NURS 101L Aultman College of Nursing Chronic Renal Failure Nursing Care Plan

NURS 101L Aultman College of Nursing Chronic Renal Failure Nursing Care Plan NURS 101L Aultman College of Nursing Chronic Renal Failure Nursing Care Plan MY SCHOOL RUNS PLAGIARISM CHECK. PLEASE DO NOT COPY I will post 3 documents. It will be an example of a completed case study, the topic of the case study, and the blank care plan template where the care plan is suppose to be completed.NURS 101L Aultman College of Nursing Chronic Renal Failure Nursing Care Plan. The instructor did not give us any instructions. He only gave us the example of another case study and the topic. All the information about patient the case study is in the “topic” document. Please just follow the steps on how the example case study did it. The main purpose of this is the make a care plan on the patient with the given information we have. The given information is in the “topic” document. Thank you! Please message me if any questions. example.docx care_plan_template.docx case_study_scenari Course: NURS 101L NURSING CARE PLAN NURS 101L Student Instructor Vlad Scott Abraham James Date Course Unit/ Room# Patient Initial DOB Code Status Allergies Temp (C/F Site) 97.8F/36.6C Oral Height/Weight Pulse (Site) 98 b.p.m./Radial Respiration 24 b.p.m. History of Present Illness including Admission Diagnosis & Chief Complaint (normal & abnormal) supported with Evidence Based Citations Chief Complaint Trouble breathing, worsened by lying down and upon exertion. Pathophysiology of Diagnosis Congestive heart failure, also known as heart failure, “is a clinical syndrome caused by structural and functional defects in myocardium resulting in impairment of ventricular filling or the ejection of blood. The most common cause for HF is reduced left ventricular myocardial function.” (Inamdar & Inamdar, 2016) This can be possibly to left ventricle hypertrophy, that results from the overexertion of the left ventricle muscle, resulting in muscle enlargement. “Some of the major pathogenic mechanisms leading to HF are increased hemodynamic overload, ischemia-related dysfunction, ventricular remodeling, excessive neuro-humoral stimulation, abnormal myocyte calcium cycling, excessive or inadequate proliferation of the extracellular matrix, accelerated apoptosis and genetic mutations.” (Inamdar & Inamdar, 2016) “CHF exacerbation is a clinical diagnosis based on at least 1 of the following symptoms: exertional dyspnea, fatigue, paroxysmal nocturnal dyspnea, orthopnea, cough, early satiety, weight gain, and increasing abdominal girth. Physical exam findings may consist of an S3 gallop, JVD, bibasilar crackles, abdominal distention, hepatomegaly, and peripheral Page 1 of 16 Pulse Ox (O2 Sat) 87% Room air Blood Pressure 165/88 mmHg Pain Scale 1-10 Denies pain Physical Assessment Findings including presenting signs and symptoms supported with Evidence Based Citations The following are M.M’s vital signs obtained during the physical assessment: Normal ? Temp: 97.8F/36.6C Oral ? Bowel sounds are normoactive x 4; no masses, bruises, or lesions detected. ? No problem voiding. ? Pulse rate: 98 beats/min. Abnormal ? Patient is alert and oriented to person, place, and purpose. Not oriented to time. ? Irregular heart sounds; S1 & S2 heard, but decreased intensity; S3 heard. ? Oxygen saturation at 87% room air. ? Skin is flushed and clammy; no tenting. ? Present bilateral radial pulses, bilateral pedal pulses present but slightly diminished. ? Bilateral lower peripheral +3 pitting edema. Course: NURS 101L NURSING CARE PLAN NURS 101L edema. NURS 101L Aultman College of Nursing Chronic Renal Failure Nursing Care Plan. The initial workup should include CBC, CMP, BNP, 12-lead ECG, and a chest X-ray.” (Feiz et. al., 2015) ? HPI 68-year-old female admitted to the Emergency room via walk-in, complaining of shortness of breath, poor endurance, and lethargy. Patient reports dyspnea worsens when laying down or upon exertion. Daughter’s, at bedside, state that patient is non-compliant with medication and has a poor diet, consisting of high carbohydrates, fat, and fried foods. Patient is obese and reports living a sedentary lifestyle. M.M’s admission diagnosis is CHF exacerbation. Patient states has had a history of congestive heart failure (CHF), hypertension (HTN), diabetes mellitus (DM), and peripheral vascular disease (PVD). ? Relevant Diagnostic Procedures/Results & Pertinent Lab tests/ Values (with normal ranges), include dates and rationales supported with Evidence Based Citations Laboratory Test Test WBC Hemoglobin HbA1c Sodium Potassium Calcium Magnesium BUN Creatinine Blood Glucose Page 2 of 16 Normal Range 4,500-11,000 cells/mm^3 14-16.5 g/dL (MALE) 12-16 g/dL (FEMALE) Good Control: <7% Fair Control: 7%-8% Poor Control: 8%< 135-145 mEq/L 3.5-5.0 mEq/L 4.5-5.5 mEq/L 1.6-2.6 mg/dL 8-25 mg/dL 0.6-1.3 mg/dL 60-110 mg/dL Current Value 10 cells/ mm^3 12 g/dL 5.9% 140 mEq/L 2.9 mEq/L 8.6 mEq/dL 1.2 mg/dL 32 mg/dL 1.9 mg/dL 198 mg/dL Respiratory rate is at 24; bilateral lower lobe crackles, pink frothy sputum upon productive cough; M.M. places on 2L via nasal cannula raising O2 saturation to 93%. Hypertensive on admission 165/88 mmHg. Normal Ranges for Vital Signs ? Body Temperature: 97.8F-99.0F (36.5C-37.2C) ? Pulse Rate: 60-100 beats per minute ? Respiration Rate: 12-16 breaths per minute. ? Blood Pressure: 120/80 mmHg ? Oxygen: 94% =/< (John Hopkins Medicine, n.d.) Past Medical & Surgical History, Pathophysiology of medical diagnoses (include dates, if not found state so) Supported with Evidence Based Citations Hypertension “High blood pressure is a common condition in which the long-term force of the blood against your artery walls is high enough that it may eventually cause health problems, such as heart disease.” (Mayoclinic, 2018) There are many events or situations that occur in everyday lives that contribute to hypertension. For example, continuous stress or pressure from work or school can contribute to chronic hypertension. “You can have high blood pressure (hypertension) for years without any symptoms. Even without symptoms, damage to blood vessels and your heart continues and can be detected. Uncontrolled high blood pressure increases your risk of serious health problems, including heart attack and stroke.” (Mayoclinic, 2018) In the case of M.M, blood pressure of 165/88 mmHg can be considered as normal for her case, since M.M has a history of hypertension. Diabetes Mellitus Diabetes is commonly associated with the inability to break down sugar. However, there is more than just the inability to break down sugar. Course: NURS 101L NURSING CARE PLAN NURS 101L BNP Troponin 100 pg/mL> 0.04 -0.40 ng/mL 5988 pg/mL 0.02 ng/mL (Martin, 2020) White Blood Cell Count (WBCc) White blood cell count can indicate underlying pathologies, revealing complications that may have gone undiagnosed. “A low or high WBC count can point to a blood disorder or other medical condition…NURS 101L Aultman College of Nursing Chronic Renal Failure Nursing Care Plan Certain medications can interfere with your lab results and either lower or increase your WBC count – antibiotics, antihistamines, diuretics…” (Higuera, 2018) In the case of M.M., low levels of white blood cells can be correlated to medication taken by M.M. to control her hypertension. “The most common condition treated with diuretics is high blood pressure. The drugs reduce the amount of fluid in your blood vessels, and this helps lower your blood pressure…Congestive heart failure, for instance, keeps your heart from pumping blood effectively throughout your body. This leads to a buildup of fluids in your body, which is called edema. Diuretics can help reduce this fluid buildup.” (Ellis, 2019) Hemoglobin (Hgb) The role of hemoglobin in the blood is to facilitate the transport of oxygen throughout the body. “Hemoglobin count is indicated to help measure the severity of anemia (low hemoglobin) or polycythemia (high hemoglobin).” (Martin, 2020) In the case of M.M., determining the hemoglobin levels is important for determining secondary complications. The reason being, “Anemia is a frequent comorbidity of heart failure and is associated with poor outcomes. Anemia in heart failure is considered to develop due to a complex interaction of iron deficiency, kidney disease, and cytokine production…”(Shah & Agrawal, 2013) M.M.’s history of congestive heart failure warrant for determining hemoglobin levels due to the possible development of anemia. Blood Glucose Glucose “levels are used to help diagnose diabetes mellitus and hypoglycemia… Glucose is the main source of cellular energy for the body and is essential for brain and erythrocyte function.” (Martin, 2020) Page 3 of 16 There are two types of diabetes. “Type 1 diabetes occurs because the insulin-producing cells of the pancreas (beta cells) are damaged. In Type 1 diabetes, the pancreas makes little or no insulin, so sugar can;t get into the body’s cells for use as energy. People with Type 1 diabetes must use insulin injections to control their blood glucose. Type 1 is the most common form of diabetes in people who are under age 30, but it can occur at any age. Ten percent of people with diabetes are diagnosed with Type 1.” (Cleveland Clinic, 2018) Therefore, those with type 1 diabetes need to administer insulin due to the inability to produce insulin. “In Type 2 diabetes (adult onset diabetes), the pancreas makes insulin, but it either doesn’t produce enough, or the insulin doesn’t work properly. Nine out of 10 people with diabetes have Type 2. This type occurs most often in people who are over 40 years old but can occur even in childhood if there are risk factors present. Type 2 diabetes may sometimes be controlled with a combination of diet, weight management and exercise. However, treatment also may include oral glucose-lowering medications (taken by mouth) or insulin injections (shots).” (Cleveland Clinic, 2018) In M.M.’s case, her blood glucose was 198 mg/dL, indicating she has the inability to breakdown insulin. This correlates M.M.’s diabetes with type 1 diabetes. Peripheral Vascular Disease Peripheral vascular disease, also known as peripheral arterial disease, “is chronic arterial occlusive disease of the lower extremities caused by atherosclerosis. The PAD may cause intermittent claudication which is pain or weakness with walking that is relieved with rest. The muscle pain or weakness after exercise occurs distal to the arterial obstruction. Since the superficial femoral and popliteal arteries are most commonly affected by atherosclerosis, the pain of intermittent claudication is most commonly localized to the calf.” NURS 101L Aultman College of Nursing Chronic Renal Failure Nursing Care Plan (Aronow, 2012) Therefore, if ischemia were to occur in the affected calf, for example, it could eventually lead to tissue necrosis. Furthermore, “persons with peripheral arterial disease (PAD) are at increased risk for all-cause mortality, cardiovascular mortality, and mortality from coronary artery disease.” (Aronow, 2012) When it pertains to gender, “Women with PAD have a higher prevalence Course: NURS 101L NURSING CARE PLAN NURS 101L Individuals with cardiovascular complications are at risk for the development of diabetes mellitus. For the most part, the risk for the development of diabetes is due to the decreased activity, poor nutrition, and decrease in skeletal muscle in individuals with heart failure. In the case of M.M., her increased blood glucose can be contributed to a poor diet, consisting of fried, fatty, and high cholesterol food, sedentary lifestyle (causing a decrease in skeletal muscle), and history of congestive heart failure; conditions/characteristics that are commonly associated with individuals with heart failure. Glycosylated Hemoglobin (HbA1c) “Glycosylated hemoglobin is blood glucose bound to hemoglobin…it is a reflection of how well blood glucose levels have been controlled for the past 3 to 4 months. Hyperglycemia in clients with diabetes is usually a cause of an increase in the HbA1c.” (Martin, 2020) In the case of M.M., glycosylated hemoglobin levels provide an accurate representation of blood glucose in the body; her glycosylated hemoglobin levels are correlated with good control of diabetes indicating control within the past 3-4 months, despite her blood test indicating high blood glucose. Brain Natriuretic Peptide (BNP) “BNP is the primary marker for identifying heart failure as the cause of dyspnea. The higher the BNP level, the more severe the heart failure. If the BNP level is elevated, dyspnea is due to heart failure; if it is normal, the dyspnea is due to a pulmonary problem.” (Martin, 2020) Aside from BNP being increased due to congestive heart failure, elevated BNP levels can lead to systemic hypertension and myocardial infarction. In M.M’s case she has a history of congestive heart failure, meaning the elevated BNP levels in M.M’s blood can be correlated to M.M’s dyspnea. Serum Sodium (Na+) Serum sodium levels are often used to determine the severity of patients with congestive heart failure. Left ventricular hypertrophy, as a result of congestive heart failure, alter cardiac output resulting in fluid retention in patients. “Hyponatremia is one of the crucial factors in the clinical prognosis of heart failure patients…the reduction of cardiac output Page 4 of 16 of leg pain on exertion and at rest, poorer functioning, and greater walking impairment from leg symptoms than men with PAD. Poorer leg strength in women contributes to poorer lower extremity functioning in women with PAD than in men with PAD. Women with PAD experience faster functional decline than men with PAD.” (Aronow, 2012) In the case of M.M, although she denies pain, her history of PVD can explain for her poor endurance and weakness. In addition, it can also correlate to M.M.’s sedentary lifestyle. Cardiac Stent Placement “A coronary artery stent is a small, metal mesh tube that expands inside a coronary artery. A stent is often placed during or immediately after angioplasty. It helps prevent the artery from closing up again.” (Mayoclinic, n.d.) A coronary artery may be impacted by platelet buildup or a thrombus, preventing proper circulation of blood to the heart. As a result, a cardiac stent is indicated to open the artery and allow proper passage of blood to the heart as means to supply the myocardial cells. This correlated to M.M.’s sedentary lifestyle and poor nutrition. Appendectomy “An appendectomy is surgery to remove the appendix when it is infected. This condition is called appendicitis. Appendectomy is a common emergency surgery.” (Johns Hopkins Medicine, n.d.) As a part of the large intestine, appendix pain is usually located on the right lower quadrant of the abdomen. This pain is commonly associated with the inflammation of the appendix as a result of infection. Common signs and symptoms of appendicitis, that result in appendectomy, are: nausea, vomiting, sharp right lower abdominal pain, and loss of appetite. In addition to infection being a reason for appendectomy, a ruptured appendix indicates for immediate surgery. As a result, the patient is becomes at risk for sepsis or death. Cesarean section A cesarean section is often indicated in situations that prevent an individual from a having a vaginal birth. “C-section is perceived as an escape from labor pain, and the false assumption that C-section is Course: NURS 101L NURSING CARE PLAN NURS 101L subsequently causes arterial under—filling…which results in the reabsorption of water and salt into the blood.” (Abebe, 2018) In, the case of M.M., previous history of congestive heart failure, hypertension, and diabetes warrant for determining serum sodium levels in the body. M.M.’s serum sodium levels indicate normal levels of serum sodium. Serum Potassium (K+) “Potassium is the most abundant intracellular cation that serves important functions such as regulate acid-base equilibrium, control cellular water balance, and transmit electrical impulses in skeletal and cardiac muscles.” (Martin, 2020) An increase in serum potassium (hyperkalemia) can lead to acidosis; on the other hand, a decrease in serum potassium levels (hypokalemia) leads to the development of abnormal heart rhythms and contributes to the development of muscle weakness and/or twitching. In the case of M.M, her poor endurance and lethargy can be contributed to the low serum potassium levels. Serum Calcium (Ca+) “Calcium (Ca+) is a cation absorbed into the bloodstream from dietary sources and functions in bone formation, nerve impulse transmission, and contraction of myocardial and skeletal muscles. Calcium aids in blood clotting by converting prothrombin to thrombin.” (Martin, 2020) An impacted cardiac output, resulting from congestive heart failure, causes the heart to increase in contractions as to make up for the decreased function of the left ventricle due to hypertrophy. In turn, an increase of calcium facilitates the increase of contraction in the heart. In the case of M.M’s, her history of congestive heart failure and sedentary lifestyle (limited use of skeletal muscles) can correlated with the increase level of serum calcium in M.M.’s blood. The practice of a sedentary lifestyle limits range of motion, decreasing skeletal muscle use and an increase of serum calcium. Serum Magnesium (Mg) Magnesium has a pivotal role in maintaining adequate blood flow. ORDER NOW FOR CUSTOMIZED AND ORIGINAL NURSING PAPERS Therefore, inhibition of magnesium intake or production, resulting from malnutrition, inactivity, or altered metabolism, can produce abnormal Page 5 of 16 painless, safer, and healthier than vaginal delivery has become prevalent among women.” (Zakerihamidi et al., 2015) However, as it was mentioned earlier, “C-section is only recommended when the life of the mother or fetus is at risk.” (Zakerihamidi, 2015) As a result of the surgery, the mother/patient becomes at risk for dislodged blood clots, hemorrhages, internal bleeding, and infection. This imposes significant risk for the development of cardiac or neurological complications, such as stroke or myocardial infarction. In the case of M.M.’s, has had two csections, indicating both daughters were c-section births. Course: NURS 101L NURSING CARE PLAN NURS 101L serum magnesium levels. In turn, a high magnesium “intake is associated with lower risk of major CV risk factors (mainly metabolic syndrome, diabetes and hypertension), stroke and total CVD” (Rosique-Esteban et al., 2018) In the case of M.M., her history of congestive heart failure, diet consisting of fatty fried foods, and sedentary lifestyle can be correlated with a low level of serum magnesium in the blood. The low levels of magnesium can contribute to worsening or exacerbated heart complication. Serum Creatinine (Cr) “Creatinine is a specific indicator of renal function. Increased levels of creatinine indicate a slowing of the glomerular filtration rate…” causing conditions such as “congestive heart failure, dehydration, diabetic nephropathy…” (Martin, 2020) The slowing of glomerular filtration rate, in association with congestive heart failure, is crucial to determine the increase or decrease of minerals, such as sodium or calcium. In the case of M.M., her high levels of creatinine can be correlated with a decrease function in glomerular filtration rate as indicated by abnormal levels of potassium, magnesium, and calcium, and history of congestive heart failure. Blood Urea Nitrogen (BUN) “Urea nitrogen is the nitrogen portion of urea, a substance formed in the liver through an enzymatic protein breakdown process. Urea is normally freely filtered through the renal glomeruli, with a small amount reabsorbed in the tubules and the remainder excreted in the urine. Elevated levels indicate a slowing of the glomerular filtration rate.” (Martin, 2020) Renal perfusion is often impacted by congestive heart failure, meaning the inability to perfuse kidney results in the decrease production of urea, causing BUN levels to increase. In the case of M.M., her history of congestive heart failure and non-compliance with medication can be correlated to the increase of BUN levels in M.M.’s blood. Furthermore, M.M.’s dyspnea further adds to the obstructed perfusion of the kidneys, adding to the elevation of BUN levels. Troponin Page 6 of 16 Course: NURS 101L NURSING CARE PLAN NURS 101L “Troponin is a regulatory protein found in striated muscle (myocardial and skeletal). Increased amounts of troponin are released into the bloodstream when an infarction causes damage to the myocardium.” (Martin, 2020) As a result normal or low levels of troponin do not indicate a myocardial infarction since troponin is usually not detectable in the blood until the individual has experienced a full myocardial infarction or angina. In the case of M.M., her low level of troponin in the blood can be correlated with normal troponin levels indicating that she has not suffered a myocardial in … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10