Critical Pathway: End Stage Renal Disease

I. Introduction

Mr. D is a 57 year old Hispanic male who presents to the ER via ambulance with a fractured femur. He was found in the bathroom floor of his accounting office by one of his employees. Upon arrival to the hospital, Mr. D appears very lethargic. His speech is slurred and he is disoriented. Vital signs and lab work are obtained for evaluation.

Vitals:

• Height 6'2"

• Weight 220 lb.

• BP 180/90

• HR 104

• Resp. 24

• Temp. 100.1

Labs:

• K+ 6.1

• Na 149

• Ca 1.4

• P04 4.6

• Glucose 255

• Hgb 12

• Hct 26

• Protein 6.0

• Albumin 2.7

• BUN 101

• Creatinine 49

• GFR 12

Mr. D's wife arrives to the hospital an hour later. She provides the nurse with Mr. D's medical history, which includes Type II diabetes, depression, hypertension and a recent diagnosis of ESRD. He has been receiving hemodialysis for the past 4 months. Mr. D's wife also reports that he was hospitalized 1 year ago due to complications of CKD in which worsening kidney function was determined. Mr. D's wife also reports that he has been very tired lately. She says he goes to his office 2 days a week for about 4-6 hours per day. She says he does little else; he does not participate in any of the activities he used to love. He has been unable to help her with any of the household chores and his appetite has been severely decreased. Yet, he continues to go to the office . Mr. D's wife says she has been extremely worried about him and has asked him to retire; he refuses. Mr. D contributes his lack of energy to dialysis. Mr. D’s wife states that she has recently noticed a severe decrease in his appetite and swelling in his feet. She says he is noncompliant at times with his medications. ...

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...n his wife's advice and retired from his accounting firm. Mr. D says he is enjoying his retirement and due to his busy schedule, does not expect to return to work. He wants to focus on his health.

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