Comprehensive Assessment and Management of End-stage Renal Disease

The assignment will bring about the assessment on the concepts of healthcare and other related aspects of health and illness among individuals. The report will focus upon the identification and assessment of a case of renal disease. Renal disease or kidney disease is one of the most critical health condition of the human body, which leads to a damage to the kidneys. It is important for an individual to emphasize the proper functioning of every part of the body, specifically kidneys. This damage affects the functioning and increases the amount of wastes leading to the occurrence of other health problems (Ghaderian et al., 2015). In context to the discussion, the report will mention the aspects with reference to the case study, in context to the renal disease, especially to the last stage of renal disease. Thus, the discussion will consist of brief of the case study, patient affected by the disease, pathophysiology, care, and management of the disease, and recommendations at the final part. Hence, readers will gain an understanding of the management of health condition of the patient at the end stage of renal disease.

Synopsis of the patient

It has been analyzed that the end stage renal disease, is called as kidney failure, i.e. ESRD is the last stage of chronic kidney disease. This particular stage is the fifth stage in the chronic kidney diseases, and the person operated on a dialysis, or may require transplant. Two common causes of the occurrence of ESRD have found as diabetes, and hypertension (Picariello et al., 2018).

Mrs Fathimath Ahmed (Name Changed for confidentiality) is 52-year old woman surviving with Type 1 diabetes, cataracts, and ESRD received hemodialysis over 2 years. The case stated that she was admitted in the hospital during morning hours for hyperglycemia and effective management of the medicines. Discussing about the family history of the Patient, it has been found that there were no such significant records of history of renal disease, dialysis or kidney transplant in any of their members.

She was then, taken to the dialysis prior to her arrival on the medical ward. On her arrival, she was lethargic, and responded slowly to the questions asked to her. This shows her low-mood and lack of energy to do her daily activities (Luo et al., 2016).

It was found that 5 kg of the fluid removed through dialysis, and other vital signs of her body included temperature as 98.3 degree, BP 88/40mm Hg, pulse rate 96 beats per minute and 12 breaths per minute respirations. The medical history of the patient, i.e. Mrs Fathimath Ahmed stated that in her childhood, she was not adhered to the diet prescribed by the professional for the concern of diabetes. Besides, this ignorance to the medications was another reason, which contributed to her present state of health. This fact is useful in explaining about her ignorance to the medical treatment, however she had diabetes in her earlier years, which impacted her behaviour towards undertaking self-care. Thus, the above discussion provides a brief of the patient’s health condition, which further led to another problem causing poor vision (Young et al., 2015).

CKD & ESKD

Chronic Kidney disease (CKD) is referred to all 5 stages of the damage to kidney, ranging from mild kidney damage (stage 1) to complete kidney failure, in the stage 5. The stage of kidney is determined through their function of filtering and excreting the waste and fluid out of blood. On the other hand, the term ‘ESKD’, defined as end stage kidney disease refers, to long-term renal disease, and they no longer support needs of the body.

Some of the major contributing factors in context to both, CKD and ESKD, includes race, gender, age, family history, low birth weight, older age, smoking, socio-economic status, and use of any harmful substance.

Pathophysiology of the end stage renal failure

Kidneys are double organ that is situated retroperitoneal at the horizontal of T12 to L3 vertebra. The right kidney lies mild lower due to presence of liver on that aspect. It is sort of 11cm prolonged and 150g in weight. Nephron is the purposeful unit of kidney that's a complicated shape. The components of an individual nephron contain; renal corpuscle, proximal convoluted tubule, loop of Henle and distal convoluted tubule which has particular activity one by one (medcell, Yale, histology) Kidneys have essential roles in human body. It serves for regulation of arterial pressure by means of excreting sodium and water which allows to secrete an enzyme called renin. Renin activates the renin angiotensin device that control blood strain. Regulation of water and electrolyte stability is every other vital feature of kidney. Kidneys paintings by balancing the quantity of water and electrolytes intake and output. Kidneys also excrete metabolic wastes which might be harmful to frame if now not removed early, consisting of urea, creatinine, uric acid and waste products from breakdown of hemoglobin. Another essential characteristic of kidneys is to provide the hormone erythropoietin, which is the precursor of red cellular production. Kidneys also help to modify vitamin D metabolism via producing energetic discern of vitamin D, calcitriol from sunlight or from ingested nutrition that is in an inactive form. Acid bas stability is also a vital characteristic of kidney. They reabsorb bicarbonate from urine and excrete hydrogen in urine creating a balance (Interactive Biology, Leslie Samuel). Stages of Chronic sickness primarily based on GFR are as follows, In degree 1 the Kidney damage with ordinary or multiplied GFR (>ninety mL/min/1.Seventy three m2), In Stage 2 Mild discount in GFR (60-89 mL/min/1.Seventy three m2), In Stage 3a Moderate reduction in GFR (45-59 mL/min/1.Seventy three m2), In Stage 3b Moderate discount in GFR (30-forty four mL/min/1.Seventy three m2), In Stage 4: Severe reduction in GFR (15-29 mL/min/1.73 m2) and in Stage 5: Kidney failure (GFR 

Diabetes will increase reactive oxygen species (ROS) within the frame. ROS assaults and damages the glomerular filtration barrier (GFB) consisting of the endothelium, basement membranes and podocytes. The GFB is liable for the highly selective filtration of the blood and when broken, ends in proteinuria. As the GFB is broken, mesangium extend and consumes the glomeruli.

The issue of fatigue increased which influenced her ability to perform other activities, due to her constant dependence on dialysis. Thus, there is a greater role of nurses to help her recognise her support systems and collaborate with her so that she becomes able to carry out her daily-life activities properly. After performing the laboratory tests, the results revealed that serum sodium, calcium, phosphorous, and magnesium were found in the normal range. Moreover, it was examined that her serum glucose was elevated which can lead to cell dehydration due to the osmotic pressure in the extracellular fluid. Thus, it stated that she might require regular insulin for glucose correction (McCance and Huether, 2018). It is found through research that insulin affects the proteins, magnesium uptake by the cells therefore, lack of insulin affected the functioning of cells. This issue led to the impact on the energy in the body, resulting into fatigue that has contributed a major part to her deteriorated health (Angeli et al., 2015).

The pathophysiology of the end stage renal disease or the patient’s dependence on dialysis led to the issues affecting the functioning of her kidney, and other systems of the body. She has also found taking anti-depressants, which has states about association of the dialysis related fatigue; therefore, it must be treated effectively (Dai et al., 2017). The studies demonstrated that the health problem of depression identified could be treated effectively with the use of medications and other therapies. The analysis of the case stated that treating depression could help reducing the levels of fatigue in the patients receiving dialysis (Wang et al., 2016). Therefore, health professionals or the nurse within health facility must focus on educating the patient about the need and significance of taking proper diet, and healthy food. Moreover, it is essential for the patient to undertake regular exercise, proper sleep, and adopt a healthy lifestyle. Thus, these aspects highlight the major aspects of initiating changes in her daily life, and eating habits as they will help reduce the symptoms of fatigue in her body. In the later section of the report, the discussion will further bring assessment of the care and treatment, i.e. management of the end stage renal disease, describing the ways through which effective care is provided to the patient (Picariello et al., 2018).

Care and management of the end stage renal disease

Chronic renal failure or ESRD is a progressive and irreversible degradation in the renal function that affects the balance of the body in maintaining effective control on the metabolic, fluid, and electrolyte (Sivaraman, Patel and Weissman, 2016). It occurred due to several different systemic diseases that consist of diabetes, hypertension, or due to the use of toxic agents, medications, and other infections. Therefore, the renal failure is identified as critical and most common health problem, which should be treated effectively to ensure proper functioning of the kidneys. The aspects of care and management in relation to the renal failure are the combined efforts or factors from the healthcare, family members of the patient, and the person itself (Ketteler et al., 2017).

Here, the aspect of management is determined and understood as medical management of the chronic renal failure. The goal of management is to ensure effective operation of the kidney function of the patients and ensuring balance of homeostasis as long as possible. The management of the disease accomplished primarily with the help of medications, diet, and other required therapies (Collins et al., 2015).

It may also include the use of dialysis, as it may be required to reduce the levels of uremic waste products in the blood; thereby controlling the electrolyte balance. In general, terms it has been analyzed that chronic renal failure is a devastating disease, which requires practicing standards of medical care for the patients. Therefore, essential aspects of standard medical care include monitoring for the signs of progression of disease, and ensuring early referral of patient to the specialists, in health care for dialysis or possible renal transparent (Webster et al., 2017).

A nurse plays a vital role in providing care to the patient, once a patient is diagnosed with ESRD, in terms of educating them about the process of dialysis, and the availability of other options. The treatment of the end stage renal disease or renal failure involves the aspect of adjusting parameters according to the levels of patient presentation (Ghaderian et al., 2015). The targets or aim of providing preventive care and diagnosis includes tight glycemic control, reducing the risks of cardiovascular diseases, and making recommendations for changes in general lifestyle. The management of the issue has been affected by the cause of diabetes, as provided in the particular case of the women. Therefore, underlying cause i.e. diabetes must be treated well to ensure effective management of the renal problem of the Patient. Amongst these ensuring glycemic, control is critical to provide care to the patient at the final stage of kidney disease followed by other aspects (Moore et al., 2018).

In context to the case of Fathimath Ahmed, it has been analyzed that she suffered from the problem of fatigue due to her emotional and psychological imbalances. The issue of fatigue has been one major reason, which contributed to the problem of management of dialysis. As nurses were in excellent position to review, monitor, or assess her situation therefore, and provided support and suggested to make changes in their lifestyle (Finelli et al., 2017). Therefore, the aspect of care and management in context to the end stage renal disease, a patient must be provided required medical resources and other facilities or intimate care such as in terms of bathing, dressing, grooming, and toileting. Thus, advance care planning is crucial, therefore to manage the disease of Mrs Fathimath Ahmed’s physician were called regarding taking decisions for the dialysis initiation and withdrawal. Medical management included the medications, provided by the nurse, i.e. Fentanyl and methadone are preferred for the patients at the end stage of renal disease (Horigan and Barroso, 2016).

Intake of dietary protein

This is one of the major aspects of care and management for the patients of end stage renal disease, and therefore it was vital to ensure to the case of Mrs Fathimath Ahmed. Dietary restriction is essentially important to the patients of renal failure, therefore she need to adhere to the restricted dietary protein foods (Palmer et al., 2015). It was suggested by the diet specialists that the patient must adhere to the low salt diet, i.e. reducing the consumption of the foods rich in phosphorous, and restricting the intake of protein. The protein is to be restricted to 0.8 per kg body weight per day contributes major to manage burden of the disease in an effective manner. It has also suggested to the patient in the case to take care of the blood vessels in her arms, as it is important to protect veins in the arms prior to the start of the dialysis process (Murtagh et al., 2016).

Communication ensures effective health service

An important aspect of undertaking care and management of the patients affected at the end stage renal disease, it has found that communication ensured amongst the patients, and the health professionals, or their support members. Communication within healthcare and home is essential to ensure that the patient is aware of every kind of information related to their treatment, use, and withdrawal of dialysis in case of renal failure. Thus, the important aspect of care highlights the need to ensure individual-focused care, which emphasizes on individual’s needs and preferences in respect to the treatment of the disease (Kent et al., 2015).

Good communication with nephrologists or dialysis team will enhance organizing the process of care plan, whereas diminished trust will affect the care plan designed for the patient. Thus, it will facilitate in determining effective care and providing counselling to the patient to enhance their self-esteem and confidence levels to focus on their health. Therefore, a nurse in the cases of high-risk patients of ESRD, need to become aware of managing several important aspects such as fluid management, blood transfusion, pain control, and hyperkalemia. Another important aspect is the testing the level of blood pressure is a crucial part of assessing, or monitoring the progression of disease and the impact on the health of person. Therefore, managing fatigue and ensuring effective communication between therapist and client is important to be carried out and analyzed being a part of the process of treatment for renal diseases or kidney failure cases (Berlowitz et al., 2017).

To relate these aspects in this case, it has been analyzed that the nurse and the other health care specialists took care of the patient, i.e. Mrs Fathimath Ahmed, and kept communicating her to assess her emotional and psychological balance. Moreover, she was directed to do regular exercise for 30-minutes and focus on socialization with people in her surroundings to get relieved from the burden of the fatigue or symptoms of disease. Some of the changes suggested made in her lifestyle that would help her improve her health condition relates to lowering the content of sodium, potassium, and phosphate and the fluid in her diet (Selamet et al., 2016). Moreover, she was advised to take adequate calories, i.e. moderate intake of protein, low fat, and vitamins A and C and carotenoids. Therefore, these things report some of the ways, through which the end stage renal disease is managed ensuring the patient better health outcomes. Reducing the level of fatigue of these patients will improve the patient practice, and ensure their wellbeing. Hence, to ensure patient good or positive health outcomes it is essential that pharmacists or nurses pay attention to the medications taken by the patient, and which needs to be discontinued which may affect the kidneys adversely.

Conclusion

To conclude the above discussion, it has been analyzed that renal failure or end stage of kidney disease is one of the critical health issue across different regions. The above research stated that chronic kidney failure could lead to various complications throughout our body, affecting number of body parts and systems. The issue has some common causes such as blood pressure, hypertension, or diabetes, which is found relevant in many countries. Thus, the report has established well an understanding of the causes, risk, and impacts of the end stage renal failure with the help of a case study. Thus, the case revealed a major cause i.e. diabetes of the ESRD of the woman in the case, and the deterioration of her health condition. Hence, it assured maintenance of kidney function of the patient by reducing the complications and attaining positive health outcomes.

Recommendations

The discussion in the above section of the report has stated different aspects of the end stage renal disease, and the influence on the kidney functioning of the individuals. Thus, now the analysis will determine some recommendations in terms of diet, or lifestyle or other habits, required for the patient at end stage of renal disease. First, it is essentially advised to the medical unit or healthcare specialists to undertake the responsibility of early diagnosis and progressing treatment for the patient.

Therefore, for the case of Mrs Fathimath Ahmed it has recommended that she must changes in appropriate dietary interventions through adjusting or reducing the consumption of food rich in phosphate, and water is essential for the patients of kidney diseases, to remove the waste material from the body. In addition, diet plan and exercising act as other important aspects recommended for the patients of renal failure, for improvement of health. As mentioned in the case, the issue of fatigue has been analyzed, which led to the present health condition of Mrs Fathimath. To avoid any situation of conflict or stress, it is essential to lead to better health and ensure fast recovery from the renal disease. The issue of stress or conflicts found to be the major factors worsening the impact of the renal failure and the associated signs and symptoms on the patient. After analyzing the whole case scenario and research carried on the healthcare aspects and wellbeing of individuals, diet, exercises and medications play an important role in the treatment process of an illness. Hence, above discussion has mentioned recommendations that are significant to incorporate towards improvement of the health condition of Mrs Fathimath Ahmed, and alleviate the negative effects of fatigue on the kidneys.

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