Question

Case Study: 22 year old with ESRD DB is a 22 yo male who developed ESRD Secondary to glomerulonephritis as an IGA nephropathy. His comorbitidies include anemia secondary to chronic disease and HTN. He also suffers from chronic UTI's and does not feel well on some days. He states he is chronically tired but must work full time. He is an undocumented worker whose primary language is Spanish. He speaks and understands some English but processes information slowly and reads only Spanish. He works as a cook in a diner and supports and lives with his elderly father. He has very few friends and no girlfriend currently. He has an AV fistula in his left lower arm which is patent and has a positive thrill and bruit. He is scheduled to receive dialysis 3 times a week for 4.5 hrs but sometimes misses appoints and often leaves early (after 1.5 hrs of treatment). He is afraid to miss work or be late for work. He usually eats 1-2 meals a day at the diner and often forgets to take his Renvela with his meal at work. He has been given a free supply of Renvela and advised to take this with every meal but compliance is poor. As an alternative he is advised to carry Tums with him and take this if he does not have his Renvela with him. His current Vs are BP 170/100, P 104, R 18, T100 orally. EKG: Sinus Tachy CXR: Clear Current Labs: Serum albumin 3.4, Creatinine14.8, Hgb 5.2, Ca 6.8, PO4 10.9, K.5.8, WBC 12.2 Orders are as follows: 1. Diet 85 GM Protein 2 GM NA 2 Gm Kand 1140 mg Phosphorus 2. Fluid restriction 1000ml/24 hrs 3. Procardia XL 90 daily 4. Lisinopril 20 mg daily 5. Coreg 25mg every 12 hrs 6. Renagel 800mg TID 7. Phoslo 1 packet TID 8. Kayexalate 15 gms TID 9. Clonidine 1 mg BID 10. Labetalol 200mg BID

Answer 1

ANSWER-J)The nurse evaluate the outcomes as-

• Firstly nurse will monitor the vital signs , in this mainly blood pressure because patient have hypertension.Decrease in blood pressure, decrease in pulse means the outcome is good .
• Nurse will monitor the intake output. Maintain intake output chart. Increase in urine output means the patient condition is improving.
• Nurse will monitor the dietry pattern of patient.
• Nurse will monitor the laboratory test or blood test routinly.
• Nurse will check the effectiveness of medications .
• Nurse will check the effectiveness of dialysis by checking intake output.
• Nurse will assess the skin integrity , check skin for swelling, peripheral edema , periorbital edema because the patient is suffering from glomerulonephritis.
• Nurse will monitor the weight of patient daily.

K) This case study be generalised to improve own practices as-

• By this case study a nurse will understand how to deal with multiple diagnosed patient.
• A nurse will understand how to assess the patient during dialysis.
• this case study helps in knowing the complications during dialysis.
• helps in understanding the diatry chart for this type of patient.
• helps in understanding how to check the intake output of the patient , how to maintain intake output chart.
• This case study helps a nurse knowing about various medications used in different diagnosis like in hypertension, glomerulonephritis, aneia, UTI. knowing about side effect of medications, action of medications , route , dosage.