Chronic Kidney Disease (CKD) Case Study and Care Plan

CKD Case Study and Care Plan Assignment
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Mr. B. Bumble, a 74-year-old man, presented with complaints of swollen legs and abdomen, headache, oliguria, nausea and vomiting, worsening shortness of breath, and activity intolerance. He has a medical history of hypertension, prostate cancer, and type 2 diabetes. He also has a history of hospital admission within the last year for an NSTEMI. Mr. B’s kidney function has been declining, and he is on follow-up with a nephrologist.
The main concern for Mr. B is low urine output. The first step as a nurse is to complete an assessment of the patient by taking a detailed medical history, checking his weight, blood pressure, and blood sugar readings, and recording vital signs. The nurse should ask relevant questions whose answers will help to relate to the signs and symptoms presented for a meaningful diagnosis and care plan. Some inquiries concerning oliguria include: How many times a day do you go for a short call? When did you start noticing a decline in your urine output? How much is your daily fluid intake? Do you feel any pain while urinating? Are you on any medication? When were you diagnosed with hypertension and diabetes? Have you been hospitalized before, when, and why? Family history of kidney disease? What is your occupation/hobbies?
It is important to compare his current weight with the previously stated weight. The excess may result from fluid overload (Gulanick & Myers, 2021). The nurse should assess and monitor the patient's blood pressure, heart rate, respiratory rate, and oxygen circulation. Since the patient has a history of hypertension and diabetes, checking and recording his blood pressure and blood sugar readings on arrival at the emergency room is essential. In addition, the nurse should perform a thorough physical examination of the patient. The nurse should palpate the bladder to investigate distention due to urinary retention. They should also assess the degree of edema on the extremities to determine the extent of fluid retention. It is also important to note the condition of the skin and mucous membrane to assess the level of hydration. While conducting the physical examination, the nurse should note any reflexes in response to pain and the location.
Oliguria refers to diminished urine output of less than 500ml in 24 hours. Mr. B. reported noticing a reduction in the quantity and frequency of urinating. He denied feeling pain apart from a headache, for which he took over-the-counter medication. He also admitted to skipping the prescribed medication sometimes. Mr. B. weighed 92 kg and reported that his last known weight was 90.5 kg. His blood pressure read 140/72, his oxygen saturation was 96%, his heart rate was 94 beats per minute and his respiratory rate at 20 breaths per minute. The patient's lower extremities were swollen, indicative of excessive fluid retention.
After obtaining an extensive history and conducting a detailed physical examination, an investigative workup is necessary. The tests include urinalysis, serum electrolytes, blood urea nitrogen (BUN), serum creatinine, and a complete blood count (CBC). The team should obtain...