NUR251 Medical Surgical Nursing Case Study: Patient with AKI and CKD

This report presents a comprehensive medical surgical nursing case study focusing on Mr. David Smith, a 72-year-old patient admitted with acute kidney injury secondary to pyelonephritis, alongside multiple comorbidities including chronic kidney disease, obesity, anxiety, hypertension, and diabetes. The report details the initial nursing assessments, including vital signs, nutritional and fluid status, and pain levels, followed by the identification of key nursing problems: fluid imbalance, anxiety, pain, skin integrity impairment, and risk of infection. For each problem, specific goals, nursing interventions, and rationales are outlined, with an emphasis on evidence-based practices. The care plan includes interventions such as assessing venous pressure, documenting fluid input/output, providing anxiety-reducing strategies, managing pain through assessment and repositioning, and implementing infection control measures. The report concludes with a discussion of patient education, including dietary modifications, anxiety management, and self-management strategies, ensuring the patient's understanding and ability to cope with his health conditions post-discharge. The report also includes progress notes reflecting the patient's status and care provided.

Running head: MEDICAL SURGICAL NURSING
MEDICAL SURGICAL NURSING
Name of the student
Name of the university
Author note

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Introduction
Need assessment is the process used by the nursing professionals in which they
conduct a systematic process so that they can collect patient information and then provide
them with effective interventions for their wellbeing (Bednarczyk et al., 2017). In this case
study analysis, the scenario of Mr. David Smith (72) would be discussed who has admitted in
the CDU medical ward with complication related to his of Acute Kidney Injury and is
secondary to Pyelonephritis. The patient hails from Darwin and originally a Caucasian male.
The patient has multiple health complications such as chronic kidney disease with baseline
Egfr 40ml/min/1.73m2, obesity, anxiety, hypertension, chronic venous leg ulcer in left leg,
and diabetes. It was also mentioned in the case study that he is an ex-smoker however he
consumes one full bottle of wine every night. He is able to take care of himself and manages
his activities of daily life. The following sections would discuss about the complications, his
health assessment and with the help if recent evidences would help to develop an effective
care plan for the patient.
Task 1
Upon understanding the complete scenario of the patient, I would start my shift with
the commencement of primarily three assessments in which I would conduct his vital sign
assessment, his nutritional and fluid assessment, and his pain assessment. All these aspects
are important for the patient’s health condition as it would help me to get an overview of
patient’s current situation. Within vital sign assessment, I would conduct the four primary
assessments including body temperature, blood pressure, heart rate or pulse rate and
breathing rate. Within this assessment the blood pressure and respiratory rate would be
critical as the patient has a history of diabetes and extensive smoking. As per the research
studies of De Boer et al. (2017), increased blood pressure of hypertension is associated with

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the increased complication of diabetes and hence, this process would be implemented, with
other vital sign assessments.
The second assessment for Mr. David would be assessing his nutritional and fluid
assessment. As per Claure-Del Granado and Mehta (2016), both of these assessment methods
are effective in determining the current health condition and it would be easier for me to
manage his diet and fluid intake. As per Silversides et al. (2017), while suffering from disease
condition related to kidney, the patients should be checked regularly for their creatinine, their
sodium potassium levels, their blood urea nitrogen levels. Hence, these are the assessment
that would be conducted for his fluid input and output (De Boer et al., 2017). Further, it was
also mentioned that the patient was forcing himself for his diabetic diet and hence, it was
important to observe his complete nutritional status, as he might skip his diet to avoid the
diabetic food. Therefore, these would be the diet and fluid assessment for Mr. David.
The third assessment would be his pain assessment as the patient reported a sharp pain
in his right flank region and it is necessary for analysing the pain state and level for Mr.
David so that with analysis of his pain level, he could be provided with interventions to
manage or control it effectively (Seers et al., 2018). If not analysed properly, it could lead to
severe pain and then it would be difficult to manage as providing morphine with multiple co-
morbidities would be critical (Claure-Del Granado & Mehta, 2016). Hence, these assessments
would be conducted while commencement of my shift.

Running head: MEDICAL SURGICAL NURSING
Task 2
Nursing problem: fluid imbalance related healthcare problem
This could be related to his kidney damage and resulting fluid volume deficit in his body. Further with acute fluid volume deficit the patient may suffer
from critical renal failure (Bednarczyk et al., 2017).
Goal of care Nursing interventions Rationale Evaluation
1. The primary
goal would be to
achieve stable
fluid volume
measurement so
that the patient
could be
protected from
acute renal
 As per Sirvent et al. (2015) for such
conditions, it is important to assess
the venous pressure of patient as
with assessment of this critical
aspect, the risk of fluid imbalance
could be easily assessed.
 The second intervention would be
documenting the fluid input and
 As per De Backer and Vincent
(2018), increase in the central
vein pressure is associated with
the hypertension and dyspnea.
Both these aspects were
observed in case of Mr. David
and hence, these conditions
would be assessed.
The evaluation would be conducted through
the analysis of the data with control (general
range in a healthy male) so that the level of
abnormality could be assessed (Bednarczyk
et al., 2017).

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failure
2. Another goal
would be to
make patient
aware of his
health
complication
and the
importance of
maintaining
proper fluid
balance for his
fast recovery
output for the patient and weighing
his weight on a regular basis De
Backer and Vincent (2018). This
would help to keep a closer look at
the patient’s condition.
 The second intervention that has
been used for Mr. David as
Bednarczyk et al. (2017)
mentions that with increased
fluid concentration, the patient
starts gaining weight. Therefore,
if the patient is suffering from
fluid imbalance. He would
suffer from weight gain or
weight loss.
Nursing problem: anxiety related healthcare problem
This is related to the mental complications of the patient that he is facing or would face while going through the interventions. This is a complication as it could

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reduce the effect of applied intervention on the patient and would affect the recovery process (García-Campayo et al., 2015).
Goal of care Nursing interventions Rationale Evaluation
1. The first goal
would be to help
the patient to
reduce his
anxiety and
make him aware
of different
coping skills
that would
reduce his
health
complication.
 The first intervention would be
educate the patient about his
anxiety condition and assess his
knowledge about anxiety
(Martinsen et al., 2016).
 The patient would be involved in
communication so that he could
share his complications
 As per Vogelmeier et al. (2017),
there are multiple aspects that
could lead to anxiety in the
patient condition and hence, it is
important to understand the
aspects that is affecting patients
thought process.
 The second intervention has
been implemented in the care
process as García-Campayo et
al. (2015) mentions about the
complications patients suffer
The effectiveness of these interventions
would be assessed through the analysis of
Mr. David’s stability, his ability to focus on
interventions (Pickett et al., 2018).

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2. The second goal
would be to
educate the
patient about his
anxiety and help
him with
developing
confidence so
that he could
implement the
stress relieving
strategies
applied for him
from during their anxiety that
affects their thought process.
Nursing problem: his pain that he mentioned about while admitting in hospital
This is related to the pain that the patient experienced in his right flank at the time of admission

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Goal of care Nursing interventions Rationale Evaluation
1. The only goal
for this nursing
problem would
be to reduce the
pain level and
the anxiety nd
restlessness
faced by the
patient due to
this condition.
 The first intervention would be
conduct pain assessment
 The patient would be asked for an
abdominal diagnosis for analysing
the reason of pain (Hager et al.,
2018).
 A complete pain assessment
helps the nursing professional to
understand the level of pain
faced by the patient and hence
depending upon the data, the
level of intervention applied for
the patient could be identified
(Schoenfeld et al., 2017).
 As per Gold et al. (2019) one of
the primary reason for the flank
associated pain is connected
with positioning issues while
After few days, the pain assessment would
be conducted again and then it would be
compared with the previous data so that the
level of pan reduced could be understood
(Chung & Kim, 2018).

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sitting, sleeping or moving.
Therefore application of
repositioning patient with
application of mild medication
would help to reduce the patient
condition.
Nursing problem: nursing problems associated with integrity of skin
This is related to the skin integrity impairment due to which the patient suffer from the risk of skin disease.
Goal of care Nursing interventions Rationale Evaluation
1. The primary
aim would be
reach the level
of capillary fill
within 6
 Firstly, the skin assessment of Mr.
David would be conducted.
 The patient would also be assessed
for the increased sensitivity or
inflammation (Avşar & Karadağ,
 This assessment would help to
focus upon the complications
that the patient may suffer from
while undergoing critical health
condition (Avşar & Karadağ,
The evaluation would be conducted by
analysing the risk of pressure ulcer as the
patient is suffering from the risk of pressure
ulcer as well as reduced quality of skin

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seconds that
demotes that the
patient’s skin
would not be
swelled or red
2018) 2018) (Kottner & Surber, 2016).
Nursing problem: risk of infection due to the insertion of IVC in both of the antecubital fossa veins
This nursing problem is related to the increases risk due to the inserted IVCs in both of the ACF or antecubital fossa veins of the patient. Improper
handling of both of these insertion sites could be the reason of infection (Cox & Thom, 2018).
Goal of care Nursing interventions Rationale Evaluation
1. If infection is
present then that
should be
identified early
 The patient would be limited for his
number of visitors
 He would be asked to intake a high
 Hand hygiene and limited
number of victor would help to
prevent risk of infection (Cox &
The patients infection assessment would be
conducted every seventh day so that the
amount of infection in the patient’s body

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so that the
prevention
could be
achieved
properly.
2. Conducting
infection
assessment for
both virus and
bacteria so that
the level of
hygiene could
be maintained
within the care
facility.
amount of fluid input
 The healthcare professionals
involved in the care process would
be asked to maintain a specific level
of hand hygiene (Narendra et al.,
2019)
Thom, 2018) could be evaluated (Lee et al., 2018).

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