NURSING CARE PLAN CUES Subjective: madali naman ako kapuyon yana, bisan pagbuhat la, nanluluya na ako

dayon as verbalized by the client Objective: Hemoglob in= 88g/dl (N=120160g/dl) Hematocri t= 0.28 (N=0.360.46) RBC count= 3.76 x1012 / L(N= 4.65.5 x1012 /L BP=120/8 0 mmhg Dyspnea on exertion (24 cpm) Heart rate= 89 bpm Muscle NURSING DIAGNOSIS Fatigue related to Chronic Anemia RATIONALE
Anemia is common in people with kidney disease. Healthy kidneys produce a hormone called erythropoietin, or EPO, which stimulates the bone marrow to produce the proper number of red blood cells needed to carry oxygen to vital organs. Diseased kidneys, however, often dont make enough EPO. As a result, the bone marrow makes fewer red blood cells source:

GOALS Short: After 8 hours of nursing intervention the client will be able to: a. Identify potential factors that aggravate and relieve fatigue. b. Verbalize increased energy and improved well- being. Long: After 2 days of nursing intervention client perform ADL without signs of fatigue such as going to comfort room without shortness of breath.

INTERVENTIONS Independent: 1. Assessed the frequency of fatigue, activities and symptoms associated with increase fatigue. 2. Monitored pulse, respiratory rate, and BP before/ after activities. 3. Discussed ways of conserving energy while bathing, transferring and so on.

RATIONALE

EXPECTED OUTCOME Goals partially met diri na gud ako sugad nga kinakapoy, diri sugad ha una, mabuhat ngan la ako hinihingal na ako as verbalized by the client.

1. This will serve as a baseline data for further interventions. 2. Indicates physiologic levels of tolerance. 3. Client will be able to accomplish more with a decreased expenditure of energy. 4. Prevents excessive fatigue. 5. Education may provide motivation to increase activity level even though client may feel too weak initially. 6. Client education legitimizes fatigue and enhances the clients control through self care and positive self talk. 7. Energy conservation strategies can decrease amount of energy used. 8. This measures can help in conserving the energy or can increase tolerance in any activity.

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4. Alternated activities with period of rest/uninterrupted sleep. 5. Discussed with client the need for activity. Plan schedule with client and identify activities that lead to fatigue.

Because of the loss of non-excretory renal function there is failure to produce erythropoietin and RBC production is impaired w/c leads to decrease d flow of oxygenated blood to tissue hence fatigue. Souce: Medical Surgical Nursing By: Black & Hawks P: 818

6. Helped client to do cognitive reframing: share information about fatigue and how to live with, including need for positive self talk. 7. Taught strategies for energy conservation (eg. Sitting instead of standing during showering). 8. Taught the importance of following a healthy lifestyle with adequate nutrition fluids and rest and appropriate exercise to decrease fatigue.

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9. Increased client participation in ADLs as tolerated.

9. Increase confidence level/self-esteem and tolerance level. Indepenent: 1. Hematopoietic agent. This
increases the number of red blood cells and elevate serum iron concentration which increases RBC components and increase oxygen carrying capacity of these cells.

Independent: 1. Administer medication as indicated. a. Renogen 4000 units SubQ b. Propan with iron 1 cap