CASE STUDY

IDENTIFICATION DATA OF PATIENT

 Name of patient : Abhinsh samal
 Age : 53 Year
 Gender : Male
 Marital Status : Married
 IPD Number : 221909
 Ward : Intensive Care Unit
 Bed No : 17
 Address : bhadrak,Odisha
 Religion : Hindu
 Education : 12 Pass
 Date of Admission : 08.03.2021
 Date of Discharge :
 Diagnosis : CKD stage-5
 Surgery (If any) : No
 Occupation : Govt. Job
 Chief Complaints with duration:
Patient is complaining of fever for 3days and also having breathing difficulty. Pt. also has
complained of loss of appetite.
 History of present illness: 
Patient is a known case of CKD stage 5. Hemodialysis is done regularly 3 times in a
week at SCB medical college & Hospital (Last on 10.11.2019). K\C\O Type 2 DM, HTN
on medication. Patient is having fever for 3 days, intermittent in nature and difficulty in
breathing also.
Patient was advised for ICU admission but refused and was admitted in the ward with
high risk bond signed.
 History of past illness:
 Past medical history:
Patient has a past medical history of Type 2 DM for 3 years and also has
hypertension.
 Past surgical history:
There is no provided surgical History

 Family history:
 Type : Nuclear
 No. of family members: 4
 Any Illness : No
 Family Composition:
Sl Name of the Age Relatio Education Occupation Health
No. Family Members n Status
With
Patient
1. Abhinash samal 53Years Self 12 PASS Govt. Job UnHealthy

2. Neeta Samal 50 Years Wife ---- Housewife Healthy

3. Madhusmita Samal 25 Years Daughter Graduate ----- Healthy

4. Bikash Samal 22 Years Son Graduate Student Healthy

 Family tree:

INDEX

- Male

- Female

- Assigned

 History of any Illness:

There is no history of any illness among the other family members.

 Socio-Economic Status:
 Family income :3,00,000 /- per annum
 Enviornmental hygiene: Well and Good
 Type of house: Pucca

 Personal History:
 Personal hygiene:
 Oral hygiene :Average
 Bath per day :Once a day
 Diet : Mixed Diet
 No. of meals per day :4-5 meals / day
 Food preference :All Type
 Tea/Coffee :Tea
 Sleep & rest :8-10 hrs\day
 Elimination Pattern:
 Bowel :Normal
 Frequency : 1-2 times per day
 Urine frequency
 During day: Irregular
 During Night: Irregular

 Habits:
 Alcohol : No
 Smoking : Yes
 Tobacco : No
 Exercises : Yes

PHYSICAL EXAMINATION
 General Appearance:
 Level of Consciousness : Conscious
 Speech : Clear
 Height : 5’ 6’’
 Weight : 65 kg
 Body Built :Healthy
 Personal Hygiene :Average
 Vital Signs:
Date Time Pulse Respiration Blood Pressure Temperatures
(mmHg)
(°F)
10.03.2021 8AM 78 /M 18 /M 132/80 98.0
9AM 80 /M 20 /M 140/86 98.4
10AM 82 /M 20 /M 136/82 98.4
11AM 82 /M 20 /M 136/80 98.4
12AM 80 /M 18 /M 134/80 98.4
11.03.2021 8AM 76 /M 20 /M 130/86 98.4
9AM 80 /M 22 /M 130/88 98.2
10AM 80 /M 22 /M 134/88 98.4
11AM 82 /M 22 /M 136/88 98.6
12AM 84 /M 20 /M 140/90 98.6
12.03.2021 8AM 86 /M 20 /M 128/78 98.0

9AM 80 /M 20 /M 130/84 98.2

 10AM 80 /M 22 /M 130/86 98.2
11AM 84 /M 20 /M 132/86 98.2
12AM 82 /M 20 /M 130/84 98.4
13.03.2021 8AM 76 /M 20 /M 130/86 98.4
9AM 80 /M 22 /M 130/88 98.2
10AM 80 /M 22 /M 134/88 98.4

11AM 82 /M 22 /M 136/88 98.6

12AM 84 /M 20 /M 140/90 98.6
14.03.2021 8AM 78 /M 18 /M 132/80 98.0
9AM 80 /M 20 /M 140/86 98.4
10AM 82 /M 20 /M 136/82 98.4

11AM 82 /M 20 /M 136/80 98.4

12AM 80 /M 18 /M 134/80 98.4

 Head:
 Size : Normal Size and Shape
 Hair Colour : Black and white mixed
 Scalp : Clean
 Face : Normal
 Facial Symmetry : Symmetrical
 Ears:
 External Ear : Equally distributed position
 Tympanic Membrane : No lesions
 Hearing activity : Normal
 Webber test : Normal
 Nose:
 External Nose : Symmetrical, Nothing abnormal
 Nostrils : No lesion or any discharge
 Sinusitis : Absent
 Sense of smell : Present
 Eyes:
 Eyes Brows : Normal
 Eye Lashes : No lesions present
 Eye Lids : Normal
  Eye Balls : Not sunken or protruded
 Conjunctiva : Transparent
 Sclera : No sign of jaundice and anemia
 Pupils : Reacted to light
 Vision : Normal
 Mouth and Pharynx:
 Lips : Brown in colour, not dehydrated
 Odour : No
 Teeth : 28 in numbers
 Denture : Absent
 Buccal mucosa : Normal
 Tongue : Not dehydrated
 Tonsils : Not enlarged and not swelled

 Neck:
 Lymph Nodes : Palpable
 Thyroid Gland : Not Enlarged
 Range of Motion : Normal
 Cardio-Respiratory System:
 Chest expansion : Expand symmetrically
 Shape : Normal
 Any deformities : No
 Breathing sound : Wheezing Sound
 Respiratory pattern : Difficulty in breathing
 Respiratory rate : 20/min
 Heart :
 Heart sound : S1 and S2 heard
 Murmur sound : No
 Diaphragmatic excursion :
 Varicose vein : No
 Abdomen:
 Inspection :
 Colour of skin : Brown
 Presence of scar : Not present
 Assess for lesions : no lesion present
 Palpation : No tenderness at the area of appendix, no muscle mass
present.
 Percussion :
 Ascites : Not present
 Auscultation :
  Bowel sound : Present

 Genito-urinary system:
 Urinary frequency : Abnormal
 Burning micturation : Present
 Hematuria : No
 Urethral discharge : No
 Bladder tenderness : No
 Musculo-skeletal system:
 Gait : No
 Posture :No kyphosis, lordosis
 Range of motion : Normal
 Spine : Normal
 Weakness : Present
 Integumentary system:
 Skin colour : Normal, brown in color but pale
 Skin texture : Pale, rashes present
 Skin integrity : Normal
 Lesions : Not present
 Cyanosis : No
 Edema : Yes, swelling in hands and feet
 Clubbing of nail : Absent
 Neurological Test:
 Co-Ordination Test: Patient responses in co-ordination test

 Equilibrium Test: Patient responses in equilibrium test.

 DISEASE DESCRIPTION

Disease name: Chronic Kidney Disease

Definition: CKD is defined as abnormalities of kidney structure or function, present for >3
months, with implications for health.

Review of Anatomy & Physiology:

The kidneys are two bean-shaped organs found in vertebrates. They are located on the
left and right in the retroperitoneal space.

In adult humans are about 11 centimetres (4.3 in) in length. They receive blood from the
paired renal arteries; blood exits into the paired renal veins. Each kidney is attached to a
ureter, a tube that carries excreted urine to the bladder.

Surface anatomy:

The kidneys lie retroperitoneally (behind the peritoneum) in the abdomen, either side of
the vertebral column.

They typically extend from T12 to L3, although the right kidney is often situated slightly
lower due to the presence of the liver. Each kidney is approximately three vertebrae in length.

The adrenal glands sit immediately superior to the kidneys within a separate envelope
of the renal fascia.

Arterial Supply:

The kidneys are supplied with blood via the renal arteries, which arise directly from the
abdominal aorta, immediately distal to the origin of the superior mesenteric artery. Due to
the anatomical position of the abdominal aorta (slightly to the left of the midline), the right
renal artery is longer, and crosses the vena cava posteriorly.

The renal artery enters the kidney via the renal hilum. At the hilum level, the renal artery
forms an anterior and a posterior division, which carry 75% and 25% of the blood supply to the
kidney, respectively. Five segmental arteries originate from these two divisions.

The avascular plane of the kidney (line of Brodel) is an imaginary line along the lateral and
slightly posterior border of the kidney, which delineates the segments of the kidney supplied
by the anterior and posterior divisions. It is an important access route for both open and
endoscopic surgical access of the kidney, as it minimises the risk of damage to major arterial
branches.
Venous Drainage:

The kidneys are drained of venous blood by the left and right renal veins. They leave the renal
hilum anteriorly to the renal arteries, and empty directly into the inferior vena cava.

As the vena cava lies slightly to the right, the left renal vein is longer, and travels anteriorly to
the abdominal aorta below the origin of the superior mesenteric artery. The right renal artery
lies posterior to the inferior vena cava.

Physiological Overview:

 Regulation of extracellular fluid volume. The kidneys work to ensure an adequate

quantity of plasma to keep blood flowing to vital organs.
 Regulation of osmolarity.
 Regulation of ion concentrations.
 Regulation of pH.
 Excretion of wastes and toxins.
 Production of hormones.

Water & Electrolyte regulation:

1. Renal blood supply to approx 20% of cardiac output 90% to cortex 1% to medulla
2. 2 capillary beds arranged in series
3. Glomerular: High pressure for absorption
4. Peritubular: Low pressure for absorption
5. Urine formation: simple filtration, selective & passive reabsorption, concentration

Stages of CKD:
 Etiology:

According to book According to patient

 Diabetes mellitus  Increased level of Urea and Creatinin in
 Hypertension urine
 Glomerular nephritis  Diabetes mellitus
 Pyelonephritis  Hypertension
 Renal artery stenosis
 Renal calculi
 Polycystic kidney disease
 Congenital defects of the kidney
or bladder
 Secondary causes (SLE,
rheumatoid arthritis, HIV, drugs-
gold, heroin use etc.)
 Drugs (NSAIDS, Amino glycoside
etc.)
 Kidney stone & infection
 Obesity

 Risk Factors:

Book Picture Patient Picture

  Diabetes Mellitus  Smoking
 Hypertension  Family history of CKD
 Cardiovascular Disease  Diabetes Mellitus
 Obesity  Hypertension
 Metabolic Syndrome
 Age and Race
 Acute Kidney Injury
 Malignancy
 Family history of CKD
 Kidney Stones
 Infections like Hep C and HIV
 Autoimmune diseases
 Nephrotoxics like NSAIDS
 Pathophysiology:
Due to etiological factors kidney function declines

Nephron damage is progressive, damaged nephron can’t function properly

Decreased Glomerular filtration rate

Remaining nephrons undergo changes to compensate for those damaged nephrons

Compensatory excretion continues as GFR diminishes

Filtration of more concentrated blood by the remaining nephrons

Damage of nephron results in hypertrophy and hyperphosphatemia of remaining

nephron

Urine may contain abnormal amounts of protein, RBC’s, White blood cells or casts
 Increased serum Creatinin, BUN level and retention of urea and other nitrogenous
waste (uraemia and azotemia)

Further damage of nephrons 80-90% damage, GFR 10-20%

CKD (Chronic Kidney Disease)

Clinical Manifestations:

Book Picture Patient Picture

 Swelling around eyes  Fever
 Edema  Breathing difficulty
 Fatigue  Edema
 Shortness of breath  Pleural effusion
 Nausea  Hypertension
 Vomiting  Anaemia
 Pleural effusion
 Bone pain
 Drowsiness
 Hiccups
 Sodium loss
 Incontinence / Retention
 Seizures
 Constipation or diarrhoea
 Hypertension
 Diagnostic Evaluation:

Book Picture Patient Picture

1. Blood test Date Investigations Normal value Patient’s
2. Serum urea Value
08.03.2021 Serum urea 12-42 mg/dL 118 mg/dL
3. Serum Creatinine
4. Serum sodium
Serum Creatinine
5. Serum potassium 0.9-1.3 mg/dL 4.7 mg/dL
 6. CBC Serum sodium 136-145 140 mm/dL
7. Blood culture mm/dL
8. Pyelogram Serum Upto 250 µL 229 µL
9. Serum albumin potassium
10.Serum LDH
11.Urine test Serum albumin 3.5-5.2 mg/dL 3.7 mg/dL
12.KUB test Serum LDH

09.03.2021 WBC count 4.00-10.00 7.5 10^3/

10^3/ µL µL
Neutrophils
40-80% 77 %
Lymphocyte
20-240% 16%
Monocyte 2-10% 04%
Eosinophils 1-6% 03%
Basophil 00-2.0% 00%
RBC count 4.5-5.5 10^6/ 2.18 10^6/
µL µL
Haemoglobi 13.00-17.00 9.17 g/dl
g/dl
Platelet count 150-410 215
10^3/ µL 10^3/ µL
PCV
40-50 g/dl 19.0 g/dl

10.03.2021 Blood culture No

growth
TLC 14.7

Radiological 11.03.2021 X-Ray chest PA

Investigation: Impression
 X-ray
  USG - Pericarditis
 CT-scan - Pleural
 ECHO 11.03.2021 effusion
USG abdomen and
pelvis:
Impression
 Parenchyma
echo is raised
bilaterally
 CM
differentiatio
n is
maintained
12.03.2021 ECHO-without silm:
M model- FF 32.8%
- FS 15.9%
2D ECHO:
Mitral valve: sev MR
Tricuspid valve:
Normall
Aortic Valve:
Normal
 Management:

Book Picture Patient Picture

DATE Name of the drug Dosage Route Time
 1. An ACE inhibitor 08.03. TAB ARKAMIN 20mg Oral BD
2. Benzopril 2021 100
3. Lasix TAB APLAZAR 200mg Oral TDS
4mg Oral BD
4. Diuretics TAB ONDEM
5. Protein diet and sodium diet
restricted
08.03.
6. Anemia-erythropiesis agents Oral OD
2021 TAB PRUVICT - 2mg
such as epoetin 2
7. Antihypertensive drugs Oral OD
TAB VAPTAM 15mg
8. Antiemetics INJ. MEROMAC 500mg IV OD
PLUS
IRON IV OD
SUCROSE fluid
100mg+100 ml
09.03. NS
2021 Oral BD
550mg
TAB Oral TDS
RIFAXIMIN 400mg
TAB PHOSCUT Oral OD
10.03. 400mg
TAB CEOVIT
2021 (Vit-A Capsule)

As Same
continued

Nursing Care Plan

Date Problems Needs Nursing diagnosis

according to priority basis
11.03.2021  Burning  To assist the Impaired urinary elimination
sensation while patient urinate related to disease condition
urinating with ease as evidenced by output
 Little urine measurement.
output

 Weakness  To reduce any risk Risk for injury related to

 Head reeling
 for injury disease condition

12.03.2021  Frequent  To verbalize Disturbed body image related

questioning self positive feelings to psychological stress as
doubt about self evidenced by verbal and
nonverbal responses to
change in body appearance.

 Swelling of  To reduce excess Fluid volume excess related

hands and feets fluid volume to disease condition as
 Edema evidence by edema

13.03.2021  Skin rashes  To reduce risk for Risk for infection related to
present infection disease condition
 Low immunity

 Stressed  To maintain Disturb thought process

 Tensed about optimal level of related to electrolyte
disease steady mental imbalance as evidence by
condition state change in behaviour
 Hypertension irritability.

Date Problems Needs Nursing diagnosis according

to priority basis
14.03.2021  Can’t eat  To maintain the Imbalance nutrition less than
properly nutritional balance body requirements related to
 Weakness and promote loss of appetite as evidence by
 Fatigue wellness nutritional parameters less
than normal.

 Weakness  To help the client Self care deficit related to

 Bed rest to do daily living disease condition as evidence
 Daily living activities by verbalization and
activities not visualization
done
15.03.2021  Frequent  To clear the doubt Deficient knowledge related
verbalization regarding disease to disease condition as
 Confused problem and evidence by frequent
 Knowledge treatment verbalization
deficit

 Hard stool To provide relief from Constipation related to

 Difficulty in constipation disease condition as evidence
passing stool by passage of hard stool
Date Nursing Assessment Nursing Diagnosis Goal Planning Implimentation Rationale Evaluation
Time
11.03.2021 Subjective Data: Patient Impaired urinary To assist the 1. To asses pt’s 1. Assessed 1. To assess the The patient
complains of a burning elimination related to patient to general patient’s problem urinates after
sensation while disease condition as urinate. 30 minutes
10AM urinating and mild pain evidence by output
condition general 2. To obtain and feels
in bladder measurement. (less 2. To monitor and condition baseline data relaxed.
than 100 ml) record vital 2. Monitored and 3. To assess for
Objective Data: signs recorded vital causing
 Increases in 3. To review for signs factors
lab finding lab tests for 3. Reviewed lab 4. To assess
(Urea and changes in tests results for retention
Creatinin) Renal function any 5. To increase
 Urinary 4. To palpate abnormalities frequency of
retention bladder 4. Palpated urination
 Edema 5. To determine bladder 6. To help the
 Output usual daily fluid 5. Increased in patient
measurement intake amount of daily urinate easily
6. To administer fluid intake 7. To promote
medications as 6. Administered relaxation
per doctor’s medication as
guide per doctor’s
7. To advice the guide
patient to be 7. Advised the
relaxed patient to be
relaxed
Date Nursing Assessment Nursing Diagnosis Goal Planning Implimentation Rationale Evaluation
Time
11.03.2021 Subjective Data: Disturbed body image The client will 1. To assess 1. Assessed the 1. To provide Patient now
11AM Patient ask frequent related to verbalize patient’s patient’s information feels better
questions psychological stress as positive mental mental about the
evidenced by verbal feelings about condition condition state of self-
Objective Data: and nonverbal self
2. To allow the 2. Allowed the concept
 Confused responses to change in
body appearance.
patient for patient for 2. To provide
 Stressed expression of expression of an
feelings and feelings and opportunity
concerns concerns to release
3. To provide 3. Provided feelings
psychological psychological 3. To promote
support support positive body
image
12.03.2021 Subjective Data: Risk for injury related To reduce risk 1. To assess 1. Assessed 1. To assess the Patient is
10AM Patient complains of to disease condition for injury general patient condition now have
weakness condition of generalized 2. To provide less risk for
patient condition data injury.
Objective Data:
2. To check blood 2. Checked blood regarding
 Weak pressure pressure hypertension
 At bed rest 3. To assess input 3. Assessed input 3. To provide
 Dull face output chart and output an
and electrolyte chart and information
panel electrolyte of renal
4. To provide bed panel function
rails 4. Bed rail 4. To manage
provided safety
Date Nursing Assessment Nursing Goal Planning Implimentation Rationale Evaluation
Diagnosis
Time
12.03.2021 Subjective Data: Patient Fluid volume excess To reduce the 1. To assess 1. Assessed 1. To obtain Patient now
11AM complains of irritations related to disease excess fluid patient’s patient’s baseline data feels a little bit
conditions evidenced level stressed and is
Objective Data: by edema, weight
condition condition 2. To assess advised for
 Swelling in gain. 2. To check vital 2. Checked vital hypertension Hemodialysis.
signs signs (BP = 140/80
hands and
feet. 3. To note 3. Note down mmHg)
amount of total amount 3. To prevent
 Edema
fluid intake of fluid intake fluid overload
 Weight gain from all from all and evaluate
 Hypertension sources sources degree of
4. To compare 4. Monitored excess
current weight fluid retention 4. To monitor
with the and compared fluid
previous current weight retention
weight at the with previous 5. To determine
time of wt (2kg excess) fluid
admission. 5. Observed retention
5. To observe presence of 6. To monitor
presence of edema kidney
edema 6. Recorded function
6. To record input-output 7. To prevent
input – output chart bed sores.
chart and 7. Changed
calculate fluid position of
volume client timely
balance. (once in 2
7. To change hour)
position of
client timely
Date Nursing Assessment Nursing Diagnosis Goal Planning Implimentation Rationale Evaluation
Time
13.03.2021 Subjective Data: Risk for infection To reduce the 1. To assess the 1. Assessed the 1. To provide Patient now
10AM Patient complains of related to disease risk for pt. condition pt. condition information has less
irritation on skin condition infection 2. To check vital 2. Checked vital about chance of
signs signs presence of infection
Objective Data:
3. To assess lab 3. Assessed lab infection
 Swelling of results(elevated result (elevated 2. To obseve
hands and feet WBC count) WBC not elevated
 Rashes 4. To practice found) temperature
present on aseptic 4. Practiced and pulse
skin technique while aseptic 3. To treat if
 Loss of doing any technique while there any
appetite procedure doing any infection
5. To clean the procedure 4. To prevent
surroundings of 5. Cleaned the cross
the patient. surroundings of infection
the patient. 5. To prevent
spread of
micro
organisms

13.03.2021 Subjective Data: Disturb thought To maintain 1. To assess 1. Assessed 1. To know Patient now
11AM Patient asks frequent process related to optimum level patient’s patient about the feels better
questions electrolyte imbalance of steady condition condition mental status
as evidence by change mental state 2. To provide 2. Provide of the patient
Objective Data: in behaviour
psychological psychological 2. To help
 Stressed irritability.
support support patient relax
 Anxious
Date Nursing Assessment Nursing Diagnosis Goal Planning Implimentation Rationale Evaluation
Time
14.03.2021 Subjective Data: Patient Imbalanced nutrition To maintain 1. To assess the 1. Assessed 1. To provide Patient will
10AM said that he can’t eat less that body nutritional nutritional nutrition comparative gradually
properly and feels weak requirements related status maintain
condition of condition , baseline
to reported balance with
Objective Data: inadequate food the patient body weight , 2. Provided oral evidence of
 Weight Chart intake as evidenced 2. To provide oral rest level of the care appropriate
by nutritional care patient 3. To establish a body weight.
 Nutrition parameters less than 3. To determine 2. Provided oral nutritional
imbalance normal care
whether extra plan
 Daily diet list calories 3. Determined 4. To establish a
 Inadequate needed or not extra calories nutritional
food intake 4. To provide diet needed or not plan
modification as 4. Provided 5. To prevent
needed modified diet further
5. To avoid 5. Advised to increase in
sodium rich avoid sodium sodium level
food rich food 6. To have
6. To encourage 6. Encouraged the proper
to do passive pt. to do circulation of
range of passive range blood
motion of motion 7. To prompt
exercise exercise. treatment
7. To administer 7. Administered
medications as medications as
ordered ordered
Date Nursing Assessment Nursing Diagnosis Goal Planning Implimentation Rationale Evaluation
Time
14.03.2021 Subjective Data: Self care deficit To assist the 1. To assess the 1. Assessed 1. To obtain Patient now
11AM Patient complains of related to disease patient in daily feels
extent of extent of information
weakness condition as living confident
evidenced by activities weakness, weakness, about the
and
Objective Data: verbalization and fatigue, ability fatigue impact of encouraged
 Weak visualization to participate 2. Encourage the activities on
 Self-care in active and patient for fatigue
deficit passive reading story 2. To provide
 Dull face activities. book news relaxation
 At bed rest 2. To encourage paper 3. To promote
reading 3. Made a independency
3. To make a schedule for and active life
schedule for the patient of
the patient for rest periods
rest periods following
following active regular
activates. exercises

15.03.2021 Subjective Data: Patient Knowledge deficit To provide 1. To assess 1. Assessed 1. To clear the Client now
10AM frequently ask questions related to disease knowledge patient’s patients doubts of the can verbalize
about the discharge condition as about the knowledge knowledge clients about the
procedure, disease evidenced by disease about the about the 2. To educate disease
process frequent questioning procedure disease disease procedure
the client
condition condition and
Objective Data: 2. To provide 2. Provided regarding the treatment
 Knowledge knowledge knowledge disease, regimen.
deficit about the about the treatment
 Confused disease disease procedure,
procedure procedure exercise,
 Stressed
3. To discus about 3. Discussed about treatment
the medications the medications, regimen
diet therapy what types of
4. To advise about diet to be
exercises, follow followed
up routine 4. Advised to do
exercises and
regular check-up

Date NURSING ASSESSMENT NURSING DIAGNOSIS GOAL PLANNING IMPLIMENTATION RATIONALE EVALUATION
 Time
15.03.2021 Subjective Data: Constipation related to To provide 1. To check on the 1. Checked on the 1. To know the Patient now feel
11AM Patient complains of disease condition as relief from usual pattern and usual pattern and normal comfortable
constipation evidence by passage of discomfort of
frequency of frequency of stool. frequency
hard stool constipation
Objective Data: stool 2. Given enema to of stool
 Stool not [assed 2. To give enema to the patient. passing
for last 2 days
the patient 2. To make it
easier for
the patient
to pass
stool
Progress Note:
Day by day patient’s condition is progressed.

11.03.2021: When he was admitted in the hospital. He had complains of fever for 3 days, loss of appetite,
breathing difficulty. Patient was in serious condition. Treatment has been started as early as possible to stable
the general condition of the problem.

12.03.2021: Patient had problem to pass the urine. Medication was administered to solve the problem. Various
nursing intervention had been applied to make the patient feel better.

13.03.2021: Patient was weak due to disease condition. Diet plan had been modified. Patient did the daily living
activities with the help of nursing professional. Oral care provided to decrease the loss of appetite. Change in
fluid therapy advised by the doctor

14.03.2021: Patient has discomfort due to fluid excess within the body. Swelling in hands and feets occurred.
Dialysis had been advised. Various aseptic techniques had been practiced to advice. Various aseptic techniques
had been practiced to avoid risk for infection

15.03.2021: Patient was tensed about his disease condition. To make him relax psychological support was
advised. BP came to a stable level. Patient feels relaxed.

Patient was in far more better condition and advised to discharge on next day along with next follow up date for
dialysis
Health Education:
 Dietary Changes:
1. Intake less amount of sodium rich food, avoid salt.
2. Eat season foods with fresh herbs, garlic, onion and sodium free spice blend instead of salt.
3. Eat less meat, yogurt.
4. Don’t practice smoking, don’t take alcohol
5. Eat medicines properly at time.
 Other Changes:
1. Get plenty of rest and sleep. Don’t take stress.
2. Exercise daily
3. Weight yourself daily at the same time of the day
4. Take your medicine exactly as directed
5. Keep all medical appointments
6. Go for dialysis as per the date given
 Follow-up Care:
1. Regularly maintain check up for monitoring any abnormality
2. Go to your doctor if having
- Trouble eating, loss of appetite
- Little or no urine output
- Trouble breathing
- Fever
- Blood in urine
- Vomiting, nausea
- Swellings of legs and hands
Conclusion:
I started taking history of the patient with diagnosis of CKD. It is a very dangerous disease. If not managed
carefully can become progressive. Therefore, it is up to professional health care providers to ensure every care
is given to slow down the disease process. I also maintained a nursing care plan to his disease. I also observed
him about his medications, reports, treatment for preparation of my case presentation. I also have given health
education to the patient about the diets to be followed at home. There is no curable treatment for CKD but
lifestyle modification can manage the disease satisfactorily.

Bibliography:
1. Brunner and Siddhartha, Text book of medical surgical nursing. 10th edition, Lippincott publisher, page
no 1053-1061
2. www.nurseslab.com
3. PK Panwar. Medical Surgical Nursing, ATBS Publication.