Nursing Health History A. Biological Data Patient B was a 46 years old Filipino, female, was born on November 07, 1966 and residing at Lapasan, Cagayan de Oro City. Her religion is Roman Catholic. She is married and living with her family and has three children. She was admitted for the first at Northern Mindanao Medical Center under doctor Flores as her admitting physician with the diagnosis of chronic kidney disease stage 5 secondary to diabetes mellitus, nepropathy. B. Chief Complaint Patient B was rushed to Northern Mindanao Medical Center Emergency due to chest tightness. C. History of Present Illness Three months prior on admission, patient experienced onset of bipedal edema with easy fatigability and early signs of periorbital edema. A month before admission, there was progression of edema on the thighs and signs of right eye blurring of vision. On the third week prior to admission, patient experienced exertional dyspnea and blurring of vision on the left eye. Patient sought consultation at City Hospital and was given Furosemide. D. Past Health History Patient had no past health history since it was her first time to be admitted in Northern Mindanao Medical Center. E. Functional Health Pattern Upon assessment, patient was in pain, restless and complained of loss of vision. Patient had non pitting bipedal edema, dyspnea even at rest. Because of this, patient had been irritable during assessment gave us small informations about her. She was a non drug user and non alcoholic drinker. Patient b has a history of hypertension and diabetes mellitus on maternal side. F. Nutritional and Metabolic Pattern Patient B’s usual daily food intake before admission was 2 cups of rice and viand with a fluid intake of 3-5 glass of water a total of 720 mL every day. Upon admission, patient B was ordered…
LOGIN ENROL FOR FREE