Nephrotic syndrome Assessment S> O> Execessive protein wasting (proteinuria 3.

7 gm/day) Periorbital edema Soft and pitting edema in the sacrum, ankles and hands Ascites WBC in urine Decreased serum bilirubin High cholesterol and low density lipoproteins, Headache Body malaise VS: BP: 160/100mmHg PR: 125BPM RR: 30CPM Temp: 37.8C,

Nursing Diagnosis Imbalanced Nutrition, less than body requirements related to Execessive protein wasting (proteinuria 3.7 gm/day)

Scientific explanation Damage to the glomeruli causes the membrane to become more porous, small proteins, such as albumin, pass through the kidneys into urine. Leakage of proteins from the blood to the urine,

Planning Discharge Outcome: On discharge the patient will be able to increased the appetite and Vital signs, blood pressure, and laboratory serum studies are within normal range Short Term Outcome:

Intervention Independent:

Rationale

Evaluation

After 8 hours of nurse- patient interaction, the the nutrients needed patient will be able in her body to: are being excreted. a. Identify the appropriate diet for This causes her to her condition.(Lowlose the nutrients in sodium diet) the body b. Follow the diet prescribed nutrition less than c. Verbalize body requirements realization of the importance of proper diet

After 8 hours of nursepatient interaction, the Assess and monitor food/f Identifies nutritional defic patient was able to: luid ingested. its/therapy needs a. Identified the appropriate diet for her Monitor weight daily at To assess the health condition.(Lowsame time, same clothing status of patient. Same sodium diet) and same scale. clothing, same timeand b. Followed the diet same scale makes the prescribed weight equal/fair c. Verbalized than yesterday realization of the importance of proper diet Recommend small, Smaller portions may frequent meals. enhance intake Discharge Outcome: On discharge the Restrict sodium as This electrolyte can quick patient was able to accumulate, causing fluid increased the appetite indicated, and limit fluid intake to 100ml retention, and weakness. and Vital signs, blood pressure, and laboratory serum Collaborative: studies are within To promote adequate normal range Administer diuretic as urine volume prescribed.

Glomerulonephritis Assessment S> masakit ang ulo ko as stated O> Fever, chills, Generalized edema, Ascites, Tenderness of the costovertebral angle (CVA) and flank pain, smokey (cola-colored) urine w/ RBC casts and traces of blood, Body malaise, Vital signs: BP of 140/90 mmHg, HR 130 bpm; RR 28 cpm; Temp- 37.8 C

Nursing Diagnosis Excessive fluid volume related to accumulation of fluids in the body secondary to glomerulonephritis related to generalized edema

Scientific explanation

Planning Discharge Outcome: Upon discharge the patient will be able to: normalize the fluid volume of the body Short Term Outcome: After 2hrs of nursing intervention the patient will be able to: Gradually excrete excessive fluid volume through urination. Demonstrate behaviors that would help in excreting excessive fluids in the body.

Intervention Independent: Elevate edematous extremities and change position frequently. Allow client to hear running water. Apply hot and cold compress on the clients bladder (just above the symphisis pubis) Encourage bed rest

Rationale

Evaluation Short Term Outcome: After 2hrs of nursing intervention the patient was able to: Gradually excrete excessive fluid volume through urination.

To reduce tissue pressure and risk for skin breakdown.

To promote diuresis

To stimulate urination by dilatation of the tube.

Collaborative: Administer diuretic as prescribed

Demonstrate behaviors that would help in excreting May promote excessive fluids in recumbency- induced the body. diuresis Discharge Outcome: On discharge the To promote water patient was able to: secretion. normalized the fluid volume of the body

Cystitis and Urolithiasis Assessment Nursing Diagnosis S> O> burning sensation upon urination, urinary frequency and urgency and urinating in small amount, low grade fever of 100.6 F. lower abdominal tenderness was noted Presence of E. coli. Urinalysis shown many bacteria. There is Hematuria and pyuria. severe back pain, nausea and diaphoresis Impaired urinary elimination related to inflammation of the bladder as manifested by urinary frequency

Scientific explanation

Planning Discharge Outcome: Upon discharge the patients urinary elimination will be in normal state and absence of bladder inflammation. Short term outcome: After 4hrs of nursing intervention the patient will be able to: Understand ways to prevent further complication

Intervention Independent: Monitor the color, odor and urine patterns, input and output. Encourage fluid intake

Rationale

Evaluation Short term outcome: After 4hrs of nursing intervention the patient will be able to: Understand ways to prevent further complication Discharge Outcome: On discharge the patients urinary elimination was in normal state and there was absence of bladder inflammation.

Serves as baseline data.

Increase hydration flushes bacteria and toxins Frequent urination, reduce static urine in the bladder and prevent bacterial growth.

If the frequency becomes a problem, assure access to the bathroom, bedpan under the bed. Instruct the patient to urinate whenever there is a desire Provide comfort measure like deep breathing exercise Collaborative: Administer medication as prescribed (antibiotic)

promotes relaxation and may enhance coping abilities

to prevent spread of infection

Acute Renal Failure Assessment S> O> Anuria (50ml) , increased BUN and Creatinine, BP, RR is rapid and deep, crackles, edema presacral and pretibial areas, ABG: metabolic acidosis, ECG: dysrhythmias (ventricular tachycardia), Vomits

Nursing Diagnosis Fluid volume excess related to compromised regulatory mechanism (renal failure) as manifested by anuria with a urine output of 50mL

Scientific explanation

Planning Discharge Outcome: Upon discharge the patient will be able to normalize the fluid volume of its body.

Intervention Independent: Weigh daily at same time of day, on same scale, with same equipment and clothing.

Rationale

Evaluation Short Term Outcome: After 4 hrs of nursing intervention the patient was able to: Understand ways to prevent complication Discharge Outcome: On discharge the patient was able to normalize the fluid volume of its body.

Daily body weight is best monitor of fluid status. A weight gain of more than 0.5 kg/day suggests fluid retention

Monitor heart rate Short Term (HR), and BP Outcome: After 4 hrs of nursing intervention the patient will be able to: Understand ways to prevent complication

Tachycardia and hypertension can occur because of (1)failure of the kidneys to excrete urine, (2) excessive fluid resuscitation during efforts to treat hypovolemia/hypotensi on or convert oliguric phase of renal failure, and/or (3) changes in the renin-angiotensin system.

Auscultate lung and heart sounds

Fluid overload may lead to pulmonary edema and HF evidenced by development of

adventitious breath sounds, extra heart sounds Assess level of consciousness; investigate changes in mentation, presence of restlessness. Collaborative: Administer medication as indicated: Diuretics, e.g., furosemide (Lasix), bumetanide (Bumex), torsemide (Demadex), mannitol (Osmitrol May reflect fluid shifts, accumulation of toxins, acidosis, electrolyte imbalances, or developing hypoxia.

Given early in oliguric phase of ARF in an effort to convert to nonoliguric phase, flush the tubular lumen of debris, reduce hyperkalemia, and promote adequate urine volume

Chronic Renal Failure Assessment Nursing Diagnosis S> . Masakit ang ulo ko at nasusuka ako madalas, as stated. O> Weight gain, pedal edema, hypertension, decreased urine output, urinary frequency, urgency or pain, DOB, rapid and shallow, crackles, malaise and ease fatigability, uremic frost, pruritus Risk for decreased cardiac output related to impaired regulatory mechanism (chronic renal failure)

Scientific explanation

Planning Discharge Outcome: Upon discharge the patient will be able to: maintain cardiac output as evidenced by BP and heart rate within patients normal range; peripheral pulses strong and equal with prompt capillary refill time. Short Term Outcome: After 4hrs of nursing intervention the patient will be able to: Prevent complications. Provide information about disease process/prognosis and treatment needs. Support adjustment to lifestyle changes

Intervention Independent: Auscultate heart and lung sounds. Evaluate presence of peripheral edema/vascular congestion and reports of dyspnea

Rationale

Evaluation Short Term Outcome: After 4hrs of nursing intervention the patient was able to: Prevent complicati ons. Provide information about disease process/prognosis and treatment needs. Support adjustment to lifestyle changes Discharge Outcome: On discharge the patient was able to: maintain cardiac output as evidenced by BP and heart rate within patients

S3/s4 heart sounds with muffled tones, tachycardia, irregular heart rate, tachypnea, dyspnea, crackles, wheezes, and edema/jugular distension suggest HF Significant hypertension can occur because of disturbances in the reninangiotensinaldosterone system (caused by renal dysfunction). Presence of sudden hypotension, paradoxic pulse, narrow pulse pressure, diminished/absent peripheral pulses, marked jugular distension, pallor, and a rapid mental deterioration indicate tamponade, which is a

Assess presence/degree of hypertension: monitor BP; note postural changes, e.g., sitting, lying, standing

Evaluate heart sounds (note friction rub), BP, peripheral pulses, capillary refill, vascular congestion, temperature, and sensorium/mentation.

medical emergency Assess activity level, response to activity Collaborative: Prepare for dialysis as indicated. Weakness can be attributed to HF and anemia. Reduction of uremic toxins and correction of electrolyte imbalances and fluid overload may limit/prevent cardiac manifestations, including hypertension and pericardial effusion.

normal range; peripheral pulses strong and equal with prompt capillary refill time.