HYPOTHETICAL CASE MANAGEMENT PAPER

Often, chronic kidney disease is diagnosed as a result of screening of people known to be at risk of kidney problems, such as those with high blood pressure or diabetes and those with a blood relative with chronic kidney disease. Chronic kidney disease may also be identified when it leads to one of its recognized complications, such as cardiovascular disease, anemia or pericarditis. Chronic kidney disease is identified by a blood test for creatinine. Higher levels of creatinine indicate a falling glomerular filtration rate (the rate at which the kidneys filter blood) and as a result a decreased capability of the kidneys to excrete waste products. Creatinine levels may be normal in the early stages of CKD, and the condition is discovered if urinalysis (testing of a urine sample) shows that the kidney is allowing the loss of protein or red blood cells into the urine.

The patient’s general condition is ill-looking and oriented to time, place and person. History of the past illness According to the patient’s party, he is undergoing regular dialysis and is under antihypertensive medicine. He does not have any allergies to any factor. He was last hospitalized in China medical college where he was diagnosed with CKD. The patient has not undergone any operations and neither is he under any special treatment. The period after retirement has to e filled with new projects but is characterized by few cultural guidelines. The achievements of this task may be obstructed by the management of another task living in a reduced income after retirement. Passed Adjusting to death of a spouse Older adults may become caregivers to their spouses.

Some older adults have to adult adapt to the death of their spouses. This is because after living with the souses for so long, after death, older people should adjust and get used to loneliness and probably move to a smaller house. My patient achieved happiness and contentment in his life based on his actions and speeches. He is faithful and devoted to his religion. He is ready to accept death completely and he has shared his experiences with his beloved grandchildren. Even though he accepted death fully but his faith and love for his worshiped God never changed. Physical assessment Name: Edwin Sitati mark Bed: 190 Status: Married Ward: Nephrology Sex: Male Vital signs Axillary T=97 degree F, PR=90/min, RR=22/min, BP=150/80mm Hg General survey Height=5 ft and 6 inches, weight =55 kilos.

No scars and wounds noted. Eyes Has symmetrical eyebrows movement, shape and hair distribution. Eyebrows have the same color with hair. Eyelashes are evenly distributed and curled outward. Eyelids have no discharge and bilaterally blink. Both nares are patent, air moves freely as client breathes through the nares. The nasal septum is straight and in the midline. The nasal mucosa is pinkish in color, has no lesions. No tenderness of sinuses noted. Mouth Lips are little brownish in color, dry and have cracks. No enlargement of the neck noted. The patient is able to flex and extend the neck and move it laterally. Chest and lungs The breathing pattern is regular. Anteroposterior diameter to transverse diameter is in 1:2. The respiratory excursion is symmetrical.

Abdomen His abdomen’s color is same as the rest of the part of the body. His umbilicus is coated with blackish dirt. Neurologic Assessment Cranial nerves; able to identify aromas by smelling with eyes closed; able to see objects; pupil constricted to light sensation; able to move eyeball downward and laterally; able to blink eyes; able to smile, raise eyebrows, puff cheeks and close the eyes, has rough and vibrating sound. Able to shrug shoulders, elevate and flex arms and legs against resistance; able to protrude tongue and move it side to side. Anatomy and physiology The kidneys are the primary organs of the urinary system in vertebrates. The work of the kidneys is much more than just the removal of waste, however.

Other functions of the kidneys include: •Helping control the amount of water lost to the outside world– most important in land animals. •Helping regulate thepH(i. e. , level of acidity or alkalinity) of the blood and the general balance of ions in the blood, and hence in the body fluid as a whole. This blood must contain glucose and oxygen because the kidney has to work hard producing urine. Blood in the renal artery must have sufficient pressure or the kidney will not be able to filter the blood. Blood supplied to the kidney contains a toxic product called urea which must be removed from the blood. It may have too much salt and too much water. The kidney removes these excess materials; that is its function.

 4) Cortex The cortex is the outer part of the kidney. This is where blood is filtered. We call this process "ultra-filtration" or"high-pressure filtration" because it only works if the blood entering the kidney in the renal artery is at high pressure. Billions of glomeruli are found in the cortex. A glomerulus is a tiny ball of capillaries. Proximal Convoluted Tubules Proximal means "near to" and convoluted means "coiled up" so this is the coiled up tube near to the Bowman's capsule. This is the place where all that useful glucose is re-absorbed from the ultra-filtrate and put back into the blood. If the glucose was not absorbed it would end up in your urine. This happens in people who are suffering from diabetes.

Loop of Henlé This part of the nephron is where water is reabsorbed. This is where most of the salts in the ultra-filtrate are re-absorbed. Pathophysiology Secondary Hypertension ↓ Arteriosclerotic lesions of the afferent and efferent arterioles ↓ Falling glomerular filtration rate ↓ Decrease capability of the kidneys to excrete waste products Due to hypertension, there are a lesion to the afferent and efferent arterioles decreasing the effectiveness of the filtration of blood in the glomerular that leads to the decreased capability of the kidney to properly excrete waste products (Gz, 2012, p.  12) Discharge Planning M- Medication ➢Instructed to complied strictly with the following home medications ➢Vitamin B Complex I tab OD PO ➢CaCO I tab TID PO ➢NaHCO3 I tab TID PO ➢ JNH-RIF-PZO-IHN I tab OD PO E- Exercise • Encourage mild exercise T- Treatment ➢Advice patient to avoid stress-related factor H-Health teachings ➢Encourage deep breathing exercise ➢Adequate bed rest O- Outpatient ➢Informed client to follow up check up ➢Emphasize the need to be present in medical procedures schedule D- Diet ➢Maintain on low salt low-fat diet ➢Limit fluid intake Evaluation This case study attempted to provide complete information about the illness regarding the patient.