Chronic Renal failure

Patient: Mr. John Smith, a 65-year-old male Chief Complaint: Fatigue, decreased urine output History of Present Illness: Mr. Smith presents to his primary care physician with a 2-month history of fatigue, decreased urine output, and swelling in his ankles. He has a history of hypertension and diabetes mellitus type 2. Past Medical History: Hypertension, diabetes mellitus type 2 Social History: Mr. Smith is a retired construction worker. He smokes 1 pack of cigarettes per day and drinks alcohol occasionally. He is married and has two adult children. Physical Examination:

• Vital signs: BP 160/100 mmHg, HR 100 bpm, RR 22 bpm, SpO2 98% on room air
• General: Well-developed, well-nourished male in no acute distress
• HEENT: Pupils equal, round, and reactive to light; Sclerae anicteric
• Neck: No jugular venous distension
• Lungs: Clear to auscultation
• Heart: Regular rate and rhythm, no murmurs, rubs, or gallops
• Abdomen: Soft, non-tender, non-distended; positive bowel sounds
• Extremities: 2+ pitting edema in bilateral lower extremities

Laboratory Studies:

• Complete blood count: Within normal limits
• Blood chemistry: Sodium 135 mEq/L, potassium 5.0 mEq/L, chloride 100 mEq/L, bicarbonate 24 mEq/L, glucose 120 mg/dL, creatinine 3.0 mg/dL, BUN 100 mg/dL
• Creatinine clearance: 15 mL/min
• Urinalysis: Specific gravity 1.010, positive for protein, glucose, and blood

Diagnosis: Chronic renal failure Treatment Plan:

• Medications:
  • ACE inhibitor
  • Beta-blocker
  • Diuretic
• Lifestyle modifications:
  • Smoking cessation
  • Weight loss
  • Increased physical activity
• Education:
  • Patient education about CRF and its treatment
  • Importance of taking medications as prescribed
  • Lifestyle modifications to reduce risk of further complications

Nursing Interventions:

• Monitor vital signs and fluid status
• Administer medications as prescribed
• Provide patient education about CRF
• Encourage lifestyle modifications to reduce risk of further complications

Discussion Questions:

1. What are the risk factors for CRF?
2. What are the laboratory and diagnostic findings that are consistent with CRF?
3. What are the medications that are commonly used to treat CRF?
4. What are the lifestyle modifications that can help to reduce the risk of complications from CRF?
5. What are the nursing interventions that are important for the care of a patient with CRF?

Conclusion: Mr. Smith is a 65-year-old male with a diagnosis of CRF. He has been started on medications and has been given education about CRF. He will be monitored closely for further complications. Additional Information:

• CRF is a progressive decline in kidney function.
• The most common cause of CRF is diabetes mellitus.
• Other risk factors for CRF include hypertension, kidney disease, and polycystic kidney disease.
• Treatment for CRF typically involves medications to control blood pressure and blood sugar, as well as lifestyle modifications such as smoking cessation and weight loss.
• In advanced stages of CRF, dialysis or kidney transplantation may be necessary.

Sample Solution

History of Present Illness: Mr. Smith presents to his primary care physician with a 2-month history of fatigue, decreased urine output, and swelling in his ankles. He has a history of hypertension and diabetes mellitus type 2.