Chronic Condition - End-Stage Renal Disease - Essay Example

?Running head: End-stage renal disease End-stage Renal Disease (school) End-stage Renal Disease Introduction Chronic diseases are diseases which last for weeks or months at a time. Many of these diseases are terminal cases of cancer and others are long-term care illnesses which require prolonged and constant care and maintenance from various health professionals. End-stage renal disease (ESRD), sometimes known as chronic kidney disease, or kidney failure is one of these chronic diseases. This paper shall be a case study about Donna, an ESRD patient. First, this paper shall define and describe ESRD; second, it shall discuss the experience of the patient in relation to her chronic condition, comparing this to the typical lived experience of those with this condition; third, an outline of differences in the perceptions held by the patient and their family members concerning the disease shall be compared with the general community; lastly, it shall discuss what self-management education the patient requires, as well as the discharge plan and community referrals the patient needs. The goals of this are established to ensure a thorough assessment of chronic diseases and their impact on patient’s physiology, as well as their psychology. Body End-stage renal disease, according to Patel (2009) is the “complete, or almost complete, failure of the kidneys to function. The kidneys can no longer remove wastes, concentrate urine, and regulate many other important body functions”. This disease can come about when the kidneys are no longer able to carry out their normal function. It is often seen with the kidneys functioning at less than 10% of normal functions (Patel, 2009). This disease is known to worsen within 10-20 years, before reaching end-stage levels. Patients at this stage require dialysis or a kidney transplant. Mostly, this disease is caused by diabetes and hypertension. In end-stage renal disease, the urine volume may decrease or may even stop, and patients afflicted with this disease require tests to assess the levels of the following: potassium, sodium, albumin, phosphorous, calcium, cholesterol, magnesium, complete blood count, and electrolytes (Patel, 2009). These tests would help establish the general condition of the patient and establish the necessary remedies which must be undertaken to ensure adequate care. Experience of your patient compared with the typical lived experience of those with this condition Donna, 37 years old, was first admitted two years prior to her current admission, with complaints of insomnia and frequent headaches. She expressed that she often woke up in the middle of the night and had trouble getting back to sleep soon after. She also experienced increasing bouts of headaches which could not be relieved by pain relievers. She also described feeling generally weak and easily exhausted. She also complained of hiccupping frequently, sometimes burping frequently, even when she has not eaten anything. Her husband also noted that she seemed to be darker as compared to before when she had lighter skin. She then sought consult with her GP who ordered some initial tests including blood work and urinalysis. Her initial results, prompted more tests to be undertaken until repeated confirmatory tests indicated that she had high creatinine levels which strongly indicated a diagnosis of chronic kidney disease. She was later admitted for AV Fistula (AVF) surgery in preparation for her dialysis. A month after her AVF, she was scheduled for dialysis. A kidney transplant was also recommended for her. Initial cross-matching tests from immediate relatives revealed no organ matches. In the meantime, her name was entered in the waiting list for patients needing new kidneys. Meanwhile, she was required to have weekly injections of erythropoietin, as well as daily medications for a variety of drugs which are meant to manage her potassium, sodium, as well as blood pressure. After one year from her initial consultation, her creatinine levels increased to levels requiring dialysis. She has since been undergoing twice weekly dialysis procedures, while waiting for a possible donor. End-stage renal disease patients manifest with most of the above symptoms described by Donna. They often feel tired or fatigued even when they have not done any tiring work; or they may feel easily exhausted after carrying out work which did not normally tire them. They also usually experienced insomnia, headaches, and loss of appetite. Some of them also feel nauseated (Mitch, et.al., 2007). They also go through skin changes, with their complexion often becoming darker, and for some patients, their skin becomes lighter. Some of them also feel disoriented or confused at times with numbness sometimes settling in on their hands and feet. They are easy to bruise and to experience nosebleeds. They have frequent hiccups and have a low level of sexual drive (Tolkoff-Rubin, 2007). Some patients even go through menstrual changes, where they often stop menstruating altogether. In some cases, insomnia is common, as well as vomiting, and general feeling of ill-health. Donna has manifested, most, but not all, of the symptoms of renal failure. However, one year after her consult, she started to manifest edema of her face, her hands, and her feet. The experience of the patient in relation to her disease is credited to the waste products which are not eliminated by her kidneys (Krishna and Kiernan, 2009). In short, she is retaining her body’s waste products, these products which be eliminated. As it is, they are circulated into her body, affecting her normal processes and disrupting her homeostasis (Warady and Chadha, 2007). For many ESRD patients, without dialysis or transplant, their prognosis is not good as they are likely to not survive the disease and its devastating implications. Differences in perceptions by the family/family members about chronic condition as perceived by the general community Patients had different perspectives regarding their disease. In a 2010 study by Davison, the respondents revealed that they were not properly informed about their disease and that they believed that their condition has not changed for the past year of their life. Many of them do not know what palliative care means or what it implies. They also consider their participation in their care as an important element of the care process (Davison, 2010). They believe that they should be informed fully about their condition, about the implications of their health, and about their prognosis and their chances for survival. They also consider their family’s support as crucial to their recovery and to the adequate management of their disease (Davison, 2010). These patients also believe that the management of their symptoms must not be focused only on their kidney disease, but also on improvements on the quality of their life. The members of the community also had limited knowledge of kidney failure, or even of how the kidney functioned (Jennette, 2010). They also had little knowledge the risk factors involved in kidney disease, as well as the treatment options available for this disease. These members of the community believed that poor communication with their GPs and their limited access to specialty care made it difficult to improve their knowledge of ESRD (Jennette, 2010). The members of the community had a better knowledge and better means of understanding kidney disease, and the barriers to health care, as well as preferences in health education through focus groups. These focus groups were able to illustrate some knowledge and awareness of kidney disease and its risk factors, as well as treatment (Jennette, 2010). These focus groups were able to gain their knowledge from family and friends, and through these groups, they were actually enlightened about kidney disease being primarily caused by diabetes and hypertension (Jennette, 2010). In relation to the patient perceptions, the community also had a limited knowledge about the disease. The patients were afflicted with the disease, but they hardly knew more than the rest of the community (Cosgrove, 2011). In other words, the perception of the community regarding chronic kidney disease is as limited as the knowledge of the patients themselves. There is therefore a need to improve the dissemination of knowledge to both patients and the general community in order to ensure compliance with (on the part of the patients) and prevention of (on the part of the general community) the disease. The lack of adequate communication between the community and their GPs as well as the patients and their GPs regarding their disease is also a common denominator in the perception regarding chronic kidney disease. The need therefore for the physicians to make clearer explanations to their patients, and for them to make a better effort to educate the public is an implication drawn from this perception. Self-management education The first part of self-management education for the chronic kidney disease patient is for her to realize that she needs to change her behavior; this mostly includes a change in her lifestyle (Plantinga, et.al., 2008). This lifestyle change would have to be made part of the patient’s behavior change in relation to her food, as well as her daily activities. Her food will have to follow the diet plan as recommended by her specialist (Coresh, et.al., 2007). She would have to stick religiously to her diet because any diversion from such plan would increase her creatinine levels and lead to an increased manifestation of her uremic symptoms. It would be difficult for her to make the transition into lifestyle changes however, these are necessary adjustments she has to make in her life in order to ensure adequate management of her symptoms. The change in behavior can also be difficult to make because Donna does not feel yet the more severe symptoms of her disease (Stenvinkel, et.al., 2008). Nevertheless, these changes involve the crucial changes in her life which would impact positively on the outcome of her disease. A major part of the health education process for this disease is in assessing the patient’s perceptions. Assessing the patient’s perceptions would help establish what she understands about her disease, the risks involved, as well as the treatment options available (Finkelstein, et.al., 2008). The patient’s concerns must also be included in this assessment, as well as the patient preferences in treatment. In order to ensure patient compliance with the treatment and diet regimen, building self-efficacy is also important because the stronger the patient’s self-efficacy is, the higher her confidence levels would be (Curtin, et.al., 2008). Improving a patient’s sense of self-efficacy is an crucial element of self-management because in the clinical setting, the higher the patient’s self efficacy, the better his compliance would likely be as to the actions and precautions she is supposed to undertake and the changes in her life she is supposed to implement (Curtin, et.al., 2008). In the management of the medical aspects of her disease, it is important for the patient to know and to be taught that her disease is already a risk factor for various diseases, including congestive heart failure and ischemic heart disease (Cianciaruso, et.al., 2008). Self-management for this disease includes the importance of adhering to the physician recommendations in terms of food and medications. The operative word here is “adhering,” not merely complying, meaning, the physician set forth mandates to be obeyed, not suggestions to be followed. An example of matters which the patient needs to comply with is on eating habits. The patient’s food must be low in cholesterol, low in sodium; the mandate is not high in cholesterol or even absent in sodium (Cianciaruso, et.al., 2008). There are reasons for these diet mandates – too high cholesterol encourages plaque formation in the arteries and high sodium causes water retention and swelling; absent sodium can cause hypotension (Cianciaruso, et.al., 2008). In effect, violation of physician mandates can cause the patient’s life to be in danger, or the patient’s condition to worsen. In self-management, it is also important for the patient not just to interpret symptoms but to report them. The patient must therefore report symptoms like fatigue, sleep disturbances, nausea, vomiting, anorexia, weight loss, pruritus, poor concentration, neuropathy, and increase in urination (Jamison, et.al., 2007). Some patient seems to prefer not to report these symptoms, and prefer to tough it out. Considering that they are not in the best state of health to make these judgment calls, it is important for the patients to report these symptoms to their GP or their specialist, and let the latter make the judgment calls. Self-management is also about helping the patient live with her emotions regarding her disease. She is already anxious, fearful and at times, depressed. In order to ensure self-management, it is important to consider the patient’s concerns, and to help clarify her emotions in order to establish her true emotional state (Kalender, et.al., 2007). Support from family and friends are important to establish at this point of the patient’s care. Donna is receiving dialysis twice a week and sometimes feels like a continuous burden to her family. There are times she is too depressed to help herself. However, by building on the family’s support and assistance, it has been possible to establish a more positive and less despondent attitude on the part of the patient. Discharge plan As part of the discharge plan, the patient must be advised to take her medication and to make sure that these medications have the right dosage and preparation. A list of medicines, and their indications, as well as dosage must be made by the patient. Medications to avoid must also be listed by the patient (Balady, et.al., 2007). The patient’s follow-up visit must also be established. The diet must also be noted by the patient, the appropriate prescriptions to such diet must be indicated. Other general principles of well-being must be followed including non-drinking of alcoholic drinks, exercise, quitting smoking, and avoiding stress (Balady, et.al., 2007). Community referrals to the community center must also be made. Scheduled visits by the social worker, and a health professional from the community center must also be made available. Conclusion This is the case of Donna who has chronic kidney failure which is basically about her kidneys slowly and gradually losing their functions. She exhibits various symptoms typical of other chronic kidney disease patients which include headaches, insomnia, frequent hiccupping darker skin tone, edema, and decreased urine output. As perceived by the patient, and by the general community, not enough information is transmitted to the patient by the GP about her disease, and not much data is also given out to the public regarding this disease. Self-management measures for this disease include lifestyle changes, assessing patient perceptions, providing emotional support, and relaying symptoms to the specialist. The patient’s discharge plan includes, diet compliance, medication compliance as well as lifestyle changes. Referring the patient to the community for follow-up is also crucial to the patient’s adequate management of her symptoms. Works Cited Balady, G., Williams, M., Ades, P., Bittner, V., Comoss, P., & Foody, J. (2007). Core Components of Cardiac Rehabilitation/Secondary Prevention Programs: 2007 Update. Circulation, volume 115: pp. 2675-2682. Cianciaruso, B., Pota, A., Pisani, A., Torraca, S., Annecchini, R., & Lombardi, P., (2008). Metabolic effects of two low protein diets in chronic kidney disease stage 4–5—a randomized controlled trial. Nephrol. Dial. Transplant., volume 23 (2): pp. 636-644. Coresh, J., Selvin, E., & Stevens, A. (2007). Prevalence of Chronic Kidney Disease in the United States. 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