Chronic Kidney Disease (CKD)
Chronic Kidney Disease (CKD) is a condition that causes the kidneys to gradually lose function over time. This is an essay about Ms. Jenna, who appeared four years ago with varied symptoms linked with CKD. Her condition was diagnosed using a variety of assessment instruments, and she was discovered to be in the fourth stage of the disease. Ms. Jenna is currently undergoing dialysis. Genetics, age, gender, low birth weight, family history, race, socio economic level, smoking, nephrotoxins, acute renal damage, diabetes mellitus, and hypertension are all risk factors for CKD. A care plan entailing person centred care is needed by Ms. Jenna to enable her to self-manage her condition, which requires identification of her current problem and coming up with measures, as well as involving her as an active participant in her healthcare and tailoring treatment to her wants and needs so as to realize optimal outcomes. Since she cannot manage her condition by herself, health care professionals, family and other patients are needed to help her be successful in the plan. The essay also has outlines measures that Ms. Jenna can take to prevent the condition from deteriorating.
Key words:
Chronic Kidney Disease (CKD), diagnosis, hyperaemia, hyperphosphaemia, hyperglycaemia, high urea, creatinine level, patient-centred care, healthcare, treatment, assessment tools.
Intermediate & Long Term Conditions (ILTC)
Overview of Chronic Kidney Disease
Chronic kidney disease (CKD) or chronic renal disease is a health condition that is featured by a slow loss of kidney function over a period of time. Ms. Jenna, who is 70 years old, has been diagnosed with Chronic Kidney disease for the last four years. The disease has damaged Ms. Jenna’s kidneys. Her kidney has gotten worse leading to the build up of wastes in her blood, which has made her be put on haemodialysis 1, 3, 5. Kidneys healthy function in cleaning the blood and in removing excess fluid as urine. Since Ms. Jenna has CKD, dangerous levels of fluids, electrolytes and fluids have accumulated in her body, thereby calling for haemodialysis to replace some of the kidney functions, because Ms. Jenna’s is not working properly.
Four years ago, Ms. Jenna went through investigation, and was diagnosed with CKD. The investigations included blood tests such as renal panel that showed hyperaemia, hyperphosphaemia, hyperglycaemia, hypocalcaemia, high urea and creatinine level, and decreased GFR. The full blood count showed that Jenna had anaemia; the albumin test indicated that she had hypoalbuminemia, and the arterial blood gas was indicative of metabolic acidosis. The chest x-ray showed that Jenna had fluid overload or pleural effusion. Urine test was important in showing the presence of creatinine, albumin and eGFR. The abdominal x-ray indicated that Jenna had ascites and smaller kidneys than normal, which are less than 9cm.
Various assessment tools were used due to their usefulness. Among the assessment tools that were used was physical assessment that indicated that Jenna had bilateral lower limb oedema, ascites, shortness of breath and crepitus over the lung’s base, uremic breath, and uremic pruritus. According to Baid, (Baid, 2006), physical assessment is an effective tool as it aids in the recognition of abnormality or in the identification of differential diagnosis, but depends on the skill of the nurse that does the physical assessment. The Glasgow Coma Scale (GCS) is another assessment tool used in Jenna’s case, which showed that Jenna is confused. The GCS is an effective tool that is used to assess the depth and duration of impaired consciousness and coma, and it is internationally accepted (Okamura, 2014).
Another assessment tool that was used in Jenna’s case is intake and output chart that indicated that she had low food intake as well as reduced urine output. This is an important assessment tool especially when monitoring short term fluid and especially in Jenna’s case, in which acute fluid balance changes are significant clinically (Wise et al., 2000). Taking of vital signs was also used as an effective assessment tool in Jenna’s case, which showed that she had RR of 30, blood pressure of 170/89, HR of 120 bpm and SpO2 of 92%.
The assessment using vital signs is very important as it measures the basic functioning of the body to determine if the values are within the normal range. Cleveland Clinic (Cleveland Clinic, 2014) notes that vital signs are usually measured to aid in the assessment of the general physical health of a patent as well as indicate recovery progress (Kyriacos et al., 2011). Through the use of integrated nursing record as a tool, I was found out that Jenna was experiencing insomnia, depression as well as financial and caregiver problems. Therefore, integrated nursing records are a major tool for communication and enhancement of quality that assures the delivery of safe and efficient care (Törnvall, & Wilhelmsson, 2008).
Presenting Symptoms Jenna Experiencing
Four years ago, Jenna had various symptoms like reduced urine output, bilateral lower limb swelling, appetite loss, nausea and vomiting, distension of the abdomen, fatigue and confusion. Currently Jenna is at the 4th stage of CKD. This means that Jenna has an advanced kidney damage that is characterized by a serious decrease in the glomerular filtration rate (GFR) of 15 to 29 ml/min (WebMD, 2017). Due to the decline in the function of the kidney, the waste products have built up in the blood to cause uraemia. Currently, Jenna missed one appointment for dialysis 2 days ago and was admitted for further assessment. The assessment revealed that Jenna is currently fatigued, has fluid retention or edema on the extremities and breath shortness, changes in her urination, problems in sleep as a result of muscle cramps, nausea and vomiting, loss of appetite, bad breath due to buildup of urea in the blood, appetite loss and concentration difficulties.
Risk Factors Associated With Chronic Kidney Disease
Early intervention is one strategy that can be used in reducing the burden of CKD, which requires identification of individuals with increased risk of the disease. According to Staples & Wong (Staples & Wong ,2010), identification of factors that predispose a person to CKD is significant in relation to community and personal health, because some risk factors can be modified to prevent or slow down the disease progression. The genetic and phenotypic makeup of person puts him or her at risk of CKD (Ritz et al., 2009). According to Köttgen et al. (2009) uromodulin mutations are linked with variations in renal function. Su et al. (2012) also reports that the contribution of renin-angiotensin system gene is significant to CKD.
The history of one’s family is another factor that predisposes an individual to CKD. Members of the family of a CKD patient have an increased prevalence of the disease. Song et al. (Song et al., 2009) advises that it is important to screen the high-risk members of a family that have CKD to try to prevent the disease. Gender is another CKD risk factor. Men have been shown to be more at risk than women (Iseki, 2005; Takamatsu et al., 2009). In the United States, several studies have been conducted, which have verified that there is an increased risk for the development of CKD in African Americans than in Caucasians, which means that ethnicity is a risk factor (Nzerue et al., 2002). In both males and females, the functioning of the kidneys decreases with age (Falodia & Singla, 2012).
Therefore, as an individual age, he or she becomes more prone to developing CKD, especially after different renal insults. According to Mackenzie, Lawler& Brenner (Mackenzie et al., 1996), low birth weight is another risk factor for CKD as they assert that restrictions in the intrauterine growth have a potential of causing low nephron number, and as a result predispose an individual to kidney disease. Similarly, Luyckx & Brenner (2010) show that there is a raise in the number of nephron by 257, 426 glomeruli in every kilogram increase in the weight of birth. Other researchers have shown that there are more CKD risk factors like obesity as shown by Chang & Kramer (2012), social economic status as indicated by Krop et al. (1999), smoking as portrayed by Bleyer et al. (2000), nephrotoxins, acute kidney injury and diabetes mellitus as noted by McClellan & Flanders (2003) and hypertension as illustrated by Klag et al. (1996).
Care Plan: Person Cantered Care
A care plan for Ms. Jenna is required that is person centred, and which encourages supported management. It is important that Ms. Jenna self manages her illness to assist slowing the progression of the disease. Person-centred care will entail involving Ms. Jenna as an active participant in her healthcare and tailoring treatment to her wants and needs so as to realize optimal outcomes (Genteis et al., 2003; WebMD, 2017). Ms. Jenna has an ineffective breathing pattern.
One of the goals in the management plan is to improve her breathing pattern. This goal will be further achieved through the administration of oxygen therapy where Ms. Jenna will received 4L/min through nasal prong, with 2 hourly monitoring by the nurses in ensuring that the saturation of oxygen is maintained within the normal limits.
Secondly, Ms. Jenna has spitting bilateral lower limb oedema and the main goal towards this problem is restrict the fluids. Since there will be discomforts in adhering to fluid restrictions, Ms. Jenna will need to be assisted to cope through explaining the rationale of the intervention and to involve her daughter to guarantee cooperation and compliance to the fluid restriction. There will be a need to empower and support Ms. Jenna and her family member, which includes her daughter to be active in her care, to integrate patient care in the entire journey of kidney care, and to improve Ms. Jenna’s access to kidney care.
Thirdly, Ms. Jenna has diabetes Mellitus, and the goal towards this problem is to assess the knowledge of Ms. Jenna and her daughter concerning diabetes mellitus, management, medication, insulin administration and the choice of diet. The rationale for choosing this intervention is that the assessment permits ensuring that the patient’s glucose in blood is kept within the normal limits and ensure that the patient is competent and knowledgeable in her skills.
Fourthly, Ms. Jenna has activity intolerance related to discomfort, fatigue and swelling of legs, and the main goal is ensure that she participates in activity within tolerance. The best thing is to assess factors that contribute to intolerance in activity to indicate those factors that contribute to fatigue severity. The patient will be assisted to plan and schedule her tasks so that she can prioritize those activities that have more importance and use energy on them.
Fifthly, Ms. Jenna has anxiety because she has little understanding concerning her condition and treatment. Therefore, to solve this problem, the goal is to assess the patient understanding about her condition, provide her and her family with information on her condition and treatment, and help her identify means of incorporating changes related to CKD and its treatment into her lifestyle (Smeltzer et al., 2010).
Ms. Jenna and her daughter will be empowered to make shared decisions with the healthcare team across the journey of kidney care. Her daughter will be involved to achieve patient-centred care because she is the main caregiver that provides more information about Ms. Jenna’s condition and history, especially on activities of daily living, disease knowledge and compliance to medication. The daughter stays with Ms. Jenna and is the main breadwinner. Both Ms. Jenna and her daughter will be engaged in the planning and evaluation of the services of kidney care. It will be important to engage Ms. Jenna in her CKD care.
Role of Health Care Professional in Supporting Self-Management
Self-management of CKD is complex and needs support from professionals in healthcare (Ormandy, 2008). It is worth noting that although person-centred care has been shown to be important, CKD patients are rarely consulted concerning their desires for self-management support. Patients do not usually self-manage alone. It is only when the patients and healthcare professionals work together when support needs can be knitted together on the basis of collaborative partnership (Havas et al., 2016). Different healthcare professionals play their roles in providing patients with instrumental, psychosocial support ad relational support. Dwarswaard, Bakker, van Staa, & Boeije (Dwarswaard et al., 2016) argue that relatives also give support to patients, especially psychosocial support. Some of the individuals that can provide input towards self-management of CKD by Ms. Jenna include family members and caregivers, nephrologists, and associations or organizations.
Outline of Measures Ms. Jenna Taking to Prevent Condition Deteriorating
Despite the fact that CKD is irreversible and progressive, there are measures that patients can take to slow down the progression so that they can live longer with no complications or the requirement for kidney transplant. According to Thomas (Thomas, 2005), the nephrology teams need to collaborate with primary care teams in an effort to delay the progression of CKD. In Ms. Jenna’s case, her family, especially her daughter, who is the primary care giver, needs to collaborate with healthcare professionals to improve the outcome. In addition, Ms. Jenna can focus on nutritional interventions, life style interventions and monitoring for the associated complications and comorbidities. Nutritional therapy delays progression of CKD ad also prevents and treats complications. Ms. Jenna should participate in behaviours that promote health like participating in physical activities and avoiding smoking (Tomson, & Cairns, 2003). Ms. Jenna should routinely monitor her blood pressure because if left uncontrolled it can speed up the loss of GFR. Moreover, she should give up smoking or taking caffeine 30 minutes before testing.
Conclusion
To conclude, individuals with CKD need to make daily decisions concerning self- managing their condition. They need to self-manage their disease to help with slowing the progression of the illness. However, they cannot be effective on their own because self-management of a chronic disease is a complex task, which is why they need to collaborate with professionals. Although the importance of person-centred care has been established, people like Ms Jenna, who have chronic kidney disease, are seldom consulted concerning their desires for self-management support from the professionals for collaborative care and self-management education. In addition to information concerning the disease and its therapies, daily strategies must be prioritized in the education that is given to the patients. Since different groups of patients vary in their general enthusiasm for learning more concerning effective self-management, Ms Jenna, who is confused about her condition, needs person-centred care as well as engagement in the renal world. Central to her plan that entails person-centred care is self -efficacy that brings about confidence to carry out a necessary behaviour for her to reach her goals. Therefore, it is worth noting that varying extents of engagement and eagerness to learn more regarding self-management of conditions like chronic kidney disease focus on the requirement for person centred plan to self-management support.
References
Baid, H. (2006). The process of conducting a physical assessment: a nursing perspective. (British Journal of Nursing), 15(13), 710-714. Retrieved on September 23, 2013 from http://www.magonlinelibrary.com/doi/abs/10.12968/bjon.2006.15.13.21482
Bleyer, A.J., Shemanski, L.R., Burke, G.L., Hansen, K.J., & Appel, R.G. (2000). Tobacco, hypertension, and vascular disease : Risk factors for renal functional decline in an older population. (Kidney International), 57(5), 2072-2079.
Chang, A., & Kramer, H. (2012). CKD progression : A risky business. (Nephrology Dialysis Transplantation), 27(7), 2607-2609. Retrieved on May 03, 2012 from https://academic.oup.com/ndt/article-lookup/doi/10.1093/ndt/gfs095
Cleveland Clinic. (2014). Vital Signs. Retrieved on May 31, 2017, from https://my.clevelandclinic.org/health/articles/vital-signs
Dwarswaard, J., Bakker, E. J., van Staa, A., & Boeije, H. R. (2016). Self‐management support from the perspective of patients with a chronic condition : A thematic synthesis of qualitative studies. (Health Expectations : An International Journal of Public Participation in Health Care and Health Policy), 19(2), 194-208.
Falodia, J., & Singla, M.K. (2012). CKD epidemiology and risk factors. (Clinical Queries : Nephrology), 1(4), 249-252.
Genteis, M., Edgman-Levitan, S., Dalay, J., & Delbanco, T.L. (2003). Through the patient’s eyes : Understanding and promoting patient-cantered care. (Journal for Healthcare Quality), 25(3), 47.
Havas, K., Bonner, A., & Douglas, C. (2016). Self‐management support for people with chronic kidney disease : Patient perspectives. (Journal of Renal Care), 42(1), 7-14. Retrieved on September 24, 2015 from http://onlinelibrary.wiley.com/doi/10.1111/jorc.12140/abstract?userIsAuthenticated=false&deniedAccessCustomisedMessage=
Iseki, K. (2005). Factors influencing the development of end-stage renal disease. (Clinical and Experimental Nephrology), 9(1), 5-14. Retrieved on February 05, 2005 from
Klag, M.J., Whelton, P.K., Randall, B.L., Neaton, J.D., Brancati, F.L., Ford, C.E., & Stamler, J. (1996). Blood pressure and end-stage renal disease in men. (The New England Journal of Medicine), 334(1), 13-18. Retrieved on January 04, 1996 from http://www.nejm.org/doi/full/10.1056/NEJM199601043340103
Köttgen, A., Glazer, N.L., Dehghan, A., Hwang, S.J., Katz, R., Li, M., & Smith, A.V. (2009). Multiple loci associated with indices of renal function and chronic kidney disease. (Nature Genetics), 41(6), 712-717. Retrieved on May 10, 2009 from https://www.nature.com/ng/journal/v41/n6/full/ng.377.html
Krop, J.S., Coresh, J., Chambless, L.E., Shahar, E., Watson, R.L., Szklo, M., & Brancati, F.L. (1999). A community-based study of explanatory factors for the excess risk for early renal function decline in blacks vs whites with diabetes : The atherosclerosis risk in communities study. (Archives of Internal Medicine), 159(15), 1777-1783. Retrieved on September 09, 1999 from http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1105637
Kyriacos, U., Jelsma, J., & Jordon, S. (2011). Monitoring vital signs using early warning scoring systems : A review of the literature. (Journal of Nursing Management), 19(3), 311-330. Retrieved on April 20, 2011 from http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2834.2011.01246.x/abstract
Luyckx, V.A., & Brenner, B.M. (2010). The clinical importance of nephron mass. (Journal of the American Society of Nephrology), 21(6), 898-910. Retrieved on June, 2010 from http://jasn.asnjournals.org/content/21/6/898
Mackenzie, H.S., Lawler, E.V., & Brenner, B.M. (1996). Congenital oligonephropathy : The fetal flaw in essential hypertension?. (Kidney International Supplement), 55, 30-34.
McClellan, W.M., & Flanders, W.D. (2003). Risk factors for progressive chronic kidney disease. (Journal of the American Society of Nephrology), 14(2), 65-70.
Nzerue, C.M., Demissochew, H., & Tucker, J.K. (2002). Race and kidney disease : Role of social and environmental factors. (Journal of the National Medical Association), 94(8), 28-38.
Okamura, K. (2014). Glasgow Coma Scale flow chart: A beginner’s guide. (British Journal of Nursing), 23(20), 1068-1073. Retrieved on November 10, 2014 from http://www.magonlinelibrary.com/doi/abs/10.12968/bjon.2014.23.20.1068.
Ormandy, P. (2008). Information topics important to chronic kidney disease patients: a systematic review. (Journal of Renal Care), 34(1), 19-27.
Ritz, E., Fliser, D., & Adamczak, M. (2009). Risk factors for progression of chronic kidney disease. (Evidence-Based Nephrology), 29-42.
Smeltzer, S., Bare, B., Hinkle, J., & Cheever, K.H. (2010). Brunner & Suddarth’s textbook of medical-surgical nursing (12th ed.). Philadelphia : Wolters Kluwer Health / Lippincott
Song, E.Y., McClellan, W.M., McClellan, A., Gadi, R., Hadley, A.C., Krisher, J., & Freedman, B.I. (2009). Effect of community characteristics on familial clustering of end-stage renal disease. (American Journal of Nephrology), 30(6), 499-504.
Staples, A., & Wong, C. (2009). Risk factors for progression of chronic kidney disease. (Current Opinions in Paediatrics), 22(2), 161-169. Retrieved on April, 2010 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2948868/
Su, S.L., Lu, K.C., Lin, Y.F., Hsu, Y J., Lee, P.Y., Yang, H.Y., & Kao, S.Y. (2012). Gene polymorphisms of angiotensin-converting enzyme and angiotensin II type 1 receptor among chronic kidney disease patients in a Chinese population. (Journal of Renin-Angiotensin-Aldosterone System), 13(1), 148-154. Retrieved on December 06, 2011 from http://journals.sagepub.com/doi/abs/10.1177/1470320311430989
Takamatsu, N., Abe, H., Tominaga, T., Nakahara, K., Ito, Y., Okumoto, Y., & Doi, T. (2009). Risk factors for chronic kidney disease in Japan: a community-based study. (BMC Nephrology), 10(1), 34. Retrieved on October 27, 2009 from https://bmcnephrol.biomedcentral.com/articles/10.1186/1471-2369-10-34
Thomas, N. (2005). Can we delay the progression of chronic kidney disease (CKD) by improving collaboration between renal units and primary care teams?. (EDTNA-ERCA Journal), 31(4), 178-181.
Thomson, C.R., & Cairns, H.S. (2003). Management of mild to moderate chronic renal failure. (Clinical medicine), 3(6), 499-503.
Törnvall, E., & Wilhelmsson, S. (2008). Nursing documentation for communicating and evaluating care. (Journal of Clinical Nursing), 17(16), 2116-2124. Retrieved on August, 2008 from http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2702.2007.02149.x/abstract
WebMD. (2017). Chronic kidney disease-exams and tests. Retrieved on May 31, 2017, from http://www.webmd.com/a-to-z-guides/tc/chronic-kidney-disease-exams-and-tests#1
Wise, L.C., Mersch, J., Racioppi, J., Crosier, J., & C,T. (2000). Evaluating the reliability and utility of cumulative intake and output. (Journal of Nursing Care Quality), 14(3), 37-42.
