He has been on hemodialysis 3 times a week. The patient was diagnosed to have ESRF one year ago. He has history of hypertension for 25 years and history of type-2 diabetes mellitus for 22 years. Other than these, the patient is also a known case of ischemic heart disease diagnosed 12 years ago and for which he underwent GAGs in 1999. He also has mild Parkinsons disease, diagnosed 6 years ago. he suffers from dementia too. There is history of recurrent falls, but with no eventful fall so far. He has a pressure ulcer on his right toe. Alison is irregular with his medication and follow-up. Despite appropriate education on dialysis, he refused the treatment initially. The patient is not allergic to any known medication. He lives with his wife and requires assistance for activities of daily living. There is history of episodic fecal and urinary incontinence which are managed by his wife. In this report, the pathophysiology, clinical interventions, medications, diagnostic tests and nursing care plan will be discussed with reference to the clinical condition of the patient.
Examination: On admission to the hospital, Alison appeared conscious, alert and oriented to time, place and person. His Jugular Venous Pressure was not elevated. His temperature was high (35.3 deg.C), blood pressure was slightly on the lower side (120/60mmHg), respiratory rate was very high (78 per minute) and oxygen saturation in room air was 96 percent (normal limits). Examination of the cardiac region revealed ejection systolic murmur. Auscultation of the chest revealed basal crackles in the lower part of the lungs with reduced breath sounds in the right base. Abdominal examination and examination of central nervous system were unremarkable except for few tremors due to Parkinsonism. Alison has a permcath in situ for dialysis. He has a pressure ulcer on his right big toe.
Diagnosis: Known patient of end-stage renal disease secondary to type-2 diabetes mellitus and hypertension