Case Study on Chronic

Kidney Disease
OBECTIVES OF CASE STUDY
GENERAL OBJECTIVES:The general objective of the case study is to gain the comprehensive knowledge
about the disease togain the practical exercise about the Adult Health Problem and also
to gain Practical experience workingwith a patient having chronic kidney disease and to
give holistic patient care according to their need.
SPECIFIC OBJECTIVES
: The specific objectives of the case study are given below: To assess the patient and find out need of patient according to nursing process.
establish a nurse-client relationship to the
c l i e n t , a s w e l l a s t o t h e f a m i l y b y r e n d e r i n g a therapeutic nurse-patient
relationship;
gather adequate information to be used in the development of the study
present the clients personal data;
illustrate the patients family tree and trace significant diseases which may be of
relevance to the study
trace the health history of the client and the family by collecting information both
of the past and present illnesses;
To provide holistic nursing care to the client to all ages using nursing process.
To manage promptly as necessary to built up comfort.
To provide psychological support to the patient
To apply knowledge from the science, nursing theory and other related
courses to plan andimplement nursing care.
To provide continuous care till discharge and follow-up care.
Counsel and make aware the patient party about importance of
c o n t i n u i t y o f m e d i c i n e a n d psychological support to prevent from worsens.
To provide the discharge teaching to the patient and family member.

BIOGRAPHIC DATA
1.)HEALTH HISTORY
A.)DEMOGRAPHIC DATA
NAME:
AGE:
SEX
ADDRESS:
RELIGION:
EDUCATION
DATE OF ADMISSION:
DATE OF DISCHARGE:
IP NO. :
OCCUPATION:
MARITAL STATUS:
ATTENDING DOCTOR:
INFORMATION SOURCE:
DIAGNOSIS:
BLOOD GROUP:
BED NO: 205
WARD:

laxman kumar pandit

68yrs
male
Permanent: nayapati -6, jorpati
Hindu
illiterate
068/4/6
068/4/17
200821/410159
farmer
married
Dr. P.K.C
patient and his son
CKD 5
A +ve
nephrology

B)CHIEF COMPLAINTS:
Swelling of legs, face for 2 days
C.)HISTORY OF PRESENT ILLNESS
According to the patients, he come for haemodialysis, due to increased
shortness of breath during dialysis he was admitted in the nephrology
ward. His general condition is ill looking and oriented with time place and person.
D.) HISTORY OF PAST ILLNESS:
According to the patients party, he is undergoing regular
d i a l y s i s a n d i s u n d e r antihypertensive medicine.
ALLERGIES According to the patient, he doesnt have any allergic reaction to any
factors.. PREVIOUS HOSPITALIZATION: Nepal medical college teaching
hospital for the diagnosis of CKD
OPERATIONS OR SPECIAL TREATMENT:

no any

E) FAMILY HISTORY:
Type of family:
No. of Family Members:

joint
8

HEALTH SEEKING PRACTICE

He belongs to literate family, According to Laxman Kumar Pandit, t h e y w e r e n o t
dependent in superstitious beliefs. If someone becomes ill in
t h e i r f a m i l y t h e y t a k e homemade medicine then sometimes go to hospital.

PERSONAL HISTORY:
Health Habits: Smoker but has left 1-2 months ago, Nonalcoholic, Non vegetarian.
No food allergy. Maintain personal hygiene Religion belief and worship kuldeuta.
Dietry history: Non vegetarian. Foods like egg-curry, rice, daal etc.
SOCIO-ECONOMIC STATUS:
He belongs to middleclass family. The major source of income is farming and
business. They are the permanent residence of Jorpati. They are well satisfied
with their economic status. They have very good inter relationship in the
community.
ENVIRONMENTAL FACTOR :
Housing Pattern:
Well facilitated
Waste disposal:
They are practicing collective approach to manage the waste product.
Such as temporary container, burning and making compost manure. The
people from Nagarpalika also come to take waste from there home.
Pollution and noise:
His house is near the road , so he is very much affected by the noise
of the vehicle and the air pollution caused by the vehicle

F) DEVELOPMENTAL NEED AND TASK COMPARING WITH NORMAL ADULT

CLIENTS
Robert Havighursts Developmental Tasks Developmental Tasks Description Passed or
Failed
1. Adjusting to decreasing physical strength and health
Older adults also have to adjust to decreasing physical strength and health. The
prevalence of chronic and acute diseases increase in old age. Thus, older adults may
be confronted with life situations that are characterized by not being in perfect
health, serious illness and dependency on people.
Passed
2. Adjusting to retirement and reduced income A central developmental task that
characterized the transition into old age is adjustment to retirement. The period after
retirement has to be filled with new projects, but is characterized by few valid cultural
guidelines. The achievement of this task may be obstructed by the management of another
task, living in a reduced income after retirement.
Passed
3. Adjusting to death of a spouse Older adults may become caregivers to their spouses.
Someolder adults have toadjust to the death of their spouses. After they have lived with
aspouse for manydecades, widowhoodmay force older people to adjust toloneliness, moving
toa smaller place,andlearning about business matters.
Failed
4. Establishing anexplicit affiliationwith one's aged groupThe development of alarge part
of the population into oldage is historicallyrecent phenomenon tomodern cities.
Thus,advancementsunderstanding of theaging process maylead to identifyingfurther
developmentaltasks associated withgains and purposefullives for adults.
Passed
5. Meeting social andcivil obligationsOlder people mightaccumulateknowledge about life,and
thus maycontribute to thedevelopment of younger people andthe society.
Passed

6.

Establishingsatisfactory

physicalliving

arrangementsOder

adults

aregenerally

challengedto create positivesense of their lives asa whole. The feelingthat life has order
andmeaning results inhappiness.
Passed
Eric Eriksons Developmental Task Integrity vs. Despair
Erikson felt that much of life is preparing for the middle adulthood stage and the
last stagerecovering from it. Perhaps that is because as older adults we can often
look back on our lives withhappiness and are contented, feeling fulfilled with a deep
sense that life has meaning and we've madecontribution to life, a feeling Erikson
called integrity. On the other hand, some adults may reach thisstage and despair at
their experiences and perceived failure.My patient achieved happiness and
contentment in his life based on his actions and speeches.He is faithful and devoted
to his religion. He is ready to accept death completely and he has shared
hisexperiences to his beloved grandchildren. Even though he accepted death fully
but his faith and love for his worshipped God never changed.

PHYSICAL ASSESSMENT
Name:

Mr. Laxman Kumar Pandit

Ward:

Nephrology Ward

Bed:

205

Age:

68 yrs

Sex:

Male

Civil Status: Married

Vital Signs:
Axillary T=97 degree F,
PR= 90/ min,
RR= 22/ min,
BP= 150/80 mmHg.

General survey
Height:
5 ft and 8 inches, weight= 56 kilos,. No signs of distress noted upon assessment,
able tosmile, cooperate well, responsive to questions, conscious and alert,
conversant. Well oriented. Showcalmness during the examination. He has no IVF
infused, and was asleep at initial assessment.
Skin:
Skin is brown in color, rough, dry and warm. He has good skin turgor. Brownish
discolorationsthat resemble wrinkles are observed on face.
Head:
Skull is round in shape, symmetrical. No masses noted. Facial movement is
symmetrical,alopecia. Scalp is clear from dandruff and lice. No scars and wounds
noted.
Eyes:
Has symmetrical eyebrows movement, shape and hair distribution. Eyebrows have
same color with hair. Eyelashes are evenly distributed and curled outward. Eyelids
have no discharges and bilaterally blink. Upper lid covers the small portion of the
iris and cornea. Lacrimal duct openings(puncta) are evident at nasal ends of upper
and lower lid with no tenderness noted. Palpebral conjunctivaare pinkish in color
while the pupils constricted to light, round in shape. He is able to rotate eyes and
hascoordinated eye movements.
Ears:
Auricle has same color with the skin, has symmetrical shape and located a little bit
higher thanthe eye. Pinnas are symmetrical with no lesions noted. He has wet
cerumen noted on both ears when pulled down and back for better visualization. he
is able to hear on both ears.
Nose:
Nose has uniform color and symmetrical in shape. Nasal hairs are very evident when
light isflashed through the nasal passageways; its color is black. No nasal flaring

observed upon respiration.Both nares are patent, air moves freely as client
breathes through the nares. Nasal septum is straight andin midline. Nasal mucosa is
pinkish in color, has no discharges and no lesions. No tenderness of sinusesnoted.
Mouth
Lips are a little brownish in color, dry and has cracks. Tongue is in midline, pinkish in
color withthin whitish coating on top. Able to move tongue freely (up & down, side to
side). Soft palate is light pink in color while hard palate is lighter in color. Gums are
pinkish in color. Plagues are present on histeeth
Pharynx
Uvula is found well placed in midline of soft palate. Mucosa is pinkish in color.
Tonsils are notinflamed.
Neck
Trachea is in midline. No tenderness of thyroid noted. No enlargement of the neck
noted. he isable to flex and extend neck and move it laterally (L and R).
Chest and Lungs
Breathing pattern is regular. Anteroposterior diameter to transverse diameter is in
1:2. Respiratoryexcursion is symmetrical (thumb separates to 2-3cm). No
tenderness, lump, Presence of breath sound inall area of lungs
Heart and Central Vessels
Heart sounds are regular. Pulsation of heart is heard in 4 anatomical areas but more
audible inapical area upon auscultation.
Back and Extremities
Peripheral pulses are symmetrical and regular. Nails are long and untrimmed, pinkish
in color, and havea capillary refill time of 2 sec. after blanching; and no clubbing of
fingernails were noted.. His hands area little rough. Muscle strength is equal on
both sides of the upper and lower extremities. He is able tostand and walk on both
feet independently, and his movements are well coordinated. Toes point
straightahead. And he is able to sit up straight.
Abdomen

 His abdomens color is same with the rest of the part of the body. His umbilicus is
coated with blackish dirt.
Neurologic Assessment
Cranial Nerves: able to identify aromas by smelling with eyes closed; able to see
objects; pupilconstricted to light sensation; able to move eyeball downward and
laterally; able to blink eyes; able tosmile, raise eyebrows, puff cheeks and close
eyes; able to respond to questions being heard;) has roughand vibrating sound; able
to shrug shoulders, elevate and flex arms and legs against resistance; able to
protrude tongue and move it side to side.
FINDINGS:
Skin is dry and rough
Alopecia of hair
wet cerumen noted on both ears
plaques are present
Nails are long and untrimmed

Cranial Nerves: able to identify aromas by smelling with eyes closed; able to see objects;
pupilconstricted to light sensation; able to move eyeball downward and laterally; able to
blink eyes; able tosmile, raise eyebrows, puff cheeks and close eyes; able to respond to
questions being heard;) has roughand vibrating sound; able to shrug shoulders, elevate and
flex arms and legs against resistance; able to protrude tongue and move it side to side.
3) DEFINITION, CAUSE AND PATHOPHYSIOLOGY OF CLIENTS DISEASES
Definition:
Chronic kidney disease (CKD), also known as chronic renal disease, is a progressive
loss of renalfunctionover a period of months or years in which the bodys ability to
maintain metabolic and fluidand electrolyte balance fails, resulting in uremia or
azotemia. In this condition, the GFR falls below 10%of the normal rate.
Causes:
Heredity
Glomerular dysfunction

Diabetic nephropathy
Hypertension
Glomerulonephritis
Polycystic kidney disease
Urinary tract obstruction
Bladder tumour
Urethral obstruction
Hypertensive nephrosclerosis (hardening of the kidney)Other causes:
Hiv infection
Kidney stones
Chronic kidney infections and certain cancers
Regular use of anti inflammatory drugs
Vesicoureteral reflux ( a urinary tract problem in which urine travels the wrong way
back towards kidney)