CUES Subjective: isang beses lang ako umihi magmula kaninang umaga Objective: (+) HD 3x a week (+)Oliguria Urine

ine output of 10cc/hr Bloated abdomen upon palpation Pale in appearance Weak looking

DIAGNOSIS Impaired Urinary Elimination r/t altered renal function

SCIENTIFIC EXPLANATION Due to Damage of the nephrons the filtration of urine to the urethra is being blocked causing obstruction in the flow of urine that leads to impairment in the urinary elimination.

PLANNING After 2 hours of nursing interventio n, pt. will able to demonstra te an adequate urine output about 30 cc.

INTERVENTIONS Independent: 1. Provide an environment that encourages toileting

RATIONALE 1. Insufficient toileting and environmental factors may contribute to functional incontinence or exacerbate other forms of urinary leakage 2. Maintains hydration and good urine flow

EVALUATION Patient was not able to demonstrate an adequate urine output about 30 cc

2. Encouraged increase fluids and maintain accurate intake 3. Ensure Mr. REBs Compliance on hemodialysis procedure.

3. These will alleviate the anxiety and fear of the patient when doing the procedure. 4. Specific gravity measures the activity for the kidneys to concentrate urine (1.006 1.030) and creatinine measures kidney damage (>0.5 1 mg/dl) which indicates renal failure

4. Monitor laboratory results that are specific to renal dysfunction such as: Creatinine and specific gravity

Dependent: 1. Administer PNSS 1L at 40 cc/hour as indicated Collaborative 1. Monitor electrolytes level

1.Assist in maintaining hydration and good urine flow

1.Creatinine measures kidney

CUES Subjective: Nahihilo ako Objective: P ale W eak looking V ital sign B P: 180/ 110 R R: 24 CR: 80

DIAGNOSIS Dizziness RT hypertension

SCIENTIFIC EXPLANATION Due to the blood volume that surpass the kidneys which cannot function well and control the blood pressure of the patient, because of damage of the kidneys..

PLANNING After 1hour of nursing intervention, the patient blood pressure will decrease from 140/100 to 130/80 mmHg

INTERVENTIONS Independent 1.Position the patient to a semi fowlers position 2.Monitor Vital sign 3.Provide safety like raising side rails and by assisting the patient when walking and raising 4.Provide calm environment 5. Instruct the patient to raise slowly Dependent 1.Give anti hypertensive drug such as lanoxin

RATIONALE

EVALUATION Goal was met as evidence of decreased in BP from 140/100 to 130/80

1.To reduce intracranial pressure to minimize dizziness 2.To provide baseline data 3.To prevent injury

4.Provide adequate rest to the patient 5. To prevent orthostatic hypotension 1.To reduce Blood pressure

DRUG NAME

CLASSIFICATION

DOSAGE

ACTION

INDICATION

CONTRAINDICATION

SIDE EFFECT

ADVERSE EFFECT Bleeding, especially at high dosages. Subcutaneo us hematomas at injection site.

NURSING RESPONSIBILITY

Low Brand name: Digoxin Generic name: Lanoxin Anticoagulant 0.5 mg IVP heparin, an anticoag ulant which prevents conversio n of fibrinoge n to fibrin and prothrom bin to thrombin by enhancin g inhibitory effects of inhibition factor Xa and antithrom bin III.

Prophylaxis thrombosis, which may lead to pulmonary embolism, in patients undergoing abdominal surgery who are at risk for thromboemb olic complication s; prophylaxis of ischemic complication s in unstable angina and non-Q-wave myocardial infarction in patients on aspirin therapy.

Acute gastroduodenal ulcer, cereberal hemorrhage, severe coagulation disorders, sepric endocarditis, CNS, eyes , ears injuries and operations, hypersensitivity to heparin or pork products.

Glossitis, GI disturban ce, urticaria, cutaneou s rash, pruritus, arthralgia .

Obtain history of

molecular of deep vein

patients underlying condition before starting therapy. Assess risk for DVT. Monitor

effectiveness by assessing for evidence DVT.

Assess for

bleeding during treatment. Assess for

hypersensitivity and adverse reaction.

DRUG NAME

CLASSIFICATION .

DOSAGE

ACTION

INDICATION

CONTRAINDICATION

SIDE EFFECTS

NURSING RESPONSIBILITIES

FUROSEMID E

LOOP DIURETIC

20mg.TA B

Inhibits the reabsorpti on of sodium and chloride from the ascendin g limb of the loop of Henle leading to a sodiumrich diuresis.

Edema associated with renal disease, CHF, cirrhosis. Hypertension

Allergy to furosemide. Sulfonamides; allergy to tartrazine, anuria, severe renal failure, hemopatic coma, pregnancy lactation.

Polyuria, nocturia urinary bladder spasm, N&V,head ache.

Administer food or milk to prevent GI upset. Reduced dosage if given with other antihypertensive drugs. Give early in the day so that increase urination will not disturb sleep.