Diagnosis of Chronic Kidney Disease - Assignment Example

Chronic Kidney Disease: Case study Glenda 27 April Chronic Kidney Disease: Case study Glenda The kidneys of human beings are normally located around the abdomen, below the rib cage; their main function is the removal of unwanted waste products from the body. Chronic kidney disease is a condition where there is a permanent loss in functions of the kidney, which can be caused by diabetes, high blood pressure, glomerulonephritis, anemia, and nephrotic syndrome amongst others. Glenda is a 42-year-old Aboriginal woman who has been diagnosed with chronic kidney disease, in this discussion we are going to assess factors that lead to this disease, how to treat chronic kidney disease and some of the preventive measure that can be applied to control it. Posting 1: Diagnosis of Chronic Kidney Disease Glenda’s diagnosis of chronic kidney disease culminated to results that showed why she manifested several signs such anorexia, nausea, confusion, itchy face, and tiredness. The tests that were done and their analysis were as follows: The purpose of the test for Serum creatinine was to determine the level of creatinine in her blood stream. Generally, creatinine is one of the waste products that are normally passed through the kidney; when the kidney fails to remove creatinine, it remains in the blood. Secondly, the purpose of GFR- Glomerular Filtration Rates is to determine how much an individual’s kidney functions. Thirdly, the purpose of micro albumin test is to detect the availability of a protein known as albumin in the urine, which is normally a sign of damage to the kidney; damage to the tiny blood vessels in the kidney normally allows the albumin to leak and pass out through the urine. The Blood Urea Nitrogen test is used in most cases for detection of increased waste levels in the blood stream, which will automatically show that the kidney is not working properly, hence further causing the patient to feel tired (Walser & Thorpe, 2004). The Creatinine Clearance (CCr) test intends to measure the amount of creatinine in the urine and blood and calculate how best the patient’s kidney is getting rid of waste products. Hemoglobin is tested to discover the amount of hemoglobin and red blood cells in the urine, as well as to investigate anemia. In this case, the presence of renal diseases is characterizes by few red blood cells responsible for the manufacture of blood. Hematocrit (Hct) test is also done to determine the percentage of red blood cells in the blood. When the test indicates a lower Hct, it will imply that the body is not manufacturing enough red blood cells responsible for carrying oxygen throughout the patient’s body; lack of this makes an individual to feel tired. Moreover, urea reduction ratio is used to indicate the level of urea removed from the body during the dialysis session (Walser & Thorpe, 2004). Gly-cosylated Hemoglobin test Alc used for the purpose of determining the blood glucose level is normally done at a two to three month period, and people with diabetes are normally encouraged to undergo this particular test. Further investigations and nursing assessments required to be added on the findings include the age of the patient, Glenda’s age, her social behaviors (for example, if she gets involved in alcoholic drinking), and her general health conditions which will determine if she has to be put on dialysis or get a kidney transplant. Other investigations involve enquiry of whether she suffers from kidney problem enhancing diseases such as anemia, high blood pressure, and diabetes amongst others (Walser & Thorpe 2004). Posting 2: Contributing Factors for Glenda’s Chronic Kidney Failure Glenda’s chronic kidney failure can be attributed to several factors that can be categorized into two groups, modifiable and non-modifiable factors. The modifiable factors include behavioral factors such as smoking, physical inactivity, poor nutrition, and biomedical factors such as high blood pressure, obesity, diabetes, cardiovascular disease, and systemic kidney inflammation (Chadban & Atkins 2005). The non-modifiable factors, which are also referred to as fixed factors include age, sex, ethnicity, family history, genetics, low birth weight, and previous kidney disease or injuries. The progression of chronic kidney disease can be slowed by controlling these modifiable factors and through the improvement of treatment and management of the disease (Chadban & Atkins 2005). Chronic kidney disease stages are usually categorized basing on the measured glomerular filtration rate-GFR, and they are five in number. It is reported that in the first stage, the kidney’s functions are normal with GFR level of 90 and above, but they decline minimally in stage 2 as it proceeds (Levey et al., 2002). In stage 2, the GFR is between 60 and 89, and there is a small reduction in the functioning of the kidney, which also points to a kidney disease. The Medicare and treatment for this stage may include observation and control of blood pressure and other risk factors. In stage 3, the GFR level is between 45 and 59, and 30 and44; this is characterized by a moderately reduced kidney function; the same will be applied as for stages 1 and 2 in health promotion/observation and control of blood pressure and the underlying risk factors. In stage 4, the GFR level is 15-29, with a severely reduced kidney function; the health promotion regarding this stage is just the same as stages 1, 2, and 3, as the patient plans for the end stage, which is renal failure. In stage 5, the GFR level is 15, and depending on the dialysis, it is characterized by very severe kidney failure (Levey et al., 2002). Incidence/prevalence and main causes of Chronic Renal Failure in Australia There has been a change in the incidence rate of Australians treated of CKD, with observation indicating an increase in patients with age groups of over 65 years, due to increased cases of diabetes, blood pressure, amongst other factors (Australian Bureau of Statistics, 2002). Prevalence estimates in Australia have shown that the number of new cases of patients starting treatment for chronic kidney disease has increased from 1751 in the year 2000 to 2,311 in 2007. This statistics have shown that males are more susceptible to this health problem than females (Australian Bureau of Statistics, 2002). The main cause of chronic renal failure in Australia include:- Diabetes and diabetic nephropathy - High blood sugar levels in most cases damage the blood filtering capillaries in the kidneys; and Glomerulonephritis, which involves damaging and inflating Glomeruli units of the kidney, consequently affects their ability to perform their functions. High blood pressure damages the blood vessels responsible for supplying blood to the kidneys, which subsequently reduces the functionality of the kidney (Chadban & Atkins 2005). Posting 3: Treatment Options For End Stage Renal Failure End stage renal failure occurs when the kidney has completely stopped working and the only treatment necessary for this condition is either an introduction to dialysis or transplant. These treatments are meant to replace/help the functionality of the kidney. Dialysis can be described as the artificial process used to eliminate waste and unwanted water from human body. There are two main types of dialysis including haemodialysis and peritoneal dialysis. The haemodialysis method uses a machine to filter waste products from the blood through an inserted catheter from the vein to the machine. The peritoneal dialysis uses the lining of the abdomen as a filter of waste products from the body; here, a sterile solution rich in minerals and glucose is introduced into the blood of the patient where it absorbs waste products, which are eventually drained out through a tube and discarded. Despite peritoneal dialysis not being as sufficient as haemodialysis, it is normally applied for longer periods, but the amount of waste removal is almost the same as haemodialysis (Mason, K., & Laurie, 2010). Kidney transplant is another treatment method whereby, a healthy kidney from a donor is placed into the body of a kidney failure patient. The newly introduced kidney replaces the function of the former kidney. Before a transplant, there is a medical evaluation that includes blood tests, x-rays to be taken, health standards before the surgery procedure, and tests on a matching donor. Both transplant and dialysis require a medical practitioner for them to evaluate and administer. In addition, they are costly, as the patient will need to pay a substantial amount for both procedures to take place. Moreover, they are both aimed at renewing the functionality of kidneys in the patient’s body. They differ to some extend in that; dialysis does not require surgery, as it would be the case for kidney transplant. In addition, for the kidney transplant one can wait for a long time just to get a donor who can match the type of kidney the patient needs (Gokal, 2000). In the case of Glenda, dialysis would help her significantly, as it would help her to remove toxins and wastes from her blood system. She will be required to get prepared for dialysis in the case for haemodialysis, which takes considerably 3 to 4 hours a week. Peritoneal dialysis can also be applied to her at home if she opts for that; here, she does not have to frequent the hospital all the time. However, the only procedure she will need to undergo is a small surgical operation to insert a catheter into the abdomen. For a kidney transplant, Glenda will need to undergo medical evaluation to test her blood, take x-rays, and check the health condition for her viability for surgery while looking for a matching donor. Unfortunately, both procedures are based on financial ability of a patient, and this will need Glenda to prepare herself financially (Gokal, 2000). Implied Consent and Compliance and How They Relate to Glenda’s Case Implied consent is a legal term that is defined as an agreement to assent to a clinical procedure by a patient inferred from signs, actions, or facts; it is also inferred by inaction or silence. It normally occurs when the patient behaves in a particular way that characterizes he/she understands and further complies with the suggestions of the practitioner. The case of implied consent might also be applied in circumstances where the patient is unconscious and admitted in an emergency room. The practitioner would assume that the patient is in dire need of a specialized treatment to save his life. In case of an eventual legal challenge, the health practitioner would argue that, due to offer an emergency care for the patient, the decision was arrived upon in good faith (Mason & Laurie, 2010). Compliance consent is a permission a person gives before he or she receives any treatment. It is required from the patient with less regard to the form of treatment however minor it is, either a simple blood test or a complex organ transplant or donation. This principle is a sensitive and important legislation of medical ethics and international human rights. For it to be valid, compliance consent is required to be voluntary without pressure from medical staff or family. The patient must also be in a capacity to give the consent; thus, he/she must understand what the practitioners are advising him/her and have the capability to make a sound decision (Mason & Laurie, 2010). These two types of consents, the compliance and implied, can be applied to Glenda’s case in several ways. She may need an explanation to the implication of using either dialysis method or applying the use of transplant to solve her problem. The benefits of each method and their disadvantages would be better availed to her, allowing her the freedom to choose the one among the two she feels suits her better according to her financial situation at that particular moment. Through legal considerations, all patients, for instance Glenda, have the right to agree or refuse renal treatment. The physicians also have legal obligation to respect and acknowledge the decision that a patient makes. The ethical considerations will be such as the advice and consultation of the renal disease physicians who advised Glenda to withdraw from the treatment, as it stopped being beneficial to her health. Being from Aboriginal ethnicity, Glenda’s religious grounds can influence her to withdraw from the treatment. Financial issues that may cripple her ability to proceed with the treatment might make her see it as a burden to herself, hence the ethical reason to subsequently withdraw (Denise O’ Shaughnessy, 2008). Posting 4: Educational and Clinical Strategies for Glenda to Prevent and Manage Side Effects of Peritoneal Dialysis Peritoneal dialysis is a form of dialysis that is used to remove waste products and excess water from a patient’s body. It works on the same principle as hemodialysis, only that the patient’s blood is cleaned while still inside the body rather than in a machine as for the case of hemodialysis. In peritoneal dialysis, the patient is provided with fluids in the peritoneal cavity, which cleans the blood constantly. This fluid is changed at intervals throughout the day. This form of dialysis has several side effects such as the bacterial infection of the peritoneum, which normally results from lack of cleanliness and sterilization of the dialysis equipment. The germs that might exist on the equipment end up bringing up bacteria, which are further passed on to the peritoneum (Gokal, 2000). The symptoms of peritonitis include lack of appetite, nausea, and abdominal pain. The mode of treating peritonitis is through injections of antibiotics directly into the tissue of the affected peritoneum. Cleanliness is the best way of preventing and further controlling this side effect; if it persists, then a change of dialysis method would be a best alternative (Gokal, 2000). Hernia is another side effect of this type of dialysis. The idea of holding fluid inside the peritoneal cavity for a long period ends up straining the abdominal muscles. The first symptom that manifests itself is the appearance of a lump in the abdominal area. Despite of the lump not being painful, some postures and activities such as bending over, leaning, and coughing make this side effect very painful for the patient to withstand. The only way to treat this hernia is through undergoing surgery, where the protruding intestine and the tissues are pushed back into the abdominal wall. The abdominal muscle wall is also reinforced through the application of a synthetic mesh. Bloating and weight gain is another observed side effect of this kind of dialysis (Gokal, 2000). This fluid used for dialysis, in this case dialysate fluid, contains sugar molecules that may enhance chances for overweight and obesity. The treatment for this can be recommendation of diet and physical exercise routine that can assist in weight loss. In connection to this, extreme dieting should be avoided because it can further interfere with indoctriunal activity of the body, making the patient feel very weak and ill (Gokal, 2000). Malnutrition is also another side effect that affects some patients who use this method. Some patients lose appetite due to full stomach caused by the dialysis solution; this affects their eating habits and this reduction usually leads to malnutrition. This condition of eating less food leads to deficiency of important diet like proteins, vitamins and other nutritional foods in the body (Gokal, 2000). In conclusion, chronic kidney failure is a non-treatable disease, which medical practitioners have tried to create ways of enabling patients to live with it. Such measures include dialysis, kidney transplant, and other forms of mediations. Prevention of the disease should be put as the first priority to reduce its prevalence in Australia. Nevertheless, diseases that precipitate chronic kidney disease such as diabetes, anemia, and high blood pressure should be treated earlier enough in order to further keep it in control. References ABS (Australian Bureau of Statistics). (2002). Australian Social Trends, 2002. Retrieved from http://www.abs.gov.au/AUSSTATS/abs@.nsf/allprimarymainfeatures/778E130171EE7102CA25709F0025EB7A?opendocument Chadban, S. J., & Atkins, R. C. (2005). Glomerulonephritis. The Lancet 365(9473), 1797–806. Gokal, R. (2000). Textbook of Peritoneal Dialysis. London, England: Publisher-Springer. Levey, A. et al. (2002). Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification. National Kidney Foundation, Inc. https://www.kidney.org/professionals/kdoqi/pdf/ckd_evaluation_classification_stratification.pdf Mason, K., & Laurie, G. (2010). Mason and McCall Smiths Law and Medical Ethics. Oxford, England: Oxford University Press. O’Shaughnessy, D. (2008). Withdrawing from Dialysis Treatment. Renal Resource Centre. Retrieved from http://www.renalresource.com/pdf/Withdrawing%20from%20Dialysis%20Treatment%20RENAL%20RESOURCE%20CENTRE.pdf. Walser, M., & Thorpe, B. (2004). Coping with Kidney Disease: A 12-Step Treatment Program to Help You Avoid Dialysis. London, England: John Wiley and Sons Inc. Read More