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This is case of a patient name

E.I.C, Filipino, Female, 75 years


old, Widow, born on January
22, 1939 in Manila. Currently
residing in Rosario Complex,
San Pedro Laguna.
Chief Complain of Drowsiness
1 day prior to admission patient was
noted to have sudden onset of
drowsiness, followed by body weakness,
associated with vomiting (1x), and
difficulty ambulating, Patient was
immediately rushed to the nearest e.r,
a nearby hospital.
CT scan was done and other
laboratories done.
Mannitol and Citicoline, Nicardipine drip
20cc/ hr started
Patient cannot follow simple command
BP=170/80 CR= 98 RR=24 Temp=36.2c
(+) Babinski reflex
With admitting diagnosis of CVD bleed;
Thalamic; HASCVD

(RENAL)
Chronic Kidney disease secondary to
hypertensive nephrosclerosis

Define what is Chronic Kidney Diseases
Identify the affected part
Discuss the Anatomy & Physiology of the
organ involved
To do a comprehensive discharge
planning & home care plan.
Formulate NCP

Chronic kidney disease (CKD), also known as
chronic renal disease, is a progressive loss of
renal function over a period of months or years.
The symptoms of worsening kidney function are
unspecific, and might include feeling generally
unwell and experiencing a reduced appetite.
Often, chronic kidney disease is diagnosed as
a result of screening of people known to be at
risk of kidney problems, such as those with high
blood pressure or diabetes and those with a
blood relative with chronic kidney disease.
Chronic kidney disease may also be identified
when it leads to one of its recognized
complications, such as cardiovascular disease,
anemia or pericarditis.
Chronic kidney disease is identified by a blood test for
creatinine.
Higher levels of creatinine indicate a falling glomerular
filtration rate (rate at which the kidneys filter blood) and as
a result a decreased capability of the kidneys to excrete
waste products.
Creatinine levels may be normal in the early stages of
CKD, and the condition is discovered if urinalysis (testing of
a urine sample) shows that the kidney is allowing the loss
of protein or red blood cells into the urine.
To fully investigate the underlying cause of kidney
damage, various forms of medical imaging, blood tests
and often renal biopsy (removing a small sample of kidney
tissue) are employed to find out if there is a reversible
cause for the kidney malfunction. classify the severity of
chronic kidney disease in five stages, with stage 1 being
the mildest and usually causing few symptoms and stage 5
being a severe illness with poor life expectancy if
untreated. Stage 5 CKD is also called established chronic
kidney disease and is synonymous with the now outdated
terms end-stage renal disease (ESRD), chronic kidney
failure (CKF) or chronic renal failure (CRF).

There is no specific treatment
unequivocally shown to slow the
worsening of chronic kidney disease. If
there is an underlying cause to CKD,
such as vasculitis, this may be treated
directly with treatments aimed to slow
the damage. In more advanced stages,
treatments may be required for anemia
and bone disease. Severe CKD requires
one of the forms of renal replacement
therapy; this may be a form of dialysis,
but ideally constitutes a kidney
transplant. II.

Risk Factors
>> are 60 years or older
>> are diabetic >> have a family history of
kidney disease
>> have established heart problems (heart
failure or past heart attack) and/or have
had a stroke
>> have high blood pressure
>> are obese - Body Mass Index (BMI) -
more than or equal to >=30)
>> are a smoker


Signs and Symptoms:
There are no warning signs for CKD and
individuals can lose up to 90% of their kidney
function before they feel any symptoms - and
by then it's too late.

The symptoms of reduced kidney function may
include:
>> high blood pressure
>> changes in the amount and number of times
urine is passed, e.g. at night
>> changes in the appearance of urine
>> blood in the urine
>> puffiness e.g. legs and ankles
>> pain in the kidney area
>> tiredness
>> loss of appetite
>> difficulty sleeping
>> headaches
>> lack of concentration
>> itching
>> shortness of breath
>>nausea and vomiting
>> bad breath and a metallic taste.

Name: E.I.C
Age: 75 y/o
Female
Birthday: January 22. 1939
Birthplace: Manila
Address: Rosario Lopez
Nationality: Filipino
Religion: Catholic
Weight: 47kgs
Date of admission: August 29, 2014
Time of Admission: 5:11 am
Chief Complain:Drowsiness
Admitting diagnosis: CVD bleed; Thalamic; HAScvd
Admitting physician: Delos, Reyes

The kidneys are the primary organs of the urinary system
in vertebrates. The kidneys filter the blood, remove the
wastes, and excrete the wastes in the urine. About 1,300
milliliters of blood flow through the kidneys each minute
(about 400 gallons a day). From this blood the
Malphigian corpuscles (see below) extract about 170
liters of filtrate a day. As this fluid passes down the
uriniferous tubules it is almost all reabsorbed. Only about
1.5 liters are left in the tubules to carry away the waste
products.
The whole blood supply passes through the kidneys every
5 minutes, ensuring that waste materials don't build up.
The renal artery carries blood to the kidney, while the
renal vein carries blood, now with much lower
concentrations of urea and mineral ions, away from the
kidney. The urine formed passes down the ureter to the
bladder.
The work of the kidneys is much more than
just the removal of waste, However,
other functions of the Kidneys include:
Helping control the amount of water lost
to the outside world most important in
land animals.

Helping regulate the pH (i.e., level of
acidity or alkalinity) of the blood and the
general balance of ions in the blood,
and hence in the body fluid as a whole.

Conserving essential substances such as
glucose and amino acids.

Renal Vein - This has a large diameter and a thin wall. It
carries blood away from the kidney and back to the right
hand side of the heart. Blood in the kidney has had all its
urea removed. Urea is produced by your liver to get rid of
excess amino-acids.
-Blood in the renal vein also has exactly the right amount of
water and salts. This is because the kidney gets rid of
excess water and salts. The kidney is controlled by the
brain. A hormone in our blood called Anti-Diuretic
Hormone (ADH for short) is used to control exactly how
much water is excreted.

Renal Artery - This blood vessel supplies blood to the
kidney from the left hand side of the heart. This blood must
contain glucose and oxygen because the kidney has to
work hard producing urine. Blood in the renal artery must
have sufficient pressure or the kidney will not be able to
filter the blood.

The kidney removes these excess
materials; that is it function:
Pelvis - This is the region of the kidney
where urine collects.

Ureter - the ureter carries the urine down
to the bladder.
Medulla - The medulla is the inside part
of the kidney. This is where the amount of
salt and water in your urine is controlled.
It consists of billions of loops of Henl.
These work very hard pumping sodium
ions. ADH makes the loops work harder
to pump more sodium ions. The result of
this is that very concentrated urine is
produced.

Cortex - The cortex is the outer part of
the kidney. This is where blood is filtered.
We call this process "ultra-filtration" or
"high pressure filtration" because it only
works if the blood entering the kidney in
the renal artery is at high pressure.
Glomerulus and Bowman's Capsule
- This is where ultra-filtration takes
place. Blood from the renal artery is
forced into the glomerulus under
high pressure. Most of the liquid is
forced out of the glomerulus into
the Bowman's capsule which
surrounds it. This does not work
properly in people who have very
low blood pressure.
Proximal Convoluted Tubules -
Don't worry about remembering
the name for your GCSE biology.
Jolly good though if you can.
Proximal means "near to" and
convoluted means "coiled up" so
this is the coiled up tube near to
the Bowman's capsule.
Loop of Henl -This part of the
nephron is where water is
reabsorbed. Kidney cells in this
region spend all their time
pumping sodium ions. This
makes the medulla very salty;
you could say that this is a
region of very low water
concentration..
Distal Convoluted Tubules - Distal means
"distant" so it is at the other end of the
nephron from the Bowman's capsule.
-This is where most of the salts in the ultra-
filtrate are re-absorbed. Collecting Duct-
Collecting ducts run through the medulla
and are surrounded by loops of Henl. The
liquid in the collecting ducts (ultra-filtrate) is
turned into urine as water and salts are
removed from it. Although our kidneys
make about 160 litres of urine every 24
hours, we only produce about 12 litre of
urine. It is called a collecting duct because
it collects the liquid produced by lots of
nephrons.

Secondary Hypertension



Arteriosclerotic lesions of the afferent and efferent arterioles



Falling glomerular filtration rate



Decrease capability of the kidneys to excrete waste products



Due to hypertension, there are lesion to the afferent and efferent arterioles
decreasing the effectiveness of the filtration of blood in the glomerular that
leads to the decrease capability of the kidney to properly excrete waste
products

Generic name: Furosemide
Brand name: Lasix
Classification: Loop diuretics
20cc/q12/IV
Indication: Acute Pulmonary Edema
Edema & Hypertension
Side effect: vertigo, dizziness, headache, hypotension,
thromboplebitis, abdominal pain, hypokalemia, anemia, muscle
pain
Watch out for signs of hypokalemia
To prevent nocturia, give preparation in the
morning & early in the afternoon

Generic name: Mannitol
Brand name: Osmitrol
Classification: Osmotic diuretics
100cc/q6/IV
Indication: Test dose for marked oliguria or suspected
inadequate renal function
-To reduce intracranial pressure & to promote dieresis in drug
toxicity
Take care to avoid extravasation
Monitor I&O accurately/ Monitor VS closely

Generic name: Amlodipine
Brand name: Norvasc
Classification: Anti-Hypertensive
Calcium Channel Blockers
500mg/q6/IV
Indication: Mgt of hypertension, angina
pectoris
Monitor BP&PR before therapy
Monitor for signs of CHF
Monitor I&O
Monitor ECG during prolonged therapy
Generic name: Vastarel Mr
Classification: Anti Anginal Drugs

Generic name: Clopidogrel
Brandname: Plavix
Classification: Anti-platelet
75mg/OD
Indication: Tx of pt. at risk of ischemic
events, hx of MI, ischemic stroke, peripheral
artery disease
Generic name: Kalium Durule
Brand name: Potassium Chloride
Classification:Electrolyte & water
balance agent/Replacement solution
Indication:To prevent & treat potassium
deficit secondary to diuretic or
corticosteroid therapy also indicated
when potassium is depleted by severe
vomiting, diarrhea, intestinal
drainage,fistulas or malabsorption
Sodium chloride (s/o salt)
Classification: Mineral & electrolyte
replacement
1gm/1tab/TID
Indication: prevention of mgt of vol.
depletion due to salt restriction or heat
prostration when excessive exposures to
high temperature
Generic name: Pamtoprazole
Brand name: Protonix
Classification: Anti ulcer agents, Proton
pump inhibitors
40mg/q12/IV
Indication:
Pathologic gastric hypersecretomy
conditions
Fluid volume R/T glomerular filtration rate
and sodium retention

Acute pain R/T stimulation of nerve
ending

Altered nutrition: Less than body
requirement R/T catabolic state,
Anorexia and malnutrition secondary to
renal failure

M- Medication - Instruct patient to comply strictly with the
following home medications

E- Exercise - Encourage mild exercise

T- Treatment - Advice patient to avoid stress related factors

H Health teachings - Encourage deep breathing
exercise
Adequate bed rest



O- Out patient - Informed client to
follow up check up
-Emphasize the need to be present in
medical procedures schedule

D- Diet- Maintain on low salt low fat diet
- Limit fluid intake

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