Case study Synopsis
Chronic kidney disease is one of the common and serious health burdens in Australia. Those with the most severe form, end-stage kidney disease(ESRD), usually require dialysis or a kidney transplant to survive. Diabetic nephropathy is one of the most common cause of end stage renal disease. I work as a renal nurse in acute and satellite haemodialysis units in Northern Territory where majority of the clients are indigenous population.
My case study will be based on one of the indigenous client Rosie who is diagnosed with end stage renal failure secondary to presumed diabetic nephropathy and on maintenance dialysis three times per week. This case study will start with the past medical history, current problems, pathophisiology of underlying cause for current hospitalization,(fluid retention) current medications and their actions and side effects, drug to drug interactions followed by the nursing care provided and the outcome of the treatment.
Rosie presented to emergency department with shortness of breath due to fluid overload after missing three sessions of dialysis, hyperkalemia, febrile due to respiratory infection. Rosie had a medical history of hypertension, coronary artery disease, and rheumatoid arthritis, cardiac failure, renal anaemia, elevated parathyroid hormone and obstructed sleep apnoea and she is on CPAP. After initial assessment in ED she got admitted to renal ward for emergency dialysis as per missed protocol. Intravenous antibiotic piperacillin and tazocin bd was administered for five days and then switched to oral antibiotic Augmentien duo- 625mg to treat the respiratory infection. Rosie got discharged from the hospital when she became stable and the medications prescribed during discharge are as follows:
Aspirin 100mg od
Amlodipine 5mg od
Augmentin duo 625mg bd
Calcitriol 0.75mg three times a week
Calcium Carbonate 1250 two tablets tid
Coloxyl and senna two tablets bd
Digoxin 62.5mcg od
Lactulose 20mg od
Paracetamol 1330mg bd
Sevelamer 1600mg tid
Need to explain each medications action,adverse effect in 2-3 sentence.Then needed drug to drug interaction,after that critical evaluation of nursing interventions and goals achieved.Interventions should include Non complaint in taking regular medications,not following renal diet and fluid restrictions, social factors contributes missing dialysis, finally evaluation of care. and conclution