Pathophysiology
Chronic Kidney Disease: Chronic kidney disease (CKD) is an irreversible condition that progresses causing kidney dysfunction and then to kidney failure. It is classified by a GFR of <60mL/min for longer than 3 months. There are five stages of CKD: Stage 1 has kidney damage but has a GFR ≥ 90. Stage 2 has mild damage and a GFR of 60-89. Stage 3 has moderate damage and a GFR of 30-59. Stage 4 has severe damage and a GFR of 15-29. Stage 5 is also known as end stage renal disease (ESRD), this is kidney failure with a GFR of ≤ 15 and theses patients are typically on dialysis or in need of an immediate transplant. The leading cause of CKD is diabetes. Hypertension is also a major cause. Since most DM patients have HTN, …show more content…

EXCESS FLUID VOLUME r/t inability of the kidneys to excrete fluid.
AEB: HTN, CHF, SOB, Chest pain 8/10, tachycardia. Dialysis x2 days removed 3.5L.
GOAL: Maintain acceptable fluid balance
OUTCOME: Patient will be free of chest pain, SOB and fluid overload by the time of discharge.
INTERVENTIONS/RATIONAL:
1. Monitor vital signs
-Tachycardia, high blood pressure, and decreased SaO2 are signs of fluid overload. (Ackley & Ladwig (2011) pg. 395).
2. Administer O2 therapy and diuretic and antihypertensive medications.
-Removing excess fluid and lowering the blood pressure while providing O2 will improve tissue perfusion and decrease cardio/pulmonary congestion. (Ackley & Ladwig (2011) pg. 395).
3. Monitor I&O’s strict fluid restriction of 1500mL/day.
-Restricting fluids and monitoring output will decrease fluid overload and will provide measurable data of the effectiveness on the kidney. (Ackley & Ladwig (2011) pg. 395).

EVALUATION:
Goal met. Patient SOB, chest pain 0/10, tachycardia resolved, blood pressure decreased and patient complied with fluid restrictions by the discharge time.
2.
KNOWLEDGE DEFICIT r/t ineffective management of therapeutic regimen.
AEB: Patient admits to non compliance of fluid restrictions and dietary choices.
GOAL: Teach patient information and importance of dietary and fluid restriction compliance.
OUTCOME: Pt will verbalize and demonstrate understanding of 1500mL fluid restriction and