Patient History : My Patient

Health teaching will be providing information on disease process and management strategies. Encourage caregiver to set aside time for himself. This could be as simple as a relaxing bath, a time to read a book, going out with friends. Acknowledge to caregiver the role he is carrying out and its value. Teach caregiver to identify how important it is to feel appreciated for their efforts. Encourage care recipient to thank caregiver for care given. Provide time for caregiver to discuss problems, concerns, and feelings. Ask caregiver how he is managing, Inquire about caregiver’s health. Refer to social worker for referral for community resources and/or financial aid, if needed.

My patient?s name is John T, age 41 was admitted to Bournewood Hospital in Brookline, MA. on September 16, 2015. He was severely depressed about his past and he started having suicidal ideals. John grew up with a mother, father and sister in Portsmouth, New Hampshire. They didn't have much money and his father was the only one paying bills while his mother was a housewife. John explained that living with his family was very uncomfortable. His father was a very mean and angry man; no one got along with him and everyone feared him. Being Italian, the meal must be plated once the husband got home. With that said, one day his father got mad at his mother about not having dinner on the table on time; things turned for the

N.L. has history of constipation and fecal impaction several years ago. Patient also has history of Diabetes Mellitus type 2 for 9 years, Hypertension for 15 years, and Chronic Obstructive Pulmonary Disease (COPD) for 5 years. Patient has also had laparoscopic appendectomy 5 years ago for erupted appendicitis and total hysterectomy 3 years ago due to uterine fibroids. N.L. smoked half a pack of cigarettes for 20 years and recently cut down to 2 cigarettes per day. N.Ll also drinks alcohol occasionally, approximately 2 drinks per month.

The kidneys lay retroperitionally, one on each side of the dorsal body wall; each kidney extends from the 12th thoracic vertebra, to the superior lumbar vertebra. The kidneys are protected by the 11th and 12th pair of ribs.

The kidneys of mammals are round, bean-shaped organs. These kidneys are located at the posterior end of the abdomen and outside of the peritoneum, which is the membrane that encloses the organs of the abdominal cavity. The indentation found on the bean-shaped part of the kidney is called the hilum, this is where the renal artery enters the kidney and where both the renal vein and ureter exit. The kidney is also divided into 2 regions, which is the outer cortex and the inner medulla. In the cortex, this is where blood is filtered

With regards to size, kidneys are around eleven centimeters long and six centimeters wide. They are uniquely structured to filter blood and produce urine. Each kidney is encapsulated in and protected by three layers of tissue; the renal fascia, the adipose capsule and the renal capsule (Parker and Winston, 2007). The renal fascia is the outer layer of dense irregular connective tissue which holds the kidneys in place by attaching them to their surrounding structures and the abdominal wall. The adipose capsule is the middle layer of fatty tissue that protects the kidneys and holds them into place. The last layer, is the inner layer called the renal capsule. The renal capsule consists of a smooth transparent fibrous membrane that is continuous with the outer coat of the ureters which protects the kidneys and helps to maintain their shape (Hull and Slegg, 2009). The kidney has two distinct regions; the renal cortex and the inner medulla. The medulla forms around six to eighteen conical structures known as renal pyramids (Premkumar, 2012). Each pyramid contains a cup-shaped calyx which opens into the renal pelvis (Gould, 2005). The part of the cortex that dips between the renal pyramids is the renal columns. The apex of the pyramids, the renal papilla is located central and protrudes into the renal sinus. Any urine that is formed is drained by the ducts in the papilla into the renal calyces. Four or five small calyces known as the minor calyces empty into two or three larger calyces, called the major calyces, which join to form a large chamber, the renal pelvis (Premkumar,

The bean-shaped kidneys are retroperitoneal in the posterior abdominal region. They lie in the extra peritoneal connective tissue immediately lateral to the vertebral column (figure 1). In the supine position, the kidneys extend from approximately vertebra T12 superiorly to vertebra L3 inferiorly, with the right kidney somewhat lower than the left because of its relationship with the liver. Although they are similar in size and shape, the left kidney is a longer and more slender organ than the right kidney, and nearer to the midline

They are located just below the rib cage, one on each side of the spine. Every day, the two kidneys filter about 120 to 150 quarts of blood to produce about 1 to 2 quarts of urine, composed of wastes and extra fluid. The urine flows from the kidneys to the bladder through tubes called ureters. The bladder stores urine. When the bladder empties, urine flows out of the body through a tube called the urethra, located at the bottom of the bladder. In men the urethra is long, while in women it is short.” (what are kidneys and what do they do?)

Social/Personal History: The patient is an engineer, lives well with his wife. He has no financial nor family dysfunction problem. He eats healthy, gets enough exercise, and maintains a regular checkup with his doctor. The patient does not smoke nor drink and denies any substance abuse.

“The Kidney are bean shaped organs, each about the size of a fist. They are located

History: The patient has a history of Chicken Pox at 5 years old. He has been a smoker for 25 years and currently smokes 2 packs a day. He consumes alcohol daily 2-4 glasses of wine. He reports of history of depression and anxiety 3 years ago after separating from his wife. His is not currently on any medications. He also has a history of a positive TB skin test with no active disease. The patient spent 15 years in the military traveling overseas. He had right rotator cuff surgery 10 years ago.

Kidneys are located behind the peritoneum on the posterior abdominal wall, on the left and right side of your spine, just below your rib cage. They are bean-shaped structures and are about the size of a fist. Each kidney consists of millions of nephrons, working unit of the kidney. One group of nephrons are known as the renal corpuscle. It contains Bowman’s capsules that are surrounded by capillaries called glomerulus, which aids in the filtration process of the kidneys (VanMeter, Hubert, & Gould, 2014, 491). It is the kidney’s responsibility for the removal of waste products and excess fluid, it produces urine. With this important responsibility, sometimes patients are predisposed to other ailments that cause the kidneys to malfunction. This leads to a process called kidney disease. “Kidney disease is the inability of the kidney to maintain normal function, so that waste products and metabolites accumulate in the blood” ( Farlex Partner Medical Dictionary,2012). According to the Kidney Disease Outcomes Quality Initiative (2015), kidney disease occurs when the loss of nephron and reduction of renal mass reaches a certain point, the remaining nephrons creates a process of irreversible sclerosis (para. 7). Since kidney disease alters the filtration process of normal functioning kidneys, we can expect to see a reduction in the amount of filtration that occurs. As kidney disease progress, there will be a higher percentage of uremia within the body. Uremia is

‘Taking a patient history: the role of the nurse’ is an article written by Tonks Fawcett and Sarah Rhynas, published in the Nursing Standard, volume 26, issue 24, pages 41-46 on February 15, 2012 . In this article, the authors write about taking a patient’s history and how this is a vital element of patient assessment. It focuses on the patient as a whole, and how the nurse can learn to elicit biographical information and personal circumstance for application to the current healthcare need.

It is a complex and major organ of our body perform several important functions like formation of urine, water and salt metabolism, acid-base balance, regulation of blood calcium level and secretion of hormones (Padmalochana et al.2015). The kidney is composed of many tortuous, closely packed uriniferous tubules, bounded by a delicate connective tissue in which run blood vessels, lymphatics and nerves. Each tubule consists of two embryologically distinct parts, the nephron, which produces urine, and the collecting duct, which completes the concentration of urine and through which urine passes out into the calyces of the kidney, the renal pelvis, the ureter and urinary bladder. A renal, or uriniferous, tubule consists of a glomerular capsule that leads into a proximal convoluted tubule, connected to the capsule by a short neck and continuing into a sinuous or coiled convoluted part . This straightens as it approaches the medulla, and becomes the descending thick limb of the loop of Henle, and then the ascending limb by an abrupt U-turn. The limbs of the loop of Henle are narrower and thin-walled within the deeper medullary tissue, where they become the descending and ascending thin segments. The ascending thick limb continues into the distal tubule. The tubule wall shows a focal thickening, the macula densa, where it comes close to the vascular pole of its parent glomerulus at the start of the convoluted part of the distal tubule. The nephron finally straightens once

The kidneys are dark red bean -shaped organs that are a very important pair of organs that perform many functions. The kidneys have a convex side and a concave side. They are each about the size of a fist. The kidneys are located near the middle back of a human, just below the rib cage, one on each side of the spine. One kidney is located below the spleen on the left side of the body, whereas the other kidney is located just below the liver. The kidneys receive blood from the paired renal arteries and the blood is drained into the paired renal veins. In a human body, the kidneys process about 200 quarts of blood to sift out about 2 quarts of waste products and extra water everyday.