I.

INTRODUCTION

A Healthy body is the most important thing that you should maintain. You cannot
buy your health; you must earn it through healthy living. There are some people who
cannot live normal because of having unexpected circumstances in life.

Chronic Kidney Disease is common. It is defined by the presence of kidney

damage or decreased glomerular filtration rate. Kidney disease often has no symptoms
in its early stages and can go undetected until it is very advanced. For this reason it is
often referred to as a “silent disease”.

The overall prevalence of Chronic Kidney Disease in the general population is

approximately 14% last 1994-2004. More than 661,000 Americans have kidney failure,
468,000 individuals are on dialysis and 193,000 live with a functioning kidney transplant.
In 2013 more than 47,000 Americans died from kidney disease. In Philippines, there are
392.6 deaths per 100,000 men in 2013; the peak mortality rate for men was higher than
that of women, which were 328.5 per 100,000 women.

Congestive Heart failure is a complex clinical syndrome that can result from any
structural or functional cardiac disorder that leads to an impaired ventricular filling or
incomplete ejection of blood.Almost half of the patients, 48%, 10, 008 males and 50.1%,
11, 036 females were in the 40-59 years age bracket. This update was last 2014. Both
diseases are major and growing public health problems because aging of the population
contributes to the increasing incidence of those diseases. The relationship between
these diseases worsens their prognoses. More than 40% of Heart Failure patients have
Chronic Kidney Disease.

The person we’ve met in Metro South Medical Center last October 7, 2017
named X.F is diagnosed with a chronic kidney Disease to consider Congestive Heart
Failure secondary to Type II Diabetes Mellitus. We chose this case because this is one
of the topic that we’ve been discussed earlier in our Major subject in Medical Surgical 1,
also this is very interesting for us to know and to be more knowledgeable about this
case.
 II. BIOGRAPHICAL DATA

NAME OF PATIENT: XF

AGE: 55 years old

GENDER: Male

STATUS: Married

ADDRESS: Bacoor, Cavite

DATE OF BIRTH: June 17, 1962

OCCUPATION: Supervisor in a Company

DATE OF ADMISSION: October 07, 2017

DIAGNOSIS: Chronic Kidney Disease T/C Congestive Heart

Failure Secondary to Type II Diabetes Mellitus

HISTORY OF PAST ILLNESS/S

On the interview, patient X.F stated that all the vaccines are completed, he
already had chickenpox, mumps and never been hospitalized but he told us that he had
maintenance before for his diabetes.

HISTORY OF PRESENT ILLNESS/S

Patient X.F, a 55 years old patient was admitted to Metro South Medical Center
on October 7, 2017, diagnosed with Chronic Kidney Disease to consider Congestive
Heart Failure. The day prior to admission patient X.F experienced non-productive
cough, fever and Bipedal edema for a month, and also increased of abdominal girth for
a week. Upon consultation the patient complaints abdominal pain cramping with pain
scale of 8 out of 10.
 Father Mother
82 y/o 73 y/o
Heart Failure/stroke
K Diabetic

Brother Brother Brother Brother Sister

53 y/o 52 y/o 51 y/o 50 y/o 43 y/o
Heart Failure Gallstone Diabetic Arthritis Breast Cancer

Patient Wife
55 y/o 53 y/o
CKD T/C CHF Hypertension / OD stigmatism

BOY
Girl Boy
31 y/o 30 y/o
Asthma / Gallstone Healthy
GIRL

DEAD
Analysis

Upon assessment, the family of patient X.F has different complications. His
father died 13 years ago due to stroke, his mother is still alive but she has diabetes.
Patient X.F has 5 siblings, he is the eldest. He got his diabetes to his mother and Heart
Failure to his father. His second brother died last year because of Heart Failure like his
father. His third brother had undergone operation of gallstones. His fourth brother also
has diabetes, his fifth brother has arthritis and his youngest sister had undergone
operation of Breast Cancer.

Patient X.F has two years gap to his wife. His wife has Hypertension and her
right eye has stigmatism. They have two children; the elder is a Girl 31 years old, has
asthma and had undergone operation of gallstones and the youngest is a boy, 30 years
old and doesn’t have any disease.

Patient X.F’s family has many health complications that can be a hereditary or
can get from lifestyle or other risk factor. All they have to do is to take care of their
health and avoid any stimulations of a complication just like DM where a person having
a possibility of getting it needs to avoid eating too much sweet.
V. ANATOMY AND PHYSIOLOGY

Anatomy and Physiology of the Blood

Blood is made up of liquid (called plasma) and solid cells. Blood cells are made in the
bone marrow. Bone marrow is the soft, spongy substance in the centre of bones.
It is made up of cellular elements and an extracellular matrix. The cellular elements—
referred to as the formed elements—include red blood cells (RBCs), white blood
cells (WBCs), and cell fragments called platelets. The extracellular matrix,
called plasma, makes blood unique among connective tissues because it is fluid. This
fluid, which is mostly water, perpetually suspends the formed elements and enables
them to circulate throughout the body within the cardiovascular system.

The main function of blood is to carry nutrients, gases, waste products, cells and
hormones. Each type of blood cell has a specific job.Red blood cells carry oxygen from
the lungs to the rest of the body. They also carry carbon dioxide from the body to the
lungs so it can be breathed out.Platelets form blood clots in damaged vessels to stop
bleeding.White blood cells help prevent and fight infection by destroying bacteria,
viruses and other foreign cells or substances.
 Human erythrocytes or red blood cells (RBCs) are the
primary cellular component of blood. They are involved in
oxygen transport through the body and have features that
distinguish them from every other type of human cell.
Adult humans have roughly 20-30 trillion RBCs at any
given time, comprising approximately one quarter of the
total number of human cells.

Erythrocytes are biconcave disks; that is, they are plump

at their periphery and very thin in the center. Since they lack most organelles, there is
more interior space for the presence of the hemoglobin molecules that, as you will see
shortly, transport gases. The biconcave shape also provides a greater surface area
across which gas exchange can occur, relative to its volume; a sphere of a similar
diameter would have a lower surface area-to-volume ratio. In the capillaries, the oxygen
carried by the erythrocytes can diffuse into the plasma and then through the capillary
walls to reach the cells, whereas some of the carbon dioxide produced by the cells as a
waste product diffuses into the capillaries to be picked up by the erythrocytes. Capillary
beds are extremely narrow, slowing the passage of the erythrocytes and providing an
extended opportunity for gas exchange to occur. However, the space within capillaries
can be so minute that, despite their own small size, erythrocytes may have to fold in on
themselves if they are to make their way through. Fortunately, their structural proteins
like spectrin are flexible, allowing them to bend over themselves to a surprising degree,
then spring back again when they enter a wider vessel.

Hemoglobin is a large molecule made up of proteins and iron and contains a binding
site for the transport of oxygen and other molecules. It consists of four folded chains of
a protein called globin, designated alpha 1 and 2, and beta 1 and 2 Each of these
globin molecules is bound to a red pigment molecule called heme, which contains an
ion of iron. Each iron ion in the heme can bind to one oxygen molecule; therefore, each
hemoglobin molecule can transport four oxygen molecules. In the lungs, hemoglobin
picks up oxygen, which binds to the iron ions, forming oxyhemoglobin. The bright red,
oxygenated hemoglobin travels to the body tissues, where it releases some of the
oxygen molecules, becoming darker red deoxyhemoglobin, sometimes referred to as
reduced hemoglobin. Oxygen release depends on the need for oxygen in the
surrounding tissues, so hemoglobin rarely if ever leaves all of its oxygen
behind. Changes in the levels of RBCs can have significant effects on the body’s ability
to effectively deliver oxygen to the tissues. Ineffective hematopoiesis results in
insufficient numbers of RBCs and results in one of several forms of anemia.

Anatomy and Physiology of the Heart

The heart is a muscular organ about the size of a closed fist that functions as the body’s
circulatory pump. It takes in deoxygenated blood through the veins and delivers it to the
lungs for oxygenation before pumping it into the various arteries (which provide oxygen
and nutrients to body tissues by transporting the blood throughout the body). The heart
is located in the thoracic cavity medial to the lungs and posterior to the sternum.

The heart sits within a fluid-filled cavity called the pericardial cavity. The walls and lining
of the pericardial cavity are a special membrane known as the pericardium. Pericardium
is a type of serous membrane that produces serous fluid to lubricate the heart and
prevent friction between the ever beating heart and its surrounding organs. The
pericardium has 2 layers—a visceral layer that covers the outside of the heart and a
parietal layer that forms a sac around the outside of the pericardial cavity.

The heart wall is made of 3 layers: epicardium, myocardium and endocardium.

Epicardium is the outermost layer of the heart wall and is just another name for the
visceral layer of the pericardium. Thus, the epicardium is a thin layer of serous
membrane that helps to lubricate and protect the outside of the heart. The myocardium
is the muscular middle layer of the heart wall that contains the cardiac muscle tissue.
Myocardium makes up the majority of the thickness and mass of the heart wall and is
the part of the heart responsible for pumping blood. Below the myocardium is the thin
endocardium layer. The endocardium is very smooth and is responsible for keeping
blood from sticking to the inside of the heart and forming potentially deadly blood clots.
The thickness of the heart wall varies in different parts of the heart. The atria of the
heart have a very thin myocardium because they do not need to pump blood very far—
only to the nearby ventricles. The ventricles, on the other hand, have a very thick
myocardium to pump blood to the lungs or throughout the entire body. The right side of
the heart has less myocardium in its walls than the left side because the left side has to
pump blood through the entire body while the right side only has to pump to the lungs.

The heart contains 4 chambers: the right atrium, left atrium, right ventricle, and left
ventricle. The atria are smaller than the ventricles and have thinner, less muscular
walls than the ventricles. The atria act as receiving chambers for blood, so they are
connected to the veins that carry blood to the heart. The ventricles are the larger,
stronger pumping chambers that send blood out of the heart. The ventricles are
connected to the arteries that carry blood away from the heart.
The heart functions by pumping blood both to the lungs and to the systems of the body.
To prevent blood from flowing backwards or “regurgitating” back into the heart, a system
of one-way valves are present in the heart. The heart valves can be broken down into
two types: atrioventricular and semilunar valves. The atrioventricular (AV) valves are
located in the middle of the heart between the atria and ventricles and only allow blood
to flow from the atria into the ventricles. The AV valve on the right side of the heart is
called the tricuspid valve because it is made of three cusps (flaps) that separate to
allow blood to pass through and connect to block regurgitation of blood. The AV valve
on the left side of the heart is called the mitral valve or the bicuspid valve because it
has two cusps. The AV valves are attached on the ventricular side to tough strings
called chordae tendineae. The chordae tendineae pull on the AV valves to keep them
from folding backwards and allowing blood to regurgitate past them. . The semilunar
valve on the right side of the heart is the pulmonary valve, so named because it
prevents the backflow of blood from the pulmonary trunk into the right ventricle. The
semilunar valve on the left side of the heart is the aortic valve, named for the fact that it
prevents the aorta from regurgitating blood back into the left ventricle. The semilunar
valves are smaller than the AV valves and do not have chordatendonae to hold them in
place. Instead, the cusps of the semilunar valves are cup shaped to catch regurgitating
blood and use the blood’s pressure to snap shut.

Conduction system of the heart

The conduction system starts with the pacemaker of the heart—a small bundle of cells
known as the sinoatrial (SA) node. The SA node is located in the wall of the right atrium
inferior to the superior vena cava. The SA node is responsible for setting the pace of
the heart as a whole and directly signals the atria to contract. The signal from the SA
node is picked up by another mass of conductive tissue known as the atrioventricular
(AV) node. The AV node is located in the right atrium in the inferior portion of the
interatrial septum. The AV node picks up the signal sent by the SA node and transmits it
through the atrioventricular (AV) bundle.. The AV bundle splits into left and right
branches in the interventricular septum and continues running through the septum until
they reach the apex of the heart.

Blood flow through the heart

Deoxygenated blood returning from the body first enters the heart from the superior
and inferior vena cava. The blood enters the right atrium and is pumped through the
tricuspid valve into the right ventricle. From the right ventricle, the blood is pumped
through the pulmonary semilunar valve into the pulmonary trunk.
The pulmonary trunk carries blood to the lungs where it releases carbon dioxide and
absorbs oxygen. The blood in the lungs returns to the heart through the pulmonary
veins. From the pulmonary veins, blood enters the heart again in the left atrium.
The left atrium contracts to pump blood through the bicuspid (mitral) valve into the left
ventricle. The left ventricle pumps blood through the aortic semi lunar valve into the
aorta. From the aorta, blood enters into systemic circulation throughout the body tissues
until it returns to the heart via the vena cava and the cycle repeats.

Anatomy and Physiology of Kidney

The kidneys are part of the

urinary system. There are 2 kidneys
deep inside the upper part of the
abdomen, one on either side of the
spine under the lower ribs. The left
kidney is slightly higher than the
right kidney.

There is an adrenal gland just

above each kidney. These glands
are part of the body’s endocrine
system, which is the group of glands
and cells in the body that make and release hormones into the blood. These hormones
control many functions such as growth, reproduction, sleep, hunger and metabolism.

The ureters are thin tubes about 25–30 cm (10–12 inches) long that connect the
kidneys to the bladder. The urethra is a small tube that connects the bladder to the
outside of the body.

The kidneys are bean-shaped

organs, about the size of one’s fist. An
adult kidney is about 12 cm (4–5
inches) long, 6 cm (2–3 inches) wide
and 3 cm (1–2 inches) thick.

Each kidney is surrounded by

the renal capsule, which is a layer of
fibrous tissue. A layer of fatty tissue
holds the kidneys in place against the
muscle at the back of the abdomen.
Outside the layer of fat is renal fascia.
It is a thin, fibrous tissue.

The inside of the kidney is made up of an outer part called the cortex and an
inner part called the medulla. The renal pelvis is a hollow, funnel-shaped area in the
centre of each kidney where urine collects.

The renal artery brings blood to the kidney, and the renal vein takes blood away
from the kidney. The area where the renal artery, renal vein and ureter enter the kidney
is called the renal hilum.

Inside each kidney is a network of millions of small tubes called nephrons. Each
nephron has corpuscles and tubules. The corpuscles contain tiny blood vessels called
glomeruli that filter the blood. A glomerulus is surrounded by a layer of cells called
Bowman’s capsule. Tubules are tiny tubes that collect the waste materials and
chemicals from the blood as it moves through the kidney.
 The main function of the kidneys is to filter extra water, impurities and wastes
from the blood. Blood from the body enters the kidneys through the renal arteries. The
blood passes through the nephrons, where waste products and extra water are
removed. The clean blood is returned to the body through the renal veins.

The waste products filtered from the blood are then concentrated into urine. The
urine is collected in the renal pelvis. The ureters move the urine to the bladder, where it
is stored. Urine travels from the bladder and out of the body through the urethra.

The kidneys also make certain hormones, which are substances that control
certain body functions. Hormones made by the kidneys are:Erythropoietin (EPO)
stimulates the bone marrow to make red blood cells. And Calcitriol, a form of vitamin D,
helps the intestines absorb calcium from the diet.Renin helps control blood pressure.

Anatomy and Physiology of Endocrine System

 The endocrine system is made up of glands that produce and secrete hormones,
chemical substances produced in the body that regulate the activity of cells or organs.
These hormones regulate the body's growth, metabolism (the physical and chemical
processes of the body), and sexual development and function. The hormones are
released into the bloodstream and may affect one or several organs throughout the
body.

The major glands of the endocrine system are the hypothalamus, pituitary,
thyroid, parathyroids, adrenals. The pancreas is also a part of this system; it has a role
in hormone production as well as in digestion.

The endocrine system is regulated by feedback in much the same way that a
thermostat regulates the temperature in a room. For the hormones that are regulated by
the pituitary gland, a signal is sent from the hypothalamus to the pituitary gland in the
form of a "releasing hormone," which stimulates the pituitary to secrete a "stimulating
hormone" into the circulation. The stimulating hormone then signals the target gland to
secrete its hormone. As the level of this hormone rises in the circulation, the
hypothalamus and the pituitary gland shut down secretion of the releasing hormone and
the stimulating hormone, which in turn slows the secretion by the target gland. This
system results in stable blood concentrations of the hormones that are regulated by the
pituitary gland.

The hypothalamus is located in the lower central part of the brain. This part of the
brain is important in regulation of satiety, metabolism, and body temperature. In
addition, it secretes hormones that stimulate or suppress the release of hormones in the
pituitary gland.

The pituitary gland is located at the base of the brain beneath the hypothalamus
and is no larger than a pea. It is often considered the most important part of the
endocrine system because it produces hormones that control many functions of other
endocrine glands.

The thyroid gland is located in the lower front part of the neck. It produces thyroid
hormones that regulate the body's metabolism. Thyroid hormones also
help maintain normal blood pressure, heart rate, digestion, muscle tone, and
reproductive functions.

The parathyroid glands are two pairs of small glands embedded in the surface of
the thyroid gland, one pair on each side. They release parathyroid hormone, which
plays a role in regulating calcium levels in the blood and bone metabolism.

The two adrenal glands are triangular-shaped glands located on top of each
kidney.

The pancreas is an organ that

stretches partway across the
abdomen, just below the stomach.
Because its main functions are to
aid digestion and produce
hormones that control blood
glucose levels, the pancreas is a
focal point for understanding
diabetes. In addition to secreting
certain enzymes that help you
properly digest food, the pancreas
manufactures hormones that
regulate blood glucose - the fuel
that provides the body's cells with
energy. Scattered throughout the pancreas are tiny nests of cells known as islets of
Langerhans; the majority of the cells are beta cells that produce and store the hormone
insulin until needed. Also located in the islets are alpha cells, which make and store
glucagon, a hormone that counteracts the effects of insulin.

After a meal, carbohydrates in foods are converted into glucose in the intestine and
liver and enter the bloodstream. Beta cells sense the rising blood glucose levels
and secrete insulin into the blood. Once in the bloodstream, insulin helps glucose
enter the body's cells, where it can be "burned" by the liver and muscles for energy.
Liver and muscles can also convert glucose to glycogen, a type of reserve form of
energy that is stored there for future needs.When the body is working as it should, blood
glucose levels quickly return to normal, and insulin secretion decreases.
Normally, the secretion of these hormones by the pancreas is perfectly balanced: Beta
and alpha cells continuously monitor blood glucose levels and release insulin or
glucagon as needed. In diabetes, this balance is thrown off because beta cells produce
little or no insulin or the body's cells are resistant to insulin action - or often both.
Glucose then fails to enter cells effectively and the fuel for energy remains stuck in the
bloodstream. The result is persistently high blood glucose levels (hyperglycemia).
VII.DIAGNOSTIC AND LABORATORY RESULT

HEMATOLOGY

Normal
Result Findings Analysis

Erythrocytes 7.2 4.5 – 6.02 Increased red blood cells indicate of a

x1012/L person having a congestive heart failure due
to reduced oxygen carrying capacity, as
caused by reduction in hemoglobin
concentration, reduces the effective maximal
oxygen carrying capacity according to
Brunner and Suddarth’s Textbook of Medical
and Surgical Nursing.
Hematocrit 0.30 0.40-0.54 Decreased hematocrit indicates of having a
chronic kidney disease . When kidney did
not make enough erythropoietin, hematocrit
decreased that deprives the body of the
oxygen level it needs according to Brunner
and Suddarth’s Textbook of Medical and
Surgical Nursing.
Abnormal hemoglobin structure can,
therefore, disrupt the shape of red blood
120-170G/L cells and impede their function and flow
Hemoglobin 101 through blood vessels that caused the
deprivation of body of the oxygen level it
needs according to Medical Author: Charles
Patrick Davis, MD, PhD
(https://www.medicinenet.com/hemoglobin/a
rticle.htm)
Thrombocyte 364 150-400 x Normal thrombocytes level
G/L

ULTRASONOLOGICAL FINDINGS
The liver is normal in size and parenchymal echogenesity. Intrahepatic ducts
measures and common bile are not dilated. Common bile duct measures 0.4 cm. Portal
venous system is unremarkable.
The gallbladder measures 5.5 x 2.6 cm. Its wall is not thickened. No intramural
masses seen.
 Pancreas and spleen are normal in size and echopattern. No focal lesions seen.
Right kidney measures 8.8 x 3.6 cm. Corticalechogenesity is increased. Cortical
thickness is 1.1 cm. No stones or signs of hydronephrosis seen.
Left kidney measures 9.6 x 3.6 cm. Corticalechogenesity is increased. Cortical
thickness is 1.3 cm. No stones or signs of hydronephrosis seen.
Urinary bladder is distensible with smooth walls. No intravesical echoes noted.
Pre-void volume= 249 ml; post-void = 67 ml
The prostate measures 2.6 x 2.9 x 3.1 (13 grams)

Remarks
Normal liver, gallbladder, Pancreas, spleen
Analysis
 The liver is normal in size and
parenchymal echogenesity.
Intrahepatic ducts measures and
common bile are not dilated.
Common bile duct measures 0.4 cm.
Portal venous system is
unremarkable.

 The gallbladder measures 5.5 x 2.6

cm. Its wall is not thickened. No
intramural masses seen.

 Pancreas and spleen are normal in

size and echopattern. No focal
lesions seen.

Normal size of kidneys with parenchymal  Diseases that destroy the

disease glumerulus of the kidney are the
third most common cause of stage 5
Chronic Kidney Disease.
Hypertension and parenchymal
disease of the kidney are closely
interrelated. Most
primary renal diseases eventually
disturb sodium and volume control
sufficiently to produce clinical
hypertension According to Brunner
and Suddarth’s Textbook of Medical
and Surgical Nursing.
Mild urinary bladder retention  The patient is experiencing mild
urinary bladder retention because
the bladder is distensible.
Incomplete bladder emptying is
diagnosed by postvoid
ultrasonography showing an
elevated residual urine volume.
Avolume < 50 mL is normal; < 100
mL is usually acceptable in patients
> 65 but abnormal in younger
patients according to Brunner and
Suddarth’s Textbook of Medical and
Surgical Nursing.

Note of moderate ascites and right pleural  Pleural effusion may be a

effusion complication of heart failure, TB,
Pneumonia, pulmonary infections,
nephritic syndrome, connective
tissue disease, PE and neoplastic
tumors.
 Pleural fluid may accumulate in the
pleural space to a point at which it
becomes clinically evident, One of
the reason why the patient feel
shortness of breath is because of
moderate ascites and right pleural
effusion according to Brunner and
Suddarth’s Textbook of Medical and
Surgical Nursing.

BLOOD CHEMISTRY RESULT

`Conv. Result Analysis

Abnormally high levels of
creatinine thus warn of possible
Creatinine H 7. 45 mg/dl 0.8-1.30 mg/dl malfunction or failure of the
kidneys according to Medical-
Surgical Nursing:Concepts and
Clinical Application by Josie
Quiambao-Udan,RN,MAN )

A high BUN value can mean

kidney injury or disease is
BUN H 57.90 8.96-20.44 present according to Brunner and
 mg/dl Suddarth’s Textbook of Medical
and Surgical Nursing.
A high uric acid level occurs
when your kidneys don't
eliminate uric acid efficiently.
Things that may cause this slow-
Uric Acid H 0.66 4.0-8.5 mg/dl down in the removal of uric acid
include having diabetes, taking
certain diuretics according to
Brunner and Suddarth’s
Textbook of Medical and Surgical
Nursing.
The patient has a hyperkalemia
that made him experience
Potassium H 5.35 3.5-5.3 mg/dl oliguria and anuria according to
Medical-Surgical
Nursing:Concepts and Clinical
Application by Josie Quiambao-
Udan,RN,MAN )
Hypoalbuminemia is common
in patients with end-stage renal
disease (ESRD). It is caused by
a combination of a reduced
Albumin L 30.50 35-55 g/l synthesis and an increased
degradation of albumin according
to Brunner and Suddarth’s
Textbook of Medical and Surgical
Nursing.

A high level of phosphate in the

Phosphorus H 5.48 2.5-4.5 mg/dl blood is usually indicates
a kidneyproblem(Medical-Surgical
Nursing:Concepts and Clinical
Application by Josie Quiambao-
Udan,RN,MAN )
SGPT/ALT 8.00 0-45 U/L The SGPT/ALT is in normal
range

ARTERIAL BLOOD GAS

Result Normal Values Analysis

Ph 7.34 7.35-7.45 Acidosis

PCO2 32 35-45 mmHg Alkalosis
HCO3 16.9 22-26 mEq/l Acidosis
PaO2 91 80-100 mmHg Normal
O2 sat. 97% 95-100% Normal

 The pH is low that indicates of acidic, low PCO2 is alkalosis, low HCO3 is
acidosis. Since pH and HCO3 are in the same direction which is both Acidic We
had analyze that the systematic ABG analysis is Metabolic Acidosis (Partial
Compensation). base on Medical-Surgical Nursing:Concepts and Clinical
Application by Josie Quiambao-Udan,RN,MAN as our guide.

URINALYSIS

Macroscopic Exam Normal Analysis

Color Yellow Yellow-Deep Normal
Amber
Transparency Hazy Clear and Hazy transparency indicates
Transparent kidney Failure according to
Medical-Surgical
Nursing:Concepts and
Clinical Application by Josie
Quiambao-Udan,RN,MAN )
Reaction (ph) 6.0 4.5-8-0 Slightly acidic
Normal
Increased gravity maybe
associated with
dehydration, diarrhea,
Specific Gravity 1.015 1.010-1.025 emesis, excessive sweating
etc. according to Brunner
and Suddarth’s Textbook of
Medical and Surgical
Nursing.
Protein (++) Absent  The protein is present,
Kidney problems, such
as kidney damage,
 Diabetic kidney disease,
and kidney cysts are
possible according to
Medical-Surgical
Nursing:Concepts and
Clinical Application by Josie
Quiambao-Udan,RN,MAN )

Glucose Negative Absent Normal

 Glucose should be absent
in urine, having glucose in
urine indicates of having
glycosuria according to
Brunner and Suddarth’s
Textbook of Medical and
Surgical Nursing.

Microscopic Examination Normal Analysis

RBC 10-15/hpf 0-5/hpf A high count of red blood cells in the urine can
indicate infection, trauma, tumors, or kidney
stones according to Khaled Fareed, medical
author.
https:www.medicinenet.com/urinalysis/article.
htm
PUS 3-6/hpf 0-1/hpf High PUS indicates an infection of a kidney
according to Khaled Fareed, medical author.
https:www.medicinenet.com/urinalysis/article.
htm
Mucus Few Normally Normal
Thread present Presence of mucus discharge may be cause
by UTI or kidney stone disease. Few mucus
may be present due to regular discharge.
according to Brunner and Suddarth’s
Textbook of Medical and Surgical Nursing.
A.Urates/ moder Normally Normal
phosphates ate present High level of phosphate in the urine also may
caused by eating a meal high in phosphorus
according to Brunner and Suddarth’s
Textbook of Medical and Surgical Nursing.
Fine 1-2/lpf 0-4/lpf Normal
Granular Fatty casts are seen in people who have lipids
cast in urine, usually a complication of nephritic
syndrome according to Khaled Fareed,
medical author.
https:www.medicinenet.com/urinalysis/article.
htm
Hyline cast 0-2/lpf 0-4/lpf Normal
Presence of hyaline casts can be caused by
dehydration according to Brunner and
Suddarth’s Textbook of Medical and Surgical
Nursing.
CAPILLARY BLOOD GLUCOSE TEST (Normal 70-100mg/dL)

DATE TIME BLOOD SUGAR ANALYSIS

10/7/17 11:30A 116mg/dL High
5:30P 110mg/dL High
10/8/17 5:30A 98mg/dL Normal
11:30A 104mg/dL High
5:30P 118mg/dL High

The physician request for CBG test before meal. As a result in CBG we can see that
patient’s blood sugar test is more on high range. Indicates of a patient having Diabetes
Mellitus.
X. DISCHARGE PLAN: (METHODS)

Medication:

- Instructed patient to continue home medications as ordered by Dr. Rubrica such

as:
 Clopidiril 75mg 1 tab once a day at bed time, 7pm
 Ketoanalogue 600mg thrice a day 6am/12pm/6pm
 Trimetazidine 35mg 1 tab twice a day. 8am/8pm.

To Follow:

- Informed patient go to follow up check up on October 16, 2017 with Dr. Rubrica

Health Teaching

- Advised patient to maintain healthy lifestyle in doing eating healthy habit like
eating raw vegetable and fruits.
- Instructed the patient to change position when lying on bed to prevent bed sore.

Observe for:

- Advised the patient to report any untoward signs and symptoms like dizziness,
chest pain.

Diet:

- Advised patient to avoid high calorie food such as chicken skin, fats, fried food.
- Advised patient to avoid simple carbohydrates like cake,pastries, because it can
cause hyperglycemia.
- Instructed the patient to restrict the fluid intake. Drink not more than 1000ml of
water a day.
- Advised patient to eat high fiber especially vegetables, cereals because fiber
inhibits glucose absorption.
Spiritual:

- Encourage patient to always pray and go to church every Sunday.