The document provides background information on a 60-year-old patient named D.P. who was admitted to the hospital with acute kidney injury. Key details include that he has a history of chronic kidney disease, type 2 diabetes, and hypertension. He lacks formal education and has a history of unhealthy behaviors like poor diet, smoking, and substance abuse. He is currently undergoing further evaluation and treatment in preparation for fistula placement and management of his acute medical issues.

1. Acute Care Scholarly Assignment 1
Acute Care Scholarly Paper
Irene Butcon
Dave Jay Manriquez
Class 201509
Vancouver Community College
Author Note: This paper is prepared for Health Promotion 4 taught by Elaine Donohoe.

2. Acute Care Scholarly Assignment 2
Introduction
Patient D.P. is a 60 years old male originally from Kelowna. He is married but he lost his
wife in a car accident 8 years ago. He has two children that are still attending secondary school
back in Kelowna. He did not finish school, he is only up to grade four as he need to help his
parents in their livelihood. He work in a farm throughout his life. His parents are now both dead.
He has four siblings. He describe his relationship with his siblings as being close as they support
each other in times of need. Patient D.P. is not observing proper diet. He loves to eat sweets such
as chocolates and cakes. He also drink alcohol when he was young but stop when he found out
that he is diabetic. Aside from drinking, he also smoke weed and cigarette. He mentioned that
when he was young, seldom have he used the health service clinic, he don’t even go for any
check-up or consultation. He used herbal medicine to treat common illness like cough and colds.
He do not believe in any religion, but he pray within the nature.
Patient D.P. has a history of Chronic Kidney Disease that lead to hydronephrosis that
required him to undergo dialysis. He is aware of his condition and always been in radar by his
doctor since the time he was diagnose having CKD. Patient D.P. is also a diabetic and had been
diagnose 20 year ago of Type 2 Diabetes Mellitus. Aside from having Type 2 DM, he has also
hypertension and dyslipidemia as well. For the past 20 years he is under maintenance of oral
hypoglycemic agents, hypertensive medication, and lipid lowering agent that he take religiously.
He mentioned that because of his condition this affect the kind of lifestyle he has. He cannot
work fulltime in the farm and lead to absences. Because of this he grew some weight that he
thinks cause the pain in his lower back, but later on with further assessment by his doctor back in
Kelowna it was found out that he is also suffering from spiral stenosis.

3. Acute Care Scholarly Assignment 3
Pertinent details that contributed to his present condition/hospitalization
He went here in Lower mainland to visit an old friend who is residing in Vancouver.
While he was on his friend house, in day two of his stay he experienced a severe lower back pain
that hinder him to move. This event led him to call for an ambulance that brought him to the
emergency department of St. Paul Hospital. Upon consultation the doctors found out that he is
suffering from Acute Kidney Injury that resulted to his admission on the unit.
Patient D.P. primary diagnosis is Acute Kidney Injury secondary to diabetes and
hypertension. He is scheduled to get a fistula on his left arm. The chief complaint of the patient
upon arrival in the emergency room is decrease mobility due to lower back pain and also being
disorientated and confused.
Two Determinants of Health and two associated risk factors
The first determinant of health that can be associated to the patient is Education and
Literacy. People with higher education levels tend to smoke less, drink less, be more physically
active, and have access to healthier foods and physical environments. Literacy can affect health
both directly (knowledgeable of the disease process), and indirectly through the use of health
services in the community (Potter et al., 2014). With less educational attainment, this put the
patient at risk of having higher stress levels and ineffective use of health services. Both risk
mentioned will probably put the health of the person in jeopardy. The second determinant of
health that can be associated to the patient is Individual Health practices and Coping Skills.
Effective coping skills help people face challenges without resorting to risk behaviors such as
substance abuse. Many so-called risk behaviours may, in fact, be coping strategies for stress and
strain caused by living circumstances (Potter et al., 2014). With the past and current practices of

4. Acute Care Scholarly Assignment 4
the patient it put him at risk for developing a very poor nutrition, substance addiction, and
physical inactivity. The risks mentioned will worsen his current illness, prolong healing time that
will lead to poor compliance.
Patient’s progresses in hospital
From the emergency unit he was transferred to the medical surgical ward for further
observation. It is still the second day of the patient in the unit during the time we interviewed
him. He is placed under renal diet. His In’s and Out’s are accurately monitored by his primary
nurse. His weight is taken daily and recorded. The doctor ordered for his blood sugar to be taken
30 minutes before meals. He is allowed to ambulate with a help of a walker if back pain do not
persist. He is scheduled for fistula placement but the time of the surgery is still undetermined.
Basically, he is still in the state of observation, so as of the time it is difficult to make an accurate
prognosis with the extent of his kidney injury. As day shift nurses assigned to him, we did a
quick priority assessment and some focus assessments related to his condition and report our
findings to the primary nurse. We did also some health teachings that is related to his condition.
Eventually, if everything goes well with the fistula placement, the patient will just be release
from the unit with some reminders of follow up consultation. “A fistula may not clot as easily as
other dialysis access. It may take several months for the fistula to form” (hemodialysis, 2014).
Interdisciplinary team involved in care
The interdisciplinary team involve in the patient care includes: his immediate attending
physician, a nephrologist looking after his kidney, anesthesiologist and surgeons as he is
scheduled for a placement of fistula access for hemodialysis, dietician for his renal diet, and the
nurses in the unit.

5. Acute Care Scholarly Assignment 5
Functional health patterns for this patient
The two functional health patterns that are considered patient’s strength are Role-
Relationship Pattern and Self-Perception Self-Concept Pattern. Patient D.P. has a good
relationship with his family. He has two children and four siblings that whom he describe having
a close ties with him. During this time of his hospitalization until he will get to be discharge he
needs all the support that his kin can provide to him. A strong and positive relationship promotes
faster healing, whereas conflict slow recovery from illness (prevention, 2011). Despite
everything happen to him and with this current hospitalization of his, he has still a positive
outlook in life. He believes that he can survive with his illness and still live a productive life. He
is not showing an expression of helplessness or loss of control to care for oneself, instead he is
motivated to get heal. The two functional health patterns that may challenge this patient upon
discharge are Health Perception-Health Management Pattern and Cognitive-Perceptual Pattern.
Both of this patterns will challenge the patient on how he will going to take care of himself after
being discharge from the hospital. With his educational attainment, struggles on understanding of
his illness and treatment might be possible. His decision making will be an important key of how
he will live a healthy life. Patient’s knowledge of the health problem, awareness of what should
be done, and ability to use appropriate resources in the community is a significant factor towards
optimum healing (Lewis et al., 2014).
Priority Problem related to above DOH’s
A potential problem that will arise with the patient current assessments is developing a
Heart Failure. The patient Education and Literacy attainment can be an important factor on how
he will prevent this illness from occurring. Basing on the patient background that he is diabetic
for 20 years, alcoholic on his younger age, smoking weed and cigarette till the present day would

6. Acute Care Scholarly Assignment 6
probably hasten the development of heart failure. This can be prevented through proper
education which can be advocated by the health care professional looking after him. Education
provide knowledge and skills to solve problems and gain a sense of control of the situation
(Potter et al., 2014). The greater challenge comes when the patient will be discharge from the
unit. Providing health teaching to him and his immediate family during discharge will make sure
that he will be constantly reminded on what to do to maintain a healthy life. Off course his
personal judgment and decision making will play a key role on how this event will unfold. The
identified problem is the most relevant as complications of a heart failure are harmful and can
lead to death.
Hypervolemia is an actual problem that the patient has in his hospital stay. This due to
the fact that he is experiencing an acute kidney injury that cause the kidneys to lose their ability
to remove extra fluid from the body (hemodialysis, 2014). But this is just a minor problem that
can lead to heart failure which is dangerous and fatal. With accurate monitoring of In’s and Out’s
will help in correcting the excess amount of blood volume.
Key patient Learning needs
The patient need to continue to have an active lifestyle. Daily ambulation and light
bearing exercise can already improve normal blood circulation. Eating nutritious food and
staying away from sugary and salty foods will help prevent complications. Cessation from
substance abuse will help in prolonging his life.
Two Community Service/Resources for this patient
The Kidney Connect Peer Support Program introduced by the Kidney Foundation of
Canada to provide one on one support to people who have been diagnose with kidney disease.
Mr.D.P. could benefit from this program because they will let him speak to someone who

7. Acute Care Scholarly Assignment 7
understands what it’s like to live with kidney disease and is willing to share their own
experiences with him. They will be able to answer many questions because they’ve been there,
too. Mr.D.P. can visit this website http://www.kidney.ca/peer-support or can contact this no.1-
866 390-PEER (7337)
The 2nd community services that can help Mr.D.P. is the Kidney Care Clinic located at
St.Paul’s Hospital and the address is 6A Providence Building, Rm.6012, 1081 Burrard Street,
Vancouver, BC V6Z 1Y6 with contact no. 604- 806 8205. They support and educate individuals
and families living with kidney disease. The goal of care is to help slow or stop the rate of kidney
decline and prevent the need for renal replacement therapy, including dialysis or transplant. This
support services will benefit Mr. D.P. because he is asking us lots of questions regarding his
condition and through this services he will be able to know more about his diseases.
Teaching Plan
Goal: We will teach Mr. D.P. on how to reduce swelling of his legs and feet.
Objectives Content Time Methods Resources Evaluation
At the end of
the teaching
session, Mr.
D.P. will know
the importance
of:
1. Ambulation
and exercise of
legs and ankle.
• Help reduce
leg swelling
by increasing
circulation to
the legs
muscles.
• Help to push
excess fluid
in the legs
through the
blood valves
6
minutes
Teach and
demonstrate
www.nlm.nih.go
v/medlineplus
Teach and
demonstrate
back

8. Acute Care Scholarly Assignment 8
2. Low sodium
diet and
avoidance of
food high in
sodium (show
the low salt
menu to the
patient).
3. Elevation of
both legs when
in bed and
sitting in the
chair, place
two pillow
under both
legs.
and back to
the heart
• Teach and
demonstrate
to the patient
about the leg
and ankle
exercises
• Higher
consumption
of sodium
may cause
water
retention
inside the
body
• Foods that
are high in
sodium are:
- canned
vegetables
- processed
meats
- carbonated
beverages
- processed
dairy foods
- seasoning
that contains
salt
• This will
help control
the swelling
6
minutes
3
minutes
Total-
15 mins
Teach and
show
Teach and
demonstrate
Manual of
medical -
surgical nursing
Understanding
the nursing
process
Teach and
show back
Teach and
demonstrate
back

9. Acute Care Scholarly Assignment 9
Supporting Research Articles
The two related article that we used are: “Insulin Edema and Acute Renal Failure”
Retrieved from: http://care.diabetesjournals.org/content/diacare/36/5/e65.full.pdf and
“Acute Renal Failure” Retrieved from: http://cclsw2.vcc.ca:2085/ehost/pdfviewer
Bibliography
Carpenito-Moyet, L.J. (2007). Understanding the Nursing Process.Concept Mapping and Care
Planning for Students. Philadelphia: A Wolter Kluwer Company.
Hemodialysis. (2014). WebMD. Retrieved from http://www.webmd.com/a-to-z-
guides/hemodialysis-20667
Lewis, S.L., Dirksen, S.R., Heitkemper, M.M., Bucher, L. (Eds). (2014). Medical-Surgical
nursing in Canada. Assessment and Management of clinical problems (3rd ed.), p. 42-44.
Toronto: Elsevier Canada.
Monahan F., Neighbors, M., & Green, C.. (2011). Manual Medical Surgical Nursing ( 7th ed.).
Maryland Heights Mo: Elsevier Mosby.
Potter, P.A., Perry, A.G., Stockert, P.A., Hall, A.M. (Eds.). (2014). Canadian fundamentals of
nursing (5th ed.), p 6-7. Toronto: Elsevier Canada.
Prevention. (2011). Health. Retrieved from http://www.prevention.com/health/healthy-
living/speed-healing-remedies-heal-faster