Nursing Care for Patients with Chronic Kidney Disease and Hyperkalemia: Two Cases study.

Abstract

      This study aimed to compare the FANCAS nursing conceptual framework in the care of patients with chronic kidney disease and hyperkalemia: Two cases study. Study instruments included the FANCAS health assessment tool and a data recording form. Analysis involved content analysis and a comparison of personal information, treatment plans, assessment findings based on the FANCAS framework, nursing diagnoses, and nursing care.             

      Results: Both case studies shared similar baseline characteristics but differed in chief complaints and clinical progression despite a common initial diagnosis of hyperkalemia. Case 1 suffered cardiac arrest and acute respiratory failure requiring mechanical ventilation. Case 2 developed acute subendocardial myocardial infarction, managed with CAG and PTCA with a single drug-eluting stent. Shared nursing diagnoses included: 1) risk of recurrent cardiac arrest and lethal arrhythmias from hyperkalemia and reduced myocardial perfusion; 2) hyperkalemia secondary to renal dysfunction; 3) risk of hemodialysis complications; and 4) risk of recurrent hyperkalemia due to self-care knowledge deficit. Key differences included: Case 1 5) Hypoxia from acidosis/fluid overload 6) Invasive device infection risks, and impaired communication from intubation; Case 2 7) post-PCI complications and risk of airway obstruction from post-PCI nausea and vomiting.