Lyceum Northwestern University Tapuac District, Dagupan City College of Nursing

In Partial Fulfillment for NCM 103, Related Learning Experience

A CASE STUDY on CHRONIC KIDNEY DISEASE secondary to DIABETES MELITUS TYPE 2

Presented to: Nursing Education Veterans Memorial Medical Center

Presented by: Albarillo, Reymark Arconado, Akemie Bala, Carina Balberan, Saro Balbin, Lea Bernardo, John Andren Bungar, Diana Rose Canabal, Kelvin Callanta, Christopher Castaneda, Myra Cereno, John Andro De Guzman, Susan Sotelo, Gladys

TABLE OF CONTENTS I. II. Introduction Objective a. General Objective b. Specific Objective Significance of the Study a. Nursing Education b. Nursing Practice c. Nursing Research Patients Profile Patients Medical History Physical Assessment

III.

IV. V. VI.

VII. Laboratory Tests/results VIII. Diagnostic Test /Results IX. X. XI. Anatomy and Physiology Pathophysiology Medical Management

XII. Drug Study XIII. Nursing Management XIV. Nursing Care Plan XV. Discharge Planning

INTRODUCTION What contributes to the failure of kidneys to malfunction? That is the question that we hope to find an answer to, through this case study. Patient X initially admitted to Veterans Memorial Medical Center, Emergency Ward, was forwarded to Nephrology Ward 4 with a chief complaint of persistent flank pain, right knee pain andwith an initial Vital Signs of , BP 160/100, PR 74, RR, 20, and afebrile. Several tests was ordered for Patient X and had an initial diagnosis of Chronic Kidney Disease (CKD) with Diabetes Mellitus (DM) Type 2. Patient X has history of Hypertension and Diabetes Mellitus, with a usual diet of ____________. and dependence on medications____________. We picked this case because we see the worth of getting into the details of this disease. Being affiliated to Nephrology Ward is an opportunity for us, not only to enrich our knowledge on the subject, but more importantly, a hand on involvement with this type of case is a privilege. In this case study, we will include in our topics the following: An overview on CKD and DM Pathophysiology of CKD and DM Anatomy and Physiology of the Renal System Patient History Laboratory Test and Diagnostic Test Medical Management Nursing Management Chronic Kidney Disease (CKD), being the umbrella of all Renal Disorder, also commonly referred to as Chronic Renal Failure (CRF) or End-Stage Renal Disease (ESRD) is a gradual, progressive irreversible loss of kidney functions that require renal replacement therapy on a permanent basis. a. b. c. d. e. f. g. The primary causes of CKD are noted as follows: May follow an Acute Kidney Disease Diabetes Mellitus and other Metabolic disorders Hypertension Chronic urinary obstructions Recurrent Infection Renal Artery occlusions Autoimmune disorders

CKD is a disease that has a systemic effect and as a result, the patients exhibits numerous signs and symptoms to include but not limited to; Cardiovascular disease and Peripheral Neuropathy.

Signs and Symptoms Neurologic Asterixis Burning of sole and feet Behavior Changes Confusion Disorientation Inability to concentrate Tremors Seizures Restlessness Slurred Speech Tremors, twitching or Jerky movements Weakness and fatigue Integumentary Decreased skin turgor Ecchymosis Pruritus Yellow-gray Pallor Purpura Thin, brittle nails Course, thinning hair Uremic Frost (late, premorbid) Soft Tissue calcification Cardiovascular Hypertension Heart failure Cardiomyopathy Pitting edema (feet, hands, sacrum) Periorbital edema Pericardial friction rub Pericardial edema Engorged neck veins Pericarditis Pericardial effusion Pericardial tamponade Hyperkalemia Hyperlipidemia

Pulmonary Crackles Thick, tenacious sputum Depressed cough reflex Pleuritic pain Pleural effusion Pulmonary edema Shortness of breath Tachypnea Kussmauls respiration Uremic pneumonitis Uremic halitosis Gastrointestinal Ammonia odor to breath (uremic fetor) Anorexia Change in accuity and sensation Constipation/Diarrhea Hiccups Metalic taste Mouth ulceration and bleeding Uremic gastritis (Possible GI bleeding) Hematologic Anemia Thromcytopenia Reproductive Amenorrhea Decrease fertility Decreased libido Impotence Testicular atrophy Musculoskeletal Muscle cramps Loss of muscle strength Renal osteodystrophy Bone pain Bone fractures Foot drop Special Problems in CKD includes:
Activity intolerance and insomnia Anemia GI bleeding Hyperkalemia Hypermagnesemia Hyperphosphatemia

Hypertension Hypervolemia Hypovolemia Hypocalcemia Infection Metabolic acidosis Muscle cramps Neurologic changes Ocular irritation Potential for injury Pruritus Psychosocial problems

OBJECTIVES GENERAL OBJECTIVES It is the aim of this case study that we, the students who prepared this will gain acquire additional knowledge, experience, and professional approach in caring a patient having a chronic kidney disease secondary to diabetes mellitus (type II), SPECIFIC OBJECTIVES Define the pathophysiology of CKD Secondary to Diabetes Mellitus (Type II). Trace the pathophysiology of CKD Secondary to Diabetes Mellitus (Type II) Enumerate the different signs and symptoms of CKD secondary to DM II. To identify the risk factors contributing to the occurring of CKD secondary to DM II. To learn clinical skills as well as update our current clinical skills required in the management of the patient with CKD secondary to DM II. To help the patient and family raise the level of awareness of having CKD secondary to DM II. To formulate and apply nursing care plan utilizing the nursing process. To develop our sense of unselfish love, empathy in rendering nursing care to our patients so that we may be able to see the future client with higher level of holistic understanding.