Nursing care for a patient with end-stage renal disease, fluid overload, and respiratory failure: A case study.

Abstract

     This case study aimed to investigate the nursing care of a 64-year-old Thai female patient with end-stage renal disease, fluid overload, and heart failure. The patient was admitted to the inpatient department of Khonsan Hospital on May 25, 2024. She presented with shortness of breath one day prior to admission and had pre-existing conditions of diabetes, hypertension, and end-stage renal disease rejecting renal replacement therapy (RRT).

     The results showed that upon admission, the patient was conscious, had shortness of breath, and was able to lie flat. Vital signs were measured, and temperature was 37 degrees Celsius. Heart rate 104 beats/minute, respiratory rate 26 breaths/minute, blood pressure 126/69 mmHg. Lung air entry poor. Blood oxygen saturation (SpO2) 86%. Pitting edema 1+. Physician considered heparin lock. Administered Furosemide 40 mg IV stat, Berodual forte 1 NB every 15 minutes, 2 doses. Oxygen mask with bag, 10 liters/min. Retained Foley catheter. Urine 300 ml, clear. Blood oxygen saturation (SpO2) 100%. Fingerstick blood glucose (DTX) 335 mg%. Electrocardiogram (EKG) result: sinus tachycardia. Chest X-ray (CXR): Reticular infiltration in both lungs. Physician diagnosed End-Stage Renal Disease (ESRD) with volume overload and acute respiratory failure. Considered admission to the Female Inpatient Department, Khonsan Hospital. -During treatment, the patient received Furosemide 40 mg IV every 8 hours (no pitting edema), Berodual forte 1 NB prn every 4 hours, and Morphine 2 mg IV prn every 2-4 hours for dyspnea, lung crepitation in both lungs, SpO2 99%, and was on oxygen mask with bag at 10 liters/min. I=3,300, O=2,000. The patient had difficulty sleeping and received Lorazepam (1 mg) 0.5 tab orally morning and evening. The patient had a sore tongue and poor appetite and received Triamcinolone oral paste 0.1% morning and evening. DTX was between 150-233 mg/dl. The patient was hospitalized for a total of 4 days. A follow-up appointment to receive the same medication was scheduled for July 12, 2024. The patient and family agreed to undergo hemodialysis. The doctor wrote a referral letter for continued treatment at Chaiyaphum Hospital.