A 52-year-old female patient with Sjogren's syndrome, systemic lupus erythematosus, depressive disorder, ESRD, secondary osteoporosis, hyperparathyroidism, secondary myopathy, who was admitted to peritoneal dialysis in October 2008, had functional dependence.
Towards the end of 2009 there is the need to perform parathyroidectomy, due to alterations in the increase of specific laboratory tests, scintigraphy compatible with hyperfunctioning parathyroid tissue abdominal CAT scan with an abdominal mass of 10 cm.
In April 2011, total parathyroidectomy was performed with self-injection in the right arm, progressing during the immediate postoperative period with symptomatic hypocalcemia of 8.8 mg / dl, which was managed with symptomatic calcium infusion May / dl.
In October 2011 she was hospitalized for severe symptomatic hypercalcemia (17.9 mg/dl), which was managed in the intensive care unit, with good response to treatment, in January 2012 showed a 50% decrease in abdominal mass.
Currently, the patient remains under serial and strict controls, without presenting new episodes of hypercalcemia.
Care plan:
Nursing care should focus on solving real or potential problems, emphasizing prevention and constant education.
1.
High risk of phosphorus-calcium mechanism related to decreased glomerular filtration rate below 15%...
a.
To assess and educate in relation to the intake of phosphorus-rich foods and the importance of proper administration of drug therapy (phosphorus chelators, vitamin D analogues, oral calcitriol).
b.
To describe the relevance of respecting the frequency, duration and efficiency of dialysis therapy.
c.
To assess and monitor monthly altered specific tests to establish treatment and monitor serum calcium, calcium-phosphorus product, PTH.
d.
To interview the patient and perform physical examination to investigate signs and symptoms of metastatic calcifications in each dialysis session.
e.
To monitor calcium concentration in the dialysis fluid and evaluate changes according to plasma levels.
f.
To establish preoperative care in patients with indication for hyperparathyroidism.
2.
High risk of altered plasma calcium levels related to parathyroid hormone withdrawal.
a.
Monitoring plasma calcium levels constantly and if necessary, according to symptoms, visit a doctor.
b.
Regular physical examination and screening for abnormalities
c.
To reinforce education on symptoms related to changes in calcium levels and importance in supplement intake.
3.
High risk of spontaneous fractures related to bone demineralization.
a.
To look for manifestations of pathological fractures: bone pain, mobility limitation, swelling of tissues and surrounding skin.
4.
Nutrition disorder: defect r/c underlying disease
a.
Controlling food and liquid intake and calculating daily calorie intake, encouraging the patient to participate in menu planning, advising for companion food intake.
b.
To advise the user and family members to keep a food diary to record and estimate calories ingested, electrolytes of interest (potassium, sodium, chlorides, magnesium, phosphorus, calcium) and proteins.
c.
Recommendation: the consumption of frequent meals, in small quantities and the use of permitted conditions oral herbs and pathologies: e.g. garlic, onion, pepper, perejil permanent care.
d.
To reinforce the compliance of nutritional therapy (oral and written) indicated by a specialist.
e.
Controlling laboratory data (affects calcium, serum proteins, albumin, haematocrit, haemoglobin, ferritin) and timely referral to specialists.
5.
Knowledge deficit (their learning situation) r/c, prognosis, treatment, self-care and needs.
a.
To check the degree of anxiety and change in thinking processes, encouraging you and giving you the opportunity to ask your questions and refer you to a specialist if needed.
b.
To review with the user the specific disease, its prognosis and possible complications with clear and concise terms, repeated periodically and updating the information as necessary.
c.
Make sure that some feelings and behaviors in the user are normal during the course of treatment.
d.
To emphasize the importance of reading the labels of all products (food and beverages, nonprescription drugs) and not taking medication or phytotherapy supplements without prior authorization from the physician.
e.
Perceived the importance of setting and fulfilling a schedule for dialysis therapy, medication and eating habits.
f.
Faced with possible changes in dialysis therapy, meet the educational needs of the user, delivering them in a comprehensible manner and reiterating them when requested.
