Assessment Diagnosis Goals Intervention Evaluation

Subjective Cues: End stage renal Short term goal: Preventive: Relieved from
I have shortness of disease To provide adequate Monitor monthly difficulty of
breath and I easily oxygenation within hemoglobin and breathing.
get tired with Nursing Diagnosis: the shift. hematocrit levels. Blood pressure
minimal effort. was returned
Impaired gas Long term goal: Reinforce epoetin injection to normal
Objective Cues: exchange r/t Verbalize as ordered range.
-Bp = 140/100 decreased oxygen understanding of the increased
mmHg -RR=21bpm
 carrying capacity of signs and symptoms Reinforce compliance to hemoglobin
-SOB
 the blood. and the proper medications and diet and hematocrit
- fatigue
 management for it level. and
-weakness
 stable abg
-pallor
 Curative: result. shows
-anemia
 Dependent nursing behavior of
-confusion
 intervention Administered understanding
Renogen 2,000 units 3x/ and
week I-t has the same compliance to
biologic effects as diet and water
-Hematology: endogenous erythropoietin intake.
that stimulate RBC
-Hct = ↓ 15 vol.(fr) - production and thus
Hgb = ↓50 gms/L - elevate or maintain The
RBC = ↓1.75 X RBC level.
10^12/L
-Provided O2 @ 2 Lpm via
ABG: nasal cannula. To provide
oxygen needed by the
-pCO2 = ↓21.1 body for functioning.
mmHg
Independent nursing
-pO2 = ↑154.1 intervention:
mmHg
Monitored VS.

Positioned with HOB

elevated to promote better
lung expansion & improve
gas exchange

Rehabilitative:
Recommended quiet
atmosphere and bed rest if
indicated.

This enhances rest to

lower body’s oxygen
requirements and reduces
strain on the heart and
lungs
Assessment Diagnosis Goals Intervention Evaluation

Subjective Cues: End Stage Renal Short Term: Preventive: Patient

Hindi ako makakain Disease
Patient will Avoid high in sodium-rich demonstrated
ng maayos.
demonstrate food. behavior,
Nursing diagnosis: behaviors, lifestyle To prevent further increase lifedtyle
Altered Nutrition: change to regain and in sodium level. chenge to
Objective Cues: Less than body maintain an regain nd
-Anemia
Requirement R/T appropriate weight Provide oral care. maintain an
hgb: 8mg/dl
Catabolic state, To prevent further spread of apppropriate
hct: 16mg/dl
Anorexia and Long Term: dental caries. weight.
Malnutrition 2O to Patient will display Patient
-Anorexia
Renal Failure normalization of Curative: displayed
laboratory values Assess general normalization
-Weak appearance and be free of signs appearance and monitor of laboratory
of malnutrition. vital signs. values and be
To establish baseline data. free of signs of
malnutrition
Identify patient at risk for
malnutrition.
To assess contributing
factors.

Ascertain understanding of
individual nutritional
needs.To determine what
information to provide the
patient.

Provide diet modification as

indicated.
To establish a nutritional
plans.

Assess weight, age, body

build, strength, rest level.
To provide comparative
baseline.

Rehabilitation:
Promote relaxing
environment.
To enhance intake.

Maintain bed rest.

To decrease metabolic
demand
Assessment Diagnosis Goals Intervention Evaluation

Subjective Cues: I End stage renal Short term goal: Preventive: Patient
have shortness of disease To stabilize fluid Instructed to limit fluid & Na manifested
breath and I feel volume within the intake. To monitor kidney stabilize
bloated and weak. Nursing Diagnosis: shift. function and fluid
fluid volume
Fluid volume excess retention .Record I&O
r/t the excessive accurately and calculate fluid AEB
Long term goal:
Objective Cues: accumulation of fluid volume balanceTo monitor balance
To verbalize
Objective: Bp = in the interstitial understanding of the kidney function and fluid I&O, normal
140/100 mmHg space 2° to ↑ signs and symptoms retention. VS, stable
hydrostatic pressure. and the proper weight, and
-Distended jugular management for it Curative: free from
vein
 signs of
dependent nursing edema
intervention:
RR=21bpm 
 Patient
-DOB -Administered Furosemide 20 demonstrate
mg IVTT q8h- inhibits d behaviors

 reabsorption of Na & Cl from to monitor
-Abdominal girth = the proximal and distal fluid status
94 cm 
 tubules & ascending limb of and reduce
the loop of Henle, leading to
recurrence
a Na-rich dieresis.
of fluid
-anasarca 

excess
Administered Aldazide 25 mg
1 tab BID toPromotes water
-anorexia 
 and Na excretion and hinders
potassium excretion by
antagonizing aldosterone in
-Distended urinary 
 distal tubule.
bladder 

bruits in 4 
 Provided O2 @ 2 Lpm via
abdominal quadrants 
 nasal cannula.
upon auscultation. 

Position patient to high-
fowlers to prevent DOB and
-weight gain over 
 help lung’s expansion.
a short period of
time. Weight before Rehabilitative:
admission = 68 kg, -Review lab data like BUN,
current weight = 72 Creatinine, Serum electrolyte.
kg. 
 To monitor fluid and
electrolyte imbalances
-Reduced constriction of
-Fluid intake vessels by avoiding crossing
exceeds output. of legs or ankles This
Intake = 230 cc, prevents venous pooling.
output = 120 cc. 

-fatigue Encourage quiet , peaceful
atmosphere To conserve
-weakness 
 energy & lower tissue oxygen
demand.

Implemented comfort
measures& safety
precautions to prevent skin
breakdown.
Part I. Introduction
Introduction:

Chronic renal failure, or end-stage renal disease (ESRD), is a progressive, irreversible

deterioration in renal function in which the body’s ability to maintain metabolic and fluid
and electrolyte balance fails, resulting in uremia or azotemia (retention of urea and other
nitrogenous wastes in the blood) . ESRD may be caused by systemic diseases, such as
diabetes mellitus (leading cause); hypertension; chronic glomerulonephritis;
pyelonephritis (inflammation of the renal pelvis); obstruction of the urinary tract;
hereditary lesions, as in polycystic kidney dis- ease; vascular disorders; infections;
medications; or toxic agents. Co-morbid conditions that develop during chronic renal
insufficiency contribute to the high morbidity and mortality among patients with ESRD .
Environmental and occupational agents that have been implicated in chronic renal
failure include lead, cadmium, mercury, and chromium. Dialysis or kidney
transplantation eventually becomes necessary for patient survival. Dialysis is an
effective means of correcting metabolic toxicities at any age.

B. Statistics
International:
93,327 people commenced treatment for end-stage renal disease annually in the US
2001 (United States Renal Data System, 2003, NIDDK) 

31% of cases of ESRD each year occurs in African Americans in America (Renal Data
Report, ANS, 1999) 2% of cases of ESRD each year occurs in native Americans
(Renal Data Report, ANS, 1999) 31% of cases of ESRD each year occurs in
Caucasians in America (Renal Data Report, ANS, 

1999)


Local: 

Kidney disease is on the rise and is an important cause of death in the Philippines.
Statistics show that kidney disease among the Filipinos is shooting up every year.
Almost 10,000 Filipinos requiring either dialysis for life or a kidney transplant for
survival. About 31% of them have the most advanced stage of the disease. 

The main cause of kidney disease seems to be the increasing diabetic conditions
among the Filipinos. It is seen that about 55% of Filipinos develop kidney disease when
they suffer from diabetes. The Philippine Society of Nephrology (PSN) issued the
statement that diabetes is the single most common cause of kidney failure among
diabetes mellitus Nephropathy patients.
Risk factors for ESRD:
Predisposing factors: Age, Risk of ESRD increases with age. Men are more likely
than women to develop ESRD. According to study African-Americans have higher rates
of ESRD than people of other races. Diabetes is also said to be the biggest risk factor
for developing ESRD. One-third of the people who develop ESRD have diabetes. On
the other hand, High blood pressure is the second most common cause of ESRD.
Education also plays a role in increasing the risk of People to develop ESRD. People
with a lower educational background have a higher risk of developing ESRD. Genetics
—Genetic factors have been identified, which either increase the risk of developing
chronic renal failure or quicken the progression of this disease.

Precipitating factors: Including in the list are; Overweight individuals, History of protein
in the urine, Low hemoglobin, Individuals who frequently have to get up at night to
urinate, .Hyperuricemia , Smoking has been linked to the progression of renal
disease among diabetic and hypertensive patients.Various lipid disorders are
associated with the development of and progression to chronic renal failure.
Recreational drugs such as Opioids and cocaine have been linked to an increased risk
for end-stage renal disease. Glomerulonephritis This disease damages the glomeruli,
which are the filtering units in the kidney. It is the third leading cause of ESRD. Drug use
—Overuse of over-the-counter pain medication or abuse of illegal drugs increases your
risk of ESRD.

Signs and Symptoms:

Persistent itching. Chest pain, if fluid builds up around the lining of the heart. Shortness
of breath, if fluid builds up in the lungs. High blood pressure (hypertension) that's difficult
to control

Prevention:
If you have kidney disease, you may be able to slow its progress by making healthy
lifestyle choices, Lose weight if you need to, Be active most days, Eat a balanced diet of
nutritious, low-sodium foods . Control your blood pressure.Take your medications as
prescribed. Have your cholesterol levels checked every year Control your blood sugar
level. Don’t smoke or use tobacco products and get regular checkups.

Medical, Surgical, pharmacological management :

For the Medical Management, The goal of management is to maintain kidney function
and homeostasis for as long as possible. Under pharmacological therapy, we have
Calcium and phosphorus binders treat hyperphosphatemia and hypocalcemia;
Antihypertensive and cardiovascular agents (digoxin and dobutamine) manage
hypertension; Anti-seizure agents (IV diazepam or phenytoin) are used for seizures,
and; Erythropoietin (Epogen) is used to treat anemia associated ESRD. Nutritional
therapy. Dietary intervention includes careful regulation of protein intake, fluid intake to
balance fluid losses, sodium intake to balance sodium losses, and some restriction of
potassium and Dialysis. Dialysis is usually initiated if the patient cannot maintain a
reasonable lifestyle with conservative treatment.Kidney transplant
Kidney transplant surgery involves removing your affected kidneys (if removal is
needed) and placing a functioning donated organ. One healthy kidney is all you need,
so donors are often living. They can donate one kidney and continue to function
normally with the other. According to the National Kidney Foundation, more than 17,000
kidney transplants were performed in the United States in 201

Nursing management :

The patient with ESRD requires astute nursing care to avoid the complications of
reduced renal function and the stresses and anxieties of dealing with a life-threatening
illness.

Assessment of a patient with ESRD includes the following .Assessing fluid status (daily
weight, intake and output, skin turgor, distention of neck veins, vital signs, and
respiratory effort). Assessing nutritional dietary patterns (diet history, food preference,
and calorie counts). Assessing nutritional status (weight changes, laboratory
values).Assess understanding of cause of renal failure, its consequences and its
treatment.Assess patient’s and family’s responses and reactions to illness and
treatment. And also assessing for signs of hyperkalemia.

Complications :
Potential complications of chronic renal failure that concern the nurse and that
necessitate a collaborative approach to care include the following:

Hyperkalemia due to decreased excretion, metabolic acidosis, catabolism, and
excessive intake (diet, medications, fluids) , Pericarditis, pericardial effusion, and
pericardial tamponade due to retention of uremic waste products and inadequate
dialysis and Hypertension due to sodium and water retention and malfunction of the
renin–angiotensin–aldosterone system . there is also Anemia due to decreased
erythropoietin production, decreased red blood cell life span, bleeding in the
gastrointestinal tract from irritating toxins and ulcer formation, and blood loss during
hemodialysis. in addition, bone disease and metastatic and vascular calcifications due
to retention of phosphorus, low serum calcium levels, abnormal vitamin D metabolism,
and elevated aluminum levels

Reference:
-https://nurseslabs.com/chronic-renal-failure/
-Source: Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, 11th ed., SC
Smeltzer et al. (eds.), Lippincott Williams & Wilkins, 2006

Take5 © 2007 Lippincott Williams & Wilkins. Available online at http://
www.nursing2007.com (click the “Educators” button).
-Chronic kidney disease (CKD) in adults. EBSCO DynaMed Plus website. Available at:
http://www.dynamed.com/topics/dmp~AN~T115336/Chronic-kidney-disease-CKD-in-
adults. Updated August 23, 2016. Accessed October 4, 2016.
 MAKATI MEDICAL CENTER

Nursing Education Research and Development

Nurse Residency Probationary Program- Batch 54 Assignment

End Stage Renal Disease (ESRD)

A CASE STUDY

Prepared by Sharmaine Camille M. De Leon

July 22 2019