Medical history: CAD, Hypertensive heart disease, LVH, Paroxysmal A Fib, PAD, chronic diastolic HF, CKD, anxiety, hyperlipidemia, hypothyroidism, post herpetic neuralgia, left renal artery stenosis. Cardiac O stent placed in Nov of 2018.
Secondary Diagnosis: Stage 2 Chronic Kidney Disease. May be increasing hypertension due to fluid accumulation and inability to regulate blood pressure.
Diagnostic Tests or Labs: Monitor urine for albumin or other proteins. Monitor GFR to see how well kidneys are functioning. Monitor creatinine and BUN. GFR is used for diagnosing CKD.
Labs: Hct of 34.6 and Hgb of 11, both low and could indicate anemia. MCHC (31.8) low, RDW (15.7, 50.4) high, could indicate iron-deficiency anemia r/t CKD. BUN of 30 and Creatinine of 1.70, both high r/t CKD. GFR of 28 and is below normal, occurs in late stage CKD. Low albumin, 3.3, from malnourishment.
Medical Treatments: Need to treat multiple factors. Anemia treatment through iron supplementation. Phosphate balance by removing dairy, red meats, and eggs. High blood pressure with anti-hypertensives or others.
Medications: Treat hypertension with nitroglycerin, Spironolactone, Minoxidil, Cloniine, Carvedilol, and amlodipine. Amiodarone treats arrhythmia. Increase Atorvastatin to help with CAD and return LDL and cholesterol labs to normal.Vitamins for general health.
Nursing Interventions: Monitor cardiac output, can be decreased. Monitor for edema, pulmonary edema r/t fluid retention. Monitor urine output, routinely urinalysis. Risk for impaired healing so prevent pressure wounds through routine turning or movement. Risk for infection, monitor hand hygiene and contamination. Increase hypertension medications to get that under control and reduce strain on kidneys. Monitor I&Os.
Signs and Symptoms: Anemia, patient has intermittent edema, fatigue, severe hypertension, has experienced SOB. Dizziness could be a part of this as well.
CKD Pathophysiology: Chronic kidney disease is the loss of kidney function. Either a change or a loss of kidney tissues begins to result in loss of function. With the loss or changing of tissues, the nephrons cannot function as well to filter, excrete, and reabsorb important electrolytes and water. The remaining nephrons begin to overwork to compensate until glomerular hypertension and nephron death occurs. End-stage kidney failure occurs.