Exploring Chronic Kidney Disease - Research Paper Example

Chronic Kidney Disease Introduction Kidneys are important organs in the body, which help in various body functions. Normal kidneys produce hormones which help in regulating body functions like blood pressure, red blood cells production, and calcium uptake. They also help the body excrete poisonous waste products like urea and creatinine resulting from protein breakdown in the body. They filter these wastes and excess fluid in the blood, which are then excreted through urine. Chronic Kidney Disease is the gradual loss of kidney function. When kidney failure reaches an advanced stage, there might be accumulation of wastes and electrolytes and dangerous fluid levels in the body. Chronic Kidney Disease becomes evident after kidney function is extensively impaired. Identification of disease process helps people to understand its cause, modes of treatment and outcomes from treatment or failure to treat. The purpose of this paper is to discuss the disease process, major treatment strategies and their impact to the disease process, and give a Nursing Evidence-Based Practice. It will also present a case study on the disease, and present a Nursing Care Plan for the disease. Disease Process Etiology/cause Chronic Kidney Disease is a problem that occurs when a kidney function is impaired by a disease, causing damage to it. Impairment on the kidney results from some of the organs attached or related to the kidney having been affected due to other infections. Examples of the diseases commonly associated with causing kidney failure include diabetes, high blood pressure, urinary tract obstruction, and recurrent kidney infections, among others. Risk factors According to Medical News Today (MNT), there are a number of factors that contribute to developing chronic kidney disease, which include; a family history of the disease, age; this disease mostly affects people over 60 years, urinary tract obstruction, kidney diseases at birth, high blood pressure, sickle cell disease and medication, among others (Nordqvist, 2013). Pathophysiologic changes Chronic Kidney disease affects the normal functioning of the body. According to National Kidney Foundation (NKF), the kidney is responsible for production of hormones called erythropoietin (EPO), which signals the body to make red blood cells (NKF, 2008). When one has kidney disease, the body may not be able to make EPO and this leads to reduced red blood cells which may lead to anemia. Since a combination or a group of cells of the same kind and which perform similar function makes a tissue, the effect of chronic kidney disease on cells affects formation of tissues. An arrangement of tissues of different types forms an organ. Chronic Kidney Disease affects production of red blood cells, a situation that leads to lose of blood. All organs in the body require blood for their operation. For example, the circulatory organ supplies blood from the heart to all parts of the body and lack of blood due to kidney failure may lead to total failure of body organs and lead to death. Clinical symptoms and complications Clinical manifestation on kidney failure shows that between stages 1 to 3 where glomerular filtration rate (GMF) is greater than 30 mL/min/1.73m2, patients with chronic kidney disease do not show symptoms of the disease (Arora, 2013). When clinically tested for loss of GMF, they do not show water or electrolyte imbalance or metabolic disturbance symptoms. These symptoms turn clinically manifest with chronic kidney disease at stage four to five where the GFR is less than 30 mL/min/1.73m2. However, people with other conditions associated with positive symptoms of the disease turn vulnerable at earlier stages. Clinical manifestation in patients with the disease shows them to accumulate multiple toxins with unknown identity and spectrum. At the fifth stage also problems in metabolism show malnutrition of protein energy, muscle weakness and lean body mass loss. There are also changes in water and salt handling by the kidney, which cause peripheral edema and high blood pressure (Arora, 2013). Other clinical manifestations include pericarditis, encephalopathy, peripheral neuropathy, and gastrointestinal symptoms, among others. Complications with their underlying pathophysiology The possible complications of chronic kidney disease are anemia, which is a result of low hemoglobin levels. This limits the amount of oxygen that reaches many parts of the body (Nordqvist, 2013). The disease can also affect the central nervous system, which controls all body organs. Fluid retention can also result from the disease leading to swollen tissue, fluid build-up in the lungs and heart failure (Nordqvist, 2013). Other complications include rise in potassium levels, which can damage the heart, male erectile dysfunction, weak bones, and weak immune system. All these complications affect the general functioning of the whole body. Treatment Strategies Kidney failure treatment strategies aim at achieving two goals. The first strategy aims at treating the cause of the disease to prevent progressing to the end-stage renal disease (ESRD), while the second intends to treat the end-stage renal disease. i. Treating the cause This strategy involves slowing or controlling the disease or condition causing kidney failure. This treatment includes; a. High blood pressure medications. People infected with kidney failure are prone to experiencing worse high blood pressure. The doctor suggests medications aimed at lowering the blood pressure and to prevent the kidney (MFMER, 2012). However, medication on high blood pressure may decrease kidney function at initial stages thus; regular check is important. b. Controlling Protein nutrition Minimizing protein diet consequently minimizes waste products in the blood. Creation of waste products in the body takes place as the body processes protein from foods of which it is the kidney’s work of filtering them. Reducing protein intake reduces the work that the kidney has to do. c. Anemia treatment Hemoglobin in red blood cells is responsible for oxygen transportation around the body. Blood transfusion is important to kidney patients with anemia. Hospitals inject blood through veins. Patients with kidney disease take iron supplements, as the body requires them for red blood cells production. The above treatment processes aim at limiting the causes of chronic kidney failure because any disorder in the body organs affects the normal functioning of the body. ii. End-stage kidney disease treatment This treatment happens for kidneys whose functioning is less than 10 to 15 percent the normal capacity. Its intention is to increase or boost the current kidney function so that the patient lives a bit longer however, the practice can be dangerous. The kidney of a patient at end-stage cannot keep up with waste and fluid elimination thus; it calls for dialysis or kidney transplant (Nordqvist, 2013). 1. Kidney Dialysis This involves removing excessive fluids and waste products from the blood when the kidney cannot do it anymore. There are two types of kidney dialysis. a. Hemodialysis This is where doctors pump blood from the patient’s body and passes through an artificial kidney, which filters the wastes out. The blood is then pumped back to the patient’s body. The process takes place about three times a week with each session lasting for at least three hours (MNT, 2013). A regular practice on hemodialysis shows an improvement on the life of the patient. This process helps boost the normal functions of the patient’s body. b. Peritoneal dialysis This is where blood is filtered into the patient’s own abdomen in the peritoneal cavity, which has a wide tiny blood vessels network. A catheter is implanted into the abdomen and a dialysis solution infused and drained as necessary to remove wastes and excess fluid. It is divided into two; continuous ambulatory peritoneal dialysis where the patient does the infusion on their own, and continuous cycling peritoneal dialysis where a cycler machine does the infusion and draining of the fluid when the patient is asleep (Nordqvist, 2013). 2. Kidney transplant This is the treatment given to patients who cannot escape kidney failure. It is better compared to dialysis however, it has conditions. The donor and recipient’s blood type, antibodies and cell surface proteins must be the same to reduce rejection risk of the new kidney. Successful kidney transplant gives resumption to normal body functions. Nursing Evidence-Based Practice Recommendations The following are recommendations according to Agency for Healthcare Research and Quality (AHRQ). i. Chronic Kidney Disease Medical Nutrition Therapy (MNT) Individuals with chronic kidney disease from stage 1 to 5 should receive MNT from a registered dietitian. MNT helps in prevention and treatment of malnutrition on protein energy and disorders in mineral and electrolyte. It also minimizes the impact of diabetes, hypertension and obesity on progression of the kidney disease (AHRQ, 2010). ii. Assessment of Food/Nutrition-Related History Assessment should be done on food and nutrient intake, medication on dietary supplements, factors that affect access to food and nutrition supplies and beliefs, knowledge or attitude on foods. This helps to effectively determine nutrition diagnoses and plan for interventions. iii. Body weight check (anthropometric assessment) Body weight helps in calculating nutritional needs such as energy and protein requirement in people with chronic kidney failure. It helps manage the progress on the patient by comparing weight changes. iv. Assessment on biochemical disorders These are issues related to glycemic control, protein-energy malnutrition, kidney function, mineral and bone disorders, anemia, electrolyte disorders among others. Assessment helps in determining nutrition diagnosis and prescription to patients with chronic kidney disease. Case Study This case study presents a 34-year-old African American who developed ESRD in 1992 resulting from idiopathic focal glomerulosclerosis (Agarwal, 2005). After assessment, doctors suggested that he receives a renal transplant, which took place in 1993, but later failed in 1997. After diagnostic evaluation, doctors found that there was combination of chronic transplant glomerulopathy and recurrence of focal glomerulosclerosis. The treatment the patient received was continuous ambulatory dialysis for 6 to 7 years until he developed intermittent peritonitis in 2003 leading to removal of his catheter. Clinical progression Doctors initiated a hemodialysis with tunneled hemodialysis catheter creating an arteriovenous fistula and the ongoing care on the man’s life is hemodialysis thrice per week and the clinical progression shows that the patient complies with his hemodialysis schedule. Complications The man is healthy personal trainer, has no family history of kidney failure neither does he smoke. However, physical examination shows that he has low blood pressure (Agarwal, 2005). The patient has normal and stable serum sodium, calcium and potassium levels. There is no metabolic disturbance and has normal creatinine level except his parathyroid hormone levels, which are slightly elevated but receives vitamin D as required. The patient has recognized the incompatible donor transplantation, and resolved to have a transplant where one of his colleagues wills to donate the kidney to him and the patient now receives evaluation for this transplant. Nursing Care Plan This nursing care plan aims at establishing the cause of chronic kidney disease, symptoms, and interventions to take care of the patient. Chronic kidney failure results from three problems namely; Prerenal, post renal and renal ( Hafiyudin, 2013). Prerenal affects the flow of blood before reaching the kidneys. Postrenal affects movement of urine out of the kidneys, while renal refers to kidney problems that inhibit proper filtration of blood or urine production. 1. Care plan for excess Fluid volume related to limited urine output and withholding of sodium and water. Goals and expected outcomes Planning Nursing interventions Evaluation The goal: maintain patient’s ideal weight without excess fluid Expected outcomes: no rapid weight changes Maintenance of fluid and dietary restrictions Ensure access to status of body fluid Limiting fluid intake to certain volumes Identify fluid potential sources Explain the need for restriction to the patient Daily weight check Monitor intake and output Assess fluid used for medication Assist the patient to cope with disease Assess blood pressure Patient shows normal urine output Maintained ideal body weight Blood pressure decreased Interventions made on the patient show maintenance of ideal body weight. 2. Nursing care plan for altered nutrition, less than body requirement related to nausea, vomiting, anorexia and dietary restrictions Goals and expected outcomes Planning Nursing interventions Evaluation Goal: to maintain adequate nutritional intake. Expected outcome: intake of high biologic value proteins and high energy foods, but within dietary limits. Take medication that causes no nausea or anorexia Limited weight changes Nutritional status assessment for base line data Nutritional intake contributory factors identification Assessment of patient’s nutritional dietary pattern for proper meals planning Assessment of weight changes Consultation with lab for protein, iron and creatinine values Provision of patient’s preferred food Assessment of patient’s understanding of restrictions of diet Encourage low biologic value intake of proteins Improved nutrition status Maintained body weight Maintained lab values for protein, iron and creatinine Normal blood pressure The nursing care plan above shows improved health and maintained nutritional intake for patients with chronic kidney disease when the nursing interventions are implemented. 3. Nursing care risk of infection that have relation to immune system alterations and host defenses Goals and expected outcomes Planning Nursing interventions Evaluation Goal: reducing risk of infection Assessment of infections history Assessment of previous reactions of medication Remove bladder catheter the soonest Use intensive pulmonary hygiene Monitor all signs of infections Administer antibiotics, but take care of dosage for renal impairment Reduced chances of infection Maintained health of patient Conclusion Chronic Kidney Disease is very rampant in the society. There are many risks associated with Chronic Kidney disease, which include permanent impairment of the kidney, and can lead to death if not properly administered. The mortality risk from cardiovascular events is high for young and old patients with end-stage renal disease (Agarwal, 2005). However, interventions discussed above can help improve and prolong life span of patients with the disease. The work has shown the disease process, which shows the cause, risk factors and clinical complications of the disease. It also shows practices, which can help, fight this disease with a case study showing their application, and concludes with a nursing care plan, which can be used to take care of patients. References Agarwal, A. (2005). A 34-year-old man with end-stage renal disease. Retrieved on October 4, 2013, from http://www.jhasim.com/files/articlefiles/pdf/W-ASIM_Issue_5_6EpCase.pdf AHRQ. (2010). Chronic kidney disease evidence-based nutrition practice guideline. Retrieved on October 4, 2013, from http://www.guideline.gov/content.aspx?id=23924&search=Transplant+of+kidney+ Arora, P. (2013). Mediscape: Chronic Kidney Disease Clinical Presentation. Retrieved on October 4, 2013, from http://emedicine.medscape.com/article/238798-clinical#a0216 Hafiyudin, I. (2013). NANDA Nursing. Retrieved on October 4, 2013, from http://nanda-nursing.blogspot.com/2011/01/nursing-care-plan-acute-renal-failure.html MFMER. (2012). Chronic Kidney failure. Retrieved on October 4, 2013, from http://www.mayoclinic.com/health/kidney-failure/DS00682/DSECTION=causes NKF. (2008). Iron and Chronic Kidney Disease. Retrieved on October 4, 2013, from http://www.kidney.org/atoz/pdf/11-10-0284_PatBro_IronDeficiency.pdf Nordqvist, C. (2013). MNT: What Is Chronic Kidney Failure? What Causes Chronic Kidney Disease? Retrieved on October 3, 2013, from http://www.medicalnewstoday.com/articles/172179.php Read More