ST.

MARY’S COLLEGE

NURSING PROGRAM

Tagum City

A CASE STUDY

On

ACUTE RENAL FAILURE

Presented to:

Elizabeth Ladroma, RN

In Partial Fulfillment of the Requirements

In

Related Learning Experience

(RLE)

By

Mia Charisse F. Lamparero

Morris Antiporta
Janice Idiong
Stephen Anthony Navarro
Catherine Ardina
Neko Nebres

BSN 4
 January 11, 2011

TABLE OF CONTENTS

I. INTRODUCTION

A Objectives

II. ASSESSMENT

A. Biographical Data

B. Chief Complaint

C. History of Present Illness

D. Past Medical and Nursing History

E. Personal, Family and Socio-Economic History

F. Developmental History

G. Patient Need Assessment

Physical Assessment

 General survey

 Vital signs

 Nutritional status

 Integumentary System

 HEENT

 Pulmonary System

 Cardiovascular System

 Gastrointestinal System
  Musculoskeletal System

 Genito-urinary System

 Course in the Ward

III. LABORATORY AND DIAGNOSTIC EXAMINATIONS

IV. PATHOPHYSIOLOGY

A. Discharge Plan

V. PHARMACOLOGICAL MANAGEMENT

VI. BIBLIOGRAPHY

A. Textbooks

B. Internet Download
 I. INTRODUCTION

As nurses, we could help our patients by having a deep understanding of the

disease, that we may learn the proper interventions for the acute kidney disease patients.

In this way, we could render quality care for them. We could as well lead them to the

proper treatment to lessen their sufferings brought by the kidney failure, in anyhow. By

having a wide understanding of the disease, we could impart teachings on how we could

prevent the worsening of the condition. As nurses, it is our responsibility to render

information and impart health teachings to improve the condition of our patients to the

best of our abilities. One of the characteristics that we, nurses, should have is to be

informative and only through a keen study of disease such as this way for us to gain all

the information that we need to learn.

OBJECTIVES

The research for this case study, its data and substantial facts could not be attained

without the improvised objectives that are needed to be followed and observed that will

guide us in planning, preparing and arranging the information systematically. The

objectives are devised within the day of our clinical exposure. The objectives would serve

us guiding principles for us to arrive to our goals and aims.

A. General Objective:

Within the time-span of duty, the student nurse will complete the chosen case to

be studied with factual pertinent data gathered. As well as to know and familiarize other
related information connected to it and apply the nursing skills that had learned and

practice not only or the call of this study but also for the future reference.

B. Specific Objectives:

 To obtain sufficient and relevant information regarding patient’s condition.

 To present personal data of the patient.

 To trace the present history of the patient’s health and illness and define the

diagnosis of the patient having Acute renal failure.

 To conduct a thorough head-to-toe assessment serving as baseline data.

 To present the pathophysiology of the patient’s diagnosis.

 To identify the different drugs ordered and to know their action, indication,

adverse effects and nursing responsibilities.

 To impart suitable and realistic health teachings to the watcher for the patient’s

welfare.

 To evaluate the outcome of the condition of the patient.

 II. ASSESSMENT

A. BIOGRAPHICAL DATA

Name : Mrs. Banana

Age : 46 years old

Sex : Female

Civil Status : Married

Birthdate : November 13, 1964

Birthplace : Bohol

Address: : Prk 19, Pag-asa, Mesaoy, New Corella, Davao

del Norte

Nationality : Filipino

Religion : Roman Catholic

Occupation : Banana Plantation Worker

Attending Physician : Dr. Cyrus Asis MD

Admitting Diagnosis : Polyneuropathy; T/C UTI

Final Diagnosis : Acute Renal Failure 2 Severe Dehydration 2 AGE

B. CHIEF COMPLAINT
 The patient was admitted at Bishop Joseph Reagan Memorial Hospital last

December 12, 2010 at 8:53 in the morning due to the complaint of generalized body

malaise She was attended at the Emergency department and had taken a clinical history

and physical assessment. She was immediately transferred at St. Joseph Right Wing room

319-6. He was attended by Dr. Asis, a resident physician of the said hospital.

C. HISTORY OF PRESENT ILLNESS

Three days prior to admission, patient had loose bowel movement of about five

times associated with vomiting more than ten times and abdominal pain, fever, dysphasia

and body malaise. Four hours prior to admission had severe generalize body malaise with

five episodes of loose watery stool, non- mucoid, non blood streaked. No consultation

done, no medications taken two days prior.

D. PAST MEDICAL AND NURSING HISTORY

Mrs. Banana was known for being hypertensive for 5 years now. She was

hospitalized in Davao Regional Hospital because of the said health problem. According

to her, her chief complain that time was only hypertension. She was discharged from the

hospital after six days of confinement.

On December 12, 2010 she was then experiencing loose bowel movement and

body malaise that cannot be tolerated anymore which led them to admission.

E. PERSONAL, FAMILY AND SOCIO-ECONOMIC HISTORY

 Aka Mrs. Banana is a 46 year old banana plantation worker. She was

separated from her husband who led her to work in order to sustain their needs. The

family of Mrs. Banana belongs to a marginalized socio-economic status. In order to

provide and sustain the daily needs of their family, she works as a banana plantation

worker. She have 2 daughters: one is 9 year old and the other is 11 year old. She doesn’t

have a history for hypertension and DM

F. DEVELOPMENTAL TASK

 Robert J. Havighurst Developmental Task Theory

According to Havighurst developmental theory, Mrs. Banana, 46 years of age,

belongs to a period of late adulthood which was achieving mainly located in family,

work, and social life. Family-related developmental tasks are described as finding a mate,

learning to live with a marriage partner, having and rearing children, and managing the

family home. Mrs Drain was working at heavy workload just to have money to help for

their everyday expenses. She doesn’t have time to care for her own needs because she

always attended her children first.

G. PATIENT NEED ASSESSMENT

Date: December 13, 2010

Name of Patient: Mrs. Banana Age: 46 years old Sex:Female Status: Married

Admission Date/Time: December 12, 2010 8:53 am

Admitting Medical Diagnosis: Polyneuropathy; T/C UTI

Arrived on Unit by: per stretcher From: Emergency Room

Accompanied by: accompanied by her sister

AdmittingWeight /VS: 48kgs BP- 80/50 RR-26 PR-123 Temp- 36.7

Client’s Perception of reason for Admission:” Luya man gud kayo akong lawas ma’am

murag dili nako malihok” as verbalized

How has problem been managed by client at home: NONE

Allergies: No allergies was being experience according to the patient

Medication (at home): NONE, (at the hospital): See Drug Study

Physiological Needs:

I. Oxygenation

 BP : 50/60 PR 96 bpm RR 25 cycles/min CR_________

 Lungs (per auscultation: character: lung sound; symmetry of chest expansion;

breathing character and pattern.) fine, short, interrupted crackling sound was

being heard upon auscultation, symmetry chest expansion was being observe

during breathing.

 Cardiac status (per auscultation sounds character; chest pain?

Dull, low pitched and longer followed by a silent then higher pitch: no chest pain

noted

 Capillary Refill: Within 2 – 3 seconds using the blanched test

 Skin Character and Color: dry, pale, dark brown in color

 Life-supporting Apparatus: O2 @ 2 LPM

 Other Observations (related): Patient cannot be able to stand alone and

experiencing dizziness

II. Temperature Maintenance:

  Temperature: 36.7º C

 Skin Character: dry, pale, dark brown in color; with good skin turgor

 Other Observations (related): N-O-N-E

III. Nutritional Fluid:

 Height: 5’ 4’’/ 48kg. Amount of food consumed: ¼ of meal served

consumed

 Prescribed Diet:

 Eating Pattern: 3x a day; can only consume ¼ of served meal

 Skin Character: dry, rough skin; with good skin turgor

 Intake (IVF: Fluid/Water):

 Other Observations (related):slightly obese and vomits all food eaten

IV. Elimination:

 Last Bowel Movement (frequency; amount, character): 5-7 times, yellow to

amber in color, watery and plenty.

 Normal Pattern: 2x a day

 Urination (frequency, amount, character, sensation): twice, with yellow ambered

colored urine, about 200 cc.

 Other Observations (related): experiencing watery stool and defecated 7x during

the shift.

V. Rest-Sleep:

 Bed Time: 6: 00PM Waking Up Time: 6:00 AM

 Sleep (amount of sleep): 4-5 hours

  Problems (as verbalized): “Wala ko katulog kagabii og luya kayo akoang

paminaw”

 Other Observations (related): N-O-N-E

VIII. Stimulation-Activity:

 Work: Banana Plantation Worker

 Reaction/Past time: Watching TV

 Hobbies/Vices: None

Safety-Security Need

 Neuro V/S: 15/15

 Mental Status (coherent, responsive, conscious, unconscious): Coherent,

Responsive and consciuos

 Emotional Problem (diaphoretic, trembling, restless) Irritable, diaphoretic and

fatigue.

Love-Belonging Need

 Children (living with?) Living with 2 daughters and raise them alone.

 Husband (living with?) NONE

Self – Esteem Need

-Need to accept to be independent but still needs assistance to people around him.

Appreciate the care and love of family. Need to discuss feelings and concerns. Interact

effectively to people.

Self- Actualization Need

 - Control one’s emotions and discipline self particularly in taking care of health. Need to

learn to listen and follow what is advised for easy recovery.

PHYSICAL ASSESSMENT

 General Survey

Patient received lying on bed, awake, responsive, coherent to verbal communication,

dry lips, with normal capillary refill (less than 3 sec) ; fatigue and weakness noted and

verbalized on lower extremeties and unable to stand alone.

Vital Signs

Date/Shift Time Temp BP PR RR O2 SAT OUTPUT OUTPUT

12/12/10 9am 36.2 80/50 123 26
11am 80/60 103 21
12nn 36 90/60 98 22
4pm 37 100/70 96 21
7:15pm 38 110/80 85 24 95%
8pm 39.8 120/80 90 30
12/13/10 12mn 38 100/60 86 24
4am 36.8 90/60 88 22
8am 36.8 100/60 90 38
12nn 36.8 80/60 94 43
4pm 37 110/80 89 31
8pm 36.8 70/50 60 30 92%
9:25pm 80/60
12/14/10 12mn 36.4 80/60 93 24
2am 80/60
3:30am 80/60
4am 37 80/60 109 26 96%
5am 90/60
6am 80/60
8am 36.7 90/60 86 28
10am 90/60
12nn 36.3 90/60 110 41 93%
  Nutritional Status

Upon admission, patient was on DAT. Normally takes meal 3 times a day but

vomited after. Depending on varied conditions, he consumes moderate amount of food

per meal. No known hypersensitivity to food allergens and other problems related to food

consumption.

 Integumentary System

Fine and thin yet dry hair was noted. His nails were in convex shape, smooth in

texture, capillary refill of less than 3 seconds with pale nail beds. With good skin turgor,

dry, and brown in color.

 HEENT

The size of head was in proportion with the body. The eyes were symmetrical with

the ears (pinna); pupils react spontaneously to light, with pale conjunctiva. Eyebrows

symmetrically aligned, eyelashes equally distributed, lids closed symmetrically. With

approximately 15 to 20 blinks per minute. No discharges noted on ears. Nasal septum

was intact and in the midline, no discharges or flaring, air moves freely through the nares.

Non-pitting edema noted at both feet.

 Pulmonary System

With symmetrical chest expansion; crackles sound heard upon auscultation; RR: 30

cpm
  Cardiovascular System

Cardiac sound from dull, low pitched (“lub”) to higher pitch (“dub”) sound , with

irregular cardiac rhythm ; 60 beats per minute abnormal. Capillary refill time takes less

than 3 seconds .

 Gastrointestinal System

Watery stool plenty , non-mucoid and non-blood streaked.

 Musculoskeletal System

Weakness and fatigue noted as manifestation of the disease process, marked reluctant

to move. With limited range of motion.

 Genito-urinary System

Patient voided after meal in our shift. Urine appears amber in color, moderate in

amount. Client’s normal voiding pattern is 4 times a day. Palpation on kidneys reveals

no evidence of tenderness and distention.

H. COURSE IN THE WARD

III. LABORATORY AND DIAGNOSTIC EXAMINATIONS

VII. PATHOPHYSIOLOGY

TYPES ETIOLOGY WHAT HAPPENS CLINICAL

FINDINGS
PRE-RENAL -volume depletion Reduced or There is decrease
(Structurally intact - hypotension deprived perfusion in GFR so causes
nephrons) (systemic of kidney-renal oliguria, azotemia,
 hypovolemia) ischemia- possible fluid
functional disorder retention and
or depression of edema
GFR or both
RENAL (with -acute tubular The necrotic Blocking of
structural and necrosis due to debris, cellular filteration barrier
functional damage) ischemia blebs block the also causes oliguria
nephrotoxin filteration barrier and if oliguria
-disease of + macula densa is nitrogenous
slomeruli also activated due compounds and
to chloride load creatinine is
hence causes obviously increased
prerenal in blood.
vasodilation
POST-RENAL -obstruction of Urine outflow is There is decrease
(Obstruction of lumen obstructed so in GFR so causes
urine flow in -compression of further filtration is oliguria, azotemia,
anywhere along lumen declined. possible fluid
urinary tract retention and
edema.

B. Discharge Plan

To the patient who is diagnose of having acute renal failure, it is deemed necessary

that after the hospital stay, compliance of the following action must be strictly observed

for rehabilitation.

Medications - Advise the client to take the medications on time to preserve the

efficacy of the drug. Instruct the client to take the medication with food to avoid GI

irritation.
Exercise/Economic Factor - Encourage to do a routine ambulation as a light

exercise. Advise not to engage in strenuous activities. Encourage to take rest every after

activity.

Treatment - Encourage to ask proper explanation before starting a procedure to

properly understand what is going to happen. Instruct client to ask and properly

understand before signing the consent.

Health Teaching - Encourage patient to take a bath and do ADL’s within limits if

her safety. Tell the patient to notify the physician immediately if there are unusualities.

Follow all instructions including medications, diet regimen and do’s and don’ts that was

instructed to her by the physician..

Out patient Follow-up - Advise to have a follow up check up any time after

discharge.

Diet - Instruct patient to eat nutritious, high protein diet to promote healing and eat
smaller, more frequent meals to decrease feeling of fullness and bloating.

Spiritual/Sexual Activities - Encourage to reflect on her life situations and properly

understand these situations. To pray every day to help in coping up ones spirituality.

IX. PHARMACOLOGICAL MANAGEMENT

XII. BIBLIOGRAPHY

A. Textbooks

Douges, M.E. et.al., (2002). Nurse’s pocket guide: diagnosis, interventions &

rationales. (8th Edition). Philadelphia: F.A. Davis Company.

 Douges, M.E. et.al., (2002). Nursing care plan: guidelines for individualizing

patient care (6th Edition) Philadelphia: F.A. Davis Company.

Gulandick, M. et.al., Nursing care plan. (3rd Edition)

Ignatavicius, D.D. & Workman, M.L. (2006). Medical-surgical nursing: critical

thinking for collaborative care. (5th Edition). St. Louis, Missouri: Elsevier Saunders.

Kozier, B. et.al., (2004). Fundamentals of nursing: concepts, process & practice.

(7th Edition). Philippines: Pearson Education South Asia PTE Ltd.

Smeltzer, S.C. & Bare, B.G. (2004).Textbook of medical-surgical nursing(10th

Edition, Volume 2). Philadelphia: Lippincott Williams and Wilkins. pp 553-538.

Spratto, G.R. & Woods, A.L. (1994). Nurse’s drug reference. USA: Delmar

Publishers Incorporated.

Ulrich & Canale. (2005). Nursing care planning guides. (6th Edition).

B. Internet Downloads

http://www.labtestsonline.org/understanding/analytes/hematocrit/test.html

http://en.wikipedia.org/wiki/Leukocytosis

http://www.healthline.com/adamcontent/fatigue#hl2

http://www.emedicinehealth.com/chest_pain/page3_em.htm