BACHELOR OF SCIENCE IN NURSING:

NCMB312 RLE
RLE LCP MODULE RLE LCP UNIT WEEK
3 2 3

Dialysis Care ( Peritonial / Fistula )

✓ Read course and laboratory unit objectives

✓ Read study guide prior to class attendance
✓ Read required learning resources; refer to course unit
terminologies f or jargons
✓ Participate in weekly discussion board (Canvas)
✓ Answer and submit course unit tasks

At the end of this unit, the students are expected to:

1. Apply the nursing process in the care of critically ill clients:
a. Assess the client’s total health condition and his/her resources.
b. Formulate nursing diagnoses based on the priority needs of the client.
c. Develop a plan of care based on priority needs.
d. Implement a plan of care applying the appropriate nursing concepts, principles, and
guidelines in caring for critically ill clients.
e. Evaluate the outcomes(s) of care.
2. Demonstrate competencies of a beginning staff nurse, nurse leader, and researcher in the
care of critically ill clients.
3. Promote personal and professional growth by showing independence in performing varied
tasks and responsibilities.

Skills laboratory equipment and materials

To facilitate the practice of students’ nursing skills, the following rules must be implemented:
1. The use of the Nursing Skills laboratory equipment and materials appropriate of the given
case scenario are allowed.
2. Use resources from the required readings.
3. Students must perform the tasks in the worksheet at a given period.

Concept: Fluid and Electrolytes

Course Outcome Learning Outcome
Apply knowledge of physical, social, natural Integrate relevant principles of social, physical,
and health sciences, and humanities in the natural and health science and humanities in care of
nursing care of at risk and sick adult clients clients with end stage renal failure based on
with problems in oxygenation, fluid and epidemiologic profile.
electrolytes, infectious, inflammatory and Gathers and analyzes data relevant the care of a
immunologic response, cellular aberrations, client with end stage renal failure in order to identify
acute and chronic. the priority needs and plan nursing actions
appropriately.
Provide safe, appropriate and holistic care to Apply appropriate nursing concepts and actions
at risk and sick adult clients with problems in holistically and comprehensively in the care of clients
oxygenation, fluid and electrolytes, with end stage renal failure.
infectious, inflammatory and immunologic Implements applicable age-appropriate health
response, cellular aberrations, acute and education activities to a client with end stage renal
chronic utilizing nursing process failure based on needs assessment.
Maintains a safe environment for the client with
end stage renal failure and performs safety
measures while ensuring privacy in all aspects of
care.
Apply guidelines and principles of evidence- Reports identified inadequacies and problem(s)
based practice in the delivery of care. encountered in the provision of care.
Recommends practical and appropriate solutions in
the care of client with end stage renal failure.
Utilizes findings in research in the provision of severe
end stage renal failure related measures and client
care.
Conforms to the 10Rs of medication administration
and health therapeutics.
Practice nursing in accordance with existing Maintain the privacy and confidentiality of client’s
laws, legal, ethical and moral principles and information.
standards. Accepts responsibility and accountability on the
decisions made relating to the client’s care.
Acts and performs nursing tasks related to a client
with end stage renal failure in accordance with
established norms of conduct expected of a nurse as
well as with the other relevant legislation.
Communicate effectively in speaking, writing Interprets and validates client’s body language and
and presenting using culturally appropriate facial expressions.
language. Utilizes appropriate means and/or channels of
communication to support the delivery of care to
clients with end stage renal failure .
Document to include reporting up-to-date Records outcome of client care related to end stage
client care accurately and comprehensively. renal failure.
Submits legible, accurate and updated documentation
and/or information regarding the care of clients with
end stage renal failure.
Work effectively in collaboration with inter-, Respects the role of other members of the health care
intra- and multi-disciplinary and multi-cultural team caring for the client with end stage renal failure.
teams. Refers the client to the appropriate allied health team
partners.
Practice beginning management and Performs nursing tasks according to professional
leadership skills in delivery of client care standards.
using a systems approach. Adapts to changes willingly by being open to new
strategies or approaches relevant to the care of a
client with end stage renal failure.
Identifies and reports inadequacies and problem(s)
encountered in the provision of care.
Recommends practical and appropriate solutions.
Conduct research with an experienced Specifies researchable problems related to the nursing
researcher. care and procedures to the client infected with end
stage renal failure.
Gather, analyze, and interpret relevant data.
Engage in lifelong learning with a passion to Performs nursing tasks according to professional
keep current with local, national and global standards.
developments in general, and nursing and Observes proper grooming and hygiene.
health developments in particular. Adapts to changes willingly by being open to new
strategies or approaches relevant to the care of a
client with .
Demonstrate responsible citizenship and Demonstrates good manners and right conduct at all
prided in being a Filipino. times.
Apply techno-intelligent care systems and Apply appropriate technological resources to support
processes in health care delivery. client care and ensures proper functioning of
equipment.
Uphold the nursing core values in the Performs nursing tasks according to professional
practice of the profession. standards.
Demonstrates good manners and right conduct at all
times.
Observes proper grooming and hygiene.
Adapts to changes willingly by being open to new
strategies or approaches relevant to the care of a client
infected with end stage renal failure.
Apply the institutional core values Acts and performs nursing tasks related to a client
(A.C.H.I.E.V.E.R.) with end stage renal failure in accordance with
established norms of conduct expected of an OLFU-
BSN student.
CASE SCENARIO:
Patient Profile

Name: Juan Dela Cruz

Age: 65 years old
Sex: Male
Civil Status: Married
Address: Valenzuela City
Occupation: Private driver
Date of admission: Nov.3,2021
Time: 6:00 AM
Chief Compliant: Pruritis, lower extremity edema, nausea and emesis.

Past Medical History: (+) Hypertension, (+) DM Type II

Day 1:

A 65- year old male, long standing type 2 diabetic and hypertensive, with end stage renal disease
secondary to diabetic nephopathy. He was taken the following medication such as Losartan 50 mg OD,
amlodifine 5 mg OD, glucophage 1,000 mg BID and glipizide 10 mg BID, lopid 600 mg BID. The patient
was advised to undergo dialysis but he was refused. One week prior to admission patient had felt itchiness
all over the body, 3 days after, patient noticed presence of edema at the lower extremities, 1 hour prior to
admission patient manifested nausea and vomiting. Hence, patient was brought to ER. In the emergency
room vital signs are as follows: BP 180/110, HR 80 bpm, RR 24cpm, Temp 36.8, O2 Sat 95%, weight of
80 kgs, ht. of 5’2’’. Upon assessment: The patient’s eyes are close but open to pressure, he can utter some
words but do not form sentences, and he was able to localize to pain. The remainder of the exam was
remarkable for 2+ lower extremity edema and superficial excoriations of his skin from scratching. The
Doctors’ ordered the following laboratories: CBC, Blood Chem, Urinalysis, CBG, Chest X-Ray.

Venoclysis started : IVF of PNSS regulated at strict KVO, the Doctors’ ordered to administered
Metoclopramide 10 mg TIV,and diphenhydramine, nicardipine drip 10mg/amp + 90 cc PNSS to run for
10mc drops /minute as SD. After an hour stay in the ER, vital signs BP 170/100 HR 90 RR 23. T 37.0
Patient was ordered to be transferred to the Medical Ward for close observation.

12:00 PM VS BP 170/100 HR 90 RR 23. T 37, Urine Output of 10 ml

The Doctors’ was ordered to insert Urinary Catheter ization, and Furosemide 40mg TIV now , for I & O
q1 monitoring.

4PM
Laboratory result as follow
Laboratory Result

Chemistry Normal Values Urinalysis

Sodium 133 136-146 mmol/L pH 6.0

Specific gravity 1.010
Potassium 6.2 3.5-5.3 mmol/L Protein 1+
Glucose negative
Acetone negative
Chloride 100 98-108 mmol/L
Occult blood negative
Bile negative
Waxy casts
BUN 170 7-22 mg/dl

Creatinine 16.0 0.7-1.5 mg/dl

Glucose 108 70-110 mg/dl

Calcium 7.2 8.9-10.3 mg/dl

Phosphorus 10.5 2.6-6.4 mg/dl

Doctors’ ordered:
The patient’s become unconscious. No urine output.
Doctors’ ordered emergency peritoneal dialysis.
The patient transported to OR for insertion of catheter through the abdominal wall into the
peritoneum,10 to 15 minutes infusion time for 2 liters of dialysate is placed in the peritoneal cavity for
the first exchange and is allowed to remain for 3 hours. Drain for 30 minutes.
TASKS: Complete the following activities to provide high quality, individualized care for the patient
following proper and correct protocol / guidelines in the care of clients with peritoneal dialysis.
1. Comprehensive Assessment (15 mins) – Collect, organize and document information about
the patient. Data will be used to:
a. Complete the client’s health record.
b. Perform a quick and comprehensive assessment of the client’s hospital admission.
c. Implement the relevant and appropriate assessment methods.
2. Implementing Care (20 minutes)
a. Perform the necessary nursing procedures (not limited to): placing client on peritoneal
dialysis monitoring, client oxygenation, obtaining specimen for random blood sugar test.
b. Prepare, administer, and document the ordered medications. (Recall correct procedure in
medication administration.)
3. Ongoing Care (15 minutes) - document the care that has been provided as follows:
a. Using the FDAR format – so that this is communicated with the healthcare team.
b. Discharge instructions (METHODS)

WORKSHEET

Patient Records

PATIENT DETAILS
Name Sam Age:
Gender Male Female
Civil Status Single Married Divorced Widowed
Address Valenzuela City
Date of Birth October 9, 1956
Hospital Number FUMC-123-456
Attending Physician Dr. Lim
Height (cm)
Weight (kg)

Admitting Diagnosis:

History of Present Illness

Family History:

Past Medical History:

Allergies:

Medications:

Social History:
 Medication Chart

PATIENT DETAILS DIAGNOSIS:

Name Age:
Gender Male Female
Civil Status Single Married Divorced Widowed
Address
Date of Birth
Hospital Number
Attending Physician
Height (cm)
Weight (kg)

MEDICATION: dose, route, frequency TIME SUN MON TUES WED THUR FRI SAT
S

Nurse’s Notes

F: D:

A;

R:
 Discharge Plan

PATIENT DETAILS DIAGNOSIS:

Name Age:
Gender Male Female
Civil Status Single Married Divorced Widowed
Address
Date of Birth
Hospital Number
Attending Physician
Height (cm)
Weight (kg)

Discharge Goal:
Return to Home (self-care)
Return to Home but needs Assistance
Transfer to other Level of Institutional Care
Referral to Support Community Services’
Home Against Medical Advice

Discharge Plan
Date: M

Time:
E

Patient’s Signature over Printed Name Nurse’s Signature over Printed Name

Date Completed:
Date Submitted:
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