Nursing Process Paper: Chronic Kidney Disease and Pulmonary Edema
This nursing process paper presents a clinical case study of Mr. Black, a 67-year-old African-American male admitted to the emergency room with swelling of the feet, shortness of breath, and fatigue. The paper documents his medication regimen for multiple comorbidities including hypertension, diabetes, asthma, and hyperlipidemia, and analyzes his laboratory and diagnostic findings. Abnormal results — including elevated potassium, low eGFR, elevated BNP, and chest X-ray findings — support diagnoses of stage three chronic kidney disease, cardiogenic pulmonary edema, and heart failure. The paper concludes with a nursing care plan addressing impaired gas exchange, fluid overload, and patient education strategies.
- Patient Overview and Medical History: Introduces patient demographics, comorbidities, and admission
- Medication Regimen: Details five prescribed drugs and nursing implications
- Laboratory Studies and Diagnostic Findings: Analyzes abnormal lab values and chest X-ray results
- Medical Diagnosis: Links lab data to CKD, pulmonary edema, and heart failure
- Nursing Care Plan: Outlines nursing interventions for fluid overload and oxygenation
- Conclusion: Summarizes diagnoses and key clinical findings
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What makes this paper effective
- Integrates pharmacology, laboratory data, and physical assessment into a cohesive clinical narrative, demonstrating how each data source informs the final diagnoses.
- Systematically links abnormal lab values (e.g., low eGFR, elevated BNP, elevated potassium) to specific pathophysiological mechanisms, grounding the diagnoses in evidence.
- Provides a practical nursing care plan that maps directly to the diagnosed conditions, connecting assessment findings to interventions and patient education goals.
Key academic technique demonstrated
The paper demonstrates clinical reasoning through convergent evidence — gathering data from multiple sources (medication history, laboratory values, diagnostic imaging, and physical assessment) and synthesizing them into a unified diagnosis. This technique is foundational in nursing education and illustrates how students learn to move from isolated data points to a comprehensive clinical picture.
Structure breakdown
The paper follows the standard nursing process framework: it opens with a patient overview and comorbidity history, proceeds through a medication table, analyzes laboratory and diagnostic findings section by section, arrives at a medical diagnosis with pathophysiological rationale, and closes with a condition-specific nursing care plan and brief conclusion. This structure mirrors the ADPIE (Assessment, Diagnosis, Planning, Implementation, Evaluation) model used in clinical nursing education.
Patient Overview and Medical History
Mr. Black is a 67-year-old African-American man who was married with three children. His wife died approximately 15 years ago in a car accident, and he has been living alone since then, with occasional check-ins from his daughter. He works as a truck driver, placing him in the middle-class income range, and his highest level of education is a high school diploma. He had been his usual self until a month before admission, when he was brought to the emergency room on February 15, 2020, after noticing swelling of his feet, shortness of breath, and fatigue. Given his preexisting conditions — hypertension, cerebrovascular accident (CVA), diabetes, asthma, and hyperlipidemia — he was admitted, and a nursing student was assigned to his care on February 17, 2020.
Medication Regimen
Mr. Black had been prescribed medications to manage his preexisting conditions. For hypertension, he was given losartan; for diabetes, metformin; for asthma, albuterol; for hyperlipidemia, simvastatin; and for gastroesophageal reflux disease, Nexium (esomeprazole). The table below summarizes the key clinical information for each drug.
Losartan
Classification: Angiotensin II Receptor Blocker. Dose/Route: 100 mg orally, once daily. Diagnosis: Hypertension. Common side effects: Diarrhea, stomach pain, dizziness, headache, tiredness. Adverse effects: Vasodilation, decreased blood pressure. Action: Blocks the binding of angiotensin II to receptor cells. Nursing assessment: Monitor blood pressure; do not administer if systolic blood pressure is below 100 mmHg without consulting the healthcare provider. Implementation: Instruct patient to avoid foods high in potassium, as they may cause hyperkalemia. Toxicity/Overdose: Can lead to death due to blocking of adrenaline; patient should visit the nearest hospital immediately.
Metformin
Classification: Biguanide. Dose/Route: 500 mg orally, twice daily. Diagnosis: Diabetes mellitus. Common side effects: Diarrhea, nausea, flatulence, indigestion, abdominal pain. Adverse effects: Allergic reaction, kidney damage, lactic acidosis. Action: Lowers blood glucose levels by decreasing hepatic glucose production. Nursing assessment: Patient should not receive this drug after procedures requiring IV contrast material. Implementation: Patients should avoid alcoholic beverages while taking this medication. Toxicity/Overdose: Lactic acidosis; treatment includes sodium bicarbonate infusion and hemodialysis.
Albuterol
Classification: Bronchodilator. Dose/Route: 180 mg inhaled, two puffs every 4–6 hours (maximum 12 inhalations per 24 hours). Diagnosis: Asthma. Common side effects: Wheezing, leg cramps, extreme thirst, blurred vision. Adverse effects: Chest pain, convulsions, tremors. Action: Prevents bronchospasm. Nursing assessment: Teach the patient to monitor heart rate. Implementation: Administer albuterol five minutes before other inhaled medications. Toxicity/Overdose: Chest pain and irregular heartbeat; a ventilator may be required to manage the airway.
Simvastatin
Classification: HMG-CoA Reductase Inhibitor. Dose/Route: 10 mg orally, once daily. Diagnosis: Hyperlipidemia. Common side effects: Diarrhea, abdominal bloating, muscle cramping, flatulence, constipation. Adverse effects: Muscle myopathies, decreased liver function. Action: Lowers LDL-C levels. Nursing assessment: Patient should not have active liver disease and should not be pregnant. Implementation: Patient should avoid grapefruit and grapefruit juice. Toxicity/Overdose: If drug is inactivated in the bloodstream, it can lead to kidney failure, heart failure, and gastrointestinal bleeding; visit the nearest hospital.
Nexium (Esomeprazole)
Classification: Proton Pump Inhibitor. Dose/Route: 20 mg orally, once daily. Diagnosis: Gastroesophageal reflux disease. Common side effects: Headache, nausea, flatulence. Adverse effects: Inhibits the gastric proton pump and prevents the formation of hydrochloric acid. Action: Controls acid reflux and its associated symptoms. Nursing assessment: Nexium should not be administered concurrently with other IV drugs. Implementation: Patient should reduce alcohol and caffeine consumption and avoid smoking and fasting. Toxicity/Overdose: Dizziness, fast heartbeat, and increased risk of hip and wrist fractures; visit the nearest hospital for treatment.
Source for all medications: Ignatavicius et al. (2018).
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