Anemia secondary to

Chronic Kidney
Disease
secondary to
Hypertensive Kidney
Disease
By: Josie P. Celyon BSN-4
I. INTRODUCTION

Patient R is a 54 years old,

male, who currently resides at
Mabini Boulevard, Davao City.
With admitting diagnosis of
Anemia secondary to Chronic
Kidney Disease stage III
secondary to Hypertensive Kidney
Disease.
Anemia is a condition in which the
hemoglobin concentration is lower
than normal, reflects the presence of
fewer than normal erythrocytes
within the circulation. As a result, the
amount of oxygen delivered to body
tissues is also diminished. Anemia is
not specific disease state per se but
a sign of an underlying disorder.
(Brunner and Suddarth textbook
of Medical-Surgical nursing 11th
edition volume 1 by Suzanne C.
Smeltzer et al. – 1045)
A person with stage 3 chronic kidney
disease (CKD) has moderate kidney
damage. This stage is broken up into
two: a decrease in 
glomerular filtration rate (GFR) for Stage
3A is 45-59 mL/min and a decrease in
GFR for Stage 3B is 30-44 mL/min. As
kidney function declines waste products
can build up in the blood causing a
condition known as “uremia.” In stage 3 a
person is more likely to develop
complications of kidney disease such as 
high blood pressure, anemia (a shortage
of red blood cells) and/or early bone
disease.
According the 2010 Global
Burden of Disease study, chronic
kidney disease was ranked 27th in
the list of causes of total number
of deaths worldwide. 10% of the
population worldwide is affected
by chronic kidney disease (CKD),
and millions die each year
because they do not have access
to affordable treatment.
Of the 2 million people who receive
treatment for kidney failure, the
majority are treated in only five
countries – the United States, Japan,
Germany, Brazil, and Italy. These five
countries represent only 12% of the
world population. Only 20% are treated
in about 100 developing countries that
make up over 50% of the world
population. More than 80% of all
patients who receive treatment for
kidney failure are in affluent countries
with universal access to health care
and large elderly populations.
Chronic kidney disease is a
worldwide health crisis. For
example, in the year 2005, there
were approximately 58 million
deaths worldwide, with 35 million
attributed to chronic disease,
according to the World Health
Organization.
Kidney diseases, especially Chronic
Kidney Disease, are already the 7 th
leading cause of death among the
Filipinos. One Filipino develops
chronic renal failure every hour or
about 120 Filipinos per million
populations per year. More than
5,000 Filipino patients are presently
undergoing dialysis and
approximately 1.1 million people
worldwide are on renal replacement
therapy.
I, the BSN 4 choose this study
because it can help me to know
and understand the disease
process and the concept of
Anemia secondary to Chronic
Kidney Disease stage III
secondary to Hypertensive Kidney
Disease as well as to gain
knowledge and skills on how to
render best care to the patient.
 
OBJECTIVES
General Objectives
After 3 days of interaction with the
patient and completing the case
study, we the BSN 4 will be able to
know and understand the disease
process and the concept of Anemia
secondary to Chronic Kidney
Disease III secondary to
Hypertensive Kidney Disease as
well as to gain knowledge and skills
on how to render best care to the
patient.
Specific Objectives
Knowledge:
 To define Anemia secondary to Chronic
Kidney Disease III secondary to
Hypertensive Kidney Disease;
 discuss the anatomy and physiology of the organ
involve;
 trace the Pathophysiology of the condition;
 understand about the disease process: the
causes, effects, management, treatment and
possible preventions;
 to know and identify the drugs received by the
patient;
 determine why certain management and
medications are given and provided for the
condition; and
 formulate Nursing Care Plan related to the case
and determine the possible intervention.
Skills:
 Perform efficiently physical
assessment to the patient;
 gather pertinent data regarding
family background and health
history from patient and
significant others;
 participate in the course of care
of patient; and
 Promote health teaching and
interventions to the family and
significant others.
Attitude:
 Establish a good interpersonal
relationship to the client and
his family; and
 provide the patient and family
with proper discharge planning.
PATIENT’S DEMOGRAPHIC DATA

Patient’s Code Name Patient R.

Age 54 years old

Birthday January 9, 1965

Birthplace Mainit Malalag, Gensan

Sex Male

Status Married

Religion Roman Catholic

Address Mabini Boulevard, Davao City

Educational Attainment College graduate

Occupation Security Guard

Chief complaint Dyspnea

Date of Admission September 18, 2019 – 11:00am

Physician Dr. Wy

Station/Room Medical Ward 3 – Alley

Anemia secondary to Chronic

Admitting Diagnosis Kidney Disease III secondary to

Hypertensive Kidney Disease

HEALTH HISTORY
Family Socio-Economic
Background
Patient R is a 54 years old, male,
currently resides at Mabini
Boulevard, Davao City, a Filipino
citizen. Married to Mrs. R and
blessed with 4 children; 2 boys and
2 girls. He got married at the age of
30 to Mrs. R. Patient R is the
youngest son among the five (5)
children of Mr and Mrs X. Most of his
siblings has a history of Arthritis.
According to Patient R, he worked
before as a guard at Mawab,
Compostella Valley for 4 years. He
was transferred at Davao City still
as a guard. His salary is 18,000 –
20,000 pesos per month. As he
stated, he only rides a bicycle
when he is going to work. When he
got transferred to Davao City they
tend to rent a house because they
have no house to live on at Davao
City which they can pay a monthly
of 3,000 pesos.
According to Patient R, he is fond
of eating “lamang loob” such as
“dinuguan” and fried small
intestines 4-5 times a week with
softdrinks (Pepsi) 8oz. 2 times per
day. He also stated that he is fond
also in eating salty viand
especially at home. He started to
drink alcoholic beverages such as
Beer 1 bottle 250mL or either
Tanduay 875mL or 250mL per day
at the age of 20 years old until 54
when he was not yet sick.
History of Past Illnesses
According to Patient R, since
September 2016 he was diagnosed
with hypertension at SPMC-OPD and
was prescribed by the physician with a
maintenance of Losartan 50mg/tab, 1
tab. On August 2019, he decided to
send his self for a check-up at SPMC-
OPD due to pain and swelling of joint
in the knee and toes and was
diagnosed with Gouty Arthritis and
prescribed maintenance medications
of Febuxostat 100mg/cap, 1 cap OD.
History of Present Illnesses
Since September 16, 2019, patient
was diagnosed with chronic kidney
disease. One (1) day prior to
admission, patient R was noted with
dyspnea and has been tolerated his
condition but as the day passed he
had been experiencing difficulty of
sleeping therefore he decided to seek
for medical advice.
Genogra
m
DEVELOPMENTAL DATA
 Erik Erikson’s Stages of
Psychosocial Development
 Jean Piaget’s Cognitive
Development
 Sigmund Freud
psychosexual theory
DEFINITION OF COMPLETE
DIAGNOSIS
Anemia is a condition in which the
hemoglobin concentration is lower than
normal, reflects the presence of fewer
than normal erythrocytes within the
circulation. As a result, the amount of
oxygen delivered to body tissues is also
diminished. Anemia is not specific
disease state per se but a sign of an
underlying disorder.
(Brunner and Suddarth textbook of
Medical-Surgical nursing 11th edition
volume 1 by Suzanne C. Smeltzer et
al. – 1045)
Chronic kidney disease, also
called chronic kidney failure,
describes the gradual loss of
kidney function. Your kidneys filter
wastes and excess fluids from
your blood, which are then
excreted in your urine. When
chronic kidney disease reaches an
advanced stage, dangerous levels
of fluid, electrolytes and wastes
can build up in your body.
ANATOMY AND PHYSIOLOGY
PHYSICAL ASSESSMENT – September
25, 2019 10:30AM
Review of Systems –verbatim-
 General Overall Health State
 “Dili okay maam, sakit kayo akoa tiil
labaw na ug matandog tapos dili pajud ko
makalakaw ky hubag kaayo”
 Integument (Skin, Hair, Nails)
 “wala man koy mga katol2 sa panit
maam”
 Head
 “wala man ga sakit akoa ulo maam, wala
man pod mga bukol2”
 Eyes
 “okay paman akoa panan.aw maam”
 Ears
 “okay aman akoa pandungog maam,
makadungog paman kog tarong”
 Nose and Sinuses
 “wala naman kaayo ko galisod ug
ginhawa maam”
 Mouth and Oropharynx
 “dili man sakit kung magtulon ko
maam”
 Thorax and Lungs
 “wala man ko ginaubo maam”
 Heart and Central Vessels
 “wala man ko ginakulbaan maam”
 Peripheral Vascular System
 “wala man koy mga varicose maam”
 Breast and Axillae
 “wala may mga bukol akoa totoy
maam”
 Abdomen
 “ga wala2 man ng sakit sa akoa tiyan”
 Musculoskeletal System
 “Gasakit gyud akoang tiil maam,
ingun sa doctor naa man daw koy
arthritis”
 Neurological System
 “naa man ko diri sa SPMC karon
maam”
 “nagpahospital ko ky hubag
man kaayu akoa tiil”
 Genitals and Inguinal Area
 “makaihi man ko maam, wala
man sakit”
 Rectum and Anus
 “makatae man ko na walay
sakit maam”
Cephalocaudal Physical
Assessment
 General Appearance and Mental
Status
 Received patient lying on bed,
awake, conscious and responsive to
questions ask. Wearing white shirt
without shorts, with IVF of PNSS 1L
at KVO rate infusing well without
signs of phlebitis and with on-going
blood transfusion of PRBC. Pitting
edema noted at both lower
extremities. Both toenails and
fingernails were untrimmed.
 Vital Signs/Measurements
 Blood Pressure: 160/100mmHg
O2 sat: 99%
 Respiratory rate: 20cpm
 Pulse rate: 86bpm
 Temperature: 36.7ºC
 Integument
 Patient skin is fair in complexion
with slightly dry skin indicating
poor skin turgor. Pitting edema
noted at both lower extremities.
Hair is short, black in color with no
presence of dandruff, nits and lice.
 Head
 Head is normocephallic upon palpation. Face
is symmetrical upon inspection. Able to
move head side to side without pain and
difficulty.
 Eye Structures and Visual Acuity
 Evenly placed and in line with each other.
None protruding. Conjunctiva is pinkish to
red in color. Pupil are equally round and
reactive to light accommodation with a size
of 3mm. Able to see near and far objects.
 Ears and Hearing
 The auricles are parallel in shape. The upper
connection of the earlobe is parallel with the
outer canthus of the eye. Presence of
cerumen not noted. Able to hear both left
and right ear.
 Nose and Sinuses
 Nose is in the midline. Flaring of nostril
not noted. Respiratory rate of 20
cycles per minute. No inflammation of
the sinuses noted upon palpation.
 Mouth and Oropharynx
 Lips is dry. Able to chew and speak.
Gums are pinkish in color. With no
dental carries noted.
 Neck
 Neck is straight and symmetrical, no
visible mass or lumps noted upon
palpation. No jugular venous
distention noted.
 Thorax and Lungs
 Chest contour of client is symmetrical
during respiration and in typical size. No
crackles sound noted upon auscultation.
Respiratory rate of 20 cycles per minute.
 Peripheral Vascular System
 No varicosities noted.
 Breast and Axillae
 No lumps noted upon palpation. No
abnormal discharges noted.
 Abdomen
 Upon auscultation borborygmi sounds
noted with a range of 10-15 in one
minute. Without pain noted upon
palpation.
 Musculoskeletal System
 Able to do range of motion with
no pain noted in upper extremities
but unable to move both lower
extremities due to pitting edema
and with pain noted. Swelling of
joints noted.
 Neurological System
 Able to recall things that are so
long ago.
 Genitals and Inguinal Area
 Able to void 5 times a day with no
signs of pain and difficulty.
 Rectum and Anus
 Able to defecate 2 times a day
without complain of pain.
 Upper and Lower Extremities
 Able to do range of motion with
no pain noted in upper
extremities but unable to move
both lower extremities due to
pitting edema and with pain
noted. Swelling of joints noted.
Capillary refill time of 4-5
seconds.
ETIOLOGY AND SYMPTOMATOLOGY
Ideal S/Sx Actual Rationale Significance

1. Sleep problems    Among people with chronic Patient R was noted

kidney disease (CKD), the with dyspnea and

prevalence of sleep has been tolerated

disturbances has been his condition but as

estimated to be as high as the day passed he

80%. had been

experiencing

difficulty of sleeping

therefore he decided

to seek for medical

advice.

 
1. Swelling of feet and    Kidney disease can also cause (+) edema in both

ankles foot and ankle swelling. When lower extremities

kidneys are not functioning

properly, fluid can build up in

the body.

1. Shortness of breath    Shortness of breath — Patient R was noted

kidney failure is sometimes with dyspnea upon

confused with asthma or heart admission

failure, because fluid can build

up in the lungs.

1. Fatigue or weakness x A build-up of wastes or a  

shortage of red blood cells

(anemia) can cause these

problems when

the kidneys begin to fail.
ETIOLOGY
Precipitating factors

Factors Actual Rationale Significance

1. Hyperten    Hypertension is one of the leading since September 2016 he

sion causes of CKD due to the deleterious was diagnosed with

effects that increased BP has on hypertension at SPMC-OPD

kidney vasculature. Long-term, and was prescribed by the

uncontrolled, high BP leads to high physician with a maintenance

intra-glomerular pressure, impairing of Losartan 50mg/tab, 1 tab

glomerular filtration.  

1. Excess    Too much sodium in a person's diet He also stated that he is fond

intake can be harmful because it causes also in eating salty viand

sodium blood to hold fluid. People with CKD especially at home.

need to be careful not to let too much

fluid build up in their bodies. 

Predisposing factor

Factor Actual Rationale Significance

1. age    As people age, there is a slow, steady decline in the Patient R is 54

weight of the kidneys. After about age 30 to 40, about years old.

two thirds of people (even those who do not

have kidney disease) undergo a gradual decline in the

rate at which their kidneys filter blood.

1. Gender    While the prevalence of CKD tends to be higher in Patient R is male.

women, the disease is more severe in men. Most of

the evidence in the current literature suggests a higher

progression rate and mortality risk of CKD in men

compared with women. Sex hormones are thought to

play a major role in the biological mechanisms

associated with variability in CKD prevalence and

characteristics between men and women.

PATHOPHYSIOLOGY
MEDICAL MANAGEMENT
 Doctors Order
 Diagnostic Examinations
DRUG STUDIES
NURSING THEORIES
Theorist Theory Application to the Case

Betty Neuman The System Model, developed by For us nurses we need to

Neuman, focuses on the response of
maintain the optimal level of
the client system to actual or potential
wellness of our patient in order
environmental stressors and the use

of several levels of nursing prevention not to have further

intervention for attaining, retaining and complication. In the application
maintaining optimal client system
to our patient we used tertiary
wellness. Neuman defines the
method such as doing test and
concern of nursing is preventing stress

invasion. If stress is not prevented, laboratories and also with the

then the nurse should protect the help of the physician we are
client's basic structure and obtain or
able to give a therapeutic
maintain a maximum level of wellness.
medical intervention that can
Nurses provide care through 

primary, secondary and tertiary maintain the optimal status of

 prevention modes. our patient.

Theorist Theory Application to the Case

Hildegard Peplau Four phases define Peplau's Interpersonal

For us student nurses
Theory or nursing. She defines the

nurse/patient relationship evolving we need to established

through orientation, identification, exploitation rapport to gain the trust
and resolution. She views nursing as a
of the patient to be
maturing force that is realized as the

personality develops through educational, able to come with a

therapeutic, and interpersonal processes.
good nursing
Nurses enter into a personal relationship with

an individual when a felt need is present. intervention.

Peplau's model is still very popular with

clinicians working with individuals who have

psychological problems.
Theorist Theory Application to the Case

Virginia Often called "the Nightingale of Modern Nursing,"

The significant of this
Henderson Henderson was a noted nursing educator and author.

Her "Need Theory" was based in practice and her

theory in our case is all

education. She emphasized the importance of about that letting the

increasing a client's independence to promote their
patient independently
continued healing progress after hospitalization. Her

definition of nursing was one of the first to mark the care after being discharge
difference between nursing and medicine. "The unique
at the hospital.
function of the nurse is to assist the individual, sick or

well, in the performance of those activities contributing

to health or its recovery (or to peaceful death) that he

would perform unaided if he had the necessary

strength, will, or knowledge. And to do this in such a

way as to help him gain independence as rapidly as

possible. She must in a sense, get inside the skin of

each of her patients in order to know what he needs."

NURSING CARE PLAN
DISCHARGE PLAN (METHOD)
 Medication:
 Instruct the patient to take the
medicines on time that has
been prescribed by the
physician.
  
 Exercise:
 Encouraged to avoid strenuous
activities
 Encouraged to do range of
motion.
 Health Teaching:
 Instructed and explained to the patient and
significant other’s the importance of compliance
in treatment regimen.
 Instructed patient to send for medical
management if unusualities occur
 Instructed to have proper hygiene
 Eat nutritious foods such as fruits and
vegetables
  
 Out Patient Follow-up
 Advised patient and significant others to have a
follow up check as ordered by the physician
 .
 Diet
 Reminded patient on renal and low purine diet.
 Increase oral fluid intake
Prognosis
Result: Fair
Because the patient sent herself to seek medical attention as
soon as he felt the signs and symptoms. He is willing to
undergone any medical treatment and nursing intervention.

           

Variables Constant Quotient Amount Product Result

          15/7=

Poor 0 X1 0 1.0-1.6 2.1

        1.7-2.3

Fair 6 X2 12

        2.3-3.0

Good 1 X3 3

      15  

Total 7  
EVALUATION
Goal met.
RECOMMENDATIONS
 
 To the patient:
 Adhered therapeutic plan by the doctor.
 Advise the patient to have a regular check-
up.
 To the family:
 Assist client in his activity.
 Should actively participate in providing,
promoting, assisting the client to perform
health activities.
 Should be knowledgeable of the signs and
symptoms of complication to be reported.
 Should understand the importance of follow
up check-up for the monitoring of
complications.
 To the Southern Philippines
Medical Center:
 Should have appropriate knowledge
in caring patient with Anemia
secondary to Chronic Kidney
Disease III secondary to
Hypertensive Kidney Disease
 Should be concern to every patient
and give their tender loving care to
them
 Must give proper health education
especially on ways how to prevention
of the disease and its complications.
 To the Paramedical students:
 Should provide appropriate health
teaching to every individual
regarding the signs and symptom
and complications of the disease as
well as on how to prevent acquiring
such disease.
 Should act as an advocate in how to
avoid in acquiring Anemia
secondary to Chronic Kidney
Disease III secondary to
Hypertensive Kidney Disease to
every individual in a certain
community
THANK YOU !!