CASE STUDY ON

ACUTE RENAL FAILURE

BY

SUNDAY ESTHER

POST BASIC STUDENT NURSE

SET 43

FCT SCHOOL OF NURSING

GWAGWALADA, ABUJA

TO MEET THE REQUIREMENT FOR THE AWARD OF CERTIFICATE

IN GENERAL NURSING

NOVEMBER, 2021

1
 APPROVAL PAGE

This case study has been read and approved by

………………………….. ………………………
Mr. David Ogbu
RN,BNSc,PGDE,PGDM,RNE M.E.D,MSc
SUPERVISOR DATE

………………………….. ………………………
Mr. Peters Ajie
CLASS COUNCELLOR DATE

………………………….. ………………………
Mr. Lakareks J.
RN,RNT,RPHN,B.Sc(N),B.Sc(PHN),PGD(Mgt)

PRINCIPAL DATE

2
 DEDICATION

This case study dedicated to God Almighty and my entire family who believed my

dreams and hold hands through the path of life.

3
 ACKNOWLEDGEMENTS

My profound gratitude goes to God Almighty the maker of the heaven and the
earth, the giver of life for guidance and my source of divine provision all through
the period of training.

I am grateful to a number of people who have been instrumental in getting this

work into completion.

My sincere gratitude goes to my project supervisor Mr. david ogbu for taking time
to read through my work and making necessary correction so as to make this work
presentable, may God Almighty bless you abundantly Sir. I also appreciate the
research committee Chairman and the entire members.

Special appreciation to my principal Mr. Lakareks James, vice principal

administration academics and the entire FCT SON tutors for their contribution to
the success of my study, God bless you all.

To my loving parents Mr. and Mrs. Sunday Bassey Udosen I have no words to
acknowledge the sacrifices you made and dream you have to let go just to give me
a shot at achieving mine, thank you a million times.

To my dearest siblings Nsikak, Ukeme and Edidiong thank you all for your prayers
and not giving up on me, I love you all forever.
Special appreciation to Mr. Odey Godwin for the support and encouragement
And my special friends Faiza, and Sadiat, thank you for standing by me right from
the beginning up till this point, I am so grateful.

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Finally, my appreciation goes to all my friends I can’t mention, all members of set
43, you guys are the best, there would not have been a better set for me than this.
Thank you all and God bless.
TABLE OF CONTENTS

Approval page - - - - - - - - - - i

Dedication - - - - - - - - - - - ii

Acknowledgements - - - - - - - - iii
Table of Contents -- - - - - - - - - iv

CHAPTER ONE

INTRODUCTION

1.1 Brief history of Patient and Illness - - - - - - - 1

1.2 Objectives of Case Study- - - - - - - - 2

1.3 Definition of Terms- - - - - - - - - 2

CHAPTER TWO

LITERATURE REVIEW

2.1 Related Physiology of the Kidney- - - - - - - 3

2.2 Disease Theory- - - - - - - - - 7

2.2.1 Definition

2.2.2 Causes

2.2.3 Path physiology of the Disease

2.2.4 Clinical manifestation

2.3 Management of disease condition - - - - - - - 8

2.3.1 Medical management

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2.3.2 Surgical management

2.3.3 Nursing management

2.4 Pharmacology of drugs used

2.5 Complications

CHAPTER THREE: NURSING PROCESS FOR PATIENT WITH ACUTE KIDNEY

DISEASE

3.1 Introduction - - - - - - - - - - 16

3.2 Patients Personal Data - - - - - - - - 16

3.3 History of Past Illness and present illness- - - - - - 17

3.4 Investigations and Observations -- - - - - - 17

3.5 Nursing process -- - - - - - - - - 18

3.6 Nursing care plan - - - - - - - 19

3.7 Summative Evaluation - - - - 19

CHAPTER FOUR

4.1 Summary - - - - - - - - - 24

4.2 Conclusion - - - - - - - - - - 24

4.3 Recommendation - - - - - - - - - 25

4.4 Advice on Discharge- - - - - - - - - 25

4.5 Bibliography- - - - - - - - - - 26

4.6 Appendices

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4.7 Vital signs chart

CHAPTER ONE

1.0 INTRODUCTION

Acute Renal Failure is a condition in which the kidneys suddenly can’t filter waste from the

blood

Acute Renal Failure develops rapidly over a few hours or days , it may be fatal, its most

common in those who are critically ill and already hospitalized , more than 100 thousand

cases per year in Nigeria (Biruh,2020)

1.1 BRIEF HISTORY OF PATIENT AND ILLNESS

Mr. P. E. is a 27 years old Igbo man; he is a business man who hails from Enugu. Who

resides at Kwali Abuja.

Patient was in his usual state of health until two weeks ago when he stated noticing body

swelling which started from the face. Body swelling started gradually initially involving

the face but represses as the day goes by.

This progressiveness involved the both legs. Abdomen and the back.

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History of reduction of urinary output could not be acertain. No history of haematuria.

There is history of frothiness of urine, coke colored urine, and also low quantity of urine

output.

No history of suprapubic or groin pain. No history of suggestive bladder outlet

obstruction, no history of sore throat or skin rash, irrational talk, seizure, vaunting,

epigastria pain, yellowness of the eyes. No history of use of NSAIDs, he does not take

alcohol. Other aspect of history and physical findings are noted.

Since the onset of symptoms, patient has been to a primary clinic where he had HBsAg

screening done and was positive. With worsening symptoms, he presented in University

of Abuja Teaching Hospital via accident and emergency ,seen by a consulting doctor and

laboratory investigations was carried out such as ultrasounds, PCV, EUCR, urinalysis,

was diagnose of acute Kidney disease with background of HBV infection on 21 st of

February 2021

He was then transferred to male medical ward for further management

He was placed on the following drugs while on admission

Ciprofloxacin 200mg 12hrly for 2days

Ciprofloxacin 500mg 12hrly for 7days

Frusemide injection start 80mg

Frusemide 40mg 12hrly for 5days

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 He is being managed with nephrology unit for Acute Glomerulus nephriies

OBJECTIVES OF CASE STUDY

(1) To acquire more knowledge and skills in the management of a patient kidney disease

(2) To enable me identify the signs and symptoms of Acute kidney disease.

(3) To formulate a nursing care plan to meet the need of patient having Acute Kidney

Disease.

(4) To fulfill nursing and midwifery council of Nigeria partial requirement for the award

of certificate in general nursing.

1.2 DEFINITION OF TERMS

 Acute: Rapid (sudden onset of a condition (illness)

 Kidneys: Are bean-shaped organs, about 11cm long, 6cm wide, 3xm thick and

weigh 50g they are embedded in, and held in position by a mass of at.

 Kidney failure also known as renal failure: it’s the inability of the kidney to

properly produce urine and filter wastes from the blood

 Disease: It is a disorder or function in a human, animals, or plant, which produces

specific symptoms or affect a specific location.

 Glomerulus: A duster of venous endings, spores, or small blood vessel especially

a cluster of capillaries around the end of the kidney tubule.

 Nephritis: It is the inflammation of the kidney

 Anuria: Cessation of the secretion of urine

 Oliguria: Deficient secretion of urine

 Edema: An excessive amount of fluid in the body tissue

 Necrosis: Death of a portion of tissue.

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 CHAPTER TWO

2.0 LITERATURE REVIEW

2.1 RELATED PHYSIOLOGY OF THE KIDNEY

KIDNEY

Kidneys are bean-shaped organs, about 11cm long, 6cm wide, 3cm thick and weigh 150g.

they are embedded in and held in position by a mass of fat. A sheath of fibrous connective

tissue, also known as the renal fascia, encloses the kidney and the renal fat.

The kidneys lie on the posterior abdominal wall, one on each side of the vertebral column

behind the peritoneum and below the diaphragm. They extend from the level of the 12 th

thoracic vertebra to the 3rd lumber rib cage. The right kidney is usually slightly lower than

the left, probably because of the considerable space occupied by the liver.

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As the kidneys lie on either side of the vertebral column each is associated with different

group of structure.

RIGHT KIDNEY

Superiorly – the right adrenal gland

Anteriority – the right lobe of the liver, the duodenum and the hepatic flexure of the

column.

Posteriorly – the diaphragm, and muscles of the posterior abdominal wall.

LEFT KIDNEY

Superiorly – the left adrenal gland

Anteriorly – the spleen, stomach, pancreas, jejunum and splenic flexure of the colon.

Posteriorly – the diaphragm and muscles of the posterior abdominal wall.

GROSS STRUCTURE OF THE KIDNEY

There are three areas of tissue that can be distinguished when a longitudinal section of the

kidney is viewed with the naked eye.

 An outer fibrous capsule, surrounding the kidney

 The cortex, a reddish-brown layer of tissue immediately below the capsule and

outside the pyramids.

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 The medulla, the innermost layer, consistency of pale conical shaped striations, the

renal pyramids.

The helium is the concave medial border of the kidney where the renal blood and lymph

vessels, the ureter and nerves enter.

The renal pelvis in the funnel-shaped structure that collets urine formed by the kidney

urine formed in the kidney passes through a renal papilla at the apex of a pyramid into a

minor calyx, then into a major calyx before passing through the nal pelvis into the water

the walls of the pelvis contain smooth muscle and are lined with transitional epithelium.

Peristalsis of the smooth muscles originating in peacemaker cells in the walls of the

calyces propels urine through the renal pelvis and ureters to the bladder this is an intrinsic

properly of the smooth muscles, and is not under nerves control.

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MICROSCOPIC STRUCTURE OF THE KIDNEY

The kidney is composed of about 1.2 million functional units, the nephrons, and a

smaller number of collecting ducts transports urine through the pyramids to the calyces

and renal pelvis, giving the pyramids their striped appearance. The collecting ducts are

supported by a small amount of connective tissue, containing blood vessels, nerve sand

lymph vessels.

THE NEPHRON

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The nephron consists of a tubule closed at one red, the other end opening into a collecting

tubule the closed or blind end is indented to form the cup-shaped glomerular capsule,

remainder of the nephron is about 3cm long and is described in three parts.

 The proximal convoluted tubule

 The modularly loop (loop of Henle)

 The distal convoluted tubule, leading into a collecting duct.

FUNCTIONS OF THE KIDNEY

 Formation of Urine

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The kidneys form urine, which passes through the ureters to the bladder for storage prior

to excretion. The composition of urine reflects exchange of substances between the

nephron and the blood in the renal capillaries. Waste products of protein metabolism are

excreted, electrolytic levels are controlled and PH (acid-base balance) is maintained by

excretion of hydrogen ion. There are three processes involved in the formation of urine.

 Filtration

 Selective re absorption

 Secretion

 Water balance and urine output: The source of most body water is dietary food and

fluid and a small amount (called metabolic water) is formed by metabolic process.

Water is excreted as the main constituent of urine, in expired air, faeces and through

the skin as sweat.

ELECTROLYTE BALANCE

Changes in the concentration of electrolytes I the body fluid may be due to

changes in:

 The body water content or

 Electrolytic levels

There are several mechanisms that maintain the balance between water and electrolyte

concentration.

 Between water and electrolytic concentration

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  Sodium an potassium balance

 Renin-angiotensin-aldosterone system

 Calcium balance

 PH Balance

In order to maintain the normal blood PH (acid base balance) the cells of the proximal

convoluted tubules secrete hydrogen ions. In the filtrate they combine with buffers.

 Bicarbonate, forming carbonic acid

(H+ + HCO3 →H2CO3)

 Ammonia, forming ammonium ions

(H+ + NH3 → NH 4 ¿) +¿

 Hydrogen phosphate, forming dehydrogenate phosphate

¿

( H +¿+→ H 2 PO3 ¿
)

2.2 DISEASE THEORY

2.2.1 DEFINITION

Acute renal failure occurs as a result of decreased in renal function that is often reversible

It is also a syndrome or physiological reaction which occurs when the kidney doesn’t

function effectively. It may be due to either failure of the renal circulation or by

glomerular or by tubular damage.

2.2.2 CAUSES

Pre Renal: results from impaired or reduced blood flow to the kidneys

It includes

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  Shock

 Hypotension

 Dehydration

 Burns

 Infection

 Major surgery

 Vomiting ,diarrhea

 Blood loss

 Heart and liver failure

Intra renal: results from acute damage to renal structures, it includes

 Glomerular nephritis

 Pyelonephritis

 Acute intestinal nephritis

Post renal: problems affecting movement of urine out of the kidneys, it includes

 Kidney stones

 Cancer of the urinary tract

 Medications

 Bladder stones

 Benign prostrate hyperplasia

2.2.3 PATH PHYSIOLOGY OF THE DISEASE

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 Acute kidney failure results from any condition that causes reduction in the renal blood

flow e.g. shock, adverse effect of burns. This lead to a reduction in glomerular filtration,

kidney ischemia and tubular damage. The substance normally eliminated is now

accumulated in the body fluid as a result or due to impaired renal excretion. This then

leads to a disturbance or interruption in haemostatic, endocrine and metabolic function of

the body.

2.2.4 CLINICAL MANIFESTATION OF ACUTE KIDNEY DISEASE

- Patients with acute kidney disease fall into two distinct categories those who are

oliguric, passing less than 500ml of urine per day an those who are nerve oliguric

but who continue to pass 1000-1500ml of dilute urine per day

- Severe weakness

- Nausea, vomiting and diarrhea

- Dehydration which may lead to dry skin

- Central nervous manifestation which include the following headache, drowsiness,

twitching convulsion oliguria.

- Lethargy

- Polyuria during management

2.3 MANAGEMENT

2.3.1 MEDICAL MANAGEMENT

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  Acute kidney disease is usually reversible with medical treatment but can fatal

without prompt management pharmacology/drug therapy include:

 Alkalinizing agents e.g. insulin glucose and sodium bicarbonate to elevate the

blood/plasma Ph, thereby causing potassium to move into the cells and lower

serum potassium levels.

 Antibiotics e.g. Ciprofloxacin, and nitrofurantoin to prevent bacterial growth in

the kidneys and bldder.

 Other group of drug used in the management of acute kidney disease are calcium

supplement, histamine receptor blockers and phosphate bonding agents.

 Dialysis is indicated in serious conditions to prevent brain cells damage

(Hemodialysis and peritoneal dialysis).

2.3.2 SURGICAL MANAGEMENT

The only surgical management for acute kidney disease is kidney transplant or renal

replacement. Patient had non

2.3.3 NURSING MANAGEMENT

 Admission: On admission the nurse should promote comfort and encourage bed

rest and ensure noise free environment

 Observation: Monitor vital signs and symptoms of uremia

 Diet/Fluid: Provide/encourage high calories and low-protein diet provide or

encourage low sodium and potassium diet. Restrict fluid during oliguric phase and

encourage fluid intake during polyuric phase.

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  Drugs: Administer drugs as prescribed, especially drugs to control electrolyte

levels.

 Physical Care: Assist in activities of daily living and carryout scheduled and

structured passive and active exercises.

 Promote measures to excess and prevent inflection such as; checking for infection

especially of the respiratory and urinary tracts, ensuring care of catheter when in

place.

 Psychological Care: Encourage salient verbalization of feelings and reassure

accordingly in order to prevent anxiety

 Education/Advice on Discharge: Educate and advice patients on the need to

follow dietary regimen. Observation of uremic symptoms such as malaise, loss of

appetite muscle weakness and tingling sensation and encourage patients to adhere

to prescribed drugs and keep medical appointments.

2.4 PHARMACOLOGY OF THE DRUGS USED

CIPROFLOXACIN

- CLASS/GROUP: FLUOROGUINOLONE

- Mode of Action: It is active against some gram-positive and gram-bacteria. It

functions by incubating DNA gyrase, and a type 11 topoisomerase, topoismerase

iv, necessary to separate bacterial DNA, thereby incubating cell decision

- INDICATION

 Acute sinusitis

 Complicated intra abdominal

 UTI

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 Chronic bacterial prostitutes

 Acute uncomplicated cystitis in females

- CONTRA-INDICATION

 Diabetes

 Low heartbeat

 Rupture of a tendon

 Seizures

 Lung transplant

 Heart transplant

 Aneurysm of aorta

SIDE EFFECTS

 Nausea and vomiting

 Blurred vision

 Headache

 Drowsiness

 Dizziness

DOSAGE

250-500mg every 12hrs for 7-11/days

Intravenously (iv)

Orally

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NURSING ACTION

 Give IV after diluting with sterile water for injection as ordered

 Make sure it is not given to diabetic patient

 It should not be given to patient who has had heart transplant.

FUROSEMIDE

Class/Group: Loop or potent diuretics

Mode of Action: It acts on loop of Henle and even the distal convoluted tubule,

preventing reabsorption into the blood stream of sodium, chloride, water and potassium,

thereby increasing the urinary output, and reducing the oedema.

Indication: Toxamia of pregnancy, pre-eclampsia, pulmonary oedema, nephritic

syndrome, hypertension

Dosage: 20-80mg daily in the morning or 20-40mg for CCF, initially 40mg twice daily

orally increasing dosage based patients response.

Route of Administration: Orally, intramuscularly, intravenously.

Side Effects: Deafness, hypokalaemia, hypovolaemia, severe dehydration, metabolic

alkalosis, weakness, dizziness nausea, pre-renal azotemia.

Contraindication: Burns, shock, cholera, Gastroenteritis, precomatose states associated

with liver cirrhosis.

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NURSING RESPONSIBILITIES

- Monitor the input and output chart of the patient

- Advice on low or restrict salt (sodium) intake in the diet to enable this drug

(furosemide)

MANNITOL (OSMOTIC)

Group: Osmotic diuretic

Mode of Action: It probably exerts on direct action on the renal blood vessels restoring

the blood flow with a consequent improvement in the urine formation and urinary

excretion (diuresis) especially in Barbiturate and tranquilizer poisons or other poisons.

Indications: Reduced renal flow, emergency reduction in volume and pressure of

cerebrospinal fluid in head injures to shrink the brain, cerebral oedema

Dosage: 100g as a 10% or 20% solution for indication above except ocular hypertension,

and 1.5-2g per kg using a 15-25% solution for ocular hypertension

Route of Administration: Intravenously and slowly side effects: Dry mouth, thirst,

headache, nausea, vomiting, increased frequency of urination, rash, burred vision,

hypotension, electrolytic imbalance.

Contraindications: Auria, severe heart failure, severe dehydration, intracranial bleeding.

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NURSING RESPONSIBILITIES

- Observe the patient for fluid and electrolytic balance, urinary output and vital

signs, since Manito produces more diuresis than another osmotic diuretic called

urea.

- The intravenous infusion should run slowly and correct dose is to be given to

prevent circulating overheating

CILAZAPRIL

Group: Angiotensin-Converting enzyme incubator

Mode of Action: It incubates the conversion of angiotensin I to a vasoconstrictor called

Angiotensin II in the kidney by inhibiting Angiotensin-Converting enzyme called

Rennin, thereby reducing the vasoconstriction and peripheral resistance and consequently

causing vasodilatation and lowering of the blood pressure.

Indication: Essential hypertension, congestive heart failure.

Dosage for Hypertension: Initially 1mg once daily use to 500 micrograms daily if used

in addition to diuretic.

Route of Administration: Orally in tablet form Side Effects, Dyspnoea, bronchitis,

hypotension

Contraindication: Hypersensitivity, renovascular disease peripheral vascular disease.

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2.5 COMPLICATION OF ACUTE RENAL FAILURE

- Encephalopathy

- Coma

- Azotemia

- Anemia metabolic acidosis

- High calcium and fluid building

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 CHAPTER THREE

3 NURSING PROCESS FOR PATIENT WITH ACUTE KIDNEY DISEASE

3.1 INTRODUCTION

Nursing process is a five part systematic decision making method focusing on identifying

and treating responses of individuals or groups of actual or potential alterations to health

NANDA, (1990). Nursing process has 5 inter-related phrases as follows:

ASSESSMENT: It the process of collecting relevant data aimed at arriving at the health

status of the client who is to receive nursing care

NURSING DIAGNOSIS: At this phase the nurse identifies clients nursing problems

PLANNING: Here, the nurse prioritize client’s problems determine objective/time lapses

and select nursing actions to resolve client health problems identified.

IMPLEMENTATION: Actualization of the plan and proper documentation of

intervention.

EVALUATION: Here the nurse verifies whether or not the therapies have successfully

solved client problems.

3.2 PATIENTS PERSONAL DATA

NAME: Mr. P. E.

AGE: 27years

DATE OF BIRTH: 5ST January, 1994

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 SEX: Male

MARITAL STATUS: Single

NATIONALITY: Nigerian

HOME ADDRESS: opposite federal government college kwali , abuja

TRIBE: Igbo

RELIGION: Christian

OCCUPATION: Business man

NEXT OF KIN: Faith Philips

DIAGNOSIS: Acute Kidney Disease

SURGICAL PROCEDURE: Non

HOSPITAL NO: 866455

WARD: Male medical word

BED NO: 20

DATE OF ADMISSION: 20/02/2021

DATE OF DISCHARGE: 5/03/2021

3.3 HISTORY OF PAST ILLNESS

Mr. P. E. has not suffered from any disease that made him to be hospitalized in the past.

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HISTORY OF PRESENT ILLNESS

Patient was well until two weeks ago when he started noticing body swelling which

started from the place, but progresses as the day goes by the progressiveness involved the

both legs, abdomen, this led to his coming to Teaching Hospital and was diagnosed of

Acute Kidney failure.

FAMILY HISTORY

He is single, from a monogamous family setting with four siblings

SOCIAL HISTORY

He does not smoke nor drink alcohol

ACTIVITY OF THE PATIENT

He is a business man who spend most of his time buying and selling goods

COMMUNICATION AND SPECIAL SENSES

He communicates well with friends, neighbors and family numbers. Speaks igbo and

English, He hears well, smell well, sees well eat well and drink well.

SEXUALITY/REPRODUCTION

Patient is currently not sexually active, but was before the disease condition.

COPING WITH STRESS

When stressed he tries to sleep and rest in a cool and quiet environment,

VALUES AND BELIEFS

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 He is achristian ,believes in the God and adheres to the catholic doctrines

ELIMINATION PATTERN

He goes to toilet twice daily or sometime once before the sickness, currently patient has

finds it difficult to void and produces little amount of urine due to the illness

PHYSICAL EXAMINATION

He is dark in complexion. He is tall. Because of the illness the whole body was

edematous, was pale febrile to touch and ill looking and anxious.

Vital signs on admission

Temperature 36.8c

Pulse 100b/m

Respiration 24b/m

Blood pressure 160/100mg

3.4 INVESTIGATIONS AND OBSERVATIONS

 Proper history from the patient tiled up with presenting signs and symptoms

 Vital signs on admission temperature 36.80c pulse: 100blm Respiration- 24b/m

Blood pressure- 160/100multg.

 Packed Cell Volume (PCV) – 30%

 Urinalysis

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  Blood analysis : high serum creatinine and potassuim

 Abdominal ultrasound scan

3.5 NURSING DIAGNOSIS, OBJECTIVES AND NURSING ACTION

NURSING DIAGNOSIS

 Excess fluid volume related to sodium and fluid re absorption, impaired renal

drainage evidenced by oligouria (urine output less than 1000mls within 24hrs)s

 Anxiety Related to Disease Process

 Altered Nutrition less than Body Requirement

Planning

They are strategies made to meet the patients need in order of priority , the components of

nursing care plan are : nursing diagnosis, nursing objectives, nursing action, scientific rationale

and evaluation

DIAGNOSIS

Excess fluid volume related to sodium and fluid re absorbtion or retention evidenced by

oligourea( urine output less than 1000ml in 24hours

OBJECTIVES

Patient will have increase urinary elimination within 24hrs of admission and oedema will

disappear before discharge.

NURSING ACTION

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  Diuretics (laxis) was given (administered)

 Salt intake was restricted

 Input and output chart was monitored

 Potassium source e.g. slow k was given

 Anxiety Related to Disease Process

OBJECTIVES

Patient anxiety will be relieve within 24hrs of admission.

NURSING ACTION

 Good nurse – patient relationship was established

 All procedure was explained to the patient

 Patient was encouraged to verbalize his fear

 Altered Nutrition More than Body Requirement

OBJECTIVES

Patient nutritional status will come down to normal before discharge.

NURSING ACTION

 Easily digestible meal was given

 Low salt diet was given

 Enough protein diet was given

 Patient was weighed everyday s

 Altered Sleeping pattern less than body requirement

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 OBJECTIVES

Patient will sleep of – 8hrs within 24-48hrs of nursing care.

NURSING ACTION

 Quiet environment was maintain

 Restrict visitors

 Sedative was administered as prescribed

3.6 NURSING CARE PLAN

S/ NURSING OBJECTIVE NURSING ACTION SCIENTIFIC EVALUATION

RATIONALE
N DIAGNOSIS
1. Excess fluid Patient will have 1) Intake and output To form base Patient urinary
line data and elimination
volume related to increase urinary chart was monitored determine the increased within
input and 24hrs of admission
sodium and fluid elimination within 24hrs 2) administered output flow and edema
disappeared before
re absorption, of admission and oedema Diuretic (laxis) To increase discharge
urinary output
impaired renal will disappear before 3) Salt intake was
To prevent re
drainage discharge. restricted absorption of
fluid

32
 evidenced by 4) Administer To balance
electrolytes
edema potassium source

e.g. slow K
2. Altered nutrition Patient nutritional status 1) Easily digestible To reduce Patient nutritional
nausea status was improved
less than body will improve to normal meal was given To decrease before discharge
intake of salt
requirement before discharge 2) Low salt diet was which increases
re absorbtion of
fluid
related to disease given To aid in the
promotion of
process 3) Appetizing diet was appetite

evidenced by given This is done not

discourage
nausea and lack 4) Avoid giving large patient from
eating
of appetite amount of food at a

(anorexia) time
3. Anxiety related to Patient will show more 1) Good nurse-patient 1)to build up Patient showed
patients more understanding
prognosis of understanding of illness relationship. confidence and and asked less
trust in the nurse questions after
disease and frequent questioning 2) All procedure was To help patient 50minutes of nursing
understand the intervention
process and
evideenceed by will bereduced after explained to the answer silent
questions
patients frequent 50minutes to 1hour of patient So that the nurse
will help clarify
questioning nursing intervention 3) Patient was fears and
feelings
encouraged to

verbalize her fears.

3.7 Summative Evaluation

33
After carrying out all the above mentioned nursing actions and interventions patients

condition was as follows:

 Patient nutritional status was reduced to normal before discharge

 Patient have increase urinary elimination within 24hrs of admission and oedema

disappear before discharge.

 Patients anxiety was allayed and she was able to participate in her own care

within 48hrs of admission.

 Patients normal sleeping pattern was restored and patient was made to sleep for at

least 6-8hrs in every 24hrs throughout his hospitalization

 Patient did not develop and skin alteration while on admission.

 Patient had the knowledge of her disease condition within the period of

hospitalization.

34
 CHAPTER FOUR

4 SUMMARY

Philips Eze, a 26yrs old Igbo man walked into the Accident and emergency unit on 20 th

February , 2021 at about 2pm in the afternoon with the history of body swelling reducing

urinary output, weakness of the body and dizziness.

He was diagnosed of having renal failure secondary to hepatitis B.

The treatment is mostly on nursing management and medical management (use of drugs).

Renal failure has some complication like encephalopathy coma, azotemia, anemia

metabolic acidosis.

In treating renal failure drugs like slow K, and diuretic, hearmatemics so that repair of

renal tissue as well as restoration of renal function can take place.

Investigations, bed bath, fluid intake and output dart are very important including

adequate diet.

4.1 CONCLUSION

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 In conclusion of this case study I have learnt a lot about renal failure, the signs and

symptoms, treatment and prevention.

Mr. Philips Eze Illness (renal failure) was improving greatly before he was discharge due

to the Doctor’s strict action.

As I studied the case from admission to discharge of the patient, my objectives to know

the depth of the disease was met.

It helped me know more about the anatomy and physiology of the investigation carried

on and low to cure the disease.

At last my aim of studying the case was achieved especially in the area of disease and to

educate the public about the disease and commend solution to my patient and the public.

4.2 RECOMMENDATION

I recommend the writing of this case study because of the benefits of the study to the

students and even to the patients.

It helps to build up student’s knowledge on the course he or she is writing or studying.

I support the writing of case study because it make the student writing on the case to

know everything about the disease.

I also recommend writing of case study because it creates good nurse-patient relationship.

4.3 ADVICE ON DISCHARGE

- Before discharge Mr. Adamu was given some drugs to take home, how to take the

drug was explained to him.

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- He was strictly warm to be smoke or use tobacco and to limit alcohol intake.

- He was adviced to keep a low-salt, low-fat diet.

- He was adviced to take much fluid than before.

- How was told to exercise at least 30mintues on most days of the week, to keep a

healthy weight.

BIBLIOGRAPHSY

Ross and Wilson Anatomy and Physiology in health and illness 12th edition.

A synopsis of Medical Surgical Nursing – Revises Edition (Fama Kinwa, T.T).

The Easier Approach to Pharmacology for all Health Professional by R.O Mustapha 4 th

Edition.

Explicit of Medical Surgical Nursing Plus related Anatomy and Physiology first edition.

Bailliere’s Nurses Dictionary, for Nurses and Heath care workers 26th Edition.

https://www.Healthline.com>Article.

https://www.develandclinic.org>

EMDOX mobile drug reference and therapeutic notes

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