Management of the End-Stage Kidney Disease - Essay Example

Management of the End-Stage Kidney Disease Introduction End-stage kidney disease (ESKD) is a situation in which the kidneys permanently stop working properly for an individual to survive without routine dialysis or kidney transplant. In this condition, the kidney function to maintain fluid and electrolyte balance fail, leading fluid retention as well as urea with nitrogenous waste. Hypertension or Diabetes mellitus cause most cases of ESKD. However, other causes can be due drug reaction, hereditary lesions such as polycystic kidney disease, infections, mechanical injury and congenital abnormality among others. This article shall address the proper management of a patient suffering from ESKD, focusing from the time of admission to discharge (Dalrymple et al. 2011). Nursing need assessment tool is one of the tools that shall be employed to develop the patient profile and assist in the plan for her management. This tool is very essential in addressing the needs of an older patient who require long-term care due to a chronic condition. The tool addresses the patient holistically and embraces professional decision-making. In addition, the tool makes the assessment in a staged approach by deviating from the conventional narrative approach to a focused assessment approach. Another tool that shall be employed is the nursing care plan, which shall help in addressing the patient problem and plan the management accordingly. The key health problems for CherylWarra Allen are the renal failure, hypertension and diabetes mellitus. These health problems are prioritised in that order because of their impact on the health status of the patient. Kidney failure has got a fatal result if not urgently managed this is because it leads to accumulation of several toxic waste as well as fluid in the body. Accumulation of nitrogenous waste and urea in the blood leads to uraemia, which is a fatal cause of confusion and coma in patients with kidney failure. In addition, the state of the patient confusion makes it difficult to treat the patient since the patient shall not cooperate during the treatment process. The patient may remove the gas mask or other intravenous medication that she is being given. Renal failure leads to accumulation of fluid in the body, which is as a result of inadequate excretion of fluid by the kidney. Accumulation of fluid in the body leads to adverse effect such as difficulty in breathing. When fluid accumulates on around the lungs and adnexa tissues, the lungs and the diaphragm may get compressed leading to shallow breathing and ultimately lead to exertion. Excess accumulation within the pleural cavity leads to excess difficulty in breathing and the patient shall require a gas mask or other assisted breathers otherwise the patient can die within a short time due to shortness of breath. Elevated blood pressure of the patient is another significant medical problem that must be taken into consideration. This is due to the effect that high blood pressure cause to the blood vessels specifically the capillaries. Hypertension damages the capillaries in the brain of an individual thus it may lead to stroke. Stroke impairs the functionality of an individual in several ways, for example, the patient shall have to depend on the significant others to meet other daily needs. Diabetes mellitus must be managed accordingly since it may worsen the condition further by damaging blood vessels that are necessary for transporting oxygen to various body tissues. Therefore, the blood glucose levels of the patient must regularly be monitored and maintained at normal levels (O’Connor & Kumar 2012). The health problem prioritised as the most urgent to manage the patient was renal failure and the following are the nursing diagnosis and the goal for each diagnosis: Diagnosis: excess fluid volume that is related to decreased urine output and retention of water. Goal: To maintain the ideal body weight of the patient without excess accumulation of body fluid The expected outcomes for this goal include; the patient demonstrates no rapid weight changes, demonstrates normal skin turgor without oedema, and reports no difficulty in breathing, exhibit no distension of the neck veins and decrease urge of thirst (O’Connor & Corcoran 2012). Diagnosis: activity intolerance that is related to fatigue and retention of waste products in the body Goal: The patient to participate in activity within tolerance. Some of the expected outcome with this goal include; patient participation in increasing levels of activity and exercise, the patient reports an increase in well-being, the patient can alternate rest and activity and she participate in some selected self-care activities. Interventions Goal: To maintain the ideal body weight of the patient without excess accumulation of body Assessment of the patient fluid status is the primary action that should be done while managing the patient. The rationale for fluid assessment is because; assessment provides a baseline data that should be used daily to monitor changes in the patient as well as evaluating the interventions that are provided. Fluid assessment shall involve; daily weight check, monitoring of input and output of fluids by charting them on the fluid chart, monitoring of skin turgor and the presence of oedema, monitoring of blood pressure and other vital signs. It is imperative to note that accumulated fluid in the body of the patient as well as electrolyte imbalance is the primary cause of the significant symptoms the patient is experiencing. Therefore, fluid assessment and close monitoring shall be of the essence during nursing management of the patient (Crawford & Lerma 2008). Another intervention to maintain the ideal body weight of the patient is the limitation of fluid intake to the prescribed volume and explaining to the patient as well as the family on the rationale for restriction. The fluid restriction shall be determined based on patient weight, urine output and the response to the therapy being administered. In addition, explanation to the patient and the family members of the reason fluid is restricted increases patient/family cooperation with the fluid restriction. A strict input and output chart shall be used to monitor the patient fluid intake and output on a daily basis (Schmid et al. 2010). Goal: The patient to participate in activity within tolerance One of the interventions for this goal is to assess those factors that contribute to fatigue such as retention of waste products, depression and accumulation of fluid or electrolyte imbalance. Identification of those factors that contribute to the patient not performing activity shall lead to the focus on alleviating those factors. In the case scenario, accumulated fluid is the primary cause of activity intolerance therefore; the patient shall be taken for dialysis. This shall enhance the patient ability to perform self-selected activities daily. Activity is one of the vital methods that improve healing and well-being of an individual since it improved blood circulation and oxygenation to various tissues of the body. The health care provider should promote independence in self-care activities that the patient can tolerate and is assisted if fatigued. This shall boost the self-esteem of the patient since she feels that the disease does not disable her. Some of the daily self-care activities that can be promoted include oral hygiene and dietary intake. These activities shall only be encouraged within the limits and adequate rest is allowed lest the patient collapse due to exertion (Brown & Johansson 2011). The four medical issues that the client might face after discharge shall include; developing of pericarditis or pericardial effusion, anaemia, hyperkalemia and bone disease. Usually, about 30%-50% of individuals with ESKD develop pericarditis due to uraemia and pericardial friction rub. Therefore, patients with ESKD needs close cardiac monitoring before and after discharge. A cardiac ultrasound shall be a vital tool in analysing the functionality of the heart and detect any fluid accumulation around the heart that may lead to reduced heart function. After discharge, the nurse shall organise a home visit a least twice in a week to monitor the patient. Moreover, the patient shall be given a return date of not more than fortnight to the nephrology for close monitoring. The family shall be engaged in monitoring the condition of the patient while at home and they are taught basic methods of identifying the cardiac malfunction. Such as hypotension, weak peripheral pulses, altered level of consciousness and bulging of the neck veins (Lingerfelt  L. & Thornton 2011). Development of bone disease and metastatic calcifications is another major problem the patient may face at home after discharge. Chronic renal failure causes several physiological changes that affect calcium, phosphorous as well as Vitamin D metabolism. It has been noted that hyperphosphatemia, hypocalcaemia and excessive accumulation of aluminum are most common in ESKD. For this reason, drugs such as phosphate binders, vitamin D supplements and calcium supplements should be administered to the patient when being discharged. Moreover, when the patient comes to the routine clinic check up serum lab test of calcium, aluminum and phosphorous levels should be checked. The patient should be advised to perform some little exercises or assisted to perform to minimize bone demineralization. Studies have shown that demineralization of bones increases with immobility (Seliger 2010). Electrolyte imbalances is a common phenomenon experienced by patients who he chronic renal failure and ESKD. The worst of the electrolyte imbalance is hyperkalemia since it is life threatening and can cause heart arrhythmias within a short period. During discharge, the electrolyte levels should be checked and an ECG performed to check on the heart function, tall T waves and widened QRS complex is a sign of high potassium level. After discharge, the patient should perform a weekly test of serum electrolytes and if the potassium is more than 5.5 mEq/L then a physician is notified immediately for review (Lingerfelt  L. & Thornton 2011). The patient may develop normocytic, normochromic anaemia because of the decrease or lack of erythropoietin home that is a significant factor in RBC differentiation in the bone marrow. Anaemia can increase the chances of morbidity and mortality when there is an existence of other cardiovascular conditions. Therefore, during discharge the patient should be given folic acid supplements and iron tablets to help in boosting RBC formation and production (Dalrymple et al. 2011). Conclusion End-stage kidney disease (ESKD) is a situation in which the kidneys permanently stop working for an individual to survive without routine dialysis or kidney transplant. The disease is usually caused by hypertension or diabetes mellitus. Kidney failure has got a fatal impact if not urgently managed this is because it leads to accumulation of several toxic waste as well as fluid in the body resulting into difficulty in breathing, confusion and activity intolerance. Management is usually symptomatic and then dialysis is done to remove the excess toxic waste and fluid from the body. The complication that is associated with ESKD are hyperkalemia, bone disease, anaemia and pericardial effusion. It is, therefore, imperative to manage and monitor the patient carefully while in the hospital and after discharge. List of reference Brown, E.A. & Johansson, L., 2011. Epidemiology and management of end-stage renal disease in the elderly. Nature Reviews Nephrology, 7, pp.591–598.  Crawford, P.W. & Lerma, E. V, 2008. Treatment options for end stage renal disease. Primary care, 35, pp.407–432, v. Dalrymple, L.S. et al., 2011. Chronic kidney disease and the risk of end-stage renal disease versus death. Journal of General Internal Medicine, 26, pp.379–385. Lingerfelt  L., K. & Thornton, K., 2011. An Educational Project for Patients On Hemodialysis to Promote Self-Management Behaviors of End Stage Renal Disease. Nephrology Nursing Journal, 38, pp.483–489. O’Connor, N.R. & Corcoran, A.M., 2012. End-stage renal disease: symptom management and advance care planning. American family physician, 85, pp.705–10. O’Connor, N.R. & Kumar, P., 2012. Conservative Management of End-Stage Renal Disease without Dialysis: A Systematic Review. Journal of Palliative Medicine, 15, pp.228–235. Schmid, H., Schiffl, H. & Lederer, S.R., 2010. Pharmacotherapy of end-stage renal disease. Expert opinion on pharmacotherapy, 11, pp.597–613. Seliger, S.L., 2010. Comorbidity and confounding in end-stage renal disease. Kidney international, 77, pp.83–85. Read More