University of Saint Louis

Tuguegarao City, Cagayan 3500

SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

OBJECTIVES
General Objective
The general objective of this case study is to further explore, assess, understand,
and describe the case of a 42-year-old male patient who was diagnosed with Chronic Kidney
Disease. This study will explain furthermore about the nature of the disease and the factors
that contributes to acquiring the disease. Moreover, it includes the management of the
disease and implementation of the nursing care plan to evaluate its effectiveness to the
patient.
To promote health, reduce risk, and potentially protect patients from disease-related
complications, the author aims to implement well-planned, effective interventions.
Additionally, the author tries to determine whether the interventions will have a positive
impact on the patient's general health or well-being.

Specific Objective
This paper specifically aims to:

● Describe Chronic Kidney Disease.

● Present the disease statistics, global and national.

● Recognize the etiology of the disease, including the predisposing and precipitating
factors.
● Identify the manifestation and the possible risk.

● Provide the patient’s information, nursing history, functional health patterns, and
physical assessments.
● Explain the Anatomy and physiology of the systems involved and the
pathophysiology of endometriotic cyst.
● Provide a patient-centered, well-organized, and effective nursing care plan and drug
studies.
● Appreciate the uses of drugs used to manage the patient with Chronic Kidney
Disease.

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 University of Saint Louis
Tuguegarao City, Cagayan 3500

SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

INTRODUCTION
Disease Description
Chronic kidney disease, also called chronic kidney failure, involves a gradual loss of kidney
function. When this happens, harmful waste and fluids begin to accumulate in the body,
causing a patient to feel unwell. Moreover, other health problems such as heart disease and
stroke may also arise because of this.

Some other health consequences of CKD include:

 Anemia or low number of red blood cells
 Increased occurrence of infections
 Low calcium levels. High potassium levels, and high phosphorus levels in the blood
 Loss of appetite or eating less
 Depression or lower quality of life

While the kidneys filter wastes and excess fluids from the blood, which are then removed in
the urine, CKD affects both these kidneys at the same time. And while the body has two
kidneys to help filter waste, one is not a “back-up” for the other. They work in unison to
cleanse the body.

When a patient is diagnosed with CKD, it means that both of the kidneys are affected and
cannot filter waste and fluid from the body properly. In the early stages of chronic kidney
disease, the patient might have few signs or symptoms and might not realize it until the
condition is advanced. On the other hand, advanced chronic kidney disease can cause
dangerous levels of fluid, electrolytes and wastes to build up in the body.

CKD has varying levels of seriousness. It usually gets worse over time and if left untreated,
CKD can progress to kidney failure and early cardiovascular disease. Although CKD is
incurable, treatment for chronic kidney disease focuses on slowing the progression of kidney
damage, usually by controlling the cause. But, even controlling the cause might not keep
kidney damage from progressing. Chronic kidney disease can progress to end-stage kidney
failure, which is fatal without artificial filtering (dialysis) or a kidney transplant.

(When the kidneys stop working, dialysis or kidney transplant is needed for survival. Kidney
failure treated with dialysis or kidney transplant is called (ESRD) end-stage renal disease)

RISK FACTORS

Predisposing Factors:
Among the non-modifiable risk factors associated with CKD:

 Genetics: a patient may be predisposed to CKD insofar as the risk of end stage
renal disease (ESRD) is three to nine times greater if the patient has a family
member with ESRD

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Tuguegarao City, Cagayan 3500

SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

 Race: African Americans, Hispanics, and American Indians are at high risk for
developing kidney failure. This risk is due in part to high rates of diabetes and high
blood pressure in these communities.
 Age: CKD is more common in people aged 65 years or older (38%) than in people
aged 45 to 64 years (13%) or 18 to 44 years (7%).
 Low birth weight, which is associated with impaired kidney development, resulting
in fewer and smaller nephrons.

Precipitating Factors:

Among the modifiable risks factors associated with CKD:

 Uncontrolled high blood pressure

 Type 1 diabetes with the onset of disease before age 20
 Poor blood glucose control in people with type 1 or 2 diabetes
 Cigarette smoking, which further constricts renal blood vessels
 Obesity, which contributes to hypertension, the risk of diabetes, and the production
adipokines—inflammatory substances that can cause damage renal tissue

Other factors that can increase the risk of chronic kidney disease include:

 Heart (cardiovascular) disease

 Abnormal kidney structure
 Frequent use of medications that can damage the kidneys
 Sedentary Lifestyle
 Unhealthy diet
 Excessive alcohol intake
 Poor management of long-term medication

SIGNS AND SYMPTOMS

Signs and symptoms of chronic kidney disease develop over time if kidney damage
progresses slowly. Loss of kidney function can cause a buildup of fluid or body waste or
electrolyte problems. Depending on how severe it is, loss of kidney function can cause:

 Nausea and Vomiting: There can be many reasons for nausea and/or
vomiting, such as medicine, being constipated, and toxins building up in your
body because of your failing kidneys.
 Loss of appetite: The progressive decline of glomerular filtration rate in
chronic kidney disease patients is associated with a significant reduction in food
intake. Approximately one third of chronic dialysis patients complain of a fair or
poor appetite and this is related directly to poor patient outcomes.
 Fatigue and weakness: If the kidneys are not working well, toxins (waste
products) build up in the blood and this can make a patient feel tired and weak

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SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

and may feel more tired as the CKD progresses. Kidney damage can also lead
to a shortage of red blood cells, causing a patient to be anaemic.
 Sleep problems: Excessive daytime sleepiness and sleep disorders, including
sleep apnea syndrome, restless legs syndrome, and periodic limb movement
disorder, occur with increased frequency in patients with end-stage renal
disease (ESRD).
 Urinating more or less: When the kidneys filters are damaged, it can cause an
increase in the urge to urinate. On the other hand, renal causes of oliguria arise
as a result of tubular damage. As a result of the tubular damage, the kidney
loses its normal function such as production of urine while excreting the waste
metabolites.
 Decreased mental sharpness: Depression, anxiety and other mental health
issues are common among people living with kidney disease.
 Muscle cramps: Severe loss of kidney function causes metabolic wastes to
build up to higher levels in the blood. Damage to muscles and nerves can
cause muscle twitches, muscle weakness, cramps, and pain. People may also
feel a pins-and-needles sensation in the arms and legs and may lose sensation
in certain areas of the body.
 Swelling of feet and ankles: Damage to the tiny filtering nephrons can result
in what's called nephrotic syndrome. Declining levels of the protein albumin in
the blood and increasing levels in the urine can cause fluid to build up and
result in edema, most commonly around the ankles and feet.
 Dry, itchy skin: When phosphorus levels get too high, it can cause the skin to
be dry and irritated. In addition, kidney disease can lead to changes in the
sweat glands, causing the skin to dry out.
 High blood pressure (hypertension) that's difficult to control: Diseased
kidneys are less able to help regulate blood pressure. As a result, blood
pressure increases.
 Shortness of breath: There can be many causes: low iron levels, extra fluid in
the lungs, build-up of acid in the blood or being anxious.
 Chest pain: If the lining that covers the heart (pericardium) becomes inflamed,
the patient may experience chest pain
Signs and symptoms of kidney disease are often nonspecific. This means they can also be
caused by other illnesses. Because the kidneys are able to make up for lost function, the
patient might not develop signs and symptoms until irreversible damage has occurred.

COMPLICATIONS

Chronic kidney disease can affect almost every part of the body. Potential complications
include:

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SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

 Fluid retention, which could lead to swelling in the arms and legs, high blood
pressure, or fluid in the lungs (pulmonary edema)
 A sudden rise in potassium levels in the blood (hyperkalemia), which could
impair the heart's function and can be life-threatening
 Anemia
 Heart disease
 Weak bones and an increased risk of bone fractures
 Decreased sex drive, erectile dysfunction or reduced fertility
 Damage to the central nervous system, which can cause difficulty
concentrating, personality changes or seizures
 Decreased immune response, which makes a patient more vulnerable to
infection
 Pericarditis, an inflammation of the saclike membrane that envelops the heart
(pericardium)
 Pregnancy complications that carry risks for the mother and the developing
fetus
 Irreversible damage to the kidneys (end-stage kidney disease), eventually
requiring either dialysis or a kidney transplant for survival

STAGES
 CKD often progresses over time and has 5 stages depending on how well the
kidneys are currently able to filter the blood. The filtration rate (GFR) indicates how
well the kidneys are working.
 Glomerular filtration rate (GFR) will be calculated using a combination of inputs.
These include age, gender and race, as well as blood’s level of creatinine – a waste
product. If the glomerular filtration rate (GFR) number is low, the kidneys are not
working as well as they should be.

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 University of Saint Louis
Tuguegarao City, Cagayan 3500

SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

Below are the 5 stages of chronic kidney disease (CKD) and their associated glomerular
filtration rates (GFRs).

Stage 1 of Chronic Kidney Disease (CKD)

Description: The kidneys are damaged, but are almost able to function normally
GFR above 90 mL/min
What this means: The patient will probably not notice symptoms of chronic kidney disease
(CKD) and can live a normal life but will have regular clinician visits to monitor GFR and
manage any other health issues that may affect kidney functioning.

In the early stages (Stages 1–3), the kidneys are still able to filter waste from the blood. In
the later stages (Stages 4–5), the kidneys must work harder to filter blood and may stop
working altogether.

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SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

Stage 2 of Chronic Kidney Disease (CKD)

Description: damage has caused a mild loss of kidney function

GFR 60-89 mL/min

What this means: Like in stage 1, the will likely not notice symptoms of chronic kidney
disease (CKD), but will need to regularly visit a clinician in order to have the GFR monitored
and manage any health problems that may affect kidney functioning.

Stage 3 of Chronic Kidney Disease (CKD)

Description: damage has caused a moderate loss of kidney function

GFR: 30-59 mL/min

What this means: The patient may still not notice symptoms of chronic kidney disease (CKD)
but will need a clinician to test regularly for complications and should discuss treatment
options with them to prepare for the case that kidney failure develops.

Stage 4 of Chronic Kidney Disease (CKD)

Description: damage has caused a severe loss of kidney function

GFR: 15-29 mL/min

What this means: The patient may notice symptoms of chronic kidney disease (CKD and
should either be in treatment for chronic kidney disease (CKD) or have discussed treatment
options with a clinician to prepare for the event that kidney failure develops.

Stage 5 of Chronic Kidney Disease (CKD)

Description: The kidneys have failed

GFR less than 15

What this means: The patient will likely notice symptoms of chronic kidney disease (CKD)
and will need to move forward with the treatment that the clinician have decided is right for
the patient.

Remember that every chronic kidney disease (CKD) patient is unique. Not only glomerular
filtration rate (GFR), but also age, physical condition, medical history and lifestyle will factor
into the clinician’s treatment recommendation. The treatment choice should always be a joint
decision between the patient and the clinician.

TREATMENT AND MANAGEMENT

There's no cure for chronic kidney disease (CKD), but treatment can help relieve the
symptoms and stop it from getting worse.

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SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

The treatment will depend on the stage of CKD but the main treatments are:

1. Lifestyle changes – to help the patient stay as healthy as possible

The following lifestyle measures are usually recommended for people with kidney disease:

 Stop smoking
 Eat a healthy, balanced diet
 Restrict salt intake to less than 6g a day – that's around 1 teaspoon
 Do regular exercise – aim to do at least 150 minutes a week
 Manage alcohol intake: Drink no more than the recommended limit of 14 units of
alcohol a week
 Lose weight if overweight or obese
 Avoid over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such
as ibuprofen, except when advised to by a medical professional – these medicines
can harm the kidneys if the patient has kidney disease

2. Medicine – to control associated problems, such as high blood pressure and high
cholesterol

 There's no medicine specifically for CKD, but medicine can help control many of the
problems that cause the condition and the complications that can happen as a result
of it.
 The patient may need to take medicine to treat or prevent the different problems
caused by CKD.

3. Dialysis – treatment to replicate some of the kidney's functions, which may

be necessary in advanced (stage 5) CKD

 For a small proportion of people with CKD, the kidneys will eventually stop working.
This usually happens gradually, so there should be time to plan the next stage of
treatment.
 One of the options when CKD reaches this stage is dialysis. This is a method of
removing waste products and excess fluid from the blood.

There are 2 main types of dialysis:

Haemodialysis – this involves diverting blood into an external machine, where it's filtered
before being returned to the body
Peritoneal dialysis – this involves pumping dialysis fluid into a space inside the tummy to
draw out waste products from the blood as they pass through vessels lining the inside of the
tummy

 Haemodialysis is usually done about 3 times a week, either at hospital or at home.

Peritoneal dialysis is normally done at home several times a day, or overnight. It will
usually need to be lifelong.
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SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

4. Kidney transplant – this may also be necessary in advanced (stage 5) CKD

 An alternative to dialysis for people with severely reduced kidney function is a kidney
transplant. This is often the most effective treatment for advanced kidney disease,
but it involves major surgery and taking medicines (immunosuppressants) for the rest
of the patient’s life to stop the body from attacking the donor organ.
 A person can live with one kidney, which means donor kidneys can come from living
or recently deceased donors. But there's still a shortage of donors, and the patient
could wait months or years for a transplant and may need to have dialysis while
waiting for a transplant.
 Survival rates for kidney transplants are very good. About 90% of transplants still
function after 5 years and many work usefully after 10 years or more.

5. Diabetes or high ACR

 If the patient also have type 2 diabetes or a high albumin to creatinine ratio (ACR), a
type of medicine called an SGLT2 inhibitor, such as dapagliflozin, as well as
medicines for high blood pressure may be offered.
 Dapagliflozin helps to lower blood sugar and can reduce damage to the kidneys.
 The patient may also be given an additional medicine called finerenone to take with
dapagliflozin
 Finerenone works by blocking the action of certain hormones that can damage the
kidneys.

6. High cholesterol

 People with CKD have a higher risk of cardiovascular disease, including heart
attack and stroke. This is because some of the causes of kidney disease are the
same as those for cardiovascular disease, including high blood pressure and high
cholesterol.
 The patient may be prescribed medicines called statins to reduce the risk of
developing cardiovascular disease. Examples include atorvastatin and simvastatin.
Side effects of statins can include:

 headaches
 feeling sick
 constipation or diarrhoea
 muscle and joint pain
 Find out more about how high cholesterol is treated.

7. High potassium levels

 People with CKD can develop high potassium levels in their blood, called
hyperkalaemia, because their kidneys do not work properly. Hyperkalaemia can
cause muscle weakness, stiffness and tiredness. If it becomes severe, it can cause
an irregular heartbeat (arrhythmia) which can lead to a heart attack.
 If a patient has CKD, it's important to avoid taking potassium supplements and some
medicines used to treat high blood pressure and heart failure because they can make
the potassium levels too high.
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SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

A medicine called sodium zirconium cyclosilicate can be used to treat hyperkalaemia in

adults, but only if it's used:

 In emergency care for acute life-threatening hyperkalaemia alongside standard care

in people with hyperkalaemia that does not get better, CKD stage 3b to 5, or heart failure

 People with hyperkalaemia that does not get better (called persistent CKD) who also
have CKD stage 3b to 5, or heart failure, should only take sodium zirconium
cyclosilicate if they:
o have a serum potassium level of at least 6.0 mmol/litre and
o are not also taking a certain amount of renin-angiotensin-aldosterone
system (RAAS) inhibitor because of hyperkalaemia
o are not on dialysis
 The patient should stop taking sodium zirconium cyclosilicate if RAAS inhibitors are no
longer suitable

8. Water retention
 The patient may get swelling in your ankles, feet and hands if he has kidney disease.
This is because the kidneys are not as effective at removing fluid from the blood,
causing it to build up in body tissues (oedema).
 The patient may be advised to reduce daily salt and fluid intake, including fluids in
food such as soups and yoghurts, to help reduce the swelling.
 In some cases, the patient may also be given diuretics (tablets to help the patient pee
more), such as furosemide.
 Side effects of diuretics can include dehydration and reduced levels of sodium and
potassium in the blood.

9. Anaemia
Many people with advanced-stage CKD develop anaemia, which is a lack of red blood cells.
Symptoms of anaemia include:

 tiredness
 lack of energy
 shortness of breath
 a pounding, fluttering or irregular heartbeat (palpitations)

If the patient has anaemia, injections of a medicine called erythropoietin may be given. This
is a hormone that helps the body produce more red blood cells. If the patient has an iron
deficiency as well, iron supplements may also be recommended.
If the patient has anaemia but do not have iron deficiency, a medicine called Roxadustat
may be given. This medicine helps the body to produce more red blood cells and comes as
tablets.

10. Bone problems

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SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

 If the kidneys are severely damaged, it can lead to a build-up of phosphate inthe
body because the kidneys cannot get rid of it.
 Along with calcium, phosphate is important for maintaining healthy bones. But if the
phosphate level rises too much, it can upset the balance of calcium in the body
and lead to thinning of the bones.
 The patient may be advised to limit the amount food which are high in phosphate,
such as red meat, dairy products, eggs and fish. If this does not lower phosphate
level enough, the patient may be given medicines called phosphate binders.
Commonly used medicines include calcium acetate and calcium carbonate.
 Some people with CKD also have low levels of vitamin D, which is necessary for
healthy bones. If vitamin D is low, a supplement called colecalciferol or ergocalciferol
may be given to boost vitamin D level.

11. Glomerulonephritis
 Kidney disease can be caused by inflammation of the filters inside the kidneys,
known as glomerulonephritis. In some cases this happens as a result of the immune
system mistakenly attacking the kidneys.
 If a kidney biopsy finds this is the cause of kidney problems, medicine to reduce the
activity of the immune system may be prescribed, such as a steroid or a medicine
called cyclophosphamide.

12. Improving muscle strength

 If the patient is having a bad flare-up and is unable to exercise, electrical stimulation
may be offered to make the muscles stronger. This is where electrodes are placed on
the skin and small electrical impulses are sent to weak muscles, usually in the arms
or legs.

13. Supportive treatment

 The patient will be offered supportive treatment if he decides not to have dialysis or a
transplant for kidney failure, or they're not suitable for him. This is also called
palliative or conservative care. The aim is to treat and control the symptoms of kidney
failure. It includes medical, psychological and practical care for both the person with
kidney failure and their family, including discussion about their feelings and planning
for the end of life.

Many people choose supportive treatment because they:

 are unlikely to benefit from or have a good quality of life with treatment
 do not want to go through the inconvenience of treatment with dialysis
 are advised against dialysis because they have other serious illnesses, and the
negative aspects of treatment outweigh any likely benefits
 have been on dialysis, but have decided to stop this treatment
 are being treated with dialysis, but have another serious illness, such as severe heart
disease or stroke, that will shorten their life

Doctors and nurses will make sure the patient receives:

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SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

 medicines to protect remaining kidney function for as long as possible

 medicines to treat other symptoms of kidney failure, such as feeling out of breath,
anaemia, loss of appetite or itchy skin
 help to plan home and money affairs
 bereavement support for the family

LABORATORY AND DIAGNOSTICS

1. Blood test form Glomerular Filtration Rate (GFR)

 The main test for kidney disease is a blood test.

 The health care provider will use a blood test to check kidney function. The results of
the test mean the following:

 a GFR of 60 or more is in the normal range. Ask your health care provider when
your GFR should be checked again.
 a GFR of less than 60 may mean you have kidney disease. Talk with your health
care provider about how to keep your kidney health at this level.
 a GFR of 15 or less is called kidney failure. Most people below this level need
dialysis or a kidney transplant. Talk with your health care provider about your
treatment options.

 GFR can’t be raised, but it can be prevented from going lower.

 Creatinine. Creatinine is a waste product from the normal breakdown of muscles in

the body. Kidneys remove creatinine from the blood. Providers use the amount of
creatinine in the blood to estimate GFR. As kidney disease gets worse, the level of
creatinine goes up.

NURSING RESPONSIBILITIES

Before the Blood Test:

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SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

1. Assessment and Preparation:

 Assess the patient's medical history, including their kidney function and any
prior blood test results.
 Confirm the need for the blood test and its purpose (e.g., monitoring kidney
function, assessing anemia).
 Check the patient's vital signs, including blood pressure, heart rate, and
temperature.
 Review the patient's medications to identify any that may need to be adjusted
before the test.
 Ensure that the patient is adequately hydrated, as dehydration can affect
blood test results.
2. Patient Education:
 Explain the purpose of the blood test and what it will involve.
 Inform the patient if they need to fast before the test (e.g., for lipid profiles or
glucose testing).
 Discuss any potential risks or discomfort associated with the blood draw.
3. Informed Consent:
 Ensure that the patient understands the procedure and obtains their informed
consent.

During the Blood Test:

1. Blood Collection:
 Perform the blood draw using aseptic technique and following established
protocols.
 Ensure the patient is comfortable and relaxed during the procedure.
 Monitor the patient for any signs of discomfort or adverse reactions.
2. Labeling and Handling:
 Label the blood samples accurately with the patient's information and the date
and time of collection.
 Ensure proper handling and transportation of the samples to the laboratory.

After the Blood Test:

1. Post-Test Monitoring:
 Monitor the patient for any immediate post-procedure complications such as
bleeding, hematoma formation, or lightheadedness.
 Provide appropriate care or interventions as needed.
2. Comfort and Support:
 Offer reassurance and comfort to the patient if they experienced discomfort
during the blood draw.
 Address any concerns or questions the patient may have about the test
results.
3. Documentation:
 Document the blood test procedure, including details of the blood draw,
patient's response, and any complications.
 Record the time of sample collection and send the samples to the laboratory
for analysis promptly.
4. Follow-Up:
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
Collaborate with the healthcare provider to review and interpret the test
results.
 Initiate any necessary interventions or medication adjustments based on the
results.
 Educate the patient about the significance of the results and any
recommended changes in their treatment or lifestyle.
5. Communication:
 Communicate the test results to the patient, ensuring they understand the
implications and any required actions.
 Coordinate follow-up appointments or consultations with the healthcare team
as needed.

2. Urine Test for Albumin

 If a patient is at risk for kidney disease, the healthcare provider may check urine for
albumin.

 Albumin is a protein found in the blood. A healthy kidney doesn’t let albumin pass
into the urine. A damaged kidney lets some albumin pass into the urine. The less
albumin in the urine, the better. Having albumin in the urine is called albuminuria.

A health care provider can check for albumin in the urine in two ways:

 Dipstick test for albumin. A provider uses a urine sample to look for albumin in the
urine. The patient collects the urine sample in a container in a health care provider’s
office or lab. For the test, a provider places a strip of chemically treated paper, called
a dipstick, into the urine. The dipstick changes color if albumin is present in the urine.
 Urine albumin-to-creatinine ratio (UACR). This test measures and compares the
amount of albumin with the amount of creatinine in eth urine sample. Providers use
the UACR to estimate how much albumin would pass into the urine over 24 hours. A
urine albumin result of

o 30 mg/g or less is normal

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BACHELOR OF SCIENCE IN NURSING – LEVEL II

o more than 30 mg/g may be a sign of kidney disease

If the patient has albumin in the urine, the healthcare provider may want him to repeat the
urine test one or two more times to confirm the results. And if he has kidney disease,
measuring the albumin in the urine helps the provider know which treatment is best. A urine
albumin level that stays the same or goes down may mean that treatments are working.

NURSING RESPONSIBILITIES:

Before the Urine Test:

1. Assessment and Preparation:

 Review the patient's medical history, including their kidney function and any
previous urine test results.
 Determine the purpose of the urine test (e.g., assessing kidney function,
monitoring for proteinuria or hematuria).
 Check the patient's vital signs, including blood pressure and heart rate.
 Review the patient's medications and assess if any should be temporarily
adjusted or withheld before the test.
2. Patient Education:
 Explain the reason for the urine test and what it entails.
 Provide instructions for collecting a clean-catch or midstream urine sample if
required.
 Inform the patient of any specific dietary or medication restrictions leading up
to the test.
3. Informed Consent:
 Ensure the patient understands the procedure and obtains their informed
consent if necessary.

During the Urine Test:

1. Urine Collection:
 Instruct the patient on the proper technique for collecting a clean-catch or
midstream urine sample, if applicable.
 Provide the necessary materials for urine collection, such as a sterile
container.
 Ensure the patient collects the sample correctly and labels it with their name,
date, and time.
2. Specimen Handling:
 Properly label the urine sample container with the patient's information.
 Ensure the urine sample is stored appropriately, following any specific
storage requirements.

After the Urine Test:

1. Post-Test Monitoring:
 Observe the patient for any immediate post-procedure complications or
discomfort.

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BACHELOR OF SCIENCE IN NURSING – LEVEL II

 Address any concerns or discomfort the patient may experience after

collecting the urine sample.
2. Documentation:
 Document the urine collection procedure, including patient instructions, the
appearance of the sample, and any patient discomfort.
 Record the date and time of collection and send the sample to the laboratory
for analysis as per hospital protocols.
3. Follow-Up:
 Collaborate with the healthcare provider to review and interpret the urine test
results.
 Initiate any necessary interventions or medication adjustments based on the
results.
 Educate the patient about the significance of the results and any
recommended changes in their treatment or lifestyle.
4. Communication:
 Communicate the urine test results to the patient, ensuring they understand
the implications and any required actions.
 Coordinate follow-up appointments or consultations with the healthcare team
as needed.

Other tests:
Sometimes other tests are also used to assess the level of damage to the kidneys.
These may include:
o to see what the kidneys look like and check whether there are any blockages
 An ultrasound scan

NURSING RESPONSIBILITIES:

Before the Ultrasound Scan:

1. Assessment and Preparation:

 Review the patient's medical history, including their kidney function and any
relevant previous imaging studies.
 Confirm the reason for the ultrasound, such as assessing kidney size,
detecting cysts, or evaluating blood flow.
 Check the patient's vital signs, including blood pressure and heart rate.
 Assess the patient's allergies and any contraindications to ultrasound contrast
agents if they are to be used.
 Explain the procedure to the patient, including its purpose and what to expect.
2. Patient Preparation:
 Ensure the patient has an empty bladder if the ultrasound involves the
kidneys. This may require the patient to void before the scan.
 Assist the patient in changing into a hospital gown, if necessary.
 Remove any metallic objects or jewelry from the patient's body that might
interfere with the ultrasound.
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Tuguegarao City, Cagayan 3500

SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

3. Informed Consent:
 Confirm that the patient understands the procedure and its potential risks and
benefits.
 Obtain informed consent from the patient if required by hospital policy or local
regulations.

During the Ultrasound Scan:

1. Assist the Patient:

 Position the patient comfortably on the examination table, ensuring they are
relaxed and properly aligned for the ultrasound.
 Provide any necessary support or reassurance to help ease any anxiety.
2. Equipment Setup:
 Assist the ultrasound technician in preparing the equipment, including
applying ultrasound gel to the transducer to enhance image quality.
3. Monitoring:
 Monitor the patient's vital signs throughout the procedure to ensure their
stability and comfort.

After the Ultrasound Scan:

1. Post-Test Monitoring:
 Observe the patient for any immediate post-procedure complications or
discomfort.
 Assess the patient for any signs of an adverse reaction to ultrasound contrast
agents if they were used.
2. Documentation:
 Document the ultrasound procedure, including patient positioning, any
complications or reactions, and the date and time of the scan.
 Ensure accurate labeling of the images and any documentation required by
the healthcare facility.
3. Patient Care:
 Assist the patient in returning to their regular clothing if necessary.
 Provide any additional care or comfort measures as needed.
4. Follow-Up:
 Collaborate with the healthcare provider to review the ultrasound findings and
their implications for the patient's care.
 Educate the patient about the results and any recommended follow-up
actions or treatments.
5. Communication:
 Communicate the results to the patient and answer any questions they may
have.
 Ensure timely reporting of the ultrasound findings to the healthcare team for
further management.

 MRI scan
NURSING RESPONSIBILITIES:

Before the MRI Scan:

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Tuguegarao City, Cagayan 3500

SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

1. Assessment and Preparation:

 Review the patient's medical history, including their kidney function and any
contraindications to MRI (e.g., presence of metallic implants, claustrophobia).
 Confirm the reason for the MRI, such as evaluating kidney anatomy or
assessing complications related to CKD.
 Check the patient's vital signs, including blood pressure and heart rate.
 Assess the patient's allergies, particularly any allergies to contrast agents if
they will be used.
 Explain the MRI procedure to the patient, emphasizing the need for lying still
during the scan.
2. Patient Preparation:
 Ensure the patient has removed all metallic objects, such as jewelry and
clothing with metal zippers or snaps.
 Confirm that the patient is not wearing any accessories or clothing that could
interfere with the MRI's magnetic field.
3. Informed Consent:
 Verify that the patient understands the MRI procedure, including potential
risks and benefits.
 Ensure informed consent is obtained according to hospital policy and legal
requirements.
4. Hydration:
 Encourage adequate hydration in the CKD patient to help protect their
kidneys, especially if contrast dye will be used. Adequate hydration can
minimize the risk of contrast-induced nephropathy.

During the MRI Scan:

1. Assist the Patient:

 Help the patient onto the MRI table, ensuring they are comfortable and
correctly positioned for the scan.
 Offer support to patients who may experience anxiety or claustrophobia
during the procedure.
2. Safety Measures:
 Ensure that the patient is not wearing any items containing metal that could
be attracted to the MRI magnet.
 Confirm that any metallic objects or devices, such as pacemakers or hearing
aids, are identified and properly managed to prevent adverse effects.
3. Monitoring:
 Monitor the patient's vital signs, including blood pressure and heart rate,
throughout the MRI procedure.
 Stay alert for any signs of discomfort or distress and respond promptly.

After the MRI Scan:

1. Post-Test Monitoring:
 Observe the patient for any immediate post-procedure complications or
reactions, such as dizziness or allergic reactions.
 Assess the patient's vital signs and general well-being.
2. Hydration and Kidney Protection:
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Tuguegarao City, Cagayan 3500

SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

 Encourage the patient to continue hydrating after the scan, as this can help
flush out any contrast dye and protect their kidneys.
 Be vigilant for any signs of contrast-induced nephropathy, such as changes in
urine output or kidney function, and report them to the healthcare team.
3. Documentation:
 Document the MRI procedure, including patient positioning, any
complications, and the date and time of the scan.
 Ensure accurate labeling and storage of MRI images and any required
documentation for the healthcare facility.
4. Patient Care:
 Assist the patient in getting dressed and provide any necessary post-scan
care or comfort measures.
5. Follow-Up:
 Collaborate with the healthcare provider to review and interpret the MRI
findings.
 Educate the patient about the results and any recommended follow-up
actions or treatments.
6. Communication:
 Communicate the MRI results to the patient and address any questions or
concerns they may have.
 Ensure timely reporting of the MRI findings to the healthcare team for further
management.

 CT scan
NURSING RESPONSIBILITIES:

Before the CT Scan:

1. Assessment and Preparation:

 Review the patient's medical history, including their kidney function and any
contraindications to contrast media or medications.
 Confirm the reason for the CT scan, such as evaluating kidney anatomy,
identifying stones, or assessing complications related to CKD.
 Check the patient's vital signs, including blood pressure and heart rate.
 Assess the patient's allergies, particularly any allergies to contrast agents if
they will be used.
 Explain the CT scan procedure to the patient, including the use of contrast
media, if applicable.
2. Patient Preparation:
 Ensure the patient has removed all metallic objects, jewelry, and clothing with
metal components that could interfere with the CT scan.
 Verify that the patient is not wearing any accessories or clothing that might
create artifacts in the images.
3. Informed Consent:
 Confirm that the patient understands the CT scan procedure, including
potential risks and benefits.
 Ensure informed consent is obtained following hospital policy and legal
requirements.
4. Hydration:
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Tuguegarao City, Cagayan 3500

SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

 Encourage adequate hydration in the CKD patient to help protect their

kidneys, especially if contrast dye will be used. Hydration can minimize the
risk of contrast-induced nephropathy.

During the CT Scan:

1. Assist the Patient:

 Help the patient onto the CT scanning table, ensuring they are comfortable
and correctly positioned for the scan.
 Offer support to patients who may experience anxiety or claustrophobia
during the procedure.
2. Safety Measures:
 Ensure that the patient is not wearing any items containing metal that could
be attracted to the CT scanner's magnetic field.
 Confirm that any metallic objects or devices, such as pacemakers or hearing
aids, are identified and properly managed to prevent adverse effects.
3. Monitoring:
 Monitor the patient's vital signs, including blood pressure and heart rate,
throughout the CT scan.
 Stay alert for any signs of discomfort or distress and respond promptly.

After the CT Scan:

1. Post-Test Monitoring:
 Observe the patient for any immediate post-procedure complications or
reactions, such as allergic reactions or delayed nausea.
 Assess the patient's vital signs and general well-being.
2. Hydration and Kidney Protection:
 Encourage the patient to continue hydrating after the scan to help flush out
any contrast dye and protect their kidneys.
 Be vigilant for any signs of contrast-induced nephropathy, such as changes in
urine output or kidney function, and report them to the healthcare team.
3. Documentation:
 Document the CT scan procedure, including patient positioning, any
complications, and the date and time of the scan.
 Ensure accurate labeling and storage of CT images and any required
documentation for the healthcare facility.
4. Patient Care:
 Assist the patient in getting dressed and provide any necessary post-scan
care or comfort measures.
5. Follow-Up:
 Collaborate with the healthcare provider to review and interpret the CT scan
findings.
 Educate the patient about the results and any recommended follow-up
actions or treatments.
6. Communication:
 Communicate the CT scan results to the patient and address any questions
or concerns they may have.

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Tuguegarao City, Cagayan 3500

SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

 Ensure timely reporting of the CT findings to the healthcare team for further
management.

 A kidney biopsy – a small sample of kidney tissue is removed and the cells are
examined under a microscope for signs of damage

NURSING RESPONSIBILITIES:

Before the Kidney Biopsy:

1. Assessment and Preparation:

 Review the patient's medical history, including their kidney function,
coagulation profile, and any relevant laboratory results.
 Confirm the indication for the kidney biopsy, such as diagnosing kidney
disease, assessing graft function, or monitoring disease progression in CKD.
 Assess the patient's vital signs, including blood pressure and heart rate.
 Review the patient's medications, especially anticoagulants and antiplatelet
agents, and coordinate with the healthcare provider to adjust or withhold them
as needed before the procedure.
2. Informed Consent:
 Ensure that the patient fully understands the kidney biopsy procedure, its
purpose, potential risks, and benefits.
 Obtain informed consent according to hospital policies and legal
requirements.
3. Patient Education:
 Educate the patient about the kidney biopsy, including the steps involved,
expected sensations (e.g., discomfort during the procedure), and potential
post-biopsy precautions.
 Provide pre-procedure instructions, such as fasting before the biopsy and the
importance of holding certain medications.
4. Pre-Procedural Medications:
 Administer pre-procedural medications as ordered by the healthcare provider,
which may include anxiolytics or analgesics to help the patient relax and
manage discomfort during the biopsy.

During the Kidney Biopsy:

1. Assist the Patient:

 Position the patient correctly, usually in a prone or supine position depending
on the approach chosen for the biopsy.
 Offer emotional support and reassurance to help alleviate anxiety or
nervousness.
2. Safety Measures:
 Ensure that the biopsy site is properly marked and identified.
 Assist the physician in maintaining a sterile field and adhering to infection
control protocols.
 Monitor the patient's vital signs throughout the procedure.
3. Monitoring and Documentation:

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Tuguegarao City, Cagayan 3500

SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

 Continuously monitor the patient's vital signs, including blood pressure, heart
rate, and oxygen saturation.
 Document the procedure, including patient positioning, the number of biopsy
samples obtained, and any complications or patient reactions.

After the Kidney Biopsy:

1. Post-Procedure Monitoring:
 Observe the patient closely for several hours after the biopsy to monitor for
any immediate complications such as bleeding, hematoma formation, or signs
of infection.
 Assess the patient's vital signs at regular intervals and record them.
2. Pain Management:
 Manage post-biopsy pain by administering pain medications as ordered by
the healthcare provider.
 Ensure the patient is comfortable and provide pain relief as needed.
3. Post-Biopsy Care:
 Encourage the patient to maintain strict bed rest for a specified period as
determined by the healthcare provider.
 Monitor the biopsy site for any signs of bleeding, infection, or other
complications.
 Administer antibiotics if prescribed to prevent infection.
4. Hydration and Kidney Function:
 Promote hydration to help flush out contrast dye and minimize the risk of
contrast-induced nephropathy.
 Monitor kidney function by assessing urine output and laboratory results.
5. Communication:
 Report any concerns, complications, or changes in the patient's condition to
the healthcare provider promptly.
 Communicate the biopsy results to the patient and address any questions or
concerns they may have.
6. Education and Discharge Planning:
 Educate the patient about post-biopsy care instructions, including limitations
on physical activity, signs of complications to watch for, and follow-up
appointments.
 Coordinate discharge planning and ensure the patient has appropriate
transportation home.

Test results and stages of CKD

Test results can be used to determine how damaged the kidneys are, known as the stage of
CKD. This can help the doctor decide the best treatment for the patient and how often he
should have tests to monitor his condition.
The eGFR results is given as a stage from 1 of 5:
 stage 1 (G1) – a normal eGFR above 90ml/min, but other tests have detected signs
of kidney damage
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SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

 stage 2 (G2) – a slightly reduced eGFR of 60 to 89ml/min, with other signs of kidney
damage
 stage 3a (G3a) – an eGFR of 45 to 59ml/min
 stage 3b (G3b) – an eGFR of 30 to 44ml/min
 stage 4 (G4) – an eGFR of 15 to 29ml/min
 stage 5 (G5) – an eGFR below 15ml/min, meaning the kidneys have lost almost all of
their function

The ACR result is given as a stage from 1 to 3:

 A1 – an ACR of less than 3mg/mmol
 A2 – an ACR of 3 to 30mg/mmol
 A3 – an ACR of more than 30mg/mmol

For both eGFR and ACR, a higher stage indicates more severe kidney disease.

STATISTICS

LOCAL STATISTICS

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Tuguegarao City, Cagayan 3500

SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

*No statistics found

NATIONAL STATISTICS

Description: There were 24,489 deaths in the year 2021 which is considered the highest
number of cases in the Philippines with the rate of 2,428,327 from within the years 2017 and
2021.

INTERNATIONAL STATISTICS

Description: There were 4 million deaths in the year 2021 which is considered the highest
number of cases globally with the rate of 933 milion from within the years 2017 and 2021.

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Tuguegarao City, Cagayan 3500

SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

PATIENT’S PROFILE

NAME: D.B. S
SEX: Male
AGE: 42 years 5 months
BIRTHDATE: March 26, 1981
ADDRESS: City of Tabuk
NATIONALITY: Filipino
DIALECT: Kalinga, Ilocano, Tagalog
RELIGION: Free Believers in Christ
OCCUPATION: Farming
CIVIL STATUS: Married
DATE OF ADMISSION: September 12, 2023
TIME OF ADMISSION: 3:41 PM
CHIEF COMPLAINT: Generalized muscle cramps
ADMITTING DIAGNOSIS: To consider Electrolyte Imbalance Chronic Kidney Disease
secondary to Diabetes Mellitus
FINAL DIAGNOSIS: ---
ATTENDING PHYSICIAN: Dr. Edmund C. Bautista, M. D.
SURGICAL PROCEDURE: Internal Jugular Insertion
DATE HANDLED: September 26, 2023

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Tuguegarao City, Cagayan 3500

SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

NURSING HEALTH HISTORY

HISTORY OF PAST ILLNESS

The SO verbalized that patient D.B. S has completed childhood immunizations but
cannot specifically recall each vaccine. Furthermore, she verbalized that the patient was also
able to complete the vaccination against COVID-19. He received the Sinovac brand. She
stated that the patient has not experienced any past unintentional injuries and childhood
illnesses. Although, the patient was already previously hospitalized in St. Paul Hospital last
2021 because of typhoid fever and kidney problems. Additionally, the SO stated that
whenever the patient suffers from common colds and fever, he managed it by drinking over-
the-counter drugs like Paracetamol and Ibuprofen. Also, he starts his day by taking Vitamin
Supplements. The SO finished the statement by stating that patient D.B. S does not have
any allergy to any food or medications.

HISTORY OF PRESENT ILLNESS

Prior to hospital admission, September 12, 2023, the SO stated that patient D.B. S
experienced severe pain during urination and suddenly noticed that there were tiny “stone-
like” objects coming out from his urethra that makes it hard for him to urinate. Later that day,
the patient also experienced severe muscle spasms to the point that he had to be strangled
and pinned down by his family members and close neighbors. This pushed the family to rush
the patient in Tabuk Hospital in order to get treatment and assistance for his situation. Due
to lack of resources and facilities, patient D.B. S had to be referred to Divine Mercy Wellness
Center then later transferred to Saint Paul Hospital because of personal reasons on
September 12, 2023 3:41 PM under the service of Dr. E. Bautista with a chief complaint of
generalized muscle cramps and with initial vital signs of: BP= 130/80, BT= 36 C, RR=
22cpm, HR=61 bpm with the admitting diagnosis of: To consider Electrolyte Imbalance
Chronic Kidney Disease secondary to Diabetes Mellitus. On September 17, 2023, he
underwent Internal Jugular insertion. The patient is still admitted in Saint Paul Hospital at the
moment where he is currently receiving treatment and medications like Nasogastric Tube
feeding and undergoing certain management procedures like Hemodialysis.

FAMILY HISTORY

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SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

SOCIAL HISTORY
The SO stated that patient D.B. S is a high school graduate. He is an Ilocano,
Kalinga and Tagalog speaker who works on the farm every day of the week at an irregular

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SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

time. The SO stated that the patient spends most of his time working and only goes back
home at night to rest and spend quality time with his wife and three children. In terms of
budget and expenses, patient D. B. S is able to provide for their basic needs and she
described him as a very thrifty man.

ENVIRONMENTAL HISTORY
The significant other stated that the patient’s house is a small, concrete bungalow-
style house with one bedroom. She said that it is fairly clean and well-lit and added that the
place is safe and conducive environment since she often visits them. According to the SO,
the patient has a nuclear type of family. She added that no one from within the patient’s
family smokes cigarettes and uses e-cigarettes nor drinks any alcoholic beverages. The SO
also added that the patient uses “nganga” (betel nut in English) most of the time and he has
been doing it since his teenage years. Their electricity is being provided by Kalinga-Apayao
Electric Cooperative. In terms of water, she stated that they use tap water. They do not have
any other pets besides two dogs but there are many stray animals in their neighborhood.
The area is accessible by riding on a bus en route to their area. Upon arrival, they still have
to ride a pedicab since their house is located at the extremity of their community.

GORDON’S 11 FUNCTIONAL HEALTH PATTERN

*NOTE: The SO was the only subject for the interview because patient D.B. S is asleep,
weak and unresponsive to verbal stimuli.

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SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

HEALTH PATTERN BEFORE HOSPITALIZATION DURING HOSPITALIZATION

1. Health The SO confirmed that patient The SO stated that she
Perception-Health D.B. S was able to completely makes sure that patient D.B.
Management receive all childhood S will adhere to all of his
vaccinations. However, she physician’s pieces of advice
cannot recall all these and medication regimen all
specifically. He was also able the time. As verbalized, “Hindi
to receive Sinovac COVID-19 kasi nakakapunta ang iba
vaccination including booster naming kamag-anak dito pati
doses. When asked about asawa nya minsan lang kasi
allergies, the SO stated that nag-aalaga ng mga anak nila.
the patient has no known Kaya sinisigurado ko na
allergies to any food or talagang naaasikaso siya ng
medications. She added that maayos dito. At gusto ko lahat
the patient manages mild ng gagawin sakanya ay alam
illnesses using over-the- ko dahil sa ngayon, ako lang
counter drugs and also takes ang maaasahan niya.”
Vitamin Supplements every
day. The patient has several
histories of hospitalization
episodes because of typhoid
fever and kidney problems last
2021. Additionally, she stated
that patient D.B. S does not
smoke cigarettes, use e-
cigarettes nor drink alcoholic
beverages. Although, he can’t
distance himself from the
smoke coming from other
cigarette users and other
pollutions since he works in a
wide, open area.
2. Nutritional – The SO verbalized that patient During hospitalization, the
Metabolic D.B. S does not measure his patient’s diet shifted to Total
food intake every meal. She Parenteral Nutrition and was
stated that, “Basta malakas receiving feedings via
siya kumain tapos kakain siya Nasogastric Tube.
hanggang sa mabusog.” His
usual meal consists of rice,
meat, and vegetables. She
further mentioned that patient
D.B. S actually prefers
vegetables and fruits rather
than meats especially those
that are very oily. She added,
“Malakas din yan uminom ng
tubig lalo dahil maghapon siya
nakabilad sa initan gawa ng
trabaho niya sa pagsasaka.”
The SO also verbalized that he
was not having any difficulty
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SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

with regards to eating such as

difficulty with chewing,
swallowing, nausea, or
vomiting.

3. Elimination The SO of the patient stated During hospitalization, the

that the patient has patient was wearing diapers
experienced pain on urination. and she seldomly changes it
Prior to admission, the patient because either it ends up
noticed a stone-like object empty or it takes a long time
coming out from his urethra before it will be full.
and that they were very painful. Furthermore, their physician
She added that the patient regularly orders for a
reported that sometimes, it Hemodialysis session for
takes several days before he patient D.B. S.
could pass stool.
4. Activity – According to the SO, patient The SO stated that, “Simula
Exercise D.B. S does not exercise nang na admit siya dito, ako
anymore because he already na ang nagging tagapag-
works all day at the farm. asikaso ng lahat ng kaiangan
niya. Kasi tignan mo naman,
sobrang hina na siya, hindi na
makagalaw at makapag salita.
Minsan nga natatakot nalang
ako na bigla nalang siyang
hindi magising.” She added
that she dials their family all
the time and places the
camera in front of patient D.B.
S and said, “Para kahit hindi
nila siya nakakausap, panatag
sila dahil nakikita lang nila
siya dyan kahit sa cellphone
lang.”
5. Sleep – Rest The SO stated that the patient During hospitalization, patient
has been feeling difficulty D.B. S is asleep most of the
sleeping for a long time now time and is not even awoken
and that he is easily awaken by during vital signs monitoring,
even the faintest sounds. therapies or feeding. He does
According to her, he did not not respond to verbal stimuli
take any sleeping pills and did so the SO and care providers
not make any other have to inflict pain to the
management about his patient in order to get a
sleeping pattern. However, response.
during afternoon, patient D.B.
S sleeps for up to 4 hours.
6. Cognitive – The SO stated that patient D. During hospitalization, the
Perceptual B. S has no problem with sight, patient is not oriented to time,
hearing, taste, touch, and place, and person. He does
smell. He also does not wear not respond to verbal stimuli
eyeglasses nor uses eye and can only move his eyes
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BACHELOR OF SCIENCE IN NURSING – LEVEL II

products for radiation slightly during painful stimuli.

protection. Additionally, the
patient does not have
problems with speech,
memory, and decision-making.
7. Self – The SO stated that patient D.B. During hospitalization, the
Perception/Self S was not very conscious of patient is able to keep up with
Concept his appearance. She stated his grooming on a daily basis
that, “Syempre magiging with the assistance of his SO.
madumi talaga yan sa trabaho
niya kaya hindi na sya nag-
aabala pa na mag-ayos. Saka
nalang siya maglilinis tuwing
uwian na. Minsan nga hindi pa
yan maliligo dahil pagod na sa
trabaho.”
8. Role – The SO stated that although During hospitalization, the SO
Relationship patient D.B. S is in a nuclear stated that the patient’s
family setting, they were still relatives took over his work at
very close to each other. She the farm. She added that
added that the patient serves although patient D.B. S does
as the breadwinner for the not get regular visits from
family and that he is satisfied friends and family, they
and content with whatever they always call him in order to
have and his relationship with show their support.
his family and others as well.
She stated that, “Harmonious
ang samahan nila at kung may
mga pagtatalo man, sinisiguro
nil ana maaayos nila ito sa
maayos na usapan. Ayaw rin
nilang pinapakita na may
problema sila sa harap ng mga
bata which is maganda naman
yun.”
9. Sexuality - The SO does not remember ---
Reproductive when patient D.B. S was
circumcised. She stated that,
“Pagdating sa pamilya nila
mismo ay hindi ako aware kasi
syempre, ang mga personal na
desisyon nila about sa loob ng
pamilya ay dapat sakanila
nalang din yun.”
10. Coping/Stress According to the SO, long work ---
Tolerance hours and natural disasters are
his sources of stress. When
stressed, he usually just come
home early and listen to music,
watch Television or scroll
through his mobile phone. The
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SO also mentioned that he

often tries to ignore or bottle up
his feelings and often does
“stress-eating”. However, this
causes him to become ill-
tempered at times.
11. Value - Belief The patient’s religion is Free During hospitalization, the SO
Believers in Christ. According states that, “Kahit hindi yan
to the SO, patient D.B. S nakakapagsalita alam ko
attends Sunday masses and nagdadasal yan sa isipan
prays all the time. Other than niya. Kaya kahit ganyan ang
those, he does not participate nangyari sakanya ay malakas
to other activities but observes ang loob niya na tuloy lang sa
traditional practices and values paglaban.” She added that
them well. she and her family also prays
for the recovery of patient
D.B. S.

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PHYSICAL ASSESSMENT
Date of Assessment: September 26, 2023 at 10 AM
General Appearance: Received patient on a Semi-Fowler’s Position asleep with ongoing IV
fluid of Normal Saline 1 Liter x KVO at 500 mL on left arm, hooked to Oxygen Support, with
Nasogastric and Internal Jugular inserted on the right side of the neck. Upon assessment,
the patient is weak and lethargic.
Upon Assessment Vital Signs:
Blood Pressure: 130/90 mmHg Height: ---
Pulse Rate: 93 bpm Weight: ---
Respiratory rate: 16 cpm BMI: ---
Temperature: 37.0 C
Oxygen Saturation: 96%
Pain Scale: ---

AREA TECHNIQUE NORMAL FINDINGS ACTUAL FINDINGS ANALYSIS

ASSESSED USED
Skin
Color Inspection Skin color based on the The patient has a tan Not normal due
genetic, race, and skin complexion. No to patient’s
environmental effects. cyanosis, although kidneys not
Normal to see pigmented there is presence of making enough
nevi, non-pigmented pallor and jaundice. erythropoietin
striae, freckles, and which causes
birthmarks the red blood
cells to drop
and anemia
Temperature Palpation Warm to touch Warm to touch Normal
Mobility and Palpation Springs back to previous Springs back to Normal
Turgor state previous state
(1-2 seconds) (1-2 seconds)
Moisture Palpation Skin surfaces varies from The skin is moist. Normal
moist to dry depending There is absence of
on the area assessed dry patches
Texture Palpation Smooth and Soft Skin is smooth and Normal
soft upon palpation
Lesions and Inspection No lesions and scars No presence of Normal
Scars lesions or scars
Hair
Color Inspection Color varies depends on The patient’s natural Normal
the genetics and race. hair color is black
Changes with rinses, with presence of
dyes, and permanents. some white hair due
to age.
Distribution Inspection Evenly distributed The hair is evenly Normal
distributed

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Texture Inspection Smooth, Firm, and Silky The hair is smooth, Normal
and firm and silky.
Palpation
Parasite Inspection No infestation No infestation Normal
and
Palpation
SCALP
Symmetry Inspection Symmetrical, appropriate Symmetrical, Normal
with age, gender, and appropriate with age,
body structure gender, and body
structure
Appearance Inspection No seborrheic dermatitis, No seborrheic Normal
lesions, and dermatitis, lesions,
inflammations and inflammations
Head
Shape and Inspection Normocephalic and Normocephalic and Normal
Symmetry Symmetric Symmetric
Consistency Inspection Hard and smooth; Hard and smooth; Normal
without nodules, masses, without nodules,
and depressions masses, and
depressions
Facial Features Inspection No dysmorphic features No dysmorphic Normal
and no presence of features and no
lesions and edema presence of lesions
and edema
Nails
Color of Nail Inspection Pinkish in color Presence of pallor Not normal
Bed and slightly yellow in due to the
color accumulation
of nitrogen
waste in the
bloodstream
Curvature Inspection Convex Convex Normal
Tissue Palpation Epidermis is intact Epidermis is intact Normal
surrounding
nail
Texture Palpation Smooth The nails are brittle Not normal
and ridged due to a low
level of keratin
Capillary Refill Palpation Pink tone returns Pink tone returns Normal
Time immediately when immediately when
pressure is released (< 2 pressure is released
seconds) (< 2 seconds)
Face
Symmetry Inspection Proportionate and Proportionate and Normal
Symmetric Symmetric
Facial Inspection Movements are equal The patient Not normal due
Movement bilaterally experiences difficulty to imbalanced
in making facial fluid and
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movements electrolytes,
diminished
muscle control,
weakness and
diminished
physical
activities
Color Inspection Same as body color Same as body color Normal

Lesion Inspection Smooth without lesion Smooth without Normal

lesion

Eyebrows
Distribution Inspection Hair distributed evenly Brow hairs are Normal
evenly distributed
Quality of Inspection Equal movement The patient Not normal due
movement experiences difficulty to imbalanced
in making facial fluid and
movements electrolytes,
diminished
muscle control,
weakness and
diminished
physical
activities
Alignment Inspection Symmetrically Symmetrically Normal
aligned aligned
Eyelashes
Evenness Inspection Distributed equally Lash hairs are Normal
equally distributed
Direction of curl Inspection Curled outwards Lashes are slightly Normal
Slightly curled outwards
Appearance Inspection Combed, moisturized, Presence of dried up Not normal due
nourished and hard rheum to decreased
self-care
abilities due to
hospitalization
Eyes
Position, Size, Inspection Symmetric Eyes are symmetrical Normal
And Shape
Movement Inspection Symmetrical in The patient Not normal due
movement experiences difficulty to diminished
in making facial muscle control,
movements weakness and
diminished
physical
activities
Eyelids Inspection Without swelling, Presence of oil build- Not normal due
discharge and lesions up and dried up, hard to decreased
rheum self-care
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abilities due to
hospitalization
Conjunctiva Inspection Pinkish; free of Presence and Not normal due
discharge, lesions, accumulation of eye to decreased
redness and lacerations discharge self-care
abilities due to
hospitalization
Sclera Inspection White; free of discharge, Presence of redness Not normal due
lesions, redness and in the sclera of the to impaired
lacerations eyes blinking and
tear formation,
leading to dry
eyes
Pupils Inspection Color varies with race; The patient’s pupils Normal
PERRLA are black, equal,
round and reactive to
light and
accommodation
Iris Inspection Round, flat and evenly Round, flat and Normal
colored evenly colored
Pupils
Color Inspection Black in color (according The patient’s pupils Normal
to race, no cloudiness). are black in color (no
cloudiness)
Shape Inspection Round and has smooth Round and has Normal
border smooth border
Symmetry of Inspection Equal in size Equal in size Normal
size
Perrla
Accommodation Inspection Pupils constrict looking Pupils constrict Normal
at near object; dilate looking at near
looking at far object. object; dilate looking
at far object.
Reaction to light Inspection Pupil constricts Pupil constricts Normal
when illuminated when illuminated
(Direct (Direct
response). response).

Pupil when not Pupil when not

illuminated constricts illuminated constricts
(Consensual response). (Consensual
Brisk response. response).
Brisk response.
Visual fields Inspection Able to see objects in *NOTE: I was not *NOTE: I was
periphery when looking able to perform this not able to
straight ahead. assessment because perform this
the patient is weak assessment
and minimally because the
responsive patient is weak
and minimally
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responsive

Extra ocular Inspection Coordinated and has *NOTE: I was not *NOTE: I was
movement unison movement of both able to perform this not able to
eyes with parallel assessment because perform this
alignment. the patient is weak assessment
and minimally because the
responsive patient is weak
and minimally
responsive

Ears
Position Inspection Symmetric The ears are Normal
symmetrical
Size and Shape Inspection Symmetric on both sides Symmetric on both Normal
sides
Color Inspection Consistent with facial The ears are Normal
color consistent with facial
color
Texture Palpation Smooth without lesions, Smooth without Normal
lumps or nodules lesions, lumps or
nodules
Discharge Inspection No discharges No discharges Normal
Hearing Acuity Inspection Responds to sound The patient does not Not normal due
respond to sound to weakness
and diminished
(The significant other physical
confirms that the activities
patient does not have
problems with
hearing)
Mouth
Lip Consistency Inspection Smooth and moist The lips are smooth Normal
without lesions and and moist without
swelling lesions and swelling
Lip Color Inspection Uniform pink color Uniform pink Normal
color
Soft, moist and the
texture is smooth Soft, moist and the
texture is smooth
Symmetrical contour
Symmetrical contour
Teeth Inspection White, no tartars, no Teeth are white, with Not normal
dental carries, complete presence of tartars, due to
set of teeth no dental carries decreased self-
care abilities
during
hospitalization
Gums Inspection Pink and Moist Gums Pink and moist gumsNormal

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Buccal Mucosa Inspection Pink and moist without *NOTE: I was not *NOTE: I was
and lesions able to perform this not able to
Palpation assessment because perform this
the patient is weak assessment
and minimally because the
responsive patient is weak
and minimally
responsive

Tongue Inspection Centrally positioned *NOTE: I was not *NOTE: I was

Pink in color able to perform this not able to
Moist, slightly rough, thin assessment because perform this
whitish coating. the patient is weak assessment
Moves freely. and minimally because the
Absence tenderness and responsive patient is weak
lesions. and minimally
responsive

Uvula Inspection No presence of lesions*NOTE: I was not *NOTE: I was

and tenderness able to perform this not able to
assessment because perform this
Placed at the middle the patient is weak assessment
and minimally because the
Uniform pink color responsive patient is weak
and minimally
responsive

Tonsils Inspection No presence of *NOTE: I was not *NOTE: I was

and discharge able to perform this not able to
palpation assessment because perform this
Pink in color, posterior the patient is weak assessment
wall is smooth and not and minimally because the
inflamed responsive patient is weak
and minimally
responsive

Nose
Position and Inspection Midline in face; Midline in face; Normal
Size Symmetric Symmetric
Configuration of Inspection With nose bridge; With nose bridge; Normal
The Nose located at the midline located at the
Bridge midline
Color Inspection Same as the rest of the Same as the rest of Normal
body the body
Tenderness, Palpation No tenderness or No tenderness or Normal
Masses, And masses masses
Lesions
Patency Inspection Air moves freely as the Air moves freely as Normal
and patient breaths through the patient breaths
Palpation the nares. through the nares.
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Discharges Inspection No discharges No discharges Normal

Nasal Flaring Inspection No nasal flaring There is presence of Not normal due
nasal flaring to pooling of
liquid in the
tissues
because of
prolonged bed
rest

Neck
Mobility Inspection Coordinated, smooth The patient has Not normal
movements with no muscle twitches in due to
discomfort association the area imbalances in
fluid and
electrolytes,
diminished
muscle control,
weakness and
diminished
physical
activities
Position and Inspection Head at center Head at center Normal
Characteristics
Muscles are symmetrical Muscles are
in size symmetrical in size
Thorax
Shape Inspection Smooth, Rounded and Smooth, Rounded Normal
Symmetric and Symmetric
Respiratory Inspection Respirations should be Respirations should Normal
Effort unlabored and unregular; be unlabored and
RR = 18-20 cpm unregular; RR = 18-
20 cpm
Tenderness and Palpation No tenderness or mass No tenderness or Normal
Masses noted mass noted
Breath Sounds Auscultation There is no presence of There is no Normal
wheezing, sighing, presence of
panting, deep inhalations wheezing, sighing,
and exhalations. panting, deep
inhalations and
exhalations.
Heart
Apical Pulse Auscultation Regular and Rapid; 60- Regular and Rapid; Normal
100 bpm 60-100 bpm
Heart Sounds Auscultation Louder, higher Louder, higher Normal
pitched, and pitched, and
of shorter duration; of shorter duration;
innocent murmurs are innocent murmurs
normal are normal
Abdomen
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Shape and Inspection Rounded and prominent Rounded and Normal

Contour in supine positions prominent in supine
positions
Color Inspection Same color as the rest of Same color as the Normal
the body rest of the body
Movement with Inspection Diaphragmatic, Diaphragmatic, Normal
Respirations abdominal and chest abdominal and chest
movements synchronize movements
synchronize
Bowel Sound Auscultation Normal bowel sounds Normal bowel Normal
occur every 10 to 30s; sounds occur every
clicks, gurgles, or growls 10 to 30s; clicks,
can be heard gurgles, or growls
can be heard
Lesions and Inspection No lesions and scars No lesions and scars Normal
Scars
Masses and Palpation Soft to palpation; without Soft to palpation; Normal
Tenderness masses and tenderness without masses and
tenderness
Upper Extremities and Lower Extremities
Color Inspection Color varies based on The patient has Not normal due
genetics and race. yellow discoloration to patient’s
(hyperbilirubinemia kidneys not
or jaundice) on the making enough
both upper and lower erythropoietin
extremities which causes
the red blood
cells to drop
and anemia
Texture Palpation Smooth Smooth Normal
Temperature Palpation 36.5°C-37.5°C normal in 36.5°C-37.5°C Normal
adult normal in adult
Mobility and Palpation Springs back to previous Springs back to Normal
Turgor state previous state
(1-2 seconds) (1-2 seconds)
Lesions Inspection Absence of lesions Absence of lesions Normal
Appearance Inspection Symmetrically aligned Symmetrically Normal
Absence of deformities aligned
Absence of
deformities
Uniformity Inspection Varies depending on Varies depending on Normal
areas that exposed or areas that exposed
not exposed with the or not exposed with
sun the sun

Moisture Palpation Minimal presence of Minimal presence of Normal

perspiration or oiliness. perspiration or
Increased perspiration oiliness.
on palms, scalp, Increased

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forehead, axillae. perspiration on

palms, scalp,
forehead, axillae.

ANATOMY AND PHYSIOLOGY

What are the KIDNEYS?
The kidneys are two bean-shaped organs that filter the blood. The kidneys are part of
the urinary system. They filter about 200 quarts of fluid every day. During this process, the
kidneys remove waste, which leaves the body as urine. Most people urinate about two
quarts daily while the body re-uses the other 198 quarts of fluid.
The kidneys also help balance the body’s fluids (mostly water) and electrolytes.
Electrolytes are essential minerals that include sodium and potassium.

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What do the kidneys do?

The kidneys have many important functions. They clean toxins and waste out of the
blood. Common waste prodycts include nitrogen waste (urea), muscle waste (creatinine) and
acids, they help the body remove these substances. The kidneys filter about half a cup of
blood every minute.
In the process:

1. Blood flows into the kidneys through a large blood vessel called the renal artery.
2. Tiny blood vessels in the kidney filter the blood.
3. The filtered blood returns to the bloodstream through a large blood vessel called the
renal vein.
4. Pee travels through tubes of muscle called ureters to the bladder.
5. The bladder stores urine until it is released through urination.

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The kidneys also:

 Control the acid-base balance (pH balance) of the blood.

 Make sugar (glucose) if the blood doesn’t have enough sugar.
 Make a protein called renin that increases blood pressure.
 Produce the hormones calcitriol and erythropoietin. Calcitriol is a form of vitamin D
that helps the body absorb calcium. Erythropoietin helps the body make red blood
cells.

An adrenal gland sits on top of each kidney. It produces hormones, including cortisol, which
helps the body respond to stress.

Cortisol also plays a role in:

 Controlling metabolism.
 Reducing inflammation.
 Regulating blood pressure.
 Increasing blood sugar levels.

How do kidneys filter blood?

Each kidney contains more than a million filtering units called nephrons. Each
nephron consists of:

● Glomeruli: Glomeruli are groups of tiny blood vessels that perform the first stage of
filtering blood. They then pass filtered substances to the renal tubules. The name for this
process is glomerular filtration.
● Rena tubules: these tiny tubules reabsorb and return water, nutrients and minerals the
body needs (including sodium and potassium). The tubules remove waste, including
excess acid and fluids through a process called diffusion. The body sends the remaining
waste through the kidneys’ collecting chambers. Eventually, it leaves the body as urine.

ANATOMY
Where are the kidneys located?
The kidneys sit just below the ribcage and behind the belly. Typically, one kidney sits
on either side of the spine. The kidneys reside between the intestines and diaphragm. A
ureter connects each kidney to the bladder.
What are the parts of the kidney?
The kidneys are highly complex organs with many parts. The main parts of the
kidney anatomy include:

 Kidney capsule (renal capsule): The renal capsule consists of three layers of
connective tissue or fat that cover your kidneys. It protects your kidneys from injury,
increases their stability and connects your kidneys to surrounding tissues.

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 Renal artery: The renal artery is a large blood vessel that controls blood flow into
your kidneys. For most people at rest, the renal kidneys pump a little over 5 cups (1.2
liters) of blood to your kidneys each minute.
 Renal cortex: The outer layer of your kidney, where the nephrons (blood-filtering
units) begin. The renal cortex also creates the hormone erythropoietin (EPO), which
helps make red blood cells in your bone marrow.
 Renal medulla: The renal medulla is the inner part of your kidney. It contains most of
the nephrons with their glomeruli and renal tubules. The renal tubules carry urine to
the renal pelvis.
 Renal papilla: These pyramid-shaped structures transfer urine to the ureters.
Dehydration and certain medications — especially nonsteroidal anti-inflammatory
drugs (NSAIDs) — may damage your renal papilla.
 Renal pelvis: This funnel-shaped structure collects urine and passes it down two
ureters. Urine travels from the ureters to the bladder, where it’s stored.
 Renal vein: This vein is the main blood vessel that carries filtered blood out of your
kidneys and back to your heart. Each of your kidneys has a renal vein.

What color are the kidneys?

The kidneys are reddish-brown.
How big is a kidney?
Each kidney is about 4 or 5 inches long, around the size of a fist.
How much do kidneys weigh?
The weight of the kidneys varies. Variances may include height, weight, age, body
mass index (BMI) and location.
For men and people assigned male at birth, the right kidney may range from 1/5 to
about 1/2 lbs. (79 grams to 223 grams). The left kidney may range from a little less than 1/5
to a little more than 1/2 lbs. (74 grams to 235 grams). The kidneys may weigh between the
weight of one tennis ball and four tennis balls.
For women and people assigned female at birth, the right kidney may range from a
little more than 1/10 to 3/5 lbs. (55 grams to 274 grams). The left kidney may range from
3/20 to a little less than 3/5 lbs. (67 grams to 261 grams). The kidneys may weigh between
the weight of one tennis ball or five tennis balls.
CONDITIONS AND DISORDERS
What causes kidney damage?
The kidneys perform several important functions within the body. Many different
disorders can affect them. Common conditions that impact the kidneys include:

 Chronic kidney disease: CKD may lessen kidney function. Diabetes or high blood
pressure usually causes CKD.
 Kidney cancer: Renal cell carcinoma is the most common type of kidney cancer.
 Kidney failure (renal failure): It may be acute (worsen suddenly) or chronic (a
permanent lessening of how well your kidneys work). ESRD is a complete loss of
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kidney function. It requires dialysis (treatment to filter the blood in place of the
kidneys).
 Kidney infection (pyelonephritis): A kidney infection can occur if bacteria enter the
kidneys by traveling up the ureters. These infections cause sudden symptoms.
Healthcare providers treat them with antibiotics.
 Kidney stones: This cause crystals to form in your urine and may block urine flow.
Sometimes these stones pass on their own. In other cases, healthcare providers can
offer treatment to break them up or remove them.
 Kidney (renal) cysts: Fluid-filled sacs called kidney cysts grow on the kidneys.
These cysts can cause kidney damage. Healthcare providers can remove them
 Polycystic kidney disease: This causes cysts to form on the kidneys. PKD is a
genetic condition. It may lead to high blood pressure and kidney failure. People with
PKD need regular medical monitoring.

Countless other disorders can affect the kidneys. Some of these conditions include:

 Acidosis: Excess acid accumulates in your kidneys, which may cause many health
problems. It can be life-threatening.
 Acute or interstitial nephritis: The kidneys become inflamed, sometimes after
exposure to certain antibiotics, which may lead to kidney failure.
 Azotemia: Nitrogen waste builds up in the kidneys. Without treatment, azotemia may
be fatal.
 Caliectasis: Excess fluid causes the calyces (where urine collection begins) to swell.
Without treatment, caliectasis may result in kidney failure.
 Diabetes-related nephropathy or hypertensive nephropathy: Unmanaged
diabetes or chronically high blood pressure causes kidney damage.
 Glomerular diseases: This may inflammation or damage to the glomeruli.
Glomerular diseases may cause kidney failure.
 Minimal change disease and nephrotic syndrome: This may cause the kidneys to
release the excess protein the urine.
 Papillary necrosis: Chunks of kidney tissue die in the medulla and papilla. The
tissue can break off and clog the kidneys, leading to kidney failure.
 Proteinuria: This means that a patient has high levels of protein in the kidneys. It
can be a sign of kidney damage.
 Pyelonephritis: This sudden kidney infection causes edema (swelling) in the
kidneys. It can be life-threatening.
 Uremia: Toxins that normally leave the body through the urine end up in the
bloodstream. Without treatment, uremia can be fatal.

What are the first signs of kidney problems?

Most kidney problems don’t have signs in their early stages. As kidney damage progresses,
these can be noticed:

 Cramping muscles: Electrolyte imbalances causes muscles to stiffen.

 Dark urine or urine with blood in it: Damage to the kidneys’ filters lets blood cells
leak into the urine.
 Foamy urine: Bubbles in the urine can signal excess protein.
 Itchy, dry skin: An imbalance of minerals and nutrients in the blood leads to itchy
skin.
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 More frequent urination: Problems filtering waste can cause the patient to urinate
more often.
 Puffy eyes or swollen ankles and feet: Reduced kidney function can cause he
body to hold onto protein and sodium, resulting in swelling.
 Sleep problems, fatigue and lack of appetite: If toxins build up in the blood, sleep,
appetite and energy levels may be off.

Kidney failure is generally a multi-organ health issue, with a variety of cross effects on
different body systems.

The Blood System

Damaged kidneys slow the production of the hormone erythropoietin, resulting in anemia
and iron deficiency. Anemia may cause irritability, tiredness, shortness of breath, dizziness
and if untreated may cause heart failure and organ failure. Most people with end stage renal
failure will suffer from anemia. Anemia may be treated by taking supplements, red cell blood
transfusions and adherence to an iron rich diet.

The Cardio-Vascular System

Kidney failure raises the risk of cardiovascular problems, and subsequently – the risk of
heart attacks and strokes. Kidney failure affects the heart in several ways:
 Fluid builds up around the lungs, heart and other body tissue, over-taxing the heart
and causing a rise in blood pressure.
 Impaired kidney function causes a buildup of urea (a by-product of dietary protein).
High levels of urea (called uremia) are toxic, and cause inflammation of the
pericardium.
 Kidney disease may result in a buildup of fluid and salt and an over creation of renin,
causing hypertension and atherosclerosis and damaging the blood vessels.
 Heart disease is the leading cause of death in ESRD, and heart function should be
monitored regularly, excess fluid drained and preventative care taken.

The Integumentary System (Skin)

The kidneys inability to balance levels of blood minerals such as calcium and phosphorus
affects and harms the body’s integumentary system. The parathyroid glands release a
hormone causing calcium to be drawn from the bones to the blood. The high levels of
hormones cause the skin on the back, chest, head and limbs to itch. Phosphorous building
up in the blood also tends to worsen itching. Constant itching and scratching may also
puncture the skin, causing sores and wounds and leaving the patient more susceptible to
infection. Intense itching can be relieved (to an extent) by removal of parathyroid glands,
medication, ultraviolet light therapy and diet.

The Skeletal System

High levels of parathyroid hormone draw calcium from the bones into the blood stream. The
mineral imbalance causes the bones to become weak, thin and malformed. Older patients
and post-menopausal women are at greater risk, but 90% of dialysis patients are affected.
Calcium levels should be monitored and patient’s should be given instruction about bone
health, stability and safety.

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Joints
Amyloidosis, a condition in which the protein amyloid is deposited in the joints and tendons,
is caused by kidney failure. Amyloidosis often results in pain, stiffness and fluid buildup in
the joints.

The Circadian System

Kidney failure often disrupts the natural circadian system, causing havoc with sleep. People
with renal failure often find themselves unable to fall or stay asleep at night. Others may
suffer from sleep apnea, affecting their breathing and quality of sleep or from restless leg
syndrome, causing restlessness and pain. Lack of sleep has been found to harm the
immune system, leaving the sufferer more susceptible to illness, and may cause exhaustion,
depression, weight gain, headaches and in general – impacts the daily quality of life.
Treatment includes moderate exercise, adequate nutrition, sleep hygiene counseling and
medication.

The Nervous System

A combination of hormonal and mineral imbalance, with lack of sleep, constant pain and a
prognosis of lifelong treatments, often cause symptoms of depression such as lethargy,
sadness, fatigue, feelings of helplessness, loss of interest, anger, an inability to focus or
concentrate and more. Counseling, medications, support groups, meditation, nutrition and
exercise have all been deemed as helpful in lessening and controlling the symptoms.

The Digestive System

High levels of urea in the blood may cause gastrointestinal issues such as nausea, poor
appetite (including an inability to consume the necessary amounts of minerals and vitamins),
bad taste in the mouth, peptic ulcers, gastrointestinal bleeds, diarrhea, vomiting and more. It
is important to work with a nutritionist who specializes in renal failure and ESRD, to create a
dietary regime that is optimal for the patient’s needs and health.

The Immune System

The immune system is affected by kidney damage. The excess toxins accumulating in the
blood stream are harmful to all organs, and inhibit the marrow’s ability to produce cells.
Elevated sugar levels, lack of sleep, depression, and damage to the skin are all contributors
and affect the body’s ability to prevent and fight disease.
Kidney failure has a multi-system effect, hurting and harming the body on many different
levels. It is crucial to start renal replacement therapy before irreversible damage sets in.
Therapies available include hemodialysis, peritoneal dialysis and kidney transplants.

47
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SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

COURSE IN THE WARD

DATE/TIME PHYSICIAN’S ORDER RATIONALE NURSING

INTERVENTIONS
9/12/2023 Please admit patient to
 Admitting the patient to  Admitted the patient
room of choice under the desired room to room of choice
the service of Dr. E. promotes comfort, under the service of
Bautista lessens anxiety, Dr. E. Bautista
encourages adherence  Assisted and
to treatment and allows accompanied the
fast recovery patient to the room of
 For further monitoring, choice
management and
evaluation of the
patient’s condition
Secure consent for  To ensure a better  Secured
admission and understanding and consent for
management compliance to admission and
treatments that will management
be provided.  Verified and
 To obtain witnessed the
permission for the signing of
procedures and consent
management
Total Parenteral To deliver proper nutrition  Monitored IV
Nutrition per shift and via Intravenous lines and sites
record administration when there regularly for any
is impaired gastrointestinal redness,
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SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

function and swelling, pain or

contraindications to enteral irritation
nutrition  Due IV
medication and
IV fluids given
and recorded
Renal diet  A renal diet is one  Monitored
#Chronic Kidney that is low in dietary intake
Disease secondary to sodium,  Ensured
Diabetes Mellitus phosphorus, and patient’s
#To consider protein. It also adherence to
emphasizes the prescribed
Electrolyte Imbalance
importance of dietary
consuming high- restrictions
quality protein and
usually limiting
fluids.
 To help promote
kidney function and
slow the
progression of
complete kidney
failure.
Intravenous Fluid:  To maintain
PNSS 500 cc x Keep catheter patency by ● Assessed the
Vein Open preventing internal
patient's vital
luminal (inner
signs before
surface) occlusion
infusion.
 to restore or ● Verified the
maintain normal prescription and
fluid volume and ensured the
electrolyte balance right IV is given
when the oral route to the right
is not possible. patient.
 useful for daily ● IVF hooked,
maintenance of regulated at
body fluids and desired dose,
nutrition, and for and ensured IV-
rehydration line patency.
● Continued
monitoring
during and after
the infusion.
Diagnostics:  To determine if kidney  Referred the
 Complete Blood function is reduced ordered tests to
Count  To determine other members of
 Sodium, imbalances in fluid and the healthcare team
electrolytes and  Explained the
Potassium,
measure how well the procedures and
Creatinine kidneys are performing purpose of the
 Electrocardiogram, their job of filtering laboratory tests to
Chest Xray waste from the blood the significant other
 HbA1c  To examine chest  Prepared the
(Glycosylated structures, useful for patient for the
Hemoglobin), diagnosing conditions procedures
49
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SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

Magnesium like kidney failure  Reviewed values

 HbA1c is an indicator and reported any
predicting insulin abnormal values
resistance  Monitored puncture
site (complete blood
count) for oozing or
hematoma
formation
Treatment:  To help improve
 Metoclopromide 1 gastrointestinal  Informed patient
ampule/IV now motility and reduce about the details,
then every 8 hours nausea and vomiting purpose, and
as needed  To address acid- importance of the
 Sodium base imbalances prescribed
Bicarbonate 650 and reduce the risk if medication.
mg/tab 1 tab three certain complications  Administered the
times a day like correction of medication
 Ketoanalogue 600 metabolic acidosis following the 14
mg/tab 1 tab three  To help preserve Rights of Drug
times day kidney function, Administration.
 Ferrous Sulfate manage  Monitored for any
capsule 1 capsule complications adverse effects.
once a day associated with
 Calcium + Vitamin kidney disease, and
D capsule 1 improve the patient’s
capsule once a overall nutritional
day status
 To treat iron-
deficiency anemia by
supplying the
necessary iron for
red blood cell
production and to
support the
effectiveness of
erythropoiesis-
stimulating agents
(ESAs) in managing
anemia
 To support bone
health, prevent
secondary
hyperparathyroidism,
reduce vascular
calcification,
enhance immune
function, and
improve muscle
strength
Attending physician For further monitoring Followed-up to attending
aware of this management and physician of the
evaluation of the patient's admission
50
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BACHELOR OF SCIENCE IN NURSING – LEVEL II

admission condition
Inform Dr. Aguinaldo For further monitoring Informed Dr. Aguinaldo
once patient is at the management and once the patient is ward
ward evaluation of the patient's
condition
Vital signs every 4 ● To closely ● Educated patient
hours, intake and
output every shift and assess and the purpose of
record monitor the vital monitoring vital
signs for any signs frequently.
deviation and
abnormal ● Monitored and
findings. documented
 Vital signs patient’s VS as
assessment serves ordered.
as an early warning ● Referred abnormal
of a change in
patient condition, deviation from
playing an important normal values to
role in assisting the the physician
healthcare immediately.
professional to ● Monitored intake
prevent adverse
and output as
events.
ordered
 To monitor fluid
balance of a patient
 Monitoring of intake
help caregivers
ensure that the
patient has proper
intake of fluid and
other nutrients
 Monitoring of output
helps determine
whether there is
adequate output of
urine as well as
normal defecation
 To assess kidney
function, manage
fluid balance, detect
electrolyte
imbalances,
evaluate medication
effects, adhere to
dietary restrictions,
and assess
treatment efficacy
Relay all laboratories  To provide valuable  Reviewed
once available information about the laboratory results
patient’s health,  Relayed all
including blood counts laboratories once
51
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SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

and more. These available

results are often
integral to diagnosing
medical conditions and
assessing the severity
of the patient’s illness.
 To determine the most
appropriate treatment
plan for the patient
 To monitor the
patient’s progress
during the course of
treatment
Refer accordingly
● To Inform the ● Referred the
attending patient
physician for any accordingly
deviation unusual
signs and
symptoms that
needs further
monitoring.
● For collaboration
and continuation
of care to meet
the needs of the
patient
9/12/2023 Please incorporate 100 To help maintain the
At 10:46 PM mEqs Sodium Chloride right fluid balance in the  Informed patient’s
to present Intravenous body SO about the
Fluid details, purpose,
and importance of
the prescribed
medication.
 Administered and
incorporated the
medication to
present
Intravenous fluid
following the 14
Rights of Drug
Administration.
 Monitored for any
adverse effects.

Please give due  To help improve

Metoclopromide 10 gastrointestinal  Informed patient
mg/IV now motility and reduce about the details,
nausea and vomiting purpose, and
importance of the

52
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SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

prescribed
medication.
 Administered the
medication
following the 14
Rights of Drug
Administration.
 Monitored for any
adverse effects.

Continue present To receive medications ● Explained the

medications appropriate to clinical purpose of the
needs - in doses that meet medications to
individual requirements for the patient and
an adequate period of time to the significant
other
● Followed the 14
rights of drug
administration
● Administered
due medications
as ordered
● Monitored the
patient for
presence of
adverse effects
Watch out for These symptoms usually ● Watched out
persistence of indicate toxins building
vomiting, headache, up in the body because for persistence
muscle spasms, and of failing kidneys of vomiting,
unstable vital signs headache,
muscle
spasms, and
unstable vital
signs
● Performed
precautionary
measures for
patient safety
such as raising
bedside rails,
administering
due medications
and more
Refer accordingly Referred the patient
● To Inform the
accordingly
attending
physician for any
deviation unusual
signs and
symptoms that
53
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SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

needs further
monitoring.
● For collaboration
and continuation of
care to meet the
needs of the patient
9/13/2023 Secure consent for ● To ensure a better ● Secured consent
At 8:45 AM Internal Jugular
understanding of from the patient’s
insertion and
the surgery and SO for surgical
Hemodialysis treatments that will operation and
be provided. management.
● To obtain ● Verified and
permission for the witnessed the
procedure and signing of consent.
management
Refer to Dr. H. For collaboration and Referred the patient to
Jamombon for Internal continuation of care to Dr. H. Jamombon for
Jugular insertion once meet the needs of the Internal Jugular
with consent patient insertion once with
consent
Intravenous Fluid to
follow: PNSS 500cc +  To help maintain ● informed the
100 mEqs sodium the right fluid patient’s SO
chloride x 24 hours balance in the body about the
 To maintain details, purpose
catheter patency by and importance
preventing internal of the prescribed
luminal (inner medication
surface) occlusion
 to restore or ● administered
maintain normal and
fluid volume and incorporated the
electrolyte balance medication to
when the oral route present
is not possible. intravenous fluid
 useful for daily following the 14
maintenance of Rights of Drug
body fluids and Administration.
nutrition, and for
rehydration ● Assessed the
patient's vital
signs before
infusion.
● Verified the
prescription and
ensured the
right IV is given
to the right
patient.
● IVF hooked,
regulated at
desired dose,
and ensured IV-
54
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SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

line patency.
● Continued
monitoring
during and after
the infusion
especially for
adverse effects.
HBsAg (Hepatitis B  This is because the  Referred the
Surface Antigen), Anti patient may be ordered tests to
HCV, Anti_HBS exposed to blood and other members of
other bodily fluids the healthcare team
during treatment and  Explained the
kidney impairment procedures and
means that the patient purpose of the
is at more risk of laboratory tests to
infection or disease the significant other
 To slow development  Prepared the
of liver disease and patient for the
reduce the risk of procedures
HCV-related post-  Reviewed values
transplant and reported any
complications abnormal values
 Monitored puncture
site (complete blood
count) for oozing or
hematoma
formation
9/14/2023 Metoclopromide 1  To help improve
At 12 noon ampule/IV every 8 gastrointestinal  Informed patient
hours round the clock motility and reduce about the details,
nausea and vomiting purpose, and
importance of the
prescribed
medication.
 Administered the
medication
following the 14
Rights of Drug
Administration.
 Monitored for any
adverse effects.

Intravenous fluid to
follow: PNSS 500cc +  To help maintain ● informed the
100 mEqs Sodium the right fluid patient’s SO
Chloride for 24 hours balance in the body about the
 To maintain details, purpose
catheter patency by and importance
preventing internal of the prescribed
luminal (inner medication
surface) occlusion
 to restore or ● administered
maintain normal and

55
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Tuguegarao City, Cagayan 3500

SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

fluid volume and

electrolyte balance incorporated the
when the oral route medication to
is not possible. present
 useful for daily intravenous fluid
maintenance of following the 14
body fluids and Rights of Drug
nutrition, and for Administration.
rehydration
● Assessed the
patient's vital
signs before
infusion.
● Verified the
prescription and
ensured the
right IV is given
to the right
patient.
● IVF hooked,
regulated at
desired dose,
and ensured IV-
line patency.
● Continued
monitoring
during and after
the infusion
especially for
adverse effects.
9/15/2023 Sodium, Potassium,  To determine  Referred the
At 8:30 AM Creatinine tomorrow imbalances in fluid and ordered tests to
electrolytes and other members of
measure how well the the healthcare team
kidneys are performing  Explained the
their job of filtering procedures and
waste from the blood purpose of the
laboratory tests to
the significant other
 Prepared the
patient for the
procedures
 Reviewed values
and reported any
abnormal values
 Monitored puncture
site (complete blood
count) for oozing or
hematoma
formation
Intravenous Fluid to
follow: PNSS 500cc +  To help maintain ● informed the
100 mEqs Sodium the right fluid patient’s SO
Chloride x 24 hours balance in the body about the
 To maintain details, purpose
catheter patency by and importance
56
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Tuguegarao City, Cagayan 3500

SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

preventing internal
luminal (inner of the prescribed
surface) occlusion medication
 to restore or
maintain normal ● administered
fluid volume and and
electrolyte balance incorporated the
when the oral route medication to
is not possible. present
 useful for daily intravenous fluid
maintenance of following the 14
body fluids and Rights of Drug
nutrition, and for Administration.
rehydration
● Assessed the
patient's vital
signs before
infusion.
● Verified the
prescription and
ensured the
right IV is given
to the right
patient.
● IVF hooked,
regulated at
desired dose,
and ensured IV-
line patency.
● Continued
monitoring
during and after
the infusion
especially for
adverse effects.
9/16/2023 PNSS 90 cc + 10
At 7:12 AM mEqs Potassium  To help maintain ● informed the
Chloride every hour x the right fluid patient’s SO
10 cycles balance in the body about the
 To maintain details, purpose
catheter patency by and importance
preventing internal of the prescribed
luminal (inner medication
surface) occlusion
 to restore or ● administered
maintain normal and
fluid volume and incorporated the
electrolyte balance medication to
when the oral route present
is not possible. intravenous fluid
 useful for daily following the 14
maintenance of Rights of Drug
body fluids and Administration.
nutrition, and for
rehydration ● Assessed the
patient's vital
57
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Tuguegarao City, Cagayan 3500

SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

signs before
infusion.
● Verified the
prescription and
ensured the
right IV is given
to the right
patient.
● IVF hooked,
regulated at
desired dose,
and ensured IV-
line patency.
● Continued
monitoring
during and after
the infusion
especially for
adverse effects.
At 12 noon Start Potassium  To help maintain
Chloride drip the right fluid ● informed the
balance in the body patient’s SO
about the
details, purpose
and importance
of the prescribed
medication

● administered the
medication
following the 14
Rights of Drug
Administration.

● Assessed the
patient's vital
signs before
infusion.
● Verified the
prescription and
ensured the
right IV is given
to the right
patient.
● IVF hooked,
regulated at
desired dose,
and ensured IV-
line patency.
● Continued
monitoring
during and after
the infusion
especially for
adverse effects.
58
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SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

Intravenous Fluid to
follow: PNSS 500cc +  To help maintain ● informed the
100 mEqs Sodium the right fluid patient’s SO
Chloride x 24 hours balance in the body about the
 To maintain details, purpose
catheter patency by and importance
preventing internal of the prescribed
luminal (inner medication
surface) occlusion
 to restore or ● administered
maintain normal and
fluid volume and incorporated the
electrolyte balance medication to
when the oral route present
is not possible. intravenous fluid
 useful for daily following the 14
maintenance of Rights of Drug
body fluids and Administration.
nutrition, and for
rehydration ● Assessed the
patient's vital
signs before
infusion.
● Verified the
prescription and
ensured the
right IV is given
to the right
patient.
● IVF hooked,
regulated at
desired dose,
and ensured IV-
line patency.
● Continued
monitoring
during and after
the infusion
especially for
adverse effects.
Secure consent for ● To ensure a better ● Secured consent
Internal Jugular
understanding of from the patient’s
insertion and
the surgery and SO for surgical
Hemodialysis treatments that will operation and
be provided. management.
● To obtain ● Verified and
permission for the witnessed the
procedure and signing of consent.
management
9/16/2023 Paracetamol 300mg IV ● Explained the
● For mild to
At 1:30 PM now then every 6 hours purpose of the
as needed for pain moderate pain medication to
relief and to treat the patient.
conditions such ● Followed the
59
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Tuguegarao City, Cagayan 3500

SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

as headache and 14 rights of

muscle aches drug
administration.
● Monitored
patient for
presence of
adverse effects
9/17/2023 For Hemodialysis  To filter wastes and  Referred the
At 8:45 AM tomorrow (2nd shift) water from the blood, ordered tests to
as the kidneys did other members of
when they were the healthcare team
healthy and fully  Explained the
functional. procedures and
 Hemodialysis helps purpose of the
control blood pressure procedure to the
and balance important significant other
minerals such as  Prepared the
potassium, sodium and patient for the
calcium in the blood. procedures
 Reviewed values
and reported any
abnormal values
 Monitored puncture
site (complete blood
count) for oozing or
hematoma
formation
Intravenous Fluid to
follow: PNSS 500cc +  To help maintain ● informed the
100 mEqs Sodium the right fluid patient’s SO
Chloride x 24 hours balance in the body about the
 To maintain details, purpose
catheter patency by and importance
preventing internal of the prescribed
luminal (inner medication
surface) occlusion
 to restore or ● administered
maintain normal and
fluid volume and incorporated the
electrolyte balance medication to
when the oral route present
is not possible. intravenous fluid
 useful for daily following the 14
maintenance of Rights of Drug
body fluids and Administration.
nutrition, and for
rehydration ● Assessed the
patient's vital
signs before
infusion.
● Verified the
prescription and
ensured the
right IV is given
to the right
60
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Tuguegarao City, Cagayan 3500

SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

patient.
● IVF hooked,
regulated at
desired dose,
and ensured IV-
line patency.
● Continued
monitoring
during and after
the infusion
especially for
adverse effects.
Sodium, Potassium To determine imbalances in  Referred the
tomorrow fluid and electrolytes and ordered tests to
measure how well the other members of
kidneys are performing the healthcare team
their job of filtering waste  Explained the
from the blood procedures and
purpose of the
laboratory tests to
the significant other
 Prepared the
patient for the
procedures
 Reviewed values
and reported any
abnormal values
 Monitored puncture
site (complete blood
count) for oozing or
hematoma
formation
Clonazepam 2 mg/tab ●
Explained the
● To manage seizures
hours of sleep purpose of the
or alleviate anxiety medication to
and sleep disorders the patient.
● Followed the
14 rights of
drug
administration.
● Monitored
patient for
presence of
adverse effects
At 2:40 PM May give Diazepam 5 ● Explained the
● To manage anxiety,
mg/IV if still with purpose of the
restlessness seizures or muscle medication to
spasms the patient.
● Followed the
14 rights of
drug
administration.
Monitored patient for
presence of adverse
61
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Tuguegarao City, Cagayan 3500

SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

effects
Refer if with To determine appropriate Observed patient for
restlessness measures, treatment and restlessness and
intervention for patient reported for signs that
safety deviate from normal
9/18/2023 For Hemodialysis  To filter wastes and  Referred the
At 8 AM today (2nd shift) water from the blood, ordered tests to
as the kidneys did other members of
when they were the healthcare team
healthy and fully  Explained the
functional. procedures and
 Hemodialysis helps purpose of the
control blood pressure procedure to the
and balance important significant other
minerals such as  Prepared the
potassium, sodium and patient for the
calcium in the blood. procedures
 Reviewed values
and reported any
abnormal values
 Monitored puncture
site (complete blood
count) for oozing or
hematoma
formation
Intravenous Fluid to
follow: PNSS 500cc +  To help maintain ● informed the
40 mEqs Potassium the right fluid patient’s SO
Chloride x 24 hours balance in the body about the
 To maintain details, purpose
catheter patency by and importance
preventing internal of the prescribed
luminal (inner medication
surface) occlusion
 to restore or ● administered
maintain normal and
fluid volume and incorporated the
electrolyte balance medication to
when the oral route present
is not possible. intravenous fluid
 useful for daily following the 14
maintenance of Rights of Drug
body fluids and Administration.
nutrition, and for
rehydration ● Assessed the
patient's vital
signs before
infusion.
● Verified the
prescription and
ensured the
right IV is given
to the right
patient.
● IVF hooked,

62
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Tuguegarao City, Cagayan 3500

SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

regulated at
desired dose,
and ensured IV-
line patency.
● Continued
monitoring
during and after
the infusion
especially for
adverse effects.
At 6:52 PM Please give 1 vial D5050 is a therapeutic
D5050 now agent that functions to ● informed the
relieve or alleviate dialysis- patient’s SO
related muscle cramps about the
(DMCs) details, purpose
and importance
of the prescribed
medication

● administered
and the
medication
following the 14
Rights of Drug
Administration.

● Assessed the
patient's vital
signs before the
administration
● Verified the
prescription and
ensured the
right medication
is given to the
right patient.
● Medication
hooked,
regulated at
desired dose,
and ensured IV-
line patency.
● Continued
monitoring
during and after
the infusion
especially for
adverse effects.
Hook to oxygen To help patients with ● Assessed the
support at 1-2 Liters breathing problems get patient’s vital
per minute via nasal enough oxygen to function signs prior to the
cannula and stay well
procedure
● Verified the
prescription and
ensured the
63
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Tuguegarao City, Cagayan 3500

SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

right order is
given to the
right patient
● Oxygen
inhalation
hooked,
regulated at
desired dose,
and ensured
nasal patency
● Continued
monitoring
during and after
the procedure
Refer
● To Inform the ● Referred the
attending patient accordingly
physician for any
deviation unusual
signs and
symptoms that
needs further
monitoring.
● For collaboration
and continuation
of care to meet
the needs of the
patient
8:38 PM D5050 1 vial IV every 6 D5050 is a therapeutic
hours agent that functions to ● informed the
relieve or alleviate dialysis- patient’s SO
related muscle cramps about the
(DMCs) details, purpose
and importance
of the prescribed
medication

● administered
and the
medication
following the 14
Rights of Drug
Administration.

● Assessed the
patient's vital
signs before the
administration
● Verified the
prescription and
ensured the

64
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Tuguegarao City, Cagayan 3500

SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

right medication
is given to the
right patient.
● Medication
hooked,
regulated at
desired dose,
and ensured IV-
line patency.
● Continued
monitoring
during and after
the infusion
especially for
adverse effects.
9/19/2023 Give Paracetamol 300 For mild to moderate pain
At 7:05 AM mg IV every 4 hours as relief and to treat conditions  Informed patient
needed such as headache and about the details,
muscle aches purpose, and
importance of the
prescribed
medication.
 Administered the
medication
following the 14
Rights of Drug
Administration.
 Monitored for any
adverse effects.

8:35 AM Sodium, Potassium,  To determine if kidney  Referred the

Complete Blood Count function is reduced ordered tests to
tomorrow  To determine other members of
imbalances in fluid and the healthcare team
electrolytes and  Explained the
measure how well the procedures and
kidneys are performing purpose of the
their job of filtering laboratory tests to
waste from the blood the significant other
 Prepared the
patient for the
procedures
 Reviewed values
and reported any
abnormal values
 Monitored puncture
site (complete blood
count) for oozing or
hematoma
formation
D5050 1 vial IV every 6 D5050 is a therapeutic
hours agent that functions to ● informed the
relieve or alleviate dialysis- patient’s SO

65
 University of Saint Louis
Tuguegarao City, Cagayan 3500

SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

related muscle cramps

(DMCs) about the
details, purpose
and importance
of the prescribed
medication

● administered
and the
medication
following the 14
Rights of Drug
Administration.

● Assessed the
patient's vital
signs before the
administration
● Verified the
prescription and
ensured the
right medication
is given to the
right patient.
● Medication
hooked,
regulated at
desired dose,
and ensured IV-
line patency.
● Continued
monitoring
during and after
the infusion
especially for
adverse effects.
Intravenous fluid to
follow: PNSS 500 cc +  To help maintain ● informed the
50 mEqs Sodium the right fluid patient’s SO
Chloride + 20 mEqs balance in the body about the
Potassium Chloride x  To maintain details, purpose
catheter patency by and importance
24 hours of the prescribed
preventing internal
luminal (inner medication
surface) occlusion
 to restore or ● administered
maintain normal and
fluid volume and incorporated the
electrolyte balance medication to
when the oral route present
is not possible. intravenous fluid
 useful for daily following the 14
maintenance of Rights of Drug
body fluids and Administration.
nutrition, and for
● Assessed the
66
 University of Saint Louis
Tuguegarao City, Cagayan 3500

SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

rehydration
patient's vital
signs before
infusion.
● Verified the
prescription and
ensured the
right IV is given
to the right
patient.
● IVF hooked,
regulated at
desired dose,
and ensured IV-
line patency.
● Continued
monitoring
during and after
the infusion
especially for
adverse effects.
Soft Diet Soft diet serves as a  Monitored
transition from liquids to dietary intake
a regular diet for  Instructed
individuals who are patient’s SO to
recovering from surgery follow a soft diet.
or a long illness  Ensured
patient’s
adherence to
prescribed
dietary
restrictions
9:15 PM For Nasogastric tube Nasogastric tubes are  Referred the
insertion typically used ordered procedure
for decompression of the to other members of
stomach in the setting of the healthcare team
Explained the
intestinal obstruction or 
purpose of the
ileus, but can also be procedure tests to
used to administer the significant other
nutrition or medication to  Prepared the
patients who are unable patient for the
to tolerate oral intake. procedure
 Monitored the
patient closely
during and after the
procedure
1600 kal in 6 equally To ensure that the  Monitored
divided feeding patient is able to receive dietary intake
complete nutrition  Instructed
despite being restricted patient’s SO to
and hospitalized follow the
ordered diet.
 Ensured
patient’s

67
 University of Saint Louis
Tuguegarao City, Cagayan 3500

SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

adherence to
prescribed
dietary
restrictions
Refer
● To Inform the ● Referred the
attending patient
physician for any accordingly
deviation unusual
signs and
symptoms that
needs further
monitoring.
● For collaboration
and continuation
of care to meet
the needs of the
patient
9/20/2023 Refer to Dr. M. Cinco For collaboration and Referred the patient to
At 7:45 AM continuation of care to Dr, M. Cinco
meet the needs of the
patient
For Hemodialysis  To filter wastes and  Referred the
tomorrow water from the blood, ordered tests to
as the kidneys did other members of
when they were the healthcare team
healthy and fully  Explained the
functional. procedures and
 Hemodialysis helps purpose of the
control blood pressure procedure to the
and balance important significant other
minerals such as  Prepared the
potassium, sodium and patient for the
calcium in the blood. procedures
 Reviewed values
and reported any
abnormal values
 Monitored puncture
site (complete blood
count) for oozing or
hematoma
formation
Intravenous fluid to
follow: PNSS 500cc x 2  To help maintain ● Assessed the
hours the right fluid patient's vital
balance in the body signs before
 To maintain infusion.
catheter patency by ● Verified the
preventing internal prescription and
luminal (inner ensured the
surface) occlusion right IV is given
 to restore or to the right
maintain normal patient.

68
 University of Saint Louis
Tuguegarao City, Cagayan 3500

SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

fluid volume and ● IVF hooked,

electrolyte balance regulated at
when the oral route desired dose,
is not possible. and ensured IV-
 useful for daily line patency.
maintenance of ● Continued
body fluids and monitoring
nutrition, and for during and after
rehydration the infusion
especially for
adverse effects.
At 8:50 PM For CT scan (plain) To detect conditions  Referred the
such as tumors or other ordered tests to
lesions, obstructive other members of
conditions, such as the healthcare team
Explained the
kidney stones, congenital 
procedures and
anomalies, polycystic purpose of the
kidney disease, procedure to the
accumulation of fluid significant other
around the kidneys, and  Prepared the
the location of patient for the
abscesses. procedures
 Reviewed values
and reported any
abnormal values
At 10:00 PM Electroencephalogram EEG is useful in  Referred the
assessing patients with ordered tests to
uremic encephalopathy other members of
and in monitoring their the healthcare team
Explained the
progress. EEG in CKD 
procedures and
usually shows irregular purpose of the
low voltage with slowing procedure to the
of the posterior dominant significant other
alpha rhythm and  Prepared the
occasional theta bursts. patient for the
procedures
 Reviewed values
and reported any
abnormal values
9/21/2023 Paracetamol 150 ● Explained the
● For mild to
At 8:30 AM mg/ml 1 ampule purpose of the
moderate pain medication to
relief and to treat the patient.
conditions such ● Followed the
as headache and 14 rights of
muscle aches drug
administration.
● Monitored
patient for
presence of
adverse effects
At 10:00 AM For complete blood To determine if kidney  Referred the
function is reduced ordered tests to
69
 University of Saint Louis
Tuguegarao City, Cagayan 3500

SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

count after meal 6 other members of

hours post (after) blood the healthcare team
transfusion  Explained the
procedures and
purpose of the
laboratory tests to
the significant other
 Prepared the
patient for the
procedures
 Reviewed values
and reported any
abnormal values
 Monitored puncture
site (complete blood
count) for oozing or
hematoma
formation
Serum sodium, To determine imbalances in  Referred the
potassium, ionize fluid and electrolytes and ordered tests to
calcium measure how well the other members of
kidneys are performing the healthcare team
their job of filtering waste  Explained the
from the blood procedures and
purpose of the
laboratory tests to
the significant other
 Prepared the
patient for the
procedures
 Reviewed values
and reported any
abnormal values
 Monitored puncture
site (complete blood
count) for oozing or
hematoma
formation
4/22/2023 Suggest  To help improve
At 8:20 AM  Give gastrointestinal  Informed patient
Metoclopromide motility and reduce about the details,
on Pro Re Nata nausea and vomiting purpose, and
basis only  For sleep, allergic importance of the
 Diphenhydramine reactions, itching, and prescribed
20 mg/IV x 1 dose dialysis treatment medication.
if okay with Dr. related complications  Administered the
Bautista medication
following the 14
Rights of Drug
Administration.
 Monitored for any
adverse effects.

70
 University of Saint Louis
Tuguegarao City, Cagayan 3500

SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

At 8:54 AM Carry out suggestion of For collaboration and Carried out

Dr. M. Anco continuation of care to suggestions of Dr. M.
meet the needs of the Anco
patient
9/23/2023 Fecalysis To help diagnose certain  Referred the
At 10:30 AM conditions affecting the ordered tests to
digestive tract. These other members of
conditions can include the healthcare team
 Explained the
infection (such as from
procedures and
parasites, viruses, or purpose of the
bacteria), poor nutrient laboratory tests to
absorption, or cancer. the significant other
 Prepared the
patient for the
procedures
 Reviewed values
and reported any
abnormal values
Increase Intravenous
Fluid to 12 hours  To help maintain ● Assessed the
the right fluid patient's vital
balance in the body signs before
 To maintain infusion.
catheter patency by ● Verified the
preventing internal prescription and
luminal (inner ensured the
surface) occlusion right IV is given
 to restore or to the right
maintain normal patient.
fluid volume and ● IVF hooked,
electrolyte balance regulated at
when the oral route desired dose,
is not possible. and ensured IV-
 Useful for daily line patency.
maintenance of ● Continued
body fluids and monitoring
nutrition, and for during and after
rehydration the infusion
especially for
adverse effects.
Intravenous Fluid to
follow: PNSS 1L x 12  To help maintain ● Assessed the
hours x 2 counts the right fluid patient's vital
balance in the body signs before
 To maintain infusion.
catheter patency by ● Verified the
preventing internal prescription and
luminal (inner ensured the
surface) occlusion right IV is given
 to restore or to the right
maintain normal patient.
fluid volume and ● IVF hooked,
electrolyte balance regulated at
when the oral route desired dose,

71
 University of Saint Louis
Tuguegarao City, Cagayan 3500

SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

is not possible. and ensured IV-

 useful for daily line patency.
maintenance of ● Continued
body fluids and monitoring
nutrition, and for during and after
rehydration the infusion
especially for
adverse effects.
At 12 noon Suggest: For mild to moderate
 Paracetamol pain relief and to  Informed patient
500mg 1 treat conditions such about the details,
tab/nasogastric as headache and purpose, and
tube now then muscle aches importance of the
as needed prescribed
every 4 hours medication.
for temperature  Administered the
greater than medication
37.8 degrees following the 14
Celsius Rights of Drug
Administration.
 Monitored for any
adverse effects.

At 12:08 PM Agree with suggestions For collaboration and Carried out

of Dr. M. Cinco continuation of care to suggestions of Dr. M.
meet the needs of the Anco
patient
At 3:00 PM Start Diphenhydramine For sleep, allergic
25 mg 1 capsule once reactions, itching, and  Informed patient
a day per Nasogastric dialysis treatment related about the details,
Tube complications purpose, and
importance of the
prescribed
medication.
 Administered the
medication
following the 14
Rights of Drug
Administration.
 Monitored for any
adverse effects.

Suggest plain cranial To provide morphological  Referred the

Magnetic Resonance information on kidneys ordered tests to
Imaging because the size of the other members of
kidneys can be an the healthcare team
Explained the
indicator of the 
procedures and
underlying disease purpose of the
laboratory tests to

72
 University of Saint Louis
Tuguegarao City, Cagayan 3500

SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

the significant other

 Prepared the
patient for the
procedures
 Reviewed values
and reported any
abnormal values
At 3:50 PM Agree with plain To provide morphological  Referred the
Cranial Magnetic information on kidneys ordered tests to
Resonance Imaging because the size of the other members of
kidneys can be an the healthcare team
Explained the
indicator of the 
procedures and
underlying disease purpose of the
laboratory tests to
the significant other
 Prepared the
patient for the
procedures
 Reviewed values
and reported any
abnormal values
9/24/2023 For hemodialysis  To filter wastes and  Referred the
At 7:45 AM tomorrow (3rd shift) water from the blood, ordered tests to
as the kidneys did other members of
when they were the healthcare team
healthy and fully  Explained the
functional. procedures and
 Hemodialysis helps purpose of the
control blood pressure procedure to the
and balance important significant other
minerals such as  Prepared the
potassium, sodium and patient for the
calcium in the blood. procedures
 Reviewed values
and reported any
abnormal values
 Monitored puncture
site (complete blood
count) for oozing or
hematoma
formation
Intravenous Fluid to
follow: PNSS 1 Liter x  To help maintain ● Assessed the
12 hours x 2 counts the right fluid patient’s vital
balance in the body signs before
 To maintain infusion.
catheter patency by ● Verified the
preventing internal prescription and
luminal (inner ensured the
surface) occlusion right IV is given
 to restore or to the right
maintain normal patient.
fluid volume and ● IVF hooked,
electrolyte balance regulated at
when the oral route desired dose,
73
 University of Saint Louis
Tuguegarao City, Cagayan 3500

SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

is not possible. and ensured IV-

 useful for daily line patency.
maintenance of ● Continued
body fluids and monitoring
nutrition, and for during and after
rehydration the infusion
especially for
adverse effects.
1:40 PM Suction secretions Pro To prevent aspiration and Observed for secretions
Re Nata clear secretions in the and suctioned if any
event a patient is unable to
remove them
Refer to rehab for The aim of physical Referred patient to
bedside Physical therapy is to relieve pain, rehab for bedside
Therapy help you move better or physical therapy
strengthen weakened
muscles.
9/25/2023 Fecalysis + Fecal To help diagnose certain  Referred the
At 8 AM Occult Blood Test conditions affecting the ordered tests to
digestive tract. These other members of
conditions can include the healthcare team
Explained the
infection (such as from 
procedures and
parasites, viruses, or purpose of the
bacteria), poor nutrient laboratory tests to
absorption, or cancer. the significant other
 Prepared the
patient for the
procedures
 Reviewed values
and reported any
abnormal values
 Monitored puncture
site (complete blood
count) for oozing or
hematoma
formation
Intravenous Fluid to
follow: PNSS 1 Liter x  To help maintain ● Assessed the
12 hours x 2 counts the right fluid patient's vital
balance in the body signs before
 To maintain infusion.
catheter patency by ● Verified the
preventing internal prescription and
luminal (inner ensured the
surface) occlusion right IV is given
 to restore or to the right
maintain normal patient.
fluid volume and ● IVF hooked,
electrolyte balance regulated at
when the oral route desired dose,
is not possible. and ensured IV-
 useful for daily line patency.
maintenance of ● Continued
body fluids and monitoring
during and after
74
 University of Saint Louis
Tuguegarao City, Cagayan 3500

SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

nutrition, and for the infusion

rehydration especially for
adverse effects.
For hemodialysis today  To filter wastes and  Referred the
water from the blood, ordered tests to
as the kidneys did other members of
when they were the healthcare team
healthy and fully  Explained the
functional. procedures and
 Hemodialysis helps purpose of the
control blood pressure procedure to the
and balance important significant other
minerals such as  Prepared the
potassium, sodium and patient for the
calcium in the blood. procedures
 Reviewed values
and reported any
abnormal values
 Monitored puncture
site (complete blood
count) for oozing or
hematoma
formation
Sodium, Potassium,  To determine if kidney  Referred the
Complete Blood Count, function is reduced ordered tests to
Creatinine tomorrow  To determine other members of
imbalances in fluid and the healthcare team
electrolytes and  Explained the
measure how well the procedures and
kidneys are performing purpose of the
their job of filtering laboratory tests to
waste from the blood the significant other
 Prepared the
patient for the
procedures
 Reviewed values
and reported any
abnormal values
 Monitored puncture
site (complete blood
count) for oozing or
hematoma
formation
At 9 AM For Serum Glutamic To diagnose any liver  Referred the
Pyruvic Transaminase diseases ordered tests to
other members of
the healthcare team
 Explained the
procedures and
purpose of the
laboratory tests to
the significant other
 Prepared the
patient for the
procedures
 Reviewed values
75
 University of Saint Louis
Tuguegarao City, Cagayan 3500

SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

and reported any

abnormal values
 Monitored puncture
site (complete blood
count) for oozing or
hematoma
formation
Suggest: To manage and treat
 Phenytoin 125 epilepsy, generalized  Informed patient
mg/5 ml (Dilantin tonic-clonic seizures, about the details,
Syrup) 5 ml twice complex partial seizures, purpose, and
a day/ Nasogastric and statis epilepticus importance of the
Tube prescribed
medication.
 Administered the
medication
following the 14
Rights of Drug
Administration.
 Monitored for any
adverse effects.

At 10:01 AM Okay to start phenytoin To manage and treat

(Dilantin Syrup) 5 mL epilepsy, generalized  Informed patient
twice a tonic-clonic seizures, about the details,
day/Nasogastric Tube complex partial seizures, purpose, and
and statis epilepticus importance of the
prescribed
medication.
 Administered the
medication
following the 14
Rights of Drug
Administration.
 Monitored for any
adverse effects.

For referral to Dr.

Jacinto for rehab
9/26/2023 Ciprofloxacin 500 To treat serious kidney
At 8:15 AM mg/tab twice a day infections. It works by  Informed patient
stopping the growth of about the details,
bacteria purpose, and
importance of the
prescribed
medication.
 Administered the
medication
following the 14
Rights of Drug
76
 University of Saint Louis
Tuguegarao City, Cagayan 3500

SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

Administration.
 Monitored for any
adverse effects.

Intravenous Fluid to
follow: PNSS 1 L x 12  To help maintain ● Assessed the
hours x 2 counts the right fluid patient's vital
balance in the body signs before
 To maintain infusion.
catheter patency by ● Verified the
preventing internal prescription and
luminal (inner ensured the
surface) occlusion right IV is given
 to restore or to the right
maintain normal patient.
fluid volume and ● IVF hooked,
electrolyte balance regulated at
when the oral route desired dose,
is not possible. and ensured IV-
 useful for daily line patency.
maintenance of ● Continued
body fluids and monitoring
nutrition, and for during and after
rehydration the infusion
especially for
adverse effects.

DIAGNOSTIC EXAMINATIONS
LABORATORY RESULTS
HEMATOLOGY
Date Requested: September 12, 2023
Date/Time Released: September 12, 2023 5:06 PM

EXAMINATION RESULT UNIT REFERENCE ANALYSIS

RANGE
77
 University of Saint Louis
Tuguegarao City, Cagayan 3500

SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

COMPLETE BLOOD COUNT

WBC: White 7.0 X10^9/L 5.0-10.0 Normal
Blood Cells
RBC: Red Blood 3.8 X10^12/L 4.5-5.5 Decreased due
Cells to reduced
erythropoietin
production
HGB: 10.1 g/dL 13.0-18.0 Decreased due
Hemoglobin to reduced
erythropoietin
production
HCT: 28.5 % 39-54 Decreased due
Hematocrit to the
development of
anemia
MCV: Mean Cell 75.8 fL 80-100 Normal
Volume
MCH: Mean 26.9 Pg 25.0-34.0 Normal
Corpuscular
Hgb
MCHC: Mean 35.4 % 31.0-37.0 Normal
Corpuscular
Hgb
Concentration
RDW: RBC 11.5 % 12.0-15.0 Decreased due
Distribution to the presence
Width of anemia
DIFFERENTIAL COUNT
Neutrophils 0.81 0.60-0.70 Elevated due to
acute response
to injury or
inflammation
Lymphocyte 0.11 0.20-0.30 Decreased due
to possible
immune system
impairment
driven by
uremia,
inflammation or
malnutrition
Monocyte 0.07 0.02-0.06 Slightly elevated
but not
significant
Eosinophil 0.01 0.01-0.04 Normal
Basophil 0.00 0.00-0.01 Normal
Platelet Count 261 X10^9/L 150-400 Normal

Date Requested: September 19, 2023

78
 University of Saint Louis
Tuguegarao City, Cagayan 3500

SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

Date/Time Released: September 20, 2023 1:51 AM

EXAMINATION RESULT UNIT REFERENCE ANALYSIS

RANGE
COMPLETE BLOOD COUNT
WBC: White 11.5 X10^9/L 5.0-10.0 Elevated due to
Blood Cells infection or
inflammation in
the body
RBC: Red Blood 3.1 X10^12/L 4.5-5.5 Decreased due
Cells to reduced
erythropoietin
production
HGB: 8.1 g/dL 13.0-18.0 Decreased due
Hemoglobin to reduced
erythropoietin
production
HCT: 24.9 % 39-54 Decreased due
Hematocrit to the
development of
anemia
MCV: Mean Cell 81.4 fL 80-100 Normal
Volume
MCH: Mean 26.5 Pg 25.0-34.0 Normal
Corpuscular
Hgb
MCHC: Mean 32.5 % 31.0-37.0 Normal
Corpuscular
Hgb
Concentration
RDW: RBC 12.0 % 12.0-15.0 Normal
Distribution
Width
DIFFERENTIAL COUNT
Neutrophils 0.84 0.60-0.70 Elevated due to
acute response
to injury or
inflammation
Lymphocyte 0.10 0.20-0.30 Decreased due
to possible
immune system
impairment
driven by
uremia,
inflammation or
malnutrition
Monocyte 0.06 0.02-0.06 Normal
Eosinophil 0.00 0.01-0.04 Slightly
decreased but
no significant

79
 University of Saint Louis
Tuguegarao City, Cagayan 3500

SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

Basophil 0.00 0.00-0.01 Normal

Platelet Count 214 X10^9/L 150-400 Normal

Date Requested: September 21, 2023

Date/Time Released: September 21, 2023 2:23 PM

EXAMINATION RESULT UNIT REFERENCE ANALYSIS

RANGE
COMPLETE BLOOD COUNT
WBC: White 11.6 X10^9/L 5.0-10.0 Elevated due to
Blood Cells infection or
inflammation in
the body
RBC: Red Blood 3.6 X10^12/L 4.5-5.5 Decreased due
Cells to reduced
erythropoietin
production
HGB: 9.3 g/dL 13.0-18.0 Decreased due
Hemoglobin to reduced
erythropoietin
production
HCT: 28.8 % 39-54 Decreased due
Hematocrit to the
development of
anemia
MCV: Mean Cell 81.1 fL 80-100 Normal
Volume
MCH: Mean 26.2 Pg 25.0-34.0 Normal
Corpuscular
Hgb
MCHC: Mean 32.3 % 31.0-37.0 Normal
Corpuscular
Hgb
Concentration
RDW: RBC 15.9 % 12.0-15.0 Slightly elevated
Distribution but not
Width significant
DIFFERENTIAL COUNT
Neutrophils 0.86 0.60-0.70 Elevated due to
acute response
to injury or
inflammation
Lymphocyte 0.08 0.20-0.30 Decreased due
to possible
immune system
impairment
driven by
uremia,
inflammation or
80
 University of Saint Louis
Tuguegarao City, Cagayan 3500

SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

malnutrition
Monocyte 0.04 0.02-0.06 Normal
Eosinophil 0.02 0.01-0.04 Normal
Basophil 0.00 0.00-0.01 Normal
Platelet Count 171 X10^9/L 150-400 Normal

Date Requested: September 25, 2023

Date/Time Released: September 26, 2023 2:08 AM

EXAMINATION RESULT UNIT REFERENCE ANALYSIS

RANGE
COMPLETE BLOOD COUNT
WBC: White 9.6 X10^9/L 5.0-10.0 Normal
Blood Cells
RBC: Red Blood 3.4 X10^12/L 4.5-5.5 Decreased due
Cells to reduced
erythropoietin
production
HGB: 9.0 g/dL 13.0-18.0 Decreased due
Hemoglobin to reduced
erythropoietin
production
HCT: 28.1 % 39-54 Decreased due
Hematocrit to the
development of
anemia
MCV: Mean Cell 82.6 fL 80-100 Normal
Volume
MCH: Mean 26.5 Pg 25.0-34.0 Normal
Corpuscular
Hgb
MCHC: Mean 32.0 % 31.0-37.0 Normal
Corpuscular
Hgb
Concentration
RDW: RBC 16.4 % 12.0-15.0 Elevated due to
Distribution early iron,
Width vitamin B12 or
folate deficiency
DIFFERENTIAL COUNT
Neutrophils 0.82 0.60-0.70 Elevated due to
acute response
to injury or
inflammation
Lymphocyte 0.09 0.20-0.30 Decreased due
to possible
immune system

81
 University of Saint Louis
Tuguegarao City, Cagayan 3500

SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

impairment
driven by
uremia,
inflammation or
malnutrition
Monocyte 0.07 0.02-0.06 Slightly elevated
but not
significant
Eosinophil 0.02 0.01-0.04 Normal
Basophil 0.00 0.00-0.01 Normal
Platelet Count 315 X10^9/L 150-400 Normal

CLINICAL CHEMISTRY
Date requested: September 25, 2023
Date/time released: September 26, 2023 2:27 AM

SI
EXAMINATION RESULT UNIT REFERENCE ANALYSIS
RANGE
Serum Glutamic 35.5 u/L Up to 45 Normal
Pyruvic
Transaminase/Alanin
e Aminotransferase

CLINICAL CHEMISTRY
Date requested: September 12, 2023
Date/time released: September 12, 2023 5:47 PM AM

Date requested: September 15, 2023

Date/time released: September 16, 2023 2:06 AM

SI CONVENTIONAL
EXAMINA RESU UNIT REFERE ANALY RESU UNI REFERE ANALY
TION LT NCE SIS LT T NCE SIS
RANGE RANGE
HBA1C: 6.0 % 4.2-6.5 Normal
Glycosylate
d
Hemoglobi
n
Creatinine 667.8 umol 58-110 Elevate 8.33 mg/ 0.66-1.25 Elevate
0 /L d due to dL d due to
decreas decreas
ed ed

82
 University of Saint Louis
Tuguegarao City, Cagayan 3500

SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

clearan clearan
ce by ce by
the the
kidney kidney
ELECTROLYTES
Sodium 100.5 mmo 135-155 Decreas 231.0 mg/ 310.5- Decreas
0 l/L ed due 3 dL 356.50 ed due
to fluid to fluid
overloa overloa
d or d or
diuretic diuretic
usage usage
Potassium 3.73 mmo 3.6-5.5 Normal 14.58 mg/ 14.08- Normal
l/L dL 21.51
Magnesium 0.80 mmo 0.7-1.0 Normal 1.94 mg/ 1.6-2.3 Normal
l/L dL

Date requested: September 17, 2023

Date/time released: September 18, 2023 5:57 AM

SI CONVENTIONAL
EXAMINA RESU UNIT REFERE ANALY RESU UNI REFERE ANALY
TION LT NCE SIS LT T NCE SIS
RANGE RANGE
ELECTROLYTES
Sodium 135.0 mmo 135-155 Normal 310.5 mg/ 310.5- Normal
0 l/L dL 356.50
Potassium 3.26 mmo 3.6-5.5 12.74 mg/ 14.08-
l/L dL 21.51

Date requested: September 21, 2023

Date/time released: September 21, 2023 2:33 PM

SI CONVENTIONAL
EXAMINA RESU UNIT REFERE ANALY RESU UNI REFERE ANALY
TION LT NCE SIS LT T NCE SIS
RANGE RANGE
ELECTROLYTES
Sodium 136.9 mmo 135-155 Normal 314.7 mg/ 310.5- Normal
0 l/L 1 dL 356.50
Potassium 3.44 mmo 3.6-5.5 Decreas 13.45 mg/ 14.08- Decreas
l/L ed due dL 21.51 ed due
to fluid to fluid
overloa overloa
d or d or
diuretic diuretic

83
 University of Saint Louis
Tuguegarao City, Cagayan 3500

SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

usage usage
Ionized 1.12 mmo 1.13-1.32 Slightly 4.48 mg/ 4.62-5.28 Slightly
Calcium l/L decreas dL decreas
ed but ed but
not not
significa significa
nt nt

Date requested: September 23, 2023

Date/time released: September 23, 2023 2:22 PM

SI CONVENTIONAL
EXAMINA RESU UNIT REFERE ANALY RESU UNI REFERE ANALY
TION LT NCE SIS LT T NCE SIS
RANGE RANGE
ELECTROLYTES
Sodium 135.2 mmo 135-155 Normal 310.8 mg/ 310.5- Normal
0 l/L 0 dL 356.50
Potassium 3.88 mmo 3.6-5.5 Normal 15.17 mg/ 14.08- Normal
l/L dL 21.51

Date requested: September 25, 2023

Date/time released: September 26, 2023 2:29 AM

SI CONVENTIONAL
EXAMINA RESU UNIT REFERE ANALY RESU UNI REFERE ANALY
TION LT NCE SIS LT T NCE SIS
RANGE RANGE
Creatinine 399.9 umol 58-110 Elevate 4.52 mg/ 0.66-1.25 Elevate
0 /L d due to dL d due to
decreas decreas
ed ed
clearan clearan
ce by ce by
the the
kidney kidney
ELECTROLYTES
Sodium 135.9 mmo 135-155 Normal 312.4 mg/ 310.5- Normal
0 l/L 1 dL 356.50
Potassium 3.98 mmo 3.6-5.5 Normal 15.56 mg/ 14.08- Normal
l/L dL 21.51

CLINICAL MICROSCOPY/PARASITOLOGY
Date requested: September 25, 2023
Date/time released: September 25, 2023 10:43 AM

84
 University of Saint Louis
Tuguegarao City, Cagayan 3500

SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

EXAMINATION RESULT ANALYSIS

Fecal Occult Blood NEGATIVE Normal

SEROLOGY AND IMMUNOLOGY

Date requested: September 12, 2023
Date/time released: September 12, 2023 5:10 PM

EXAMINATION: COVID-19 Rapid Antigen

Reagent /Kit Used: Wondfo COVID-19 Ag Rapid Test
Lot. No: W196302005
Specimen: Nasopharyngeal Swab
Methodology: Lateral Flow Immunoassay
RESULT INTERPRETATION: NEGATIVE for SARS-CoV-2 Antigen

Date performed: September 12, 2023

Result Date: September 13, 2023 5:03 PM

EXAMINATION: X-RAY CHEST PA-LATERAL

HISTORY: Generalized body weakness
COMPARISON: None
FINDINGS:
No focal opacities or areas of consolidation.
Heart is not enlarged.
The hemidiaphragm and sulci are intact.
Bones and soft tissues are unremarkable.
IMPRESSION:
No focal lung opacities or areas of consolidation

Date requested: September 13, 2023

Date/time released: September 13, 2023 12:41 PM

EXAMINATION RESULT ANALYSIS

HBsAg Screening NONREACTIVE Normal
Anti-HCV NONREACTIVE Normal

Date requested: September 13, 2023 3:50 PM

Date/time released: September 13, 2023 5:03 PM

PARAMETER PATIENT’S RESULT INTERPRETATION METHOD ANALYSIS

INDEX
Anti-HBS 0.00 NEGATIVE Negative: Less CLIA Normal
than 10 mIU/ml
Positive: More than
or equal to 10
mIU/ml
85
 University of Saint Louis
Tuguegarao City, Cagayan 3500

SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL II

DISCHARGE PLAN

86