearance
related to
retained
secretions in
the
respiratory
tract
Normally the lungs
are free from
secretions. But with
Bronchopneumonia,
bacteria are invading
the lung parenchyma
thus, producing
inflammatory process.
And this response
leads to filling of
the alveolar sacs
with exudates leading
to consolidation. Due
to consolidation the
airway is narrowed
thus wheezes is being
heard, DOB in some
cases orthopnea is
observed
STO:
>Within 8
hours of
effective
nursing
interventions,
patient will
be able to
maintain
airway
patency.
LTO:
>Within 2 days
of nursing
interventions,
the patient
will be able
to demonstrate
reduction of
congestion
with breath
sounds clear.
Dx:
>Monitor vital
signs noting
blood pressure
or pulse
changes
>Observe for
improvement in
symptoms
>Observe for
signs of
respiratory
distress
Tx:
>Position head
midline with
flexion
appropriate
for condition
>Assist with
appropriate
testing
>Auscultate
breath sounds
and assess air
movement
>Keep
environment
>to assess
changes
>to evaluate
the
interventions
done
>to assess
changes
>to open or
maintain open
airway in at-
rest or
compromised
individual
>to identify
causative
factors
>to ascertain
status and
note progress
>to maintain
adequate
STO:
>After 8 hours
of effective
nursing
interventions,
patient was
able to
maintain
airway
patency.
LTO:
>After 2 days
of nursing
interventions,
the patient
was able to
demonstrate
reduction of
congestion
with breath
sounds clear.

24. 24
allergen free
>Provide
supplemental
humidification
Edx:
>Encourage
deep breathing
and coughing
exercises
>Support
cessation of
smoking
>Encourage
patient to
have adequate
rest
patent airway
>to mobilize
secretions
>to maximize
effort
>to improve
lung function
>to promote
wellness