Nursing and Medication Management: Acute and Chronic Renal Failure - Case Study Example

Nursing and Medication Management Insert Name Tutor Date Introduction This paper is about nursing practice in chronic renal failure which Mr Emery is suffering from. Some of the issues looked at include the details of the disease including the symptoms, nursing interventions for some of the problems being experienced and the effectiveness of the medications that the patient has been put on. Differences between acute and chronic renal failure Acute renal failure is the condition where there is abrupt deterioration in the renal function. It is usually reversible within a period of few days or weeks. This condition is usually accompanied by decreased volume of urine. On the other hand, chronic renal failure is a clinical syndrome which occurs as a consequence of metabolic and systemic gradual, substantial and irreversible reduction in excretory and homeostatic functions of the kidneys. These two conditions differ on their symptoms, causes and diagnosis. The symptoms of acute renal failure include decreased kidney function manifested as build up of fluids and electrolyte imbalance. Others include presence of blood in urine, low urine volume, extreme thirst as a result of dehydration, weak pulse and light headedness or a feeling of faintness. The symptoms of chronic renal failure are usually seen when the function of kidneys is at a very low level. Some of the symptoms include anemia, high levels of phosphates in blood (hyperphosphatemia) plus other complication which occur due to kidney failure such as fluid retention. However, these symptoms of chronic renal failure are only seen after the kidney has failed for quite some time (Hart & Loeffler 2011, p255). Regarding the causes, acute renal failure is in most cases caused by an event that occurs in the body resulting in malfunctioning of the kidney. This may include dehydration and loss of blood from an injury or surgery, or use of some medicines (Schmeltzer & Norsworthy 2012, p215). Chronic renal failure is on the other hand caused by a long term illness such as hypertension or diabetes which over time damages the kidneys reducing their functioning. Acute renal failure is diagnosed through routine tests which may indicate high levels of creatine and Blood Urea Nitrogen (BUN). These levels are however compared with previous levels to determine whether it is acute or chronic renal failure. Ultrasound may also be conducted where if it shows smaller than normal kidneys; the condition may be chronic renal failure. Pathophysiological links between Mr Emery’s past history and the development of Chronic Renal Failure The condition of chronic renal failure in Mr Emery could have been caused by his past history of type 1 diabetes mellitus and hypertension. Diabetes leads to chronic renal failure due to the damage it causes to the blood vessel in the kidneys, nerves in the body and the urinary tract. Regarding the blood vessels, high blood sugar levels makes the blood vessels narrow and clogged reducing the amount of blood reaching the kidneys. The kidneys therefore do not receive enough blood and this damages them. This enables albumin to pass through the kidney filters ending up in urine. Diabetes also damages the nerves which carry messages between the brain and other parts of the body including the kidney. They also inform the brain when the bladder is full. Therefore when the nerves in the bladder are damaged, one may not know when the bladder is full and pressure due to its fullness may damage the kidneys. High sugar levels in the urine may cause growth of bacteria and when this urine stays for long in the bladder, the bacteria may infect the urinary tract. Such infections can be easily passed to the kidney (National Kidney Foundation, 2007, p8). High blood pressure damages the kidneys in two ways. One, it damages the blood vessels in the body including those in the kidney. This reduces blood flow to the kidneys as well as damaging the tiny filtering units in the kidneys. The kidneys are therefore unable to remove wastes and excess fluids which in turn build up raising the blood pressure more. On the other hand, high blood pressure further complicates chronic renal failure because kidneys play the role if maintain a healthy range of blood pressure. Therefore damaged kidneys cannot regulate blood pressure and it therefore remains high. Therefore high blood pressure worsens the kidney conditions (National Kidney Foundation, 2010, p7). Relationship between his presenting symptoms and his disease process The symptoms that Mr Emery is presenting include anemia, nausea, malaise, pitting edema bilaterally on his lower extremities and fingers and hands, pruritus, depression, SOB, sallow color and multiple ecchymosis on all limbs. Anemia in people with chronic renal failure results low production of red blood cells by the bone marrow. This is because of inability of the kidney to produce hormone erythropoietin which helps in normal red blood cells production. Nausea, pruritus, and malaise are the non specific symptoms that are usually reported in chronic infections. Pitting edema usually occurs in systemic disease that affects various body organs including the kidney. This is because the body retains a lot of salt which in turn makes the body retain a lot of water. This water is then taken to the extremities resulting in swelling (Parmar, 2008, 346). Multiple ecchymosis occurs as a result of failure of the kidney to excrete waste materials thus accumulating them in blood. Also due to the age of Mr Emery, the walls of the blood capillaries become very frail and are therefore highly susceptible to injuries. Shortness of breath on exertion also occurs especially where there is anemia. This is due to low hemoglobin levels in the body. Sallow color is a pale-yellow or brown-toned skin which is also associated with anemia. The depression that he is experiencing may be due to his social history indications where he lives alone and is having a bad relationship with his children. Also the fact that he has not been working may cause him depression. Such a social status for an old ailing man may be depressing. Hematuria may be due to infection of the kidneys while large amounts of protein in urine are due to diabetes and hypertension which cause inflammation of the kidneys Johnson et al., 2012, p224-225). Part B: Nursing interventions for: a. Fluid retention which is causing edema The main goal for nursing intervention is to ensure that the patients maintain ideal body weight without edema that is resulting from the excess fluids. Some of the nursing interventions to be undertaken include assessment of fluid status by checking daily weight, the balance between fluid intake and output, checking the skin turgor for presence of edema, checking the distention of neck veins, the blood pressure, heart rate, and respiratory rate. Other interventions include limiting the patient’s fluid intake, and identifying the sources of the fluids which may be the foods or fluids for taking medications. It is also important to explain to the patients the need for fluid retention and help him cope with the associated discomforts (Carpenito-Moyet, 2008, p 675). The rationale for assessing fluid status is to acquire the baseline and ongoing data that will be used for monitoring the changes and evaluating the interventions. Limiting the fluid intake will however be determined on the basis of changes in weight, the urine output and how the patient is responding to the interventions. The rationale for identifying potential sources of fluids may be due to unrecognized sources which may be acting against the interventions. Explaining to the patient will ensure that the patient and his family members understand and this will promote cooperation. Helping the patient cope with discomforts will ensure compliance with any dietary restrictions. The interventions will be evaluated based on expected outcomes such as no rapid weight gain, patient’s maintenance of fluid restrictions, normal skin turgor and absence of edema, no distention of neck veins, and no reports of difficulty in breathing or shortness of breath (Galanes & Gulanick, 2012, pp2). b. Anemia The main goal for nursing intervention on anemia will be to end the complications that are associated with anemia. Some of the nursing interventions to be involved include monitoring of the red blood cells count, the hemoglobin levels and the hematocritic levels. Another intervention will be to administer the prescribed medication such as Ferrous Fumarate, avoiding taking of unnecessary blood specimens, explaining to the patient on how to prevent bleeding for example by avoiding vigorous blowing of the nose and also by using a soft toothbrush. The rationale for monitoring the red blood cells count is to obtain the basis for assessing the degree of anemia. Ferrous Fumarate medications are for supplying the necessary iron for the production of red blood cells. It is also important to avoid unnecessary drawing of blood specimens because this worsens anemia. The rationale for avoiding bleeding is because from whichever part of the body, bleeding worsens anemia (Coyne 2011, p1). The outcomes for evaluating these interventions include the patient having a normal skin color which is not pale. The patient’s hematology values should also be within the acceptable limits of between 41 – 53 percent and the patient should not experience bleeding from any part of the body. Medications Eprex is used for treating anemia in people with chronic renal failure. Its active ingredient is Epoetin Alfa which is the synthetic form of the hormone erythropoietin which stimulates the bone marrow to produce red blood cells. Eprex injections are given intravenously or subcutaneously depending on the doctor’s advice. However in the case of Mr Emery, it is given subcutaneously. Some of its side effects include diarrhea, headache, general body weakness, nausea and vomiting. Some of the nursing interventions when the patient is on this drug include regular blood tests, continuous monitoring of the blood pressure and also proper storage of the drug in the refrigerator at 2 to 8 degrees centigrade (Carpenito-Moyet, 2008, p 685). Tenormin is used to treat hypertension. Its active ingredients are microcrystalline cellulose, magnesium stearate, povidone and sodium starch glycolate. It is a beta-blocker which ensures proper blood flow through the arteries. Some of its side effects include nausea, faintness, slow heartbeats and shortness of breath. The nursing intervention for this patient involves regular checking of the blood pressure (Anaizi, 2007, p34). Ferro-tab is a source of iron and folate and is used to treat and prevent iron and folate deficiency anemia. Some of its side effects include diarrhoea, constipation, nausea and stomach upset although they are short lived. The nursing intervention for the patient taking Ferro-tab involves monitoring of the hemoglobin levels to see whether there is improvement. Vitamin D3 is used in kidney disease to ensure normal levels of calcium and to ensure normal bone growth. This medication usually has no side effects unless when used in excess. It is however important for the nurse to ensure that it is given in the right amounts (Anaizi, 2007, p50). Others include insulin for controlling the blood sugar, Ondasetron for preventing dehydration and morphine to act as a pain killer. It is however important for the nurse to ensure administration of all these medications. Conclusion With proper nursing care, Mr Emery will recover from the condition successfully. The medications prescribed are usually effective in correcting the intended conditions which are complicating his condition of chronic renal failure. It is however important to ensure that he follows the treatment regime completely. Bibliography Anaizi, N., 2007, Drug Therapy in Kidney Disease, Rochester Institute of Technology, New York. Carpenito-Moyet, L., 2008, Nursing Diagnosis: Application to Clinical Practice, Random House Books, Australia. Coyne, D., 2011, Anemia management in Chronic Kidney Disease and End-Stage Renal Disease: clinical Case Studies, Medscape. Retrieved on 11th December 2012 from Galanes, S. & Gulanick, M., 2012, Nursing Diagnostic Care Plans, Elsevier, Retrieved on 11th December 2012 from Hart, M., & Loeffler, A., 2011, Introduction to Human Diseases, Maynard MA, Jones & Bartlett Publishers. Johnson, D., Jones, G., Mathew, T., Ludlow, M., Chadban, S., Usherwood,T., Polkinghorne, K., Colagiuri, S., Jerums, G., MacIsaac, M. and Martin, M.,Australasian Proteinuria Consensus Working Group, 2012, Chronic kidney disease and measurement of albuminuria or proteinuria: a position statement, Medical Journal of Australia, 197 (4): 224-225. National Kidney Foundation, 2007, Diabetes and Chronic Kidney Disease, National Kidney Foundation, New York. National Kidney Foundation, 2010, High Blood Pressure and Chronic Kidney Disease, National Kidney Foundation, New York. Parmar, M., 2008, Chronic Renal Disaese, British Medical Journal; 325:85 Schmeltzer, L., & Norsworthy, G., 2012, Nursing the Feline Patient, John Wiley & Sons, New York. 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