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