University Nursing Case Study: Patient Care, Assessment, and Education

This case study details the comprehensive nursing care of a patient, Michael, with chronic kidney disease (stage 3) and related complications including hypovolemia, hyperglycemia, and a history of stroke. The assignment outlines the initial assessment, including vital signs, blood tests, and physical examinations, emphasizing the importance of monitoring fluid balance, electrolyte levels, and blood glucose. It presents a nursing care plan addressing the risks of fluid volume deficit, electrolyte imbalance, and unstable blood glucose, detailing specific interventions such as fluid management, medication administration, and dietary control. Furthermore, the case study highlights the importance of patient education, multidisciplinary team collaboration, and the role of support workers in providing comprehensive care and improving patient outcomes. The plan emphasizes regular monitoring, assessment of medication side effects, and the implementation of appropriate interventions to manage the patient's condition effectively.

Running Head: Nursing
Case Study
Name of the Student
Name of the University
Authors Note

2Case Study
Task 1
Firstly, the nurse should conduct head-to-toe examination and vital signs of the patient should be checked. Along with the vital signs
some other attributes should also be checked such aslevel of the blood glucose, BMI, smoking habits, cardio vascular and respiratoryreports.
Nurses shouldmonitor the vital signs specially blood pressure, body glucose level, heart and respiratory rate within proper interval. Any
abnormalities in reports will be informed and documented with other blood and urine reports. Vital signs checking is one of the primary
responsibilities of nurses as vital signs will give an entire idea of patient’s health.
After that nurse’s responsibility is to monitor urine output in hourly basis; as this will help to understand the scanty to normal volume of
urine. To monitor daily urine output, intake and output chart should be used by nurse.Thecurrent report of the patient indicates that the patient is
suffering from the hypovolemia of the pre-renal condition of acute kidney failure(Aitken, Marshall &Chaboyer, 2016). The person is suffering
from hypovolemia so that it is a very important to monitor the blood and the urine output.During acute kidney failure decrease of Vitamin D is
very common therefore calcium level should be checked.The blood glucose level, production of Vitamin D, the blood cell count should be
checked from the blood test.BUN, creatinine and urea report should be evaluated. Examination of oedema, rash mouth, ulcer stomach will be
done. Creatinine is a breakdown product for muscle and urea is waste product of use protein human body. The level of the substances or more
precisely the ratio of the substances will represent the status of kidney. Nephritic screening for blood quality test should be done. As Michael is a
patient of chronic kidney disorder(stage 3), above discussed assessments should be done properly. If the assessment and the interventions are not
executed, a situation of kidney failure and kidney transplantation might be occurred.
Monitoring fluid and electrolyte balance is very important in this case study to understand the condition of patient’s kidney in absorption
and transportation of minerals in the blood. Fluid and electrolyte balance will be assessed with the help of Hydration chart and fluid imbalance
chart (Pinnington, Ingleby, Hanumapura& Waring, 2016).After that the blood reports should be assessed to understand haemorrhage and
haematuria in the body.The capillary refill rate will help in assessment of sepsis. The blood reports will help in assessing the liver failure also.If
the chances of infection might be observed then it should be treated promptly. Patients’ urine output should be checked by the 24 hours
assessment.As a nurse, patient’s fluid and electrolyte levels will be checked for understanding the physical condition and the consequences
Electrolyte levels should be checked to understand whether hypokalemiaor hyponatremia is present or not in the patient.Monitoring of the bowel
and urine will help to assess dehydration and gastrointestinal fluid loss. Imbalances in electrolytes is a common consequence in chronic kidney
failure, therefore without treating this imbalance severe hypokalemiaor hyponatremia might take place.
The patient should be monitored strictly so that he would not opt for alcohol or high carbohydrate food. The diet of the patient should be
checked as the patient had hyperglycaemia and hyperlipidaemia. The patient’s urine output and blood result will help the nurses to understand
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which kind of medication changes will be suggested in the documentation. The side effects of drugs should also be analysed with help of
patient’sresponsesand further assessment with continuous observation. Micheal’s kidney’s condition is very critical. Without controlling glucose
level in body, a person might face different disorders. Uncontrollable glucose in body will be a cause of acute kidney failure. Glucose machine
will help the nurses to assess the regular glucose level (Kodner, Anderson&Pohlgeers, 2017).
Nurse should execute pulmonary and respiratory assessment to provide interventions for better pulmonary function. Although the case
study does not show any kind of pulmonary abnormality but to check the respiratory rate and any kind of response respiratory abnormalities
patient should be evaluated properly.The muscle strengths and reflexes will be assessed in the patient as the patient had stroke. Patient’s personal
care should be executed.
The three condition which are needed to solve are
 Deficit fluid volume ( oliguria)
 Decreased blood pressure
 High blood sugar level
Task 2
Nursing Care Plan:
Nursing problem:Risk of fluid volume deficit
Related to: low urine output by experiencing the vascular, cellulardehydration and lower GFR(30 mL/min/1.73 m2) .
Goal of care Nursing interventions Rationale Evaluation
Balanced fluid intake and
urine output of the
patient with improvement
of skin turgor and
normal heart beat.
 Regular input and output
measurement should be done fluid
losses should we waited and
 Monitoring the fluids for 24 hours
to avoid diuretic phase.
 Monitoring blood pressure and
 Input output assessment it will
help estimating the needs of
fluid replacement. Measuring
the fluid intake will help to you
compare the output. After
measuring input and output
 Vital signs will be checked in both
supine or lying down and standing
position. As the fluid deficit is
leading to hypotension in the patient.
 Skin turgor will be evaluated by
pinching the folder of skin between
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heart rate with noting down the
postural changes.
 Dull sensorium, peripheral
vasoconstriction, mucous
membrane, thirst and dehydration
signs and symptoms will be
checked
 Body temperature should be
checked and prevention should be
taken for pressure ulcers skin
turgor.
diaphysis and metabolism can
be measured
 Continuous fluid will help to
convert the diuretic phase in
oliguric phase. If the patient in
phase the fluid intake will
maintain the water
balance(Thomas ,2019).
 Orthostatic hypotension related
to hypovolemia and tachycardia
can be monitored.
 Extracellular fluid volume
depletion will influence thirst
centre of brain an excessive
sodium depletion will be
responsible for continuous
thirst. Continuous fluid loss is
related of acute Kidney Disease
 diaphoresis will be reduced. As
diaphoresis contribute in in fluid
loss
 Large urine loss might lead to
Sodium Potassium and Calcium
wasting with urinary Sodium
and potassium loss
Thumb and forefinger and the skin
will be e selected from abdomen
sternum so that patient should feel
resilient and could move easily.
 The capillary refill rate will be
assessed by pinching the of the
patient for 5 second and release it. It
takes maximum 3 seconds in normal
full stop if the patient is dehydrated
then it will take longer time.
 Neck veins of the patient will be
appeared flat. The neck veins will be
assist in supine position
 By examining tongue several small
pharaohs will be we observed rather
than one main follow
 Blood urea nitrogen to serum
creatinine ratio will be checked. If
the ratio is more than 20 is 21 then it
is abnormal.
 Urine specific gravity E and
osmolality will be checked for
checking the concentration of the
urine.
 Haematocrit or the percentage of red
blood corpuscles blood plasma will
be checked. If the value is increases
then there is a chance of
haemorrhage(Bardón et al., 2019).
Nursing problem:Risk of electrolyte imbalance
 Related to: imbalance of the electrolyte in the blood of the patient.
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Goal of care Nursing interventions Rationale Evaluation
The patient will have a
normal serum electrolyte
balance with normal level
of Sodium Potassium
Chloride and Calcium
 Serum electrolyte levels should be
monitored. Clinical condition of
situation pre medical history will be
referred in this case
 Data related to consumption should
be monitored
 Tissue trauma or wound drainage or
hemorrhage should be assist in the
patient
 The drugs are and evaluated.
Therefore drugs cannot influence
electrolyte balance of the body
 Endocrinol dysfunctions will be
checked
 Gastrointestinal fluid losses should
be checked
 The reasons of fatigue should be
discuss with the patient
 The level of electrolytes in the
body become too low to high
which need to be e evaluated.
Abnormality in serum
electrolytes should be
understand by evaluating
Sodium, Potassium, Chloride,
total calcium, ionized calcium,
magnesium, phosphate from the
reports of patient.
 The clinical condition of the
patient is acute kidney disease
with effect from electrolyte as
Acute Kidney Disease. Kidney
is affected and serum
electrolytes cannot be produced
in good amount.
 Thiazide diuretics can increase
sodium delivery in distal
segment of distal tubule.
Therefore potassium loss can be
occurred. Sodium reabsorption
in exchange to potassium and
hydrogen ion can eliminated by
urine (Akbari&Khorasani-
Zadeh, 2019).
 Thiazide diuretics can also
increase calcium reabsorption
which causes hypokalemia.
 Variation in the secretion of
The electrolyte panel is used to identify
electrolyte fluids and imbalance(Noble, 2020).It
is frequently ordered as part of the routine health
exam of basic metabolic panel and
comprehensive metabolic panel which are used
with BUN and creatinine and glucose level
readings.
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antidiuretic hormone from
posterior pituitary gland place
the patient at risk for Sodium
imbalance. Cortisol analyst and
secretion can also affect the
endocrine function
Nursing problem:Risk of unstable blood glucose level
Related to:
The patient has hyperglycaemia and this condition is affecting the condition of his kidney.
Goal of care Nursing interventions Rationale Evaluation
Normalise body glucose
with the help of dietary
control and nutritional
supplement
 The patient should be supported
with healthy eating pattern
 Basal and prandial insulin should be
administered. The insulin should be
administered as per the physicians’
suggestion.
 Dietician should be referred to the
patient with proper nutritional
balance(Powers et al., 2017).
 The patient should be educated to
follow the prescribed meal and
maintain the nutritional balance.
 The nurses should taught how to
measure the capillary blood
glucose.
 The nurses should assess the blood
glucose level before and after the
meal .
 As the patient is obese so that
it is necessary to give him a
balanced diet.
 To promote tissue perfusion and
controlling the glucose level
basal and prandial insulin
should be used(Wulandari,
Nursalam, & Has, 2017).
 Nutritionists will help the
patient to assist in better and
suitable meal planning. The
professional can help him to
understand the pattern of the
eating and exercises.
 Due to the withdrawal of
alcohol and effect of different
medications; the patient might
get frustrated and depressed.
To reduce anxiety and
depression nurses should help
The blood glucose will be evaluated several
times a day
 before breakfast , lunch and
dinner
 2 hours after having meals
The glucose level will be monitored by CGM
( continuous glucose monitor) machines
(Paldus et al., 2018). The blood glucose level
will be checked with the help of the glucose
meter by the patient.
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 The alcohol intake should be
assessed.
 The physical activity pattern for the
patient should be assessed.
 Anxiety, depression , slurry
speech and tremors will be
assessed in the patient.
the patient by educating him
and by giving him motivation
to lead the healthy life .
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Task 3
The patient will be educated by the help of proper professionals for in taking the
medicines and performing the exercises. The patient and her daughter should be informed
how to deal with emergency condition before admitting the patient to hospital. A support
worker will be appointed to the patient as he was very old and cannot do daily life activities.
The support worker will be trained how and when to check blood pressure and blood sugar.
The support worker will be informed that urinalysis and blood report should be assessed
and evaluated by the nurse interval of 15 days.
Multi-disciplinary team will be formed to take care of him. Physiotherapist,
Registered nurses, laboratory experts, psychologists and support workers will execute their
duties with the suggestion of the physicians (Rizo-Topete & Ronco, 2017). The
multidisciplinary team members will visit the patient or the support worker will help
him to visit them in the hospital. Physiotherapist will help him to practise breathing
exercises and to improve breathing patterns. The therapist will help him in managing pain by
suggesting some relaxation therapies (Moist, 2020). The therapist will help Michael to
improve his pulmonary hypertension and blood glucose level by suggesting some low
intensity exercises. Physical therapy will help the person to improve mobility and reduce
anxiety. The healthcare support worker will help Michael in performing daily life activities.
These daily life activities will help him in improving his mobility and independence to do his
own works (Takahashi, Hu, & Bostom, 2018). Therapeutic approach of nursing such as
effective and non-verbal communication, counselling, pain reducing treatment and educating
the patient will increase quality of care in Michael’s non-pharmachological treatment (Ruiz,
& Niven, 2019). Psychotherapist will counsel both Michael and his daughter so that they can
cope with the difficulties. Disease progression and related sufferings are the factors for
depression and anxiety in patient’s family (Hole et al., 2016). Therefore, proper education and
counselling are needed to prevent depression among family members and patient.
Psychotherapy might help Michael in withdrawing alcohol consumption and motivate him to
lead a healthy life. Dietician and diabetologist have important role in care management of
Michael as he is a patient of hyperglycemia. Dietary habit management will be required as
Michael is an obese person. Therefore, dietician with the collaboration of doctors and nurses
will make diet plan for him (Powers et al., 2017). As Michael is an elderly patient with acute
illness he must be undergone through regular check-ups. Therefore, blood test and other
reports are very important to keep a track of his health condition.
The patient should maintain a balanced diet and try to stop alcohol intake. The patient
should maintain a journal which will help him and the nurses to assess his both physical and
emotional condition.
Task 4
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Drug calculation
Formula
IV Drip rate = ( Volume to be given in ml)/(Time in hours )
Source:(Gage & Toney-Butler,2019)
Intravenous compound sodium lactate
= (500/2)ml/hour
= 250 ml/hour
Intravenous compound sodium chloride
= (1000/8)ml/hour
= 125 ml/hour
Pharmacokinetics of Rampiril
The medication is administered to the patient with thiazide diuretics and in the post
stroke condition. This medication will be absorbed up to 50% to 60% after the oral
administration(Cianfrone et al., 2017). The medicine will be bound to the serum protein
and is metabolised to the ramiprilat as it has ACE inhibiting effect. 60% of this
medication is excreted by urine and 40% by faeces. The side effects of this medications are
fatigue, confusion and sweating.
Pharmacokinetics of furosemide
Diuresis takes place within 5 minutes I.V. administration and increases the effect in 20
to 60 minutes.it bounds to the plasma protein and minimally metabolised by the liver. The
medication is excreted by urine(Sleeper, O’Donnell, Fitzgerald&Papich, 2019). It has
diuretics, peripheral vasodilatationand the hypertensive action. It is used in the condition
of the hypercalcemia.The side effect of the medication are muscle cramps, weakness,
diarrhoea , stomach pain and dizziness.
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References
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